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[Belm]

Hi there.  Could do with some advice, please?

Been on Evorel Sequi for nearly a month.  I've been having lots of menopause symptoms for about a year or so (but kind of coping) then after a crisis with my 13-year-old son about 3 months ago I had a sudden acute onset of severe anxiety (so bad it was hard to do anything - even make a cup of tea).   I still have the anxiety although it is not as acute I am now also feeling low a lot of the time.    At first, I didn't connect the anxiety to the menopause but then after doing some research realised that it could be.   Asked my GP about it and he prescribed me evorel sequi.  I'm not sure if I still have periods as am on the minipill.  I started using the patches (with the minipill) but then had a worsening of my anxiety so asked if I should half the patches which my GP agreed to. 

I've been on them now nearly a month and although the anxiety is not as acute it's still hard to cope with and I also feel low.  I'm experiencing other symptoms too - palpitations, dizziness, strange nerve sensations (buzzing sensations in bottom of my back).  What I don't know is if these symptoms are side effects of the patches or symptoms of the menopause and I actually need to be on a full patch rather then half the patch. 

I know it's probably an impossible question to answer but I wondered if anyone can comment and provide any help?  My GP is nice and tries to help but I feel doesn't really know what he's doing when it comes to HRT. 

[Jari]

Hello Belm and welcome to the forum.

You say you were having symptoms, but were coping, but that you started with anxiety with some concerns with your son.

It's possible this is stress related anxiety. Are you still stressed with that situation?

What is your age and where are you in your menopause? Have your periods stopped yet?

Did you feel better before the hrt or is it making you feel worse? X

[Belm]

Hi Jari. Thanks for your message.

I was having unusual nerve sensations, aches & pains, vaginal dryness, occasional hot flushes, fluctuating low grade anxiety & low mood before the onset of this acute anxiety.

I'm 50 & don't know if my periods have stopped because I am on the mini pill (started it about 10 years ago to stop heavy periods).

The issue with my son has passed now & everything is fine which is why I can't understand why I'm still so anxious. The last time I had anxiety like this was when he was born & I was diagnosed with post natal depression. It feels so similar which makes me think it is hormonal not stress related.

I certainly don't feel worse now I've started the HRT but it hasn't made a dramatic improvement (which I guess is what I was hoping for). Not able to work at the moment & finding that hard as I love my job & miss my colleagues.
 Xx

[Jari]

Hi Belm,

I'm wondering if the stress you had with your son, might have triggered something.
Do you manage to do much exercise? I've found that good brisk walks really helped with my anxiety some years back.
Have you come off the mini pill now? If not, would you consider this, so you can see where your periods are at?
I'm 49 and my periods stopped 2 years ago. I'm not on hrt.

If your son's situation triggered something with your anxiety, I do think it would be good to break that, if you know what I mean. Make a change like brisk walks with good deep breathing and maybe ask your gp about some cbt? Just thoughts. Hope you feel better soon. X

[Belm]

Hi Jari. Thanks for your suggestions.

I've been doing all those things (I work in mental health so have a good knowledge base about what helps with anxiety) & also seeing a counsellor but unfortunately although they help a bit I'm still feeling pretty rubbish most of the time.  That's what's making me feel it's hormonal in the main. 

At the moment I'm wondering whether I need to up the dose of Evorel Sequi I'm on from 1/2 a patch to a whole one.

Wondering if there's anyone out there who's been in similar position?

xx

[Hurdity]

Hi Belm

 

Sorry to hear about the crisis with your son but glad that has resolved, also about your ongoing symptoms.

My first thought is that you are now taking a lot of progestogen if you are on the mini pill as well, and also half a patch is a very low dose so your symptoms could either be due to too much prog or too little oestrogen. Personally I would look to changing your regime.

Personally in your position I would stop the mini pill (which one is it?). If you are needing contraception from the mini pill you could either take one of the newer combined pills which are a bit like HRT - Qlara is one such (contains estradiol like the Evorel), or perhaps have the Mirena coil fitted which would protect your uterus from the build up due to HRT and also provide contraception as well as prevent heavy bleeding. (Qlaira might not be prescribed due to your age but some docs might allow it). Then you could add oestrogen (gradually) at a level that was right for you, but with much less progestogen.

Hurdity x

[Belm]

Hi Hurdity. 

Thanks for your message. That's really interesting info. 

I'm on Ceravette - I've been on it a long time & started because of heavy periods. I don't want the coil as I've had some traumatic experiences with my cervix in the past - it seems to be very sensitive ( I went into shock when I had a cervical biopsy many years ago & there have been a number of other things happen too).

I hadn't considered the combined pill. Would I get enough progesterone in that without needing anymore? That seems like a good option. I assume I could then add the oestrogen as a patch?

Really appreciate your help x

[Belm]

Hi Hurdity (or anyone else who can help)

Do you know if I can expect a period (assuming I still can) if I'm on Evorel Sequi & the mini pill?  If so, do you know when it would be in the cycle? I'm guessing after I finish the 2 weeks of Evorel Conti?

Haven't had a period for a longtime & wondering if I should get some sanitary products in to be prepared?

Many thanks x

[pants46]

Hey Belm.
I was on Evorel Sequi and the Minipill for a short while. And the answer to your question is NO. You will not get a period, assuming you were not getting periods on the minipill before starting HRT. If you get any bleed, it will be about 3 days after you stop the conti patches, and will be really light. But I didn't get a bleed when on both.
Best wishes. x

[Belm]

Thanks pants46 - that's really helpful.

Can I ask, did you have any problems with the fact that your getting extra progesterone from the mini pill on top of the progesterone in the 2 weeks of the Evorel Conti patch?

Many thanks x

[Hurdity]

Hi Hurdity. 

Thanks for your message. That's really interesting info. 

I'm on Ceravette - I've been on it a long time & started because of heavy periods. I don't want the coil as I've had some traumatic experiences with my cervix in the past - it seems to be very sensitive ( I went into shock when I had a cervical biopsy many years ago & there have been a number of other things happen too).

I hadn't considered the combined pill. Would I get enough progesterone in that without needing anymore? That seems like a good option. I assume I could then add the oestrogen as a patch?

Really appreciate your help x

The combined pill I mentioned - Qlaira doesn't need any more oestrogen or progestogen as it is balanced. It eventually suppresses ovulation but contains variable doses of oestrogen throughout the month from 1 mg to 3 mg so is sufficient as a replacement. There are only two pill free days and progestogen on 22 days. The issue might be your age though as it's supposed to be stopped at 50 - don't know why though as the oestrogen is the same as in HRT unlike the stronger CCP types.

I think you're still having too much progestogen but not sure what the answer is if you might still have heavy bleeding and can't have the Mirena. If you went onto a cyclical HRT (and stopped the mini pill) then your withdrawal bleeds might be too much - depending on where you are in menopause. You could try an oestrogen only patch with separate progesterone although this might still be too much prog along with the mini pill?

Or - you could try one of the combi pills eg Clinorette (2 mg), Elleste Duet ( 2 mg) or Femoston 2/10 - and come off the mini pill. You would get a monthly bleed though.

The dose of half a patch is definitely very low though. 50 mcg is the average medium dose for symptoms relief but some women need much more.

Re your other Q - I would get some sanitary products in just in case you get a light bleed like pants says....

Hurdity x

[pants46]

Belm, I did worry about that, so stopped the minipill. Carried on with the Evorel sequi for another 2 months, before stopping everything.
1 month after stopping the minipill I got a light bleed. The 2nd month I got a slightly heavier bleed, but it was early ... so was my own cycle kicking in. So, if you stop the minipill your bleeding could be temperamental for a while.
I didnt feel any different on the minipill with HRT, and on HRT only.
The prog dose in the minipill is low, and if you've tolerated it for a number of years, I wouldn't rush to give it up.
It's a shame the minipill isn't strong enough to protect the womb on its own, cos then we would only have to add estrogen.