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[Birdbrain]

Hi,

I'm perimenopausal and started Evorel Sequi (with the Evorel 50 and Evorel Conti patches) a few months ago. I noticed immediate improvement in mood. Prior to that my mood, particularly before my period was getting worse and worse. My hair and skin improved too. Since then, I've noticed a decline in things again, with my period getting shorter and this month later and lighter. Also my voice is getting deeper and odd chin hairs are growing.

Recently I saw a menopause specialist through the NHS and asked if I should go on to something stronger, but they said stick to Evorel Sequi and let's see in a few months time. I agreed. But the PMS before my period has now getting so bad I am starting to have suicidal thoughts. I don't intend to do anything about it for various reasons but the thought that I should put my affairs in order to ready myself to go does keep occuring to me. I don't want to tell my menopause specialist or my GP about this as I don't want 'has suicidal thoughts' on my health record.

Any thoughts as to what I can do to up my dose? I am wondering if I should buy HRT privately, and if so, what should I go up to? Is there an equivalent of evorel sequi with 75 patches?

Any pointers appreciated.

[CLKD]

Hi!  It's a good idea that we all put our affairs into order, by making Power of Attorney for parents/partners as well as making a Will updating every 5 years unless situations alter.

It is documented that pre-menstrual symptoms may cause suicidal ideology.  Dr Kathleen Dalton did a lot of research in the 1980/s90s ------- The National Association for Pre-menstrual Syndrome advised me to eat every 3 hours, 24/7.  PMT begins 10-14 days prior to the next period and stops once the bleed begins.

The idea then was that if blood sugar levels drop it can take up to 10 days for levels to even out - eating every 3 hours certainly eased that sudden energy dip = anxiety.  I was already on anti-depressant medication.  My puppy soon found out that after her early morning P that there were bistuics on my side of the bed ;-).  Ginger and cream crackers in the night as well as keeping hydrated: and eating regularly throughout the day saved my life at the time.  I got to carrying my own foods so that I could eat within my necessary times, I had to tell MinL to treat me like a diabetic! 

Is this a 'specialist' or a GP who thinks that they know about HRT?   Hopefully some1 will be along but I am sure that some ladies do add a little more pump or cutting patches to add a small amount a few times a week, not all at once 'cos that may cause more upheaval. 

U shouldn't have to pay for HRT privately.  What I also suggest is that you send a hand written letter covered by an e-mail to the 'specialist' explaining that you are not feeling well, asking what advice they can give now, that you aren't able to wait for a 'few months'. Do U have an appt.? 

[Taz2]

Hi Birdbrain. Would you consider a change of progesterone? Evorel conti contains Norethisterone which is known to cause low mood, depression and PMT type symptoms in some women.

Do you have a period as well as your withdrawal bleed each month?

Taz x

[Birdbrain]

Hi CLKD,

Thanks for your reply.

It doesn't seem to make any difference how oftern/a lot I eat. The specialist menopause doctor is someone who works at the women's health clinic. I just saw her the other day and at the time my PMS wasn't so bad (it ebbs and tides) but that night it got really really bad so this happened straight after my appointment.

My PMS becoming suicidal tends to happen the day before I get my period where it seems to reach a peak.

I have thought about cutting up/adding patches but don't know whether that requires increase in just the evorel 50 patches that just contain estrogen or the Conti patches that contains both estrogen and progestrone.

[Birdbrain]

Hi Taz,

Thanks for your reply.

Yes I would consider a change of progesterone. I did mention that to the specialist and they said they could swith to utrogestan but that to see how things are in a few months time.

I'm not sure if the type of progestrone is causing the problem, as I still get my period which is out of sync with the patch cycle (therefore no other monthly bleed) due to mistakes in timing of taking it. I get my period during the first week of progestrone or at the end of the second week of estrogen, and I'm not sure if I necessarily noticed any mood changes when switching to the combined progrestrone patches from the estrogen only patches.

Also, I was feeling like this back in December before I started HRT in January, and this went away or improved a lot in February and March and now in May seem to be back to the awful PMS mood swings. The PMS is also not necessarily constantly bad but seems to spike extremely the day before I get my period. It become almost unbearable and I feel like there is no solution to anything in life, that things will never get better and the best thing is to just opt out of life. Then I get my period and I think I can't believe I've fallen for it again.

[CLKD]

It takes about 3-4 months of eating every 3 hours religiously to even out those awful feelings, which you are aware are pre-menstrual.  Those feelings are real, triggered by hormone upheaval.