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[born2misbehave]

Please help ladies, I’m so desperate this morning after the worst weekend of my life.

43 and private menopause Dr recently prescribed Estradot 50 patches and Utrogestan 200mg vaginally for 14 days of my cycle. I was previously suffering with mood swings, night sweats for a week leading up to my period, and my cycles were getting shorter (last few only 24 days), and periods shorter and lighter. I have a history of gastritis so wanted to avoid anything oral.

Patches seemed to really start to help for first 14 days of cycle, improved mood and reduced heart palpitations. Started Utrogestan at night and seemed fine, only side effect minor breast tenderness. Until this weekend…day 25 of cycle today and since Saturday morning I’ve had bad night sweats as usual pre menstrually but the WORST depression I’ve ever had in my life. I haven’t a history of depression until peri seemed to make me swing both depressed and anxious a lot. But this last couple of days has been like nothing I’ve ever experienced. I sat and cried last night which hasn’t happened for years, and I feel like cancelling work today and curling up in a ball and hiding. This is WAY worse than how I usually am premenstrually. The only usual pre-menstrual side effect I am missing is the spotting, assuming the Utrogestan is stopping that from happening. But I feel so much lower than usual, nauseous and just terribly sad and hopeless.

I’m terrified this will go on as I have another four doses of Utrogestan to go, I’ve taken it for ten nights so far. Thought it was suiting me fine for the first 7 days but after this weekend I’m wondering whether it’s making things worse as my period approaches.

Usually these symptoms all stop on day 1 of my cycle but if the Utrogestan is stopping me from bleeding will this depression carry on until I stop taking it in four more days??

Am I not on enough estrogen as the pre menstrual night sweats are still with me?

Is 200mg vaginally for 14 days too much??

I’ve emailed the Dr this morning, praying she replies speedily but any advice you guys could give me would be so gratefully received xx

[CLKD]

Morning.  Your symptoms seem cyclical, if they ease once a bleed begins, this is pre-menstrual syndrome .  Periods becoming lighter or scatty is a sign of peri-menopause.  Mine waxed and waned, disappeared, came back for about 3 years B4 the final bleed = menopause.

U can of course stop the HRT if depression is becoming worse.  No drug in my opinion should cause those severe symptoms.

In the 1990s I was advised by the NAPS - National Association for Pre-menstrual Syndrome - to eat every 3 hours to ease those anxiety surges.  Every 3 hours, 24/7 even in the night.  It took some practice but has continued to work for me. 

[born2misbehave]

Thanks for replying. Yes some are cyclical, always worse during the week leading up to my period. Some are all the time though, the anxiety and heart palpitations and brain fog. All kicked in 8 months ago when I quit taking my combined pill because of my gastritis, suspected the tablet was not helping my stomach so GP advised to try stopping it. Perimenopause symptoms hit me after that and didn’t get any better so after 8 months I booked the consultation with the specialist, who prescribed me the Estradot and Utrogestan.

Just watched a video by Dr Sarah Ball that says you should halve the Utrogestan dose if taking vaginally instead of orally, so I’m wondering whether this will help me with the side effects from the Utrogestan? Maybe I’m getting too much of it?

[CLKD]

Sorry, can't help much.  MayB put the product names into the search box: individually: and read any threads that pop up?  Make notes ;-)

[born2misbehave]

Thank you, I shall do this now

[Aubrey]

Hi bor2misbehave,

I also had an awful reaction to 200mg of Utrogestan, so I began using 100 mg vaginally, with the advice of the Newson clinic. It is so much better. I have had an endometrium scan and all is fine. I have a good bleed every month. Maybe try that?

[born2misbehave]

Thanks so much for this. In the absence of a reply from my menopause consultant so far…I have been googling and asking on forums and Facebook groups and have come to the same conclusion! I’m going to ask about halving the vaginal Utrogestan dose to 100mg for the next go at it. I can always re-increase in the future if this works and my body gets used to it I figured? I read that it’s advisable to have a scan once a year if I continue the dosage halving and I’d be more than happy to do that if it means none of this horrible depression!

The more I’ve read this morning, the more sure I am that I’ve given myself too much progesterone in comparison to the estrogen I’ve been prescribed! I’ve had bloating, water retention, and my boobs are bigger and firmer and a bit tender this last week too! Initially thought the latter was a nice ‘firming’ effect of the estrogen but now I’m realising it’s likely all the progesterone!
And if too much progesterone, it’ll outweigh the estrogen won’t it? Likely rendering my patch not as useful as it could be being?

[bombsh3ll]

I am a big proponent of using combined hormonal contraception rather than menopause hormone therapy to manage perimenopause, as this can get rid of your cycle, keeping you bleed free and hormonally stable if taken continuously, rather than exacerbating it as sequential MHT can.

Since you stopped the combined pill due to gastritis, your best options might be the Nuvaring or the Evra contraceptive patch.

I have never used the patch as there's no way I personally could keep a patch on for 7 days, plus this would cost extra if used continuously rather than spending every 4th week untreated, however I have used the Nuvaring and I loved it.

I just changed it every 4 weeks and didn't bleed at all, it is so easy and convenient although cost can be a barrier if you have to pay for it.

[born2misbehave]

These were the two things I asked my GP for 9 months ago when I had to quit my Yasmin because of the gastritis. She said she wasn’t allowed to prescribe the patch because of cost, and she’d never heard of the ring!!
I did try to order the NuvaRing from an online pharmacy and paid for it but I was then refunded with a note saying they couldn’t get hold of it.
I didn’t think you were allowed to use the contraceptive patch without a break in perimenopause as the hormone levels are considered too high for constant use at my age? I read that somewhere. Like you, I’d much prefer to not have a cycle at all and be level and balanced all the time!

[CrispyChick]

Hey

I've no real advice, only to say that a few years back I was told by the NHS meno clinic to try all combined pills, and the ring and patch. I did indeed try them all. Nothing suited me.

But the point I'm making is I was told to try the ring and patch. I got both through my GP. But I'm in Scotland.

I found the patch a lot stronger than a combined pill.

[bombsh3ll]

Any combined contraceptive product can be used continuously in a bleed free regimen. I have been doing this for 20 years, and it is now openly supported by the FSRH and has been for several years.

A clinician who thinks it is mandatory to have a bleed on CHC has a poor understanding of both the physiology and politics around why artificial withdrawal bleeding was historically included in contraceptive regimens. This is 2025, not 1965!

I too am in Scotland and for a while I got the Nuvaring free from a small local NHS sexual health clinic, however when that closed down my GP wasn't able to prescribe it due to cost.

I can't get my pill Zoely on the NHS in Scotland either but it is much cheaper privately than the Nuvaring.

If you are able to pay for it you could maybe get a prescription from your private menopause clinic (unless they are ideologically wedded to "body identical") and then you can get it from any pharmacy.