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[rferdi]

I'd recently started HRT taking a continuous regime, with estradiol daily and also 100mg progesterone. It didn't really make all my many and severe perimenopausal symptoms go away for the most part, but at least what it did is I could finally sleep, it really did improve my sleep a lot.

I switched to the cyclical regime only 7 days ago (I started this on day 1 of my period), where I'm on estradiol gel daily and will wait till day 14 to start on 200mg of Utrogestan.

The first 3 days of doing this were pretty great, many of my symptoms were gone and I almost felt normal for the first time in years, I had lots of energy too, and on top of it I slept great the first two nights, I was able to get 7 hours of deep sleep with no interruptions. I was so happy. However from day 4 things began to change rapidly and symptoms reappeared, some really strong, and sleep was pretty bad on the third night with the past 2 nights being horrible.

Last night it was the worst, I was dizzy, had all the palpitations, skipping heart beats, etc etc etc... and was wide awake and feeling awful again, unable to sleep, and I've barely had any sleep. I wanted to last the 2 full weeks and wait till day 14 to take the progesterone but I don't know if I'll be able to do it, as any more nights like this feel unbearable, and I feel really unwell during the day too.

I wonder if anyone's had the same or similar thing happen and did it get better, or did you have to go back to continuous progesterone?
Also what's so wrong with taking continuous progesterone in perimenopause I wonder.

[bombsh3ll]

Also what's so wrong with taking continuous progesterone in perimenopause I wonder.

Nothing!

Combined HRT was historically designed in a cyclical regimen based not on any medical reason but simply due to paternalistic beliefs about women wanting to have periods, thinking they were pregnant if they didn't and/or being unable to cope with any irregular bleeding that MIGHT occur with continuous progestogen.

It's the same with the birth control pill if you've ever been on that. Many women are STILL needlessly spending every 4th week bleeding on the pill because they are never told the artificial withdrawal bleeds are optional and can be skipped.

Now, it is slightly more complicated with cyclical hormone therapy as it is not strong enough to shut down your own cycle if you still have one.

So the current thinking is that by giving perimenopausal women cyclical hormone therapy it will sync with their natural cycle and produce regular bleeds every four weeks.

This is the case for many, however some women continue to bleed chaotically despite this.

With continuous progesterone, there is more of a chance that you will get some unpredictable bleeding. This may be a nuisance but is not harmful.

If you don't mind this, then you should be able to choose continuous for other quality of life related reasons such as sleep or tolerability, rather than the clinician simply deciding on your behalf that bleed pattern is the only or most important variable to consider.

[sheila99]

Another option would be to take utro 25 days out of 28, it can particularly useful on late peri as it allows a bleed if there's been a build up. Really you need to give any regime 3 months to settle before changing. Many find utro helps them sleep though it makes mine worse. Palpitations are usually oestrogen related and can be from too much as well as too little oestrogen. My insomnia was from oestrogen deficiency. And you have the added problem in peri that you don't know how much your own hormones are affecting things. If you still have a strong cycle of your own you're very likely to bleed on conti as hrt doesn't override your own hormones in the way a bcp does. If you want to be bleed free a mirena is your best option.

[joziel]

Like sheila says, most of those symptoms sound like low estrogen to me...

When you switched to sequential progesterone, did you also change estrogen type (product) or dose??

[rferdi]

Thanks for all that info bombsh3ll, I'm gonna take all this into account to decide what to do. Today the rest of my day has turned out to be more tolerable, who knows why.

[rferdi]

I hadn't heard about this option yet sheila99, to take it every day except for the last 3 days of the cycle to allow for bleeding.

I know I really should stick to this for the 3 months and I hope I can. To be honest I've not been patient. I started HRT in April and have tried different modalities every month. The first 2 months Lenzetto + Utrogestan continuous, 1 spray then later 2 just for a few days as it was too much. The 3rd month I decided by myself to take only Utrogestan 100mg every night and slept well but symptoms didn't improve much. Then in July I went for estradiol gel half a pump (it's called Oestraclin here in Spain and it's the equivalent of Estrogel I believe) with continuous Utrogestan 100mg. Felt a bit better. And now this month I've started the cyclical with the same Estradiol gel but 1 full pump and will start on Utrogestan 200mg on day 14 if I can do it till then.

Today for the rest of the day things have improved and I've been feeling better than yesterday, so maybe I can make it another day.

[rferdi]

Hi joziel, yes I changed dose, I had been taking half a pump of estradiol gel the month before on continuous and this month it's a full pump.

Also I had been on Lenzetto for 2 months earlier, 1 spray mostly, and last month I was prescribed the gel by another doctor, so I switched to it then, but just a half a pump.

I'm trying to to find out what's the equivalency of 1 spray of Lenzetto to 1 pump of gel, as I'm not sure if it's better absorbed than the spray or is it that the dose is higher or lower than the 1 spray.

[joziel]

"Last night it was the worst, I was dizzy, had all the palpitations, skipping heart beats, etc etc etc... and was wide awake and feeling awful again, unable to sleep, and I've barely had any sleep."

All those symptoms are classic low estrogen symptoms. And you've just changed your estrogen product and dosage, so this is an estrogen issue - not progesterone.

You need more estrogen. You're on an incredibly low dose there. Lenzetto is very low dose. One spray is less than one pump of gel. And we all absorb products differently.

The fact is that you have classic low estrogen symptoms, you've just changed estrogen products and you are on a staggeringly low dose of estrogen....

[rferdi]

All those symptoms are classic low estrogen symptoms. And you've just changed your estrogen product and dosage, so this is an estrogen issue - not progesterone.

You need more estrogen. You're on an incredibly low dose there. Lenzetto is very low dose. One spray is less than one pump of gel. And we all absorb products differently.

The fact is that you have classic low estrogen symptoms, you've just changed estrogen products and you are on a staggeringly low dose of estrogen....

Joziel, I'd not seen this reply until now! Thank you, that's one thing I'd been wondering, whether those specific symptoms were due to low or high estrogen. And what about the strong pounding heart that feels like it's resonating all over my body? I guess those are low estrogen as well?

I switched to oestrogel (Oestraclin gel which is just about the same) on the 1st of this month (1 measure of the syringe - I said pump but there's no pump in this, it's a tube), and did notice I felt better than with 1 spray of Lenzetto, although my symptoms are not totally gone yet. For now I may continue with this new cyclical regime for a bit longer, and if after 2 months I see things don't improve more then I'll try adding more gel.

[joziel]

Well, you can check out my night time smorgasborg of sh&t symptoms in this other post I just wrote in this thread: https://www.menopausematters.co.uk/forum/index.php/topic,70467.0.html

[rferdi]

Well, you can check out my night time smorgasborg of sh&t symptoms in this other post I just wrote in this thread: https://www.menopausematters.co.uk/forum/index.php/topic,70467.0.html

Oh my god all this that you described here is exactly what happens to me! :

Heart beating so hard I can hear it in my ear and see it in my chest. Inner tremors feeling like I have mobile phones inside me. Hypnic jerks startling me awake just as I begin to drift off. Hands going numb in my sleep, as if the circulation has been cut off - although they are just lying on my chest where they've been all my life. The feeling of an electric current all around my body.

Every single thing you said. I'd add as well as hands, feet and legs, arms and eventually all of my body going numb, even my face, after feeling lots of pins and needles for a while first. Also in my case although many times I had all these symptoms during the day, it's true for me too that for some reason when lying down in bed at night to go to sleep they'd either start or if I already had them they'd ramp up dramatically.

Thank you joziel, this has helped me very much, I think you're right and I may need more estradiol, like right now. I'll think about it and do a trial to see how I feel.

[joziel]

Yes, we might need quite high levels. Getting there is going to be the interesting part. I have had improvements as I've increased - symptoms getting less intense, more possible to sleep through them, the numb hands during sleep have mostly stopped...

The thing is, many women who absorb easily would have 270-330pmol with 2-3 pumps of gel or a 75mcg patch. So just because we are liberally applying much more, doesn't mean we have tried what we need to try if we're not absorbing it.

The final option is to try oral HRT if you can't get there with transdermal...

[karab]

I'm interested to hear if increased estrogen fixes this for you. 

I am in peri and I had the same set of problems on a higher (.1 patch) dose of estrogen when I tried to use cyclic progesterone.  I had to take progesterone (200 mg) continuously to feel okay and sleep.  My doctor puts most everyone in peri who has sleep problems on continuous progesterone because of how much she feels it helps with sleep.  It did cause me bleeding problems, though.  Now I am on slynd because the irregular bleeding became a worsening issue for me. 

I agree with others about the taking a 3 day break -- for me that didn't make symptoms too crazy, but helped me regulate my cycle. 

Taking progesterone only half the month also seemed to increase my body's reactivity to it -- more bloating, which drove me crazy.

I hope increased estrogen fixes things for you.

Kara

[rferdi]

@ joziel  I only got started with HRT, and I expect I'll be getting some blood tests in a couple of months to check hormone levels including estradiol, I'm very curious to know what they'll be like.

I'm only taking what I'm guessing would be the equivalent to 1 pump of Oestrogel, that's minimum dose I think, and I'm already feeling symptoms improving, hopefully that means I'm absorbing pretty well so maybe I'll reach good blood levels with not too many pumps? I hope so, as I really wouldn't want to take oral estradiol.

The fact that your symptoms have improved as you've increased estradiol is very encouraging.

[rferdi]

Hi Kara, thank you. When I posted this originally, more than 2 weeks ago, it was just the beginning of this new cyclical regime, and now that I'm 3 weeks in I can say things have improved.

For me continuous progesterone which I did for 2 months prior to starting the cyclical, also caused a lot of bleeding. I had 2 periods the first month and 3 the second, all of them lasting almost a week each. I didn't know this was due to progesterone then.

Since I'd been sleeping quite well with the nightly progesterone I was a little bit afraid to do the first 2 weeks of estradiol only, and they sure were sometimes quite challenging, but never as bad as before I was on HRT, and after the first week it was quite a lot better.

When time came to take the 200mg of progesterone it was pretty awesome to be honest, I've been having much better sleep than when I was on the continuous, and symptom-wise it's improved slightly as well. Thankfully I've not had any bloating from it, at least not yet.

I'm now persuaded to continue on the cyclical for the 3 months to fully see how my body likes it, and I don't know what will happen on month 2 or 3, I hope it only gets better. Although I think most likely I'll have to increase my dose of estradiol, but I don't want to do it just yet, I may start to increase on month 2 and see how I feel.

I'll keep updating this post with progress, I hope it's helpful to you.