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[vintagefiend]

I have a recent thread re: qlaira and that it was making me utterly miserable, so this follows on from that.
Advice greatly appreciated! I'm 44 with regular periods- definitely perimenopausal.
I have stopped qlaira today as feel horrible- very low.
I was a week into month 3 so am thinking that ovulation reasonably well suppressed, maybe entirely?
I want to make the most of the fact that I'm likely suppressed and immediately begin some other treatment- if I wait, my own cycle will gather momentum and mess things up! At least, that's how I see it- I may be wrong.
Some time ago I saw a PMS doctor and she sanctioned the use of 200mcg estradiol patch (evorel, I think) to override my own cycle with separate (and not continuous) progestogen. I didn't get very far- I think I took the patch off on the second day as felt dreadful!!
However, I'm thinking a) my own cycle will also have been present (unlike now), and b) I've since read that 100mcg should be enough to suppress- so I could try half as much?
I still have the patches and really want to give it a go. Would it be best to do so immediately? I don't want to waste the fact that I may be suppressed at the moment!
Also, I need to know what I'm like without the dreaded progestogens! Thank you

[Dancinggirl]

Vintagefiend

You say you get regular periods but if you have been on Qlaira then I think this may be a withdrawal bleed controlled by the hormones in this BCP - so in other words not a natural period.  Did you get regular periods before you started the Qlaira?
You also say you are DEFINiTELY peri meno so I assume that a series of blood tests have confirmed this?
The problem with the peri stage is that you will have fluctuating hormone levels and this is the key problem of the peri stage - therefore, you have less control over the oestrogen level overall.
If you are suffering with low mood and anxiety and wishing to control this with hormones, then I think this is very difficult to achieve - particularly when still peri meno. 
When I was peri meno, a high dose of oestrogen actually made me feel worse in many ways - probably because my hormones were fluctuating. You may well be still producing some oestrogen and progesterone yourself and this will give highs and lows.
I think there is a special drug that will completely suppress your own hormones and then oestrogen and progesterone is given in a controlled way but this needs to be prescribed through a specialist gynae. The gynae I have been seeing says he does this type of treatment if he feels it's appropriate. I also think very high doses of hormones also suppress ovulation but, as you experienced before, can give other side effects.

I don't know what you have been advised but if you have been feeling dreadful on the Qlaira my gut instinct would be to stop everything for 3-4 weeks to let the body adjust and settle - see how you feel - perhaps see if you get a natural period and then start fresh.  When starting again, begin with a lower dose of oestrogen patch for the first 2-3 months, with progesterone taken separately as prescribed, and keep a diary of how things go.
The alternative is to simply put the patch on now and see how you get on.

There are no quick fixes - patience and perseverance are needed.  You need to give each regime at least 3 months before changing and if you start on a high dose and feel dreadful then you will never know what will work - so starting low for a few weeks might be a good option.   
In my late 30s when I was peri, I had been feeling dreadful on the higher dose of HRT, I was advised to take a 4 week break and was then put on one pump of Oestrogel daily (so a very low dose) with 10 days of progesterone each month and this worked a treat!!!!  Sometimes less is more. I only increased to 2 pumps per day (a medium dose) when I was in my early 40s and clearly into post meno.
I hope that helps - I'm sure you are desperate to get your life back on track. I only hope you are getting good specialist advice.  DG xxx

[vintagefiend]

Thank you so much DG I really do appreciate your taking the time to reply.
Yes, I'm desperate to get my life back on track- crying as I type that!- and I can tell that you understand.
Sorry, I wasn't clear re periods- meant to say that i had regular periods prior to qlaira- just to show that I'm prob early peri. I say "definitely" simply because I've never felt like this before, never had PMDD, never felt so low during my periods- I really am not me!! Stopped working, don't socialise, feel unable to control what's happening. Also the cyclical element to my moods seems to indicate hormonal element.
I'll be honest, I've just stuck a 100mcg patch on, just before seeing your message! but i'm confused- reading what you've written- it sounds as tho you were better off on low dose. i don't understand because then my own hormones will come into play? including my progesterone? should i not be looking at trying to suppress? i know there are prob no clearcut answers and i certainly appreciate your experience. I may well take this patch off and try half ie 50mcg- but then for sure my own cycle will kick in? i'm just thinking out loud!
i have had a wealth of specialist advice and i have come to realise that there is no magic bullet- and that different specialists say different things and none are wrong strictly speaking- i've been offered hysterectomy and i'd do it in a heartbeat if i thought would work but worry it might make me worse.
how do you feel now that you're post meno? thank you so much x

[Dancinggirl]

vintagefiend - I know there are various theories and approaches to treating hormone related PMDD and PMT etc. and it is very clear there is no magic bullet.  I simply had a premature menopause and the peri stage was making my life hell - I was also going through a very tough time in my life at the same time. What worked for me may not work for you.  If, so far, suppressing ovulation and your own hormones hasn't really worked then perhaps you do need to look at it in a different way.  If you are very early peri then this will be tricky. I don't think you should view your own hormones or cycle as the enemy - if the peri stage is making hormones fluctuate and is therefore the cause of these terrible lows, then stabilising you own hormones by using a low dose HRT might be a different approach to try? As I said, I am not an expert but when you said the high dose made you feel worse, my logical mind is saying why not try the opposite approach by merely supplementing your own hormones???
Hysterectomy is pretty drastic and should really be a last resort. 
As you have stuck the patch on already, why not just give this dose 3-4 weeks to settle and see how you feel.

I assume you have tried ADs/SRRIs or are you on one of these alongside?

The problem with hormonal issues is how much it messes with our heads - it is very difficult to be objective.

Sorry I can't be any more help - just be patient, keep with this 100mg patch for a while and see what happens.  DG xx

[Hurdity]

I would just say that if you were only a week into the third month then you haven't given Qlaira enough time as I seem to remember reading somewhere that it takes at least 3 months to settle and that some women feel worse before they begin to feel better.

Briony (she hasn't been on for a while so you might like to search for her posts and think about sending her a pm perhaps?) is the expert on Qlaira on MM and I think still takes it. I am sure she went through a bad patch with it early on so might be worth persevering a while longer?

As far as I know 100 mcg patch is not sufficient to guarantee suppression of your cycle in most women. You said you tried 200 mcg - and this is a high dose but again it will take a while to work as you give yourself a very large dose initially and then your body needs to switch off its own hormone production, so there will be side effects initially.

I don't think you will feel instantly better with anything you try because your body needs to acclimatise. I know it's difficult to work through the side effects when you are suffering but if you can possibly do so, as Dancinggirl says - give things a few weeks and ideally 3 months.

Hurdity x

[vintagefiend]

Thanks again, DancingGirl and Hurdity. I actually took the patch off after about 20 mins and have decided to take it all slowly!
Unfortunately I cannot face taking qlaira tho i'm aware it worked for briony- i've seen her posts!
Whatever i do next, i will do cautiously and i will attempt to stay the 3 month distance. Given that a 100mcg patch wont necessarily suppress me, I will definitely start low x

[soniad]

Hi vintagefriend,

Just wanted to chime in and let you know that I am 49, in perimenopause and was having regular periods prior to starting HRT. I have opted for the 'start low and go slow' approach.

I'm currently on a 37.5 mcg patch and seem to be doing okay with that.

I hope you get it all sorted out soon.


Take care.

[vintagefiend]

Thank you, Sonia- that's a really positive thing to read on a bleak morning!
In the end I decided to quarter a patch- so 25mcg, begun yesterday.
Obviously having only stopped the pill yesterday, my hormones will be recalibrating over next few weeks so I won't make any hasty judgements.
Can I ask how long you've been using 37.5mcg? Were you experiencing any emotional symptoms of peri?
Hope you don't mind me asking!

[soniad]

Hi Vintagefriend

I started on 25 mcg on 26th July this year. I was also taking 100mg Utrogestan vaginally for 14 days. I have no emotional symptoms but insomnia was my main problem.

Initially the insomnia got much worse and when I started HRT I got hot flushes for about 7 days (I never get hot flushes). It was very discouraging and I was tempted to throw in the towel many times. But I kept reading stories on here and other forums and everybody said you have to give each dose at least 4-6 weeks.

After 2 weeks my sleep started to improve but still wasn't great. I decided to wait 6 weeks before adjusting the dose. A few days prior to the 6 week mark I started my second course of Utrogestan and all of a sudden I couldn't fall asleep or stay asleep! I took a punt and increased to 37.5 mcg on 6th September and my sleep improved immediately.

Since then it has been pretty good. We'll see what happens when i start my third round of Utrogestan on 1st October.

As you say, your hormones are going to take some time to recalibrate, and as others here have said - patience is the key.

I think starting low is a sensible approach. I hope you find the right dose for you.

Best of luck.

[vintagefiend]

That's great to hear, Sonia- long may it continue for you!
I probably should have waited until my natural cycle kicks in but I'm impatient!
I've had problems sleeping the last few nights and I wonder if you get a paradoxical effect initially with patches (eg you had hot flushes- not what you'd expect!)- find I can't drop off.
Wow to the increase in September having an immediate effect- brilliant!
I feel cautiously optimistic about this, though I know I'm going to have to be patient as feel a bit pants at the moment.
I wonder if you need to take quite as much utrogestan: I've noticed on this forum that some women only take it 3 monthly and they're on higher doses oestrogen. Might be worth checking with your gp/meno specialist if it keeps you awake again in October! Hope it all goes well and thanks again x

[soniad]

I've had problems sleeping the last few nights and I wonder if you get a paradoxical effect initially with patches (eg you had hot flushes- not what you'd expect!)- find I can't drop off.

I can't speak for others but it definitely happened to me.

I wonder if you need to take quite as much utrogestan: I've noticed on this forum that some women only take it 3 monthly and they're on higher doses oestrogen. Might be worth checking with your gp/meno specialist if it keeps you awake again in October! Hope it all goes well and thanks again x

I'll give it a few months and then I will start experimenting with reducing the dose.

Take care x