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[Chocolatechaos]

I was diagnosed with perimenopause a year ago aged 41. It was a bad year with lots going on,  bereavement, building work, three littlies beginning school, work dramas and working full time. I guess things got too much for my delicate disposition and my ovaries gave up. So in the new year I was given hrt tablets 1mg which helped with the symptoms. In May I switched to evorel sequi 50 due to ibs and tablet absorption problems. Recently I have been feeling emotional again with overwhelming brain slowness, more anxiety, tiredness etc. I feel like I am slipping with my menstrual cycles showing erratic timings again.  My gp suggested we may need to increase the patch dose at my last appointment. Three weeks ago I decided to put one and a half patches on to try an increased dose. At the moment I have headaches, shakiness, tiredness and no energy. Would it be the progesterone increase? I don't have breast tenderness so I assume the oestrogen isn't too high. Should I continue and the symptoms settle down over the next few months or should I go back to one 50 patch? My gp appointment isn't for a few weeks for my next prescription.

[Dancinggirl]

chocolatechaos - my first thought after reading your post is that you are maybe struggling with the progesterone in the Evorol sequi patches. Many women do find they get low mood with the more testosterone based progesterones and perhaps a change of HRT would be worth trying. Stick with the transdermal oestrogen, so switch to oestrogen only patches or Oestrogel, and then have progesterone as a pill fro 12-14 days each month and use either Utrogestan or Provera. 
Do have a look at the bottom section of this page on MM which explains about this option:
http://www.menopausematters.co.uk/postmeno.php
You could print this off to show you GP.
I have a very sensitive digestive system but find Utrogestan fine to take even though you need to take it on an empty stomach before bed. Many women seem to do extremely well on Provera which is also well tolerated but this can be taken with food so is less likely to give digestive problems.  I have actually found my bowels have settled much better on Oestrogel and Utrogestan - it is trial and error and because you are young and you need to find something that works for you.
Dealing with menopause mood swings is challenging and one mustn't rule out the fact that your own hormones may still be kicking in and causing issues.
Have you had your oestrogen levels checked? I believe at your age ideally they should be around 500-600 but I tend to feel better when it's lower for some reason - I am 59 so it's different for me. I had a premature meno in my mid 30s and was reassessed at a private meno clinic when I was 40 and they put me on a lowish dose that really suited me as I had been getting horrid headaches because I was using too high a dose.
I wouldn't assume that a higher dose of HRT will improve mood especially if it involves an increased dose of synthetic progesterone - a different progesterone may well help though. If your flushes and nights sweats are under control then I find it's best to find other ways to control low mood e.g. Mindful Meditation. DG x

[Hurdity]

I agree with Dancinggirl that you would be better off changing to separate oestrogen and progesterone if you want to stay with the transdermal HRT, and especially because an increased dose of that particular progestogen (in Evorel sequi) may make your mood worse if you are sensitive to this one - notably during the second 2 weeks of the cycle ( ie when you are on the  combi patches = the Evorel conti ones).

Hurdity x

[Chocolatechaos]

Thank you for your replies. I am finding it harder emotionally during the progesterone weeks or the week after when the progesterone levels dump out. My gp suggested increasing the oestrogen to regulate my bleeds so should I increase oestrogen and change the progesterone type? What dose of provera goes with oestrogen 50 or 75? I assume I would need to change the evorel to another oestrogen only patch? Sorry for all the questions but I am not so aware of separate therapies currently used. I am not so keen on gels so would prefer patches. Thank you.

[Briony]

I echo what everyone else says. I really liked taking Utrogestan - very different from the synthetic progesterones I'd had in the past. Only reason I stopped is because I didnt like the post Utrogestan dip at the end of the month (felt great on it) but being in my early 40s and having periods, I wasn't able to take it  continuously. Switched to a low dose contraceptive pill instead. The 50mcg patches did nothing for me. My GP said it was because being younger, but estrogen deficient, my body needed/expected a higher dose.
Good luck x

[Dancinggirl]

Chocolatechaos - You may need to start with a 50 patch and then use either Utrogestan 200mg for 12 days each month or Provera 10mg (also available as Climanor or MPA) for 14 days each month. These progesterone are kinder but you may still get a dip in mood for a few days before your withdrawal bleed as this is quite normal when you stop taking the progesterone.   At least you might feel better when on the progesterone though.
As I suggested, I would print off the relevant section on this site to show your doctor and explain that you want to try the progeserones that tend to give fewer side effects. The erratic bleeds may be more to do with your own hormones kicking in - this would also explain the emotional roller coaster.
Here is the relevant section that you need to look at:

Tailor made sequential combined therapy is useful in patients who develop PMS type symptoms on a fixed HRT, particularly if the regime contains a progestogen of testosterone derivation (norethisterone, norgestrel and levonorgestrel). FEMOSTON, PREMIQUE CYCLE & TRIDESTRA are fixed preparations using the less androgenic medroxyprogesterone acetate or dydrogesterone.

PROGESTOGENS - Progestogens are given with estrogen to protect the womb lining from becoming thickened from stimulation by estrogen. Progestogens are generally not required after a hysterectomy (removal of the womb). (See Menopause and HRT after hysterectomy)

In the Perimenopause, progestogens are given for part of each 4 week cycle of estrogen, leading to a 4 weekly bleed in most users. This is known as “Sequential” HRT.


Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.

As well as being given as part of a ready made combined therapy, the following progestogens can be given with estrogen only regimes:

PROVERA -
also available as Climanor (5mg tabs)MPA - 10 mgs daily for 14 days per 28 days   Â£3.27 for 28 5mg tablets

UTROGESTAN   micronised progesterone   2 x 100mg daily at bedtime for 12 days per 28 days (days 15-26 inclusive)   Â£4.28 for 15 200mg capsules

Hope this helps  DG x

[Nina]

Hello I take utrogestan days 1-25 as prescribed by my doc and I'm only 43. No way could I take it sequentially - it made me very ragey.

[Briony]

Hello I take utrogestan days 1-25 as prescribed by my doc and I'm only 43. No way could I take it sequentially - it made me very ragey.

Nina, did you still have regular periods? Hope you dont mind me asking x

[Nina]

Hi briony well I did have periods yes but they were very light and I would sometimes miss one.  Since I started utrogestan 7 months ago (first sequentially) I've only had one bleed and that was spontaneous.

I basically started conti myself after researching it. I think really that the main problem with conti in peri is erratic bleeding and spotting etc, which can be troublesome for some, but hasn't been for me.

I haven't had any problems at all with it, I'm very stable. When I changed myself from sequi to conti I just told the doctor I now take it days 1-25 and she looked in her book and said fine.

For the record I used to use oestrogel 3 pumps but now am on estradot 100 doc says start high (although I'm a bit foggy standing looking at something wondering how I got there sometimes at this dose so going to snip a quarter)

[GypsyRoseLee]

That's interesting Nina. Before starting sequi HRT with separate Utro my periods had become very light during the previous year. Some months it was essentially just heavy spotting for a couple of days.

[Nina]

are you settled now gypsy. You didn't get  on with utrogestan?

[Briony]

Thanks Nina, that's really useful to know. If I ever switched back to patches (currently happy on low dose, bio identical contraceptive pill)  I would do just what you're doing. I hated the post-progesterone dips when taking Utrogestan sequentially - bit of spotting is a small price to pay! x