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[perimandy]

I'm feeling totally fed up and am hoping someone might have some words of wisdom!  Please read the following with the knowledge that I have always had mild anxiety and depression, on and off.  I've been on low dose citalopram for about 10 years, and it seems to suit me well.

I started hrt about 16m ago, I'm 50.  I was still in a regular cycle of periods, which were becoming increasingly painful, but was having night sweats and insomnia and vaginal dryness, so it seemed like a good idea.  almost immediately I could feel that the oestrogen, (started on a low dose Elleste tablet), was wonderful for the anxiety and depression.  Although in the second half of the pack my sleep was very poor, anxiety worsened and the period when it came, very very painful.  Flow heavy but manageable. 

After trying Elleste for 6m I switched to Tridestra, hoping to only have a period every 3m.  Nope.  I bled each 4 to 5 weeks, and the period at the end while on the placebo was the absolute pits - I was tearful, very abrupt mood swings, awful pain, exhausted, migrane, etc (I'm sure you know how it goes!)

Really wasn't sure what the answer was, but needed to do something about the period pain, so against my better judgement perhaps had a Mirena fitted, that was at end of April.  Now I have a hormone patch for the estrogen part (I think that might be called Elleste too, it comes in a pink box).  When doing the fitting my gp said I had a retroverted uterus, and that might be why my periods have been so painful.  It would make sense in that I always feel my bowel and rectum and back are involved in my period too! 

My periods have stopped now, but I am feeling so low, and have been this way now for a good 6 weeks.  I saw my gp and suggested it might be the mirena (the depression seemed to worsen about 1 month after the fitting), but she said well it's just anecdotal, and there is nowhere near as much progesterone in my blood as when I was on the hrt tablets.  I have agreed to an increase in my citalopram (from 20mg to 30) but that just makes me constipated and sweaty.

I really think for my sanity I need to have the mirena removed, but what would be the answer then?  I'm very confused and getting more and more obsessed with the whole business.  I'm thinking of coming off the hrt all together to see what is happening 'underneath' as it were.

Does any one have any good ideas???  feeling very unhappy and totally miserable 

[MIS71MUM]

Hi PeriMandy
All I would say is that you have had mild anxiety and depression in the past, then you know what's normal for you. 

It sounds pretty much to me like you don't do well with the progesterone parts of the HRT.  Maybe you could request the mirena to be removed and restart a patch like evorel maybe and then try micronised progesterone called Utrogestan which can be used vaginally or orally.

Some ladies take it for 7 days a month at 100mg and some take as much as 200mg for 25 days a month.

Good luck
Mandy

[Dancinggirl]

Hi and welcome to MM perimandy
Mis71Mum has done a good post but I wouldn't rush into removing the Mirena just yet as Utrogestan is not ideal for everyone - particularly if you have problems with heavy and painful bleeds.
Your GP is right, the amount of progesterone absorbed around the body is a lot less with the Mirena, however I think many of us do experience an initial ‘hit' of progesterone in the first few weeks and months - this should wear off.
I think for those who are very sensitive to progesterone it is very difficult to find the right HRT.  Many swear by Utrogestan, as it is a bio identical progesterone, but it can have a strong sedative effect, can lower mood and I experienced problems with bleeding and cramps with this.  I did have a Mirena for 4 years in post meno, with Oestrogel for the oestrogen part of this combination - I found it generally good and it is very good if you have problems with bleeds and cramps.
You haven't told us how much oestrogen you are using??? You may need a higher dose? Sometimes the patches don't absorb properly - Estradot are the best patches I believe.   You could try some Oestrogel (applied morning or evening to inner thighs) and start on 2 pumps per day and then increase after 4-6 weeks if need be.  You have options but I wouldn't rush to have the Mirena removed just yet.  Dg xxx

[CLKD]

Have a  ……. fortunately I haven't had constipation with my ADs -  could this co-incidentally be your hormones ……. ?

Make notes! let us know how you get on.

[perimandy]

Hello there mismum, dancing girl and ckld, thank you for your responses.  I am feeling still very fed up, depressed and quite agitated.   There seems no end to these feelings, and they don't feel normal for me.  The oestrogen patches I am using are Elleste MX 40, in case that matters.  I've been reading Menopause for Dummies, what a good book!  Explains it all in such an understandable way. 

Have toyed with the idea of paying to see someone privately, an expert, who I can explain it all too.  How the Tridestra made me feel I didn't need the citalopram any more, I felt totally normal on that.  I've been trying to see if I can compare how the amount of oestrogen from a patch might correspond to an oral amount, but can't seem to find info on that. 

Have toyed with coming off HRT all together.  I had a conversation with my elder sis last night, and she has only had one period in the last year, with no real menopausal symptoms at all, and on no hormones at all.  She is only 18m older than me, so perhaps I've not got long left.  Would it be worth just cold turkey and going without for a year or two in the hope it will all soon be over.  Hard to know what to do for the best.  Well, not hard, impossible!!

this seems like a lovely forum for support and care, which is just what I need right now.  thanks all x