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[Babsm67]

Hello,. I am so confused with this perimeno business.  I recently posted my day 2 hormone test results, having been told I was 'borderline' with an oestradiol level of 73, FSH of 18.2 and LH of 4.5.  From Feb 2013, I started keeping a menstrual record of cycle lengths & symptoms as I noticed my cycle was starting to go awry (aged 46).  Most cycles were shorter then I started having spotting a few days beforehand leading to mid-cycle spotting in June 2014 - my PMS symptoms were severe.  At this point, I was referred to an excellent gynae GP who prescribed me 2 pumps of oestrogel (& 14 days of utrogestan from month 2 onwards).  Within days, I felt my mood lift but, a few weeks later, I started to get bloating, swollen, painful breasts, an aching left leg & swelling down below. The first period I experienced after the first cycle of oestrogel was late & lighter.   On the gp's advice, I cut down the dosage but to no avail & had to give up in late Sept. The spotting had gone.  Within a few months, I started experiencing other symptoms with worsening severe pms amongst them & had a breakdown shortly afterwards. 
In 2015, my periods were still very heavy with flooding & it was discovered that I had a small fibroid.  Tried transxemic acid - no joy so I was referred for ablation but then was asked to try a Mirena in Feb 2016.  As I tried this roughly 10 years ago & didn't get on with it, I was reluctant to try again, particularly as I had terrible problems with synthetic progesterones in two types of mini pill.  In early spring, as previously advised, I tried oestrogel again during days 14-28, only to experience the bloating & 'jittery' feelings within days along with tingling in my feet - I put on 4 pounds in a week.
In the last few months, my cycle has lengthened to 29-32 days with just one day of flooding instead of two.  Ironically, there are no proper hot flushes yet (just when anxious) but I get very hot at night in 2nd half of cycle, sometimes sweating, along with many other symptoms on the 'list' throughout the month.
This month, after obtaining the blood test results, I have tried 1 pump of oestrogel again but the same symptoms have appeared within days - this morning, I woke up extremely jittery again & this hasn't subsided - I did not have this before starting the oestrogel.  My feet are also tingling.
Does anyone think that maybe, oestrogel does not suit me or should I try & stick it out for 3 months?  After trying it for almost 3 months in 2014, I gave up.  The anxiety is horrendous & I wonder if I should try either a patch or Femoston?  I am waiting for an appointment to come through for the gynae GP again & have researched the different types of hrt on here.  I am just wondering if anyone else has had a similar experience with oestrogel & has found success with another type of hrt, particularly during what I think is early peri meno stage (think I must have been late reproductive stage 3 years ago)? Sorry this is so long.
Thanks x

[Elizabethrose]

Oh Bloss, I'm so sorry: this pesky peri malarkey is nothing but a pain in the neck!

Truthfully, I am absolutely NOT an HRT expert. I was forced to try it years ago in an attempt to manage my pure menstrual migraine which had become horrific. Every step was managed by two very experienced, well considered specialists and they couldn't make it work for me. A number of routes were tried. I am ridiculously sensitive to hormone change and my own cycles could not be suppressed by any sort of manipulation. The side effects were intolerable.

I did try Oestrogel but it just didn't work for me, but saying that others swear by it. Others haven't been able to use it but have been successful with other options. We are all just so very different.

I would be very reluctant to make changes without seeking proper medical advice. We none of us are medics on here, as far as I know, and some women can react very easily to even little tweaks. However, listen to any feedback you receive and go armed with this to the GP or Gynae. The better informed you are about the possibilities the better you will able to manage your consultation. We all feel so much better if we feel we are involved in the decision making process.

Oh Bloss, don't feel despondent, I'm sure the right treatment is out there for you it's just a case of persistently trying to find it! Needle in a haystack springs to mind. I'm sure that one size doesn't fit all with HRT.

As an after thought, Dancing Girl has tried a number of options over the years and seems very knowledgable, in a very kindly positive way, she might be able to give you some advice from experience. Is it worth personal messaging her? Either way, given how reactive you've been in the past, it's probably best to get it all checked out with your medics.

I really wish you well and hope some lovely experienced member comes along with valuable advice soon! x

[Babsm67]

Hello Elizabethrose & Stellajane, thanks for your encouragement - I know DancingGirl said before that peri-meno is very challenging. After reading past posts on here, I am convinced I must have been in late reproductive stage when I first tried hrt although some other peri meno symptoms definitely starting appearing autumn/winter 2013, most notably the terrible mood swings, insomnia & worsening pms.  So, I did wonder if perhaps it was too early on to start it two years ago, hence the build up of estrogen.  I thought that, as my blood results were 'borderline' instead of 'normal' like the last test in January, 2014, it might be ok to try again.  It is frustrating because so many people have had success with oestrogel &, because it is transdermal, it is classed as safer plus the dosage is easy to adjust.  Maybe a patch would deliver a consistent dose  but I would need to ask the gynae GP about it.  DancingGirl has also mentioned about Femoston having a kinder progestogen.  My own GP surgery won't even entertain prescribing hrt - I just get referred on as soon as I mention anything about it.  Perhaps I just need to be patient xx

[Hurdity]

Hi Madbloss

Sorry to hear you are still feeling rough despite taking HRT.

It is very difficult to say what is for the best in your circumstances. As you say - if you are having regular periods still and ovulating regularly then you may well still be in the late - late reproductive stage - a time which can be notoriously difficult to treat with HRT. At this stage (I'm sure I've linked to the reproductive ageing paper - if not will do so!) as you have found mood swings and pms become much worse because hormones begin to go haywire as the ovaries don't work quite so well as before but still working. It seems that it is often the extreme fluctuations at this point which give rise to the horrible (worsening) pms symptoms - I started to get bad pre-menstrual migraines for the first time and cried at the drop of a hat, as well as blood sugar problems (extreme sugar cravings) - but my periods were regular. Some women do find their oestrogen levels have declined by this stage (even with regular periods) - and so a little extra often does help - but not always.

I am sorry I'm not familiar with adding oestrogen at this point and what too much oestrogen feels like - as I didn't start taking HRT until late peri so it worked from the start (Estradot patches) and I have never tried gel. The idea of adding a low dose oestrogen would be to top up at mid ccyle ( but not too much) and prevent the extreme dip at between say - days 23 and Day 5 ish - but a 25 mcg patch might be too low. Could be worth a try? (if so try Estradot!) I'm not sure whether at this low dose you would be prescribed additional progesterone initially if your own periods are regular? 2 pumps seems quite high if you are having regular periods. However I know some private gynaes aim for higher in order to suppress the cycle/ovulation. Femoston also may work - if you are happy taking tablets and do not have stomach problems.

Have I suggested or have you thought about using Qlaira the CCP which contains estradiol - the same oestrogen as in HRT? This suppresses the cycle and so will prevent the mood swings, and only has 2 tablet free days. However you would need to be able to tolerate the synthetic progestogen - which is different I think from the mini pill ones? Also you have to be under 50 - I can't remember if you are or not?

How appalling that your own GP won't prescribe HRT!!!! But at least you are being referred for specialist help - hard though if you have to wait too long for appointments.

Sorry I can't help further and just thinking aloud really - wishing you all the best with your search for the right treatment and do keep us updated

Hurdity x

[Babsm67]

Hello Hurdity,
  thank you for taking the time to reply to me - I am 49 so, sadly  , I don't think Qlaira would be an option for me now (which is a pity).  Yes, my periods are still regular in that my cycle is 29-32 days after being around 23-25 days for three years.  I couldn't find the link that you mentioned but thanks for trying to post it for me .  I have been coming over very hot at night (occasionally sweating) during the 2nd half of my cycle along with having menstrual migraines & stress/occasional urge incontinence for several years now.  As you will have seen in my first post, many other symptoms on 'the 'list' have appeared over the last 3 years!
I would definitely be happy to try a patch or Femoston . The gynae GP suggested, in February, that I try the Mirena as additional progesterone - she said it would help PMS symptoms but I am very wary of this as I know some of it is still absorbed systemically & the mini pill made my pms worse.  I was also told to try a Mirena for 6 months by a consultant in 'the team' at the hospital last September (seen for heavy periods - have very small fibroid) even though I voiced my concerns about it (having already had it 10 years ago).  A 2nd consultant in the team suggested I tried transxemic acid (did not work).  Finally, I have been referred for ablation assessment at the end of September after a 3rd consultant in the team agreed that the Mirena would not be ideal considering my history (it has taken a year).  I was going to try & hold on until at least the assessment had been done before trying hrt again but some of the symptoms have been extremely problematic.  As I have never used the gel for more than one cycle at a time (after my first approx 3 month trial in 2014) due to the side effects, I have utrogestan capsules left which are still in date - need to use them by the end of the year. 
 Just lately, I seem to be lacking in energy (and motivation) which is frustrating (I stopped going to my evening fitness classes 4 weeks ago due to this) along with 'brain fog' (muddled words, inability to concentrate etc) &, on a personal note, my libido seems to be rapidly waning.  Thanks to this forum, I now know that lack of testosterone can contribute to this but I did not ask for this to be tested as I thought it would be refused on the NHS. If I have no joy from the Gynae GP, I may try & obtain testosterone privately (locally).  All I know is that I have reached a point where I feel I cannot carry on trying to function (let alone go to work) like this much longer & I need energy as I have my adult autistic son to look after.  Last night, I woke up several times after spending ages trying to get to sleep. In April, I had my thyroid level tested & it was 'normal' at 2.91.  My Vitamin D was low though so I am taking a supplement with a high Vitamin D content.
In summary, I have many of the symptoms on 'the 'list' but NOT full bIown hot flushes and missed periods!  I am getting pretty desperate to get these symptoms under control as they have had a major impact on my life (out of work at the moment). 
Thanks again - your advice is invaluable  xx

[MIS71MUM]

Hi Madbloss
Sorry if I'm late replying to this but I also found the gel increased my anxiety. It made me feel quite fluttery and could feel the "hit" of the oestrogen when I used 1 pump per day. I could also feel it wear off too. Then when I split the dose, to 1 pump am and 1 pump evening, it affected my sleep, so stopped taking it. 

I then moved onto a patch and feel much better on this. This seems to be a steady constant delivery and haven't had any problems with it.

I know a few others on here have had problems starting off with oestrogel. I wouldn't rule it out for future use but at the moment, a patch suits me best xxx

[Babsm67]

Hi Mis71mum, Hope you are ok - I was going to reply last night but I had to abandon it as we had water leaking through the shower socket in the bathroom ceiling & it was 'all hands on deck'!  Thanks for your reply - I am trying to persevere for a bit longer but, yesterday evening, I appeared to a have a 'mini' hot flush  I was standing in the kitchen when I came over all hot & my face was sweating - I went into the living room to speak to my husband & he told me that my face was bright red - which it was.  I cannot find any other explanation for this as I hadn't eaten or drank anything I shouldn't (I have some food intolerances), it wasn't exceptionally hot in the house & I wasn't anxious at that point.
It is interesting that you have had the same experience with the gel as so many ladies seem to get on well with it - I wonder if it is something to do with being peri rather than postmenopausal?  Hurdity said that this stage is tricky to treat & one lady mentioned in another thread of mine that things were much more stable post menopause without the erratic hormonal fluctuations.  I do wonder if my absortion of the gel is consistent - it sounds as if the patch delivers a consistent dose which is one less fluctuation to worry about! 
Thanks again xxx 

[Tempest]

Just popping by very quickly, but I'll reply in more detail later.

Yes, I had this happen on Estrogel. I've now switched to a different type of HRT, but my situation is rather different to yours (I am near your age though - 47). There may be a more detailed explanation as to why you're feeling  this way starting HRT, and I have done a lot of research into the increasing anxiety issue.

If you click on my profile and look at the last post I posted before this one, there may be some info. there which may help and reassure you.

Sending you hugs! xxxx

[Babsm67]

Hello Tempest, thank you for your lovely reply & the hugs  - I have just read your post about cortisol & that definitely resonates with me!  I also remember getting that horrible shaky feeling in the morning when I took SSRI AD's - my anxiety was off the wall when I first started taking them.  I had terrible problems sleeping on SSRIs as well, when the early peri symptoms started.  It ended up that I was taking sleeping tablets for the last year of being on escitilopram (not good).   It worked reasonably well in that it stopped panic attacks (I have always been fairly anxious, particularly since having my children) but the sleep problems were horrendous & the sleeping tablets stopped working in the end with it.  Around the same time, I became intolerant to it along with some antibiotics (itchy skin, sore eyes, horrid red bumps) I can't cope with SSRI's at all now.  Since stopping them,  I have tried to 'get by' with the odd diazapam tablet but I rarely take them (I think I took the last one for flying in July) - they cause a terrible drop in mood the following day even if I haven't taken any for weeks beforehand & I am aware of how addictive they are.
The hormonal fluctuations are a nightmare - it certainly explains why I have felt so anxious since starting the hrt.  I wish I knew when the appointment for the gynae GP is going to come through -  I will try & persevere a bit longer but if it gets unbearable, I will have to stop - need to find something though to bring some relief long term so that I can get some sanity back!
Thank you so much    xxx

[Kate Pring]

I’m the same been feeling rotten with fatigue blood pressure up jittery dry throat deep voice and depression hot flushes starting to come back. Just realised when I looked through all my blood tests in March I changed from the patch to gel since then my oestrogen levels have plummeted from 700 pmo/l to 170 pmo/l out it down to the gel not absorbing enough I’ve now stuck a patch on and ordered some more to go back on the patch.

[CLKD]

Let us know how you get on!