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[lisa789]

Thanks Dangermouse that's so helpful.

Good luck with your regime and I hope you find the right combo to suit.

I took my first pill last night and so far so good. I have emergency diazepam in case the anxiety gets too bad but can't imagine it's possible to feel worse than I have recently. I honestly thought I was ready to be sectioned or I would kill myself. The hormones surges calm down and I'm ok for a while and it all begins again...... What a nightmare some of us have.

[Chi chi]

Really sorry to hear this GRL as I was wondering how you were getting on 
Have you thought about trying the medication to shut everything down to mimic how you would feel if you had a hysterectomy? I'm also seriously considering it

 

[orchid]

Sorry GRL I didn't get back to you sooner! I was on Trazadone for about 5 weeks. I started on 25mg in medicine form as i am so sensitive to AD's and basically was terrified I'd have a bad reaction on the standard dose as I'd  had with SSRI's ie Prozac. I tolerated the 25mg ok so increased in tablet form to 50mg only. It improved my symptoms of anxiety and depression a bit, but I felt dizzy on it so, decided to go back to Dosulepin which I had previously been on for 12 years. My dr had switched me from Dosulepin to Mirtrazepine as I thought the Dosulepin was making my palpitations worse. However, by the time I'd increased Mirtrazepine from 15-30 mg my anxiety was worse and I had awful digestive problems and abdo pain. I'm fine now I'm back on Dosulepin 75mg...well a lot better than I was when I went through withdrawal of everything. How are you feeling now?

[dogdoc]

Hi GRL. I've posted this before but thought I'd say it again. Absolutely FOR ME! in early peri the anxiety/weeping/depression symptoms (as well as other symptoms too numerous to mention) were ABSOLUTELY the result of high estrogen spikes and NOT low estrogen.

My worst symptoms were at ovulation ( high estrogen) and were completely different from other PMS like symptoms ( also terrible but different) that I was getting for the week before my period started.
I tried estrogen in multiple forms and in multiple doses during this period and they made symptoms much much worse, particularly at ovulation but in general I had increased anxiety, weeping, suicidal thoughts, shakes, internal vibrations, jitters like all my neurons were firing, headaches, brain fog etc etc. I can induce these symptoms out of the blue by putting on a moderate estrogen dose even now.
During this time my periods were also very close together, very heavy etc.

I elected to stop all hormones until i was further along in the process as I was told repeatedly by a variety of doctors that my estrogen level was fine MOST OF THE TIME, although it certainly was starting to dip into the lower ranges some of the time and although overall my estrogen levels were likely lowering, the spikes made supplemental estrogen intolerable. The only thing that helped with anxiety during this period was Gabapentin ( also called neurontin) which affects the GABA system in the brain and is calming. SSRI did nothing.

I am further along in the peri process although who knows how many years I have left. Now i've started drying up everywhere, hot flashes etc.  I have elected to hold off on hormones ( except vaginal)>Periods coming farther apart, skipped one, lighter. The science tells us that our estrogen doesn't really get low and stay low until within 1-2 years of true menopause. So unless you have missed periods and have gone a full 60 days without a period, on average you are unlikely to be within a year or two of menopause and your estrogen ( although lower) may still be adequate for you. The spikes may be whats causing much of your distress. Or the rapid drops from high spikes at ovulation.

You've tried a ton of hormones at a ton of doses and it's not helping...so it seems reasonable to try a few months without any supplemental hormones.
I highly recommend trying Gabapentin if you haven't. I also liked MACA which i was on for a number of months and I THINK really helped the mood.

Good luck.
PS I was in your shoes for almost 2 years....i think there's a light at the end of the tunnel as now that I'm further along there has been a dramatic improvement in the mood/anxiety/depression symptoms without any hormones at all. Worth a try.

[Briony]

HI GRL

Just a quick reply as I'm about to go out the door, but didnt want to read and run.

Really sorry to hear that things arent good. You must be exhausted with the 'when will this end?' feeling we all know only too well.

The more I read of this thread, the more I think you have similar issues to me. Neither of us are menopausal yet, but we do have slumps and sudden increases in our estrogen levels, often quite randomly. My levels have dipped to 41pmol previously, yet I still have normalish periods and no hot flushes. Therefore, by adding the three pumps of gel - or the 100mcg patch in my case - we are in no way controlling our fluctuating hormone levels and are, at times, ending up with excessively high levels of estrogen. I reacted in very much the same way as you with high dose transdermal estrogen. The more I read, the more I see that to prevent ovulation with estrogen alone, you need to be nearer 200mcg patches - and that in itself brings its own issues. Any less, and we are potentially exacerbating our wayward hormones.

The only time either of us has had a longer patch of normality has been whilst on the pill. Remember how, with Marvelon, you felt great until you took a break? If nothing else, this proves that your issues are likely to be hormonal rather than purely psychological. This suggests we both benefit from suppressed ovulation and, as a result, reduced fluctuations. Have you therefore considered a slightly lower dose pill? Perhaps even talking to your local FPC who often have a better knowledge of pills and their respective side effects. Have you ever tried a fourth generation progesterone? My doctor recently explained that they are the nearest to 'natural' progesterone (though still synthetic, with a slightly elevated risk) and certainly, from my experience, the only pills I can tolerate.

I'd be lying if I said I felt 100% like my old self, but switching back to a 4-phase, limited break 4th generation pill, for me, has at least got me feeling more 'even' again ..... massively better than how I felt on hrt or a more potent pill like Marvelon. Did either Studd or Annie Evans mention this?

Hang in there, B x


PS At the risk of contradicting myself, I do also agree with those who've said you've tried a lot of different things and perhaps your body needs a break. I just also wanted to say, when your head's clearer, that there are still options to try. When I realised that myself, I know it helped reduce that awful 'rabbit in headlights' hideous feeling of dread I had - even though I left it while before I did anything about it.

[Briony]

For anyone reading this who is considering the pill to control hormonal fluctuations, I'd recommend Googling Avon Pill Ladder which is very useful. Only problem with it is that the newer pills, including the 4th generation ones like Qlaira and Zoeley with bio identical estrogen are not on it. It does cover all the ones mentioned by previous posters.

I can't find the original, but this is similar:

http://www.gpnotebook.co.uk/simplepage.cfm?ID=792002630

[charliegirl]

I take quetiapine at lowest dose possible combined with citalopram. This was prescribed by a psychiatrist and is great for anxiety. Stick with it for a bit. I believe the body and mind are all one and one affects the other, so both approaches are valid.
Love Charliegirl.

[lisa789]

For anyone reading this who is considering the pill to control hormonal fluctuations, I'd recommend Googling Avon Pill Ladder which is very useful. Only problem with it is that the newer pills, including the 4th generation ones like Qlaira and Zoeley with bio identical estrogen are not on it. It does cover all the ones mentioned by previous posters.

I can't find the original, but this is similar:

http://www.gpnotebook.co.uk/simplepage.cfm?ID=792002630

That's really interesting, thanks for posting.

I've just started Microgynon and was told to take continuously. I'm now wondering if I've to take it every day is it safe not to have a break? I thought you needed to have a break to shed endometrial lining or is that just for HRT?

Sorry if I'm asking daft questions but I'm new to all this

[Briony]

Not a daft question. It confused me too, Lisa.

My GP told me that when the pill was invented, scientists included a pill free break and accompanying bleed simply because they thought women would 'want' a bleed. I assume they were male scientists! 

I assume that there is more progesterone in the pill, and it is taken daily, hence the womb won't build up in the way it does with hrt?

That said, most people I know still have a break every three months rather than no break at all. There is a pill - think it's Seansonique or Seasonalle - which only has blank pills after 80 odd days. I take a pill which only has two non pill days, which is great as there's no big withdrawl, plus it gradually decreases so there is no sudden fluctuation. This suits me perfectly as I get hormonal migraines, but it doesn't suit everyone. I have a number of friends who take Yas which only has three non pill days. I think Eloine is like this?

[lisa789]

Thanks Briony. I'll ask when I go for my follow up appointment in 6 weeks time.

Is Microgynon one of the older pills then with the old fashioned progesterone in?

At a previous appointment the specialist did mention qlaira but when I got to my last appointment I was so relieved that my ultrasounds, smear and bloods were all okay I never thought to question the Microgynon prescription she gave me.

[Briony]

Lisa, the one you're on is one of the older , cheaper and safer combined pills which suits many women. It is however more androgynous (not the right word, I know, but mind gone blank). I would give it a few months to let it settle before thinking of changing. Qlaira - which would be on the right hand part of the ladder, opposite to your pill - is massively more expensive, has less potent estrogen and only two blank pill days, which I like, but others have been less happy with it. It definitely took me three months to feel the benefit as I had initial side effects. I think you can't judge a pill properly in less time than this, but it is a very long time to wait when you're feeling rubbish, I know!

[dangermouse]

It's unopposed oestrogen that puts the womb at risk. By taking progesterone, this will keep the endometrial lining thin so oestrogen cannot stimulate cancer to grow there.

If you have it continuously (like with the Mirena coil, the mini pill or back to back combined pill), the lining will stay thin.

With cyclical HRT, you take less progesterone so there is a bigger margin of error in opposing the oestrogen. I dont think the bleed is a helpful function, it just occurs when you take progesterone breaks and is more an indication of how well you are opposing the oestrogen. I think a smaller bleed shows you are opposing it well and a heavy bleed means the opposite, as a bigger lining has shed. (I think re. this part as I've not tried HRT, pls correct me if I'm wrong!).

If you have too much oestrogen in the pill (as our own levels on top are all different) then you will get breakthrough bleeding so should switch to a more progesterone dominant pill. This would be the only thing to keep a check on. No need for any breaks.

[Briony]

That's interesting Dangermouse. Is breakthrough bleeding the same as what my GP called spotting? (Very light bleed for a few days part way through the pill pack)? The reason I ask is that if they are the same, then my GP said I needed more estrogen, not less. I was switched to Marvelon which is not progesterone dominant. It helped the spotting but made me feel awful, with permanent nausea and horrible anxiety/anger, so eventually I switched back. This time round the bleeding seems fine (fingers crossed). The weird thing is, nausea was initially one of my symptoms when my estrogen was low (before I took the pill or hrt)   - I thought it was high estrogen that caused nausea? I seem to get it at either end of the scale. Or do you think it's surges that cause it?


This is taken from the pill ladder:
in general with breakthrough bleeding, it is worth trying a higher dose of oestrogen (of course pathology such as a cervical problem or a sexually transmitted in ection (STI) needs to be excluded first). Certain progesterones are associated with better cycle control than others (LNG better than NET, GSD better than DSG) but if a woman finds a particular progesterone suits her, for example DSG, but she experiences breakthrough bleeding with a low dose 20 mcg EE (Mercilon), then you can try moving up the same ladder staying with the same progesterone but increasing to a 30 mcg EE pill (Marvelon)

[lisa789]

Thank you both, put my mind at rest. Only on day 4 but so far so good side effect wise, touch wood!

It was a consultant I was seeing privately and it was a private prescription she gave me so I had to pay for the pills,,so I don't think her decision was based on cost like some GPs do. I'll ask when I go back why she thought this was the most appropriate choice for me.

[lisa789]

Yes I would've thought too much progesterone would cause break through bleeding