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[Hurdity]

Flyingsquirrel - I haven't read all the posts in this thread and the detailed discussion of different birth control pills as there is no info provided on this site about most of these - and we mostly discuss HRT!

However just looking at a couple of things you said - firstly that your periods were regular before you started...what? HRT? If your periods were bang on more or less regular and hadn't lengthened or shortened and very variable in cycle length then whenever that was - you were not yet peri-menopausal but in what is known as the Late Reproductive Stage - which is the last stage before peri-menopause officially starts ie ovulaton still happening regularly but things begin to go a bit wonky re hormones - hence your suffering of increasing pms and unlucky enough to start getting flushes which most of us don't start to experience until peri starts or is well on its way. However you might be there now!

That being the case then HRT is not actually indicated although it can help a few women to regulate their cycle. In view of your age and symptoms it sounds to me like some form of BCP (COP) is the best way to do this - not the POP though which does not always suppress ovulation. You need the high dose of oestrogen that the pill contains but you want to suppress ovulation so that you don't get depression and mood swings. I know very little about these pills except that I know gynaes do prescribe them in younger women experiencing symptomns that you were getting - to help them through the last stage before peri and the first part of peri, until you can graduate to HRT which may not need to happen for a long time.

There are a couple of BCPs which contain the same type of oestrogen as HRT ie estradiol, rather than the synthetic ones - in UK called QLAIRA and ZOELY (not sure if this last is still available) but you could google BCP estradiol and see if there is one in US?

Re Studd regime. His way of treating reproductive depression prior to menopause is to suppress ovulation through very high doses of oestrogen and then add the progesterone dose - the 7 days is not recommended but you might get away with 10 per calendar month under medical supervision. You would need to know you were absorbing the oestrogen via whichever method you chose so that you were taking sufficient to suppress ovulation otherwise you would be adding to already high levels aaround the time of ovulation - not sure what effect this would have?

I presume you've read his website and pages on reproductive depression?

Good luck with trying out additional pills and hoep you find one that works for you!

Hurdity x

[flyingsquirrel]

you were not yet peri-menopausal but in what is known as the Late Reproductive Stage - which is the last stage before peri-menopause

Oh, so there's a name for that?  Thanks!  I've been trying to tell people I'm sort of at the final stage before perimenopause, which confuses them.  Nurse didn't give me the name for it, so I just started calling it peri or even peri-peri-menopause because I got tired of explaining.  I would have been more clear if I knew the name for it!  But like you said, I've been on birth control long enough that I might be there already but not know it.

The thing I'm struggling with right now is that I've been through five birth control packs and nothing is alleviating the depression.  If it weren't for the Trazodone, I wouldn't be sleeping much either.

You said that it's just PMS getting worse, but once this monster hit September of last year, I got depressed and anxious 24/7.  I don't get a break.  Periods can be more frantic emotionally with even less sleep.  PMS is cyclical, the depression factor of this is not.  And yet I don't think it's a coincidence that I'm having hot flashes.  Looking back to about mid-2017, I started having out-of-the-blue physical anxiety, felt tense all the time, etc.  Then late 2017 - early 2018 I started getting horrible depression only during periods.  Then I got roughly six months off until this horrible new stage hit September of last year.  It's got to be hormones.  But what would cause the depression to be 24/7 regardless of whether I'm on the pill or not?  And I haven't even started peri yet!

So...if I try the other two suggested birth control packs and they don't work, then what?

There's another factor, too, as far as why I'm interested in creams or patches.  I've had two migraine auras several months ago while on birth control.  If I have them again, the nurse said she will have to take me off birth control, anyway.  In which case, we'll be doing creams or patches or whatever anyway.  I am also nervous of the risk for clotting.  I definitely did not do well on the 10mcg birth control pack.  It made my jaw lock.  But the risk of clotting goes up the higher the dose goes up.  I have a PFO in my heart (atrial septal defect thing).  A clot would be very, very bad.

I dunno.  Any ideas?  I've tried every OTC supplement on the planet.  Nothing has stopped the depression.  I'm scared to try antidepressants because I might not be able to taper back off without brain zaps, or I might have ugly side effects, or I might feel even worse, etc.

[KiltedCupid]

I honestly don't know how to compare synthetic versus bio-identical, I would like to know myself.  It's not only potency but also a different substance and a different kind of delivery. Maybe someone else comes along with an answer. I do believe you will find the right one but if you need a peptalk please do pop in ( if that's the right expression).

Alicess 🌷

Alicess and Flyingsquirell - this is the only comparison chart I've found. It's an Australian site but the equivalencies are relevant here too. Essentially they're saying a 50mcg patch which is roughly 2 pumps of gel = 10mcg ethinyl oestradiol. Ergo, you'd need 4 pumps gel or 100 patch for 20mcg or 6 pumps gel/150patch for 30mcg EE.

And thereafter you'd need to work out the best and adequate progestin for that amount.

There's also the Avon pill ladder which allows you to compare and contrast different bcp according to their potency at either end of the oestrogen/progestin scale, thereby selecting a more oestrogen or progestin dominant pill.

[KiltedCupid]

Sorry, here's the table:

https://www.earlymenopause.com/hrt-equivalencies/

[flyingsquirrel]

Sorry, here's the table:

https://www.earlymenopause.com/hrt-equivalencies/

Wow, awesome!  Thanks!

So, maybe then switching to creams in feasible in the right dosage, especially if there is an absorption issue with the oral pills?  It sure looks like it!

[Alicess]

Thank you, Hurdity. Also for Levonorgestrel and Drosperinone only pill. Searched a lot for these but only came up with  Levonorgestrel as a morning after pill.

[Alicess]

Ps I'm not sure about the equivalence of ethinylestradiol versus bio-identical though as ethinylestradiol is not bound by SHBG. And as the note below states ethinylestradiol is 3-5 times more potent.

Flyingsquirrel, if a lot of symptoms subsided on BC then I don't think it's an absorption problem. The progestin part can have a great influence and can counteract the benefits of ethinylestradiol. Regarding migraines, I've always had them on anti- androgenic BC's like Diane 35 but they stopped on EE/ Levonorgestrel (Microgynon). Women reported migraines on Urtrogestan too.There's just no telling eitherway how it will effect you.
According to this research (page 4) 3e and 4e generation pills like Desogestrel and Gestodene increase the risk of veneous thrombosis more then 2e generation pills like Levonorgestrel

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5531518/

[KiltedCupid]

Ps I'm not sure about the equivalence of ethinylestradiol versus bio-identical though as ethinylestradiol is not bound by SHBG. And as the note below states ethinylestradiol is 3-5 times more potent.

Flyingsquirrel, if a lot of symptoms subsided on BC then I don't think it's an absorption problem. The progestin part can have a great influence and can counteract the benefits of ethinylestradiol. Regarding migraines, I've always had them on anti- androgenic BC's like Diane 35 but they stopped on EE/ Levonorgestrel (Microgynon). Women reported migraines on Urtrogestan too.There's just no telling eitherway how it will effect you.
According to this research (page 4) 3e and 4e generation pills like Desogestrel and Gestodene increase the risk of veneous thrombosis more then 2e generation pills like Levonorgestrel

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5531518/

Thanks Alicess - the equivalence comparison of 3-5 times is also noted at the bottom of the table I posted.

Only trial and error with EE doses would determine an individuals' needs for one versus the other and shouldn't really be embarked upon without prior discussion with your gynae.

[Alicess]

I'm sorry, KiltedCupid,  I've called you Hurdity,...

[Hurdity]

Oh, so there's a name for that?  Thanks!  I've been trying to tell people I'm sort of at the final stage before perimenopause, which confuses them.  Nurse didn't give me the name for it, so I just started calling it peri or even peri-peri-menopause because I got tired of explaining.  I would have been more clear if I knew the name for it!  But like you said, I've been on birth control long enough that I might be there already but not know it.

Yup - it's all in here "STRAW" (Stages of Reproductive Ageing Workshop)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340903/

Obviously it will not hold true excatly the same for all women but the pattern is consistent across thousands so I understand and it's not a question of flicking a switch as you go from one stage to another - there will be a gradual change. Neverthelss it is useful for working definitions and to understand what's happening.

Hurdity x

[Hurdity]

I'm sorry, KiltedCupid,  I've called you Hurdity,...

Thank you, Hurdity. Also for Levonorgestrel and Drosperinone only pill. Searched a lot for these but only came up with  Levonorgestrel as a morning after pill.

But it was me that gave the info about the two pills, but not the table - which is actually a bit inaccurate anyway re equivalences....well compared to the HRT we use here in UK eg Micronor - the licensed doses here are higher.

There's a lot going on in this thread!

Hurdity x

[KiltedCupid]

I'm sorry, KiltedCupid,  I've called you Hurdity,...

Thank you, Hurdity. Also for Levonorgestrel and Drosperinone only pill. Searched a lot for these but only came up with  Levonorgestrel as a morning after pill.

But it was me that gave the info about the two pills, but not the table - which is actually a bit inaccurate anyway re equivalences....well compared to the HRT we use here in UK eg Micronor - the licensed doses here are higher.

There's a lot going on in this thread!

Hurdity x

Thank you Hurdity. I provided the table for rough equivalents, not licensed doses. If you have a more up to date UK equivalence table, please do post.

[Hurdity]

Most of the tables are for HRT as ethinyl estradiol is not a major oestrogen for HRT in UK but for interest if members want to see equivalents there are various comparison tables.

The BMS one is here:
https://thebms.org.uk/wp-content/uploads/2019/02/03-BMS-TfC-HRT-Practical-Prescribing-02A.pdf

Australian one here:
https://www.menopause.org.au/hp/information-sheets/426-ams-guide-to-equivalent-mht-hrt-doses

Canadian one here:
https://www.jogc.com/article/S1701-2163(17)31083-6/pdf

And - because as in all things scientific - it is not as simple as saying one is x times as strong as another - there is a good technical account on Wikipedia which gives different comparative affinities eg for the different oestrogen and other receptors, as well as comparison between oral and other forms - various tables are presented:
https://en.wikipedia.org/wiki/Ethinylestradiol


Hurdity x

[Alicess]

Sorry ladies, my mind went on a world tour and hasn't returned yet.... thank you both.

Maybe a bit of topic but I found this on Wiki about different absorption of estradiol with different administration and conversion to estrone, estradiol etc. Ethinylestradiol is also mentioned and potency is consirably higher. Interesting read

https://en.m.wikipedia.org/wiki/Pharmacokinetics_of_estradiol#Transdermal_patches

[KiltedCupid]

Sorry ladies, my mind went on a world tour and hasn't returned yet.... thank you both.

Maybe a bit of topic but I found this on Wiki about different absorption of estradiol with different administration and conversion to estrone, estradiol etc. Ethinylestradiol is also mentioned and potency is consirably higher. Interesting read

https://en.m.wikipedia.org/wiki/Pharmacokinetics_of_estradiol#Transdermal_patches

Thanks Alicess - I can certainly identify with the world tour thing!