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[Gilla999]

I thought I'd post this in a new thread. After 3 months on the contraceptive Pill Zoely for Perimenopause cyclical debilitating insomnia and night sweats I am suspecting that my own hormones have not been fully suppressed, as I am still experiencing cyclical insomnia, night sweats (though they have improved somewhat) and cramps in the mornings during these episodes which are 4 weeks apart.

I have no idea where to turn or what the next step is. I've read that if the cycle is not being fully suppressed you need to increase the Progestin? But have heard others talking about topping up with Estrogen HRT.

I know it's a long shot as most people here are on HRT but does anyone have any experience with this? xx

[Floo36]

Hi Gilla999,

I was put back on a low dose combined pill 20mg that worked previously but unfortunately now that my hormones are fluctuating, I think late peri the pill didn’t work this time and we tried adding extra Estrogen but it didn’t work, apparently the pill can affect the natural Estrogen, not sure if it does.  I have stopped taking the pill and now just on the hrt and hoping I can get it to work because I’m still very ill like you with awful symptoms, I don’t sleep any night without help so I’m desperate to find a solution.  It may work for you though as we are all so different. 

[Gilla999]

Thanks for the reply Floo - sounds like you're going through exactly the same thing as me - it is so awful. How long have you been taking the HRT for and what dose are you on? I think I'm going to try switching from Zoely to Qlaira and see if I get any joy from that as a first step. If not then perhaps I need to think about giving HRT another go and sticking with it... x

[Floo36]

Hi,

I only stopped the pill 10 days ago so early days.  On 5 sprays Lenzetto at the moment as we think I don’t absorb it well but waiting to see if stopping the pill makes a difference to the absorption.  I didn’t absorb gel well if at all.  I may do a blood test in a couple of weeks to work out if I’m absorbing but it’s difficult to know when your hormones are fluctuating so much.  Just hoping peri he’ll ends soon, it’s been 9 years but the last 2 from hell.  Have you tried the higher dose combined pills?

[Gilla999]

Good luck with the spray, I really hope it helps you.

Which kind of pills do you mean by the high dose ones - things like Microgynon? X

[Floo36]

Yes, the usual combined pill with synthetic estrogen, they are high dose compared to HRT but in my experience your own hormones are still declining and fluctuating so you still get symptoms breaking through which i have found out.  Good luck I hope you find a solution soon.  It should be better on the other side I'm told.

[Dorothy]

I was on Ovranette for years to correct hormone imbalances and I always felt it didn't suppress my cycle fully.  I would get cramping, bloating etc on a monthly basis.  My GP was just 'that's your imagination - the pill suppresses your natural cycle so it's impossible for you to be feeling these things'.  But it wasn't as though I was expecting them to happen - I'd be wondering why on earth I had these cramps and why I couldn't do my jeans up and I was bulging out of my bra...and then I'd look at the calendar and realise I'd been the same a month previously...

[Alicess]

Hi Gilla999,

The estradiol (hemihydrate of valerate)  in Qliara, Zoely or HRT will not surpress your cycle, it adds to your own  hormones. It's just not potent enough. According to Nick Panay you'll need 30 mg of estradiol to surpress your cycle. For some the topping up is enough, for others not so much.

Birth control pills which contain ethinylestradiol, a synthetic estrogen, and a progestin are more potent and can surpress your cycle. If they work properly.

Every progestin has it's own properties; some are more potent then others, some are more androgenic then others of have other properties like antimineralocorticoid and glucocorticoid activity. If you search the name of the progestin on Wiki you can see the differences.
Progestins do matter and they can give side-effects or benefits on their own.

It's confusing that both Qliara and Zoely are also named contraceptives when they are so different from synthetic birth control pills.

It's trail and error I'm afraid.

Alicess X

[Gilla999]

Thanks Alice - now I'm totally confused  I read that the estrogen in Zoely is the equivalent of 50mcg of the synthetic estrogen and that if your cycle isn't being suppressed it's the progestin that needs to be increased, not the estrogen?

Admittedly this information I've pieced together myself off the internet because (a) I'm desperate and (b) I'm getting no help at all from GPs or the like. I even paid to see a menopause specialist who flat out told me there's nothing wrong with my hormones, despite all of my symptoms happening cyclically, always.

This is what I found:

• "... 0.625 mg conjugated estrogen is equivalent to 1 mg estradiol, 0.05 mg ethinyl estradiol, or 1 mg 17B estradiol

• "It may be due to the particular pill being insufficiently strong to consistently suppress ovarian function. In this case, changing to a BCP with a stronger progestin and a longer half life should resolve the problem."

Did you speak to Nick Panay yourself? I would fork out the money if I thought it would be worth it!

[Alicess]

Surpressing ovulation isn't enough to surpress the fluctuations, you still need sufficient estrogen. On top of that progestins are anti-estrogenic.
The right progestin can make a difference though.

Synthetic BCP's contain 0,030 mg of ethinylestradiol, your information about 0,050 mg being equivalent to 1 mg estradiol is simply not true.
Where did you find this information?

https://en.m.wikipedia.org/wiki/Ethinylestradiol  read chapter Pharmacodynamics

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

I didn't speak to Nick Panay myself unfortunately. I understand you are desperate but don't let doctors, GP's and so called specialists discourage you.

Alicess

[Gilla999]

Alice, thanks so much for the links. The link to where I saw the equivalent is here:

https://www.medscape.com/viewarticle/413884

I couldn't work out the Estrogen equivalents from your Wikipedia link - it's all so complex! If you need at least 30mg Estriadol to suppress your cycle fully, I'm trying to work out what that equivalent of synthetic Estrogen is so that I can choose another contraceptive Pill to try - I ideally want to start this weekend. I had been planning to switch to Qlaira today as I have a prescription but it sounds from what you're saying like that's not going to help me either?

I really appreciate your help x

[Alicess]

Read the chapter about Pharmacodynamics at Wiki Ethinylestradiol. Sorry, I'm pressed for time otherwise I would explain it myself.

I think Qliara can cause more upheaval because it contains different doses of estradiol and progestin

[CrispyChick]

Gilla. I feel your pain. Many a time over the last 3 years I've been down the rabbit hole of desperate Google searching. I don't think I'm ever any further forward...

Firstly. If you can, step back. I know you feel desperate, but only a week or so ago you told me things were going well. Could you manage through this blip every 4 weeks??? If the in between times are better???

You know I've tried many combined pills over the last 12 months and had a bad time on all of them. They just don't seem to suit me anymore.

Although, I do admit, I had read about suppression before moving to microgynon and it is the reason I stuck with artificial estrogen and at 30mg. I am still hopeful.

The only other thing I can say is I was on cerazette (mini pill) for years. Its the one that has sufficient progesterone to suppress ovulation. It stopped my ovulation and periods. When I tried it to sort this jess out, it stopped ovulation and periods, but boy I could feel my own cycle going up and down badly in the back ground. I guess we're just in such an unstable phase that we feel all that.

If you do switch, I'd go for a 30mg estrogen pill. I tried 20mg but it meant the progesterone affects are stronger as they never reduce the progesterone (prob because that's needed to stop ovulation}.

Xx

[CrispyChick]

Maybe you had a better night???

[Gilla999]

Crispy thanks so much, I have also been trying to remind myself that not so long ago I was saying things were much better. But the last few days have been SO bad that I just can't go through this every month - I've had to take another week off work. The cramps I've been getting at the same time as it happens really makes me think that my own hormones are still going on in the background, though I am also very aware of the desire to want to find a reason and fix it. And I am sure there is also a psychological element to it now that it's become A Thing.

The Google rabbit hole is so accurate and I hate doing it this way, but it is purely because I've felt like GPs have been no help whatsoever.

Funnily enough I have thought about you over the last couple of days and whether I should join the Microgynon rage crew    I chose Zoely specifically because of the natural Estrogen and therefore the lack of side effects, but I had no idea it wasn't as potent as the synthetic Estrogen and what that might mean. I have managed to get an appointment with a GP later this afternoon who specialises in female health and I'll ask her advice on which to switch to but I agree that I'm definitely going to go for something along the Microgynon lines.

How have you been feeling the last few days? Is there a reason that you chose a Pill with one of the second generation Progestins rather than newer ones? Or did you just go for it as you've been on it before? xx

Thanks Alice also for your help, I wouldn't have had a clue about the potency without it!