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[LittleClaire]

Hi Ladies,

So today I visited my doctor following on from hormone blood tests I had done two weeks ago to check FSH and oestrogen levels due to having several symptoms for around 5 months. She told me my bloods were fine but due to the symptoms I was having I had a few options depending on what I wanted to do about it. She mentioned combined pill and HRT. I told her I was on the pill until beginning of October where I decided to come off it and see what my periods were really doing, and while I was on it I was still having these symptoms so it wasn’t really helping anyway, so could I try HRT. She did mention that if I was having symptoms whilst on the pill then HRT probably wouldn’t do anything to help but she agreed to let me try it. I am 37 and she also told me I am a bit young to be peri menopausal but whatever I’ve heard that many times recently and no I am not too young.

I have decided to opt for the combined patches rather than gel or tablets just as it will work better for me, and I will have a review in 3 months to see how I get on with it.

I was just wondering, do both the pill and HRT contain similar amounts of the hormones and am I wasting my time getting the patches if the pill didn’t help anyway?

[joziel]

It's probably best to avoid the combined patches for multiple reasons. Firstly the type of P they include is not body identical, it is a synthetic progestin - not the natural body identical progesterone your own body is making. So it will not replace your missing hormones and it does have a higher risk profile in terms of BC risk, lipid profile etc - in other words, it's not great for you if you can avoid it.

Second, it comes in a fixed dosage of 50mcg of estrogen in the combined patches. If you need more than this (or less), it is not possible to adjust the dose of E and P independently of each other. If you take a separate E and P you can adjust each separately.

The combined pill contains synthetic hormones, both synthetic estrogen and synthetic progestin. It does not replace your missing hormones. Your GP is incorrect and a bit ignorant if they expect it to. The only exception to this is a combined pill called Zoely and another called Qlaira which contain body identical estrogen - but still a synthetic progestin. All other pills contain synthetic hormones.

You are not too young to have symptoms or to be on HRT - but if your GP gets difficult about prescribing HRT at your age, or about increasing dosage etc, one option is to try Zoely so that you at least get body identical estrogen and then can transition to HRT in a few years.

[CrispyChick]

Often the combined pill is recommended in peri to 'shut down your own system'.

The NHS meno clinic told me I was best taking that in early 40s.

HRT tops up your own hormones. Which is fine if you've lost them. But often in early peri, it's volatility that's the problem, not necessarily low levels. So you can be topping up already sinking hormones.

It's all a bit trial and error I'm afraid. 😞

[LittleClaire]

It sounds quite complicated 

So if I am in early peri and not the later stages, HRT may not even do anything with my own hormones being up and down anyway? I’m guessing that’s right as when I’ve taken “at home” FSH tests from amazon with the urine sample all 3 have came back positive yet today I was told my bloods are fine and I was tested for FSH. This was on day 4 of my cycle too not sure if that makes a difference. I’ll see what the patches do and I have a review in 3 months anyway so can let them know if they’re no good

[bombsh3ll]

Trying something that you think might help is never a waste of time, either it does or it doesn't and you can just rule it out and move on.

Birth control does usually contain a higher equivalent dose of estrogen, but as most of them have synthetic ethinylestradiol this may not relieve some menopausal symptoms as well as 17 beta estradiol. Two pills, Zoely and Qlaira contain body identical estradiol and can be a good choice for peri.

The main reason I believe women experience menopause symptoms on the pill though is because they are only taking it 3 weeks out of four, and going untreated a quarter of the time - this is completely outdated and unnecessary.

Personally I much prefer the pill (I'm on Zoely) which I take continuously, as it gets rid of your own cycle completely and adds back a stable low dose of estrogen and a progestin. No bleeding or hormonal turbulence.

No menopause hormone therapy will do that.

However not everyone gets on with particular types of pill, although changing to a different formulation may help and there certainly are many.

There's also the Nuvaring which I loved- I used to leave it in for 4 weeks instead of 3 to avoid withdrawal bleeds- or the contraceptive patch.

What I would say about combined birth control options is as brilliant as they are, because your ovaries are shut down this usually results in low testosterone, so I take dhea for this.

[LittleClaire]

Thanks for all your replies.

I just don’t think going back on the pill is for me, I do want another child soon if I am able to so contraception wouldn’t suit and also as my symptoms have been quite bad I feel a patch which is absorbed directly into the bloodstream rather than taking a pill would be more effective. Obviously if it doesn’t work after a few months and I feel no different I can speak to the doctor to see about adjusting it or adding testosterone as you say. It’s difficult knowing what will work and what won’t ..

[bombsh3ll]

If you are hoping to conceive the recommended hormone therapy would be estradiol and sequential micronised progesterone, not the synthetic progestin in the combined patch.

You could still take estrogen patches alone plus the micronised progesterone orally or vaginally.

[joziel]

I agree with bombshll, especially if you are late 30s already and want to have another child, shutting down your ovaries with a synthetic progestin really doesn't sound like a good idea. Instead, body identical estrogen and progesterone can support your own cycle. They are not contraceptives though, so if you don't want another child right now, you'd need to use condoms or something else...