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[mcgalel]

Hi Forum,

Female, 41 here suffering severe insomnia past few years.

Have tried SSRI and sleeping pills nothing worked but though may be in perimenopause as also suffering dryness and low libido.

I have already been on a combined progrestrin and Oestrogen pill for years so GP has trialed me on two months of 100mg progesterone and vaginal oestrogen. In 5th week and already suffering bowel cramps, huge anxiety and a rollercoaster of emotions. Had three nights in a row with zero sleep too so feel exhausted. I only sleep two hours a night and no amount of sleep hygiene, fitness or diet will improve it. The oestrogen cream is working well though

My question is whether to stop the progesterone as its having a huge impact on my mental health and no improvement to my sleep. I also can I do BCP and HRT as same time? is it too many hormones?

I cant get a GP visit until mid February so figured I might stop taking them as I feel awful.

Have you any advice as to what I need to do if my Combined pill isnt helping the symptoms?

[bombsh3ll]

The combined pill is much better for perimenopause in my experience.

Taken continuously ie every day no dummy pills or treatment breaks it gets rid of all the bleeding and hormonal fluctuations, and should provide enough estrogen to avoid any menopause symptoms.

Micronised progesterone is not strong enough to provide menstrual suppression but is strong enough to induce withdrawal bleeding if taken cyclically - that's a lose lose situation in my book.

The estrogen in birth control pills is a higher dose than menopause hormone therapy - you should not take both together - however you can use vaginal estrogen with the pill - sometimes the progestin in birth control can cause vaginal dryness.

Also the pill shuts down ovarian function (this is a good thing) but it does lead to reduced testosterone hence no libido, however testosterone is often low anyway by our 40's so this may make little difference in perimenopause.

There's no data on using transdermal testosterone alongside a combined pill, but there is safety data for dhea which I take for androgen replacement alongside my combined pill.

Whilst everyone has their own preference, I plan to stay on the combined pill until menopause can reasonably be assumed in my early to mid 50s then switch to a licensed HRT product.

Insomnia is also a challenge for me - not hormonal in my case as it is lifelong - I found low dose mirtazapine helpful but it does unfortunately cause weight gain. If you are thin I would say it is definitely worth a try.

[mcgalel]

Thanks @bombsh3ll

I was thinking to not take them together and its making me much more anxious.

The main issue is the sleep as its only got bad past few years and I know Progesterone HRT is the best treatment for the constant waking up in the middle of the night. Someone else has recommended Mirtazapine to me and yes I am slim.

some people have suggested I try a progesterone only pill and add in low dose oestrogen but then I dont want to go through the hassle of tweaking HRT options and potentially not getting any better. I would like to stay on my combined pill and if I keep using the Oestrogen cream then it would help its just the insomnia I want to tackle.

Hard to know what to do

[bombsh3ll]

If the estrogen cream is just local treatment for the vagina this is absolutely fine to use alongside any type of birth control pill.

Vaginal estrogen is not absorbed systemically - even women with breast cancer use it.

It is just systemic hormone therapy eg patches, gel or tablets that shouldn't be used with the pill.

If you are slim then i would definitely give mirtazapine a try. i found it highly effective but have gained weight on it which unfortunately is common.

[AliBaliBee]

I am also 41 and have been told I am too young for my symptoms to be related to menopause! I am so fortunate than I have never really suffered with insomnia, but my husband does so I can understand a little bit about how it affects you. I am sorry you get such little sleep. Can I ask what sleeping meds you’ve been prescribed in the past?

[joziel]

AliBaliBee....

This is a bit of a confusing situation you're in there.

You are definitely not too young for this to be menopause/peri-menopause. I've been on HRT since 42 (now I'm 46). And I've had symptoms since age 38. If your GP is telling you that you are too young, you need to find another GP because that's just ignorance - and there's no excuse for ignorance in a doctor when it comes to something which over 50% of the population are going to be dealing with.

Secondly, when it comes to insomnia (which I have had a heck of a time dealing with and has been one of the worst things for me), for most women it is caused by low/fluctuating estrogen. Not progesterone. That means - you need systemic estrogen. If your doctor has just given you local estrogen cream, that's lovely for your vagina - but it's not going to be doing anything systemically for you.

Thirdly, the vast majority of birth control pills use synthetic hormones. These cannot replace the hormones your body used to produce because they are completely different, chemically and structurally. There is one pill called Zoely which uses body identical estrogen (the same as in HRT) and a synthetic progestin and another called Qlaira (which is used less often) but besides those two, you are looking at synthetic hormones in BC. If you really want to stick with birth control, try Zoely.

Otherwise, move to HRT. Really it sounds like you need to change doctors....