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[Focus]

I've been taking Loestrin 30 since January and it's helped incredibly. Mostly in the almost constant monster bleeds I was having, but also other things.

I'm still getting some night sweats and now hot flushes too. But they're nowhere near as bad as before. More something that I notice happening in the background.

Why am I still having these symptoms, even though I'm on the combined pill?

I've also been taking the pill continuously since I started in January, so have had no 'withdrawal bleed'. What a relief. I was totally traumatised by what was happening to my body in the previous six months (maybe a bit longer).

Anyway, this morning I noticed something like my body was trying to start a withdrawal beed. Why would this be?

I honestly never want to have another period again. Last year was really traumatic.

[Dancinggirl]

Hi Focus

How old are you?  When did the peri meno symptoms start?

You are meant to get a withdrawal bleed each month on this BCP. Why are you taking it continuously? 
Here is the information from the leaflet:
How much to take
The recommended dose is one Loestrin tablet taken once a day.
• Take the tablet at about the same time of day, for 21 days in a row
• The packet of tablets is marked with the day of the week when you should take each tablet.
This will help you remember to take one tablet for these 21 days
• If you are not sure whether you have taken your tablet, look at the day on the pack to see.
Once you have taken all 21 tablets, stop taking Loestrin for 7 days
• A few days after you have taken the last tablet, you should have a period
• You do not need to use any additional contraceptive protection during the 7 days' break,
provided all of the tablets have been taken correctly.
After the 7 days' break, start the next pack of Loestrin
• Start on the same day of the week that you started your previous pack • Start taking Loestrin on that day, whether or not you are still bleeding.


You must still be peri menopausal and if using either continuous HRT or BCP I would have thought there was a strong possibility that your womb lining would build up and spontaneously start to shed which would cause bleeding. In peri meno it is important to have a withdrawal bleed regularly to stop the build up of the lining. I know that occasionally skipping the 7 day withdrawal phase is Ok now and then but I suspect that in peri meno this might not be such a good idea. 

If you have had problematic bleeding then having a Mirena fitted is often the best way to control this.  You are currently using a combined BCP which includes oestrogen and this is more likely to build the lining if you do not have a withdrawal bleed.
If you are peri menopausal then a BCP is probably not the right hormone treatment and this is why you are still getting flushes etc.

If you had the Mirena fitted you could use oestrogen alongside this at a dose that controlled your meno symptoms, it would give you contraceptive protection but also reduce and possibly even stop any bleeding.
 
Here is the info on the Mirena as part of HRT:
MIRENA
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years. However national guidelines recommend that it can be used for up to 5 years for the progestogen part of HRT.
Price: £88.00



I hope that helps.  DG x

[Focus]

Not using the Mirena. Already discussed this with my GP. PTSD issues.

You can take the combined pill continuously. Research and news articles just come out about it.

[dangermouse]

GPs no longer recommend withdrawal bleeds with the combined pill, particularly if you have heavy bleeding problems. It was only due to the church's stipulation for Christians that a withdrawal bleed was recommended.

Continuous progesterone will keep the lining from building up but you may get breakthrough bleeding if oestrogen goes too high, naturally or from the pill's oestrogen. Withdrawal bleeds may help if the pill oestrogen is too high but would make it worse if your natural oestrogen is too high - with what happened to you previously (I remember how desperate you were!) it points to the latter and needing the pill to suppress your own cycle as much as possible.

Loestrin 20 may be a bettering option as is has less oestrogen in than the 30.

[Dancinggirl]

I am aware that you can take the BCP continuously but I'm questioning whether this is wise in peri meno. BCPs are also not designed to control menopause symptoms - HRTs now contain natural oestrogen which is better overall.
Having a Mirena is usually less of a problem than taking progesterone every day orally.
There are some BCPs that do have natural oestrogen and these are often a good choice in peri meno - so perhaps research Qlairi.
Why not just ride things out with your current BCP and see how you feel in a couple of months.
Dangermouse makes a good point - why not try the lower dose version?  DG x

[Focus]

I tried Loestrin 20 and was getting mid cycle bleeds.

Progesterone only was worse than useless.

Nobody comes near me naked except my fiance. PTSD. I'd end up physically fighting the doctor and retraumatised. Please listen and think about what I'm saying about PTSD. Nobody is sticking anything inside me. It's in my medical notes. NO COIL. EVER.

I want to have a say in what goes on and who does what to my body.

[Focus]

I don't want to have any more periods.

The amount of clots and blood that came out of me for weeks on end, for months...no more bleeding. I don't want it. All over the bed, the floor, on bus seats, car seats, through all my protection down the front of my jeans almost to the tops of my knees, trapped indoors unable to earn my living, unable to even go out for a 20 minute run, not able to be close with my fiance, insomnia, depression, triggering my PTSD, feeling suicidal. No. I don't want any more bleeding.

[dangermouse]

You probably need the 30 then to suppress your own oestrogen as it's clearly very high. The pill can only suppress to a point though and I found that the pill couldn't control my high oestrogen enough to not still feel fluctuations. HRT is unlikely to help as it's not strong enough to suppress your strong cycle.

Hopefully your symptoms won't get any worse.

[Focus]

Thank you so much dangermouse! That makes total sense.

So it's a waiting game until my own levels drop...

[NorthArm]

Hi Focus

I'm hearing you re the PTSD. I had similar bleeding to you, and they put me on norethisterone, as well as a conti hrt (too soon, I know). It threw me into the worst PTSD event I've ever had, this was two years ago, and I'm still coming back from it. I think the sudden collapse of hormones triggers it as I'd been managing well after several years of psychotherapy, for years. And ADs made it worse. I hope all goes well, hugs to you ❤️❤️

[Dancinggirl]

Focus

I'm sorry if you feel I am not understanding your problems with PTSD - I'm sure this is truly awful - however you want to be bleed free and this can be difficult through peri meno.  As others have pointed out, high doses of progesterone can bring more low mood, in fact peri meno is fraught with so many issues and controlling meno symptoms is challenging.

Excessive or problematic bleeding can be down to a number of reasons (thickened womb lining, fibroids, polyps etc) and is not uncommon in peri meno due to the flucatating hormones.   If you are unable to have full investigations due to your PTSD then it may be difficult to find a solution. 

By taking the BCP continuously you are reducing the chance of any bleeding but if your own hormones are fluctuating in the background then some spotting or bleeding may well still occur because the womb lining may be building up.  The consolation is that as you get deeper into menopause you are less likely to have any bleeding provided you don't use too much oestrogen.

Generally speaking, oestrogen is the ‘feel good hormone' that reduces flushes, night sweats and other meno symptoms.  Progesterone protects the womb lining from building up but sadly often brings PMT type symptoms and other side effects - however there are a few women who actually feel really good on progesterone!!!  Getting the right balance is often tricky but in your case having enough progesterone to help reduce or stop all bleeding could be challenging for a while. 

It may well be worth asking to be referred to a menopause specialist to advice on your best course of action particularly because of your PTSD. If you were to have a specialist gynaecologist, who set out your options clearly, you would then be in control to choose the treatment options.

The menopause is traumatic for many of us - I had a premature menopause; tried so many HRT options over the years and now at 63, having stopped systemic HRT 3 years ago, I just use local oestrogen to control my urogenital atrophy.  Sleep deprivation, headaches, flushes, aching joints etc are getting worse not better for me as time goes on.

I wish you well and hope you find a good way forward.  DG xxxxx

[Focus]

Thank you.

I know I am one of those women that feels good on progesterone. I had norethisterone to stop some horrendous bleeding and clots on time and felt amazing on it...myself again.

Then when I stopped and it started leaving my system my mood started to slide back down again.

[Focus]

Apologies...at work, so I'm answering in chunks.

It was the third healthcare professional I saw that recommended the Loestrin 30. And she was brilliant, gave me all the options and info without telling me what I should do. And that's exactly the right approach for me.

I'm very upfront about my PTSD when I'm talking to these people and I let them know what approach works for me and which one I will find triggering.

If they want to tell me what to do and I get triggered, then I've actually already warned them. I tell them I'm getting triggered. But some of them don't back down. So they end up having to deal with my reaction.

Really, at this point, stuff them. I fought for my life and won, in a foreign country, in the middle of nowhere, with a nutter - and I  won. So there's no way some self important GP is going to get one over me at that point.

The really good contraception specialist I saw gave me an external ultrasound for fibroids, and she thinks I have two 3 cm ones.

She also gave me some papiloma virus swab kit to take away with me. I can do it myself if I want and she will send it off to get tested.

I haven't done it as I don't want to end up being cornered and pressured into some course of action I have no control over.

[Focus]

OK ladies, please don't laugh, or say I told you so.

The little bleeding I was having wasn't going away. It was just a little, every day, but I was getting fed up of it. I was also away from home working, doing a very, very long hours and full on job.

I took my courage into my hands and decided to take a break from taking the CP for three/four days.

So, in my past, normal life, I would get stomach cramps the day I got my period. Just one day only, and that would be that. They were never really bad, more of an inconvenience. I could stilled stuff like go to the gym, although I'd maybe keep off the abs exercises for that day.

Anyway, when I took a break from taking the CP this time, I had crippling stomach cramps for two days. They were blinding, almost made me feel dizzy and faint with the pain.

I had a normal-ish 'period' for two days, and then it stopped.

Bearing in mind I had no idea what my body was going to do when I stopped taking the CP for those few days, and remembering the utter hell I'd been through last year, I was really, really scared.

Plus, I was working away from home, with no way to take breaks when I wanted/needed to if things got bad.

So I might see if I can factor in some sort of three day break from taking the CP every three months (or slightly less) so I don't have to go through that again.

I'm finding this all really overwhelming and more than a little traumatic.

[NorthArm]

That sounds like a great plan Focus. Let us know how you get on xx