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[Willos]

Hi everyone.  First post here and I am hoping someone can help me because I'm at a loss at what to do.

Background:  I'm 47, peri-meno and have always had regular periods on 26/28 day cycle.  I exercise, eat pretty well and am at the ideal weight for my height.  I also don't smoke, vape or drink alcohol.  Interestingly, I have been unable to cry since August 2024, but I am still happy to socialise, go out, talk to people (it's freaking me out a bit, but maybe it is better than constantly crying?).

I realised I was peri this time last year after having an out-of-the-blue bad case of heartburn and acid reflux.  This was followed by tiredness and I was found to have low folate levels.  After taking supplements for 3 months to correct this, I got back in the gym and tried to live my life, but still didn't feel right.  I now know that I had a one off anxiety attack a month later in April (I've never suffered with anxiety before) where I felt hot all of a sudden and rough (I thought I was suffering with a 24 hour bug or something).  In June last year, my periods changed from 6 days to 4 days and that was when I knew I'd hit perimenopause at 46-and-a-half.  Throughout June, July and August, my periods stayed at 4 days (still on time though).  I just did what I usually do which is to exercise, weight train, eat well, try and sleep well and take my supplements.  Come August, I got brain fog, hot flushes, struggled to sleep and couldn't remember if I had taken my supplements or not, and so headed to my GP.

To be fair, the GP listened, saw what I had been doing for the past 3 months and said I could start on HRT.  I started on 25mg Evorel patches with 200mg of Gepretix progesterone on days 15-26 in September 2024.  Felt absolutely awful on the Gepretix and at my 3 month check up I asked to change to Utrogestan to see if this worked.  Instead of taking orally though, I took them vaginally to see if they helped.  I did feel better on them so continued.  I was still struggling with symptoms so I was put onto one-and-a-half patches (37.5mg) and 2x100mg Utrogestan from days 15-26.  This is what I am on at the moment and have been since December 2024.  I was also found to have low iron levels but this has now been corrected.  I have no other deficiencies, my thyroid levels are good, along with all other levels.

The HRT is definitely working, the brain fog has gone and I have been better and clearer.  So this month I have been writing down exactly how I feel, every day in my cycle, so I can take it to the GP, as I always feel worse when on the progesterone.  I seem to be better when I am just taking the estrogen and then feel rough when on the progesterone.  I have noticed I get warm in bed at night when on the progesterone, I wake most nights at 5.30am, I get a throbbing pulse in my neck whilst trying to sleep, my hands and feet get cold, I have tender breasts, a bit of bloating/fluid retention, I lack confidence when I normally wouldn't and I have been getting a little irritable.  I have been doing the deep breathing, meditation and simply just ignoring it and trying to carry on.

But, I am struggling.

So this month I decided to take only 1x100mg progesterone for the 12 days to see if I felt any better on it and I do a bit.  Here's the embarrassing bit though...whilst trying to figure out just why I feel so rough, I've been looking through all the dates of my periods and it have become apparent that I have been taking the progesterone on the wrong days.  What I mean is, that I started the patches on the first day of my period (this is what you were supposed to do) and I was then to take the progesterone on days 15-26 for 12 days before stopping and allowing my period to start (which I also did).  This has been fine and my period has come on time for the past 3 months (but seems to have gone down to pretty much 2 days now) but I have been making a big error by starting my new cycle from the first day of my bleed (usually day 26) INSTEAD of starting my cycle from day 28.  Effectively, for the past 8 months I have started my cycles a day early and my natural cycle is now 9 days out of sync.  As of today, if I had taken everything at the right time, I should be on day 15 of my cycle and should be starting to take progesterone for the next 12 days.  Instead, I am on the progesterone already and will be stopping this Thursday (day 26) for my bleed.  I am now thinking perhaps I am feeling so awful because I've ballsed up the timing and my HRT and natural cycle are out of sync?  I can't believe I have got the timing wrong, I'm so embarrassed.

Here's what I want to ask you...

Do I sound like I suffer with progesterone intolerance?

Or am I suffering with elevated PMS from the progesterone?  (When I was not on HRT, I would get tender breasts, a bit of fluid retention and a little bit of stomach cramping, but otherwise felt fine during all the years whilst on my period premenstrual).

And can I try to re-sync the HRT with my natural cycle to see if this helps?  I'm 9 days out of sync.  If I can do it, how would I go about it?

I don't have any female relatives that I can ask about this.  The female friends that I have that have been through this either couldn't take HRT, had no symptoms or quietly suffered in silence.  I'm also currently unemployed, so can't pay to see a specialist menopause doctor just yet.  I'd be so grateful for any help or advice you can give.  Thank you.

[bombsh3ll]

You are massively overthinking it and if you are perimenopausal your cycle was likely to become irregular no matter what you did.

Many clinicians in the context of irregular menstrual cycles still advise sticking to a 28 day cycle for progesterone, or even just using the first of every calendar month.

I don't necessarily think this is a fantastic solution but I am not personally a proponent of sequential HRT in perimenopause anyway, it's like trying to time the stock market.

I prefer the combined pill taken continuously to just shut it down and add back a stable daily dose, without any of the bleeding or drama.

If you are really wedded to cyclical HRT and want to try and synchronize the anticipated withdrawal bleed with your own cycle, just start the progesterone 14 days before you expect your next period to start.

You can't really get it "wrong" as such - if you miss time the progesterone it's a nuisance, not a catastrophe, and you just try again next cycle.

[Willos]

Thank you so much for replying.

My cycles have always been really good at arriving on time for most of my life and since my GP repeated on numerous occasions how important it was for me to make sure that I took the progesterone on the correct days, I thought I'd mucked it up.  Hence, I thought I was still feeling rough because of it.

I asked for patches and progesterone because these seemed to carry less risk of clots and so I thought these body identical HRT would be better.  I am going to stop the progesterone when it stops (like Hurdity has said below) to get back to my natural cycle and I'll take a look at the combined pills you have mentioned with the GP when I see them.   

Thank you again for the advice.

[CLKD]

....and breath.

U R doing all the 'right' things but sometimes the body doesn't play ball due to rising/falling levels.

My periods waxed and waned for a few years, I knew it was The Change so wasn't worried.  Some months they were regular, others were missed for months .... at least the excruciating pains disappeared! 

I did have itchiness once the periods went away, initially it was my insteps when I took off socks.  For a few months it was across my back, usually caused as oestrogen levels drop.

[Hurdity]

Hi Willos

 

If your periods are still regular then you are not yet peri-menopausal according to the medical definition - which means that you are before the time when HRT is recommended as the best course of treatment.

To clarify - the the months or years leading up to peri-menopause periods remain regular - and it is called the late Reproductive stage. However it can be a tricky time because various hormones begin to go sa bit awry even though the ovaries are still functioning and you are ovulating each month. This can give rise to some peri-menopausal symptoms. This period of time can be difficult to treat because HRT as such may not work - which may be what you are finding.

Often periods get closer together in the last part of this stage before they start to become irregular - and varying by a week in length between months - when peri-menopause proper, begins. Not everyone fits into a standard pattern though.

In your position yes you should have kept your cycles the same length so if your periods were every 26-28 days then each cycle should be this length too. If you add up the days you took progesterone ( 12 days) and then the days of oestrogen only, these should come to 26-28 so no wonder you're out of sync.

The timing - you could just carry on taking the progesterone for an extra 9 days maybe? I'm a bit ubnclear as to what's happened ie whether you have bked twice or actually artificially shortened your natural cycle by doing this? or you could just stop at the time you expect and not take it for a month and restart counting your cycle when you bleed the following month. It won't hurt for one month especially if you are ovulating regularly and producing your own progesterone.

I have read reports of women starting on Femoston (oral tablet with progestogen dydrogesterone - well tolerated) in your position. It's a light dose HRT and can do the trick at this point. This would help sort out the side effects caused by Utrogestan but you'd still want to resync your cycle.

Otherwise I would suggest as per bombshell - go onto one of the two combined pills designed for peri-menopause - which suppress the cycle and provide bioidentical oestrogen - QLAIRA or ZOELY. Because of the number of progestogen days, bleeding is likely to be minimal. Qlaira is more "natural" in that there is a variable dose of oestrogen and some days are oestrogen only without progestogen, whereas for Zoely it's the same dose of each  for 24 days. There are also only 2 placebo days for Qlaira (4 for Zoely). Not many reports on here but maybe because it works so well no-one comes on here with problems?

Hope this helps

Hurdity x

[Willos]

Hi Hurdity,

Thank you for the warm welcome and thank you for your detailed response.

I should be a clearer in saying that my periods were regular in that I got one a month for every month around the same time.  However, I noticed my periods had started arriving a few days earlier each month prior to the first perimenopause symptoms I experienced in April 2024.  My periods were never more than 3 days early or late and have never varied by a week or more between months.  In June last year they then went from 6 days to 4 days in length though.   Does that mean I am in the late reproductive stage rather than perimenopause?  Or do I qualify for perimenopause due to the sheer number of physical symptoms I was getting?  As you say, this time is proving tricky for me.  I was getting so many symptoms I was thinking about getting a Bingo card and filling it in, I think I would have been able to call 'House' 

I found that the Evorel patches really helped with the brain fog within a week or two of starting, but the progesterone is proving to be a real pain and the side effects are proving troublesome.

I think I'll take your advice and will stop the progesterone this week on Thursday when I am supposed to.  I am still getting periods and it will help me to resync my period.  I have never heard of Femoston.  Does it sound like this is something that would be better suited for me at my stage?  I seem to tolerate the estrogen okay, just not the progesterone.  I just want to feel as normal as possible and thinking clearly so I can work and get myself sorted.  I have also not heard of the two combined pill brands, but must admit, I didn't think to try them because I thought they may have increased risk of clots?

I will go through this website and do some learning.  I'll stop the progesterone this week, sort my cycle out and book a GP appointment.

Thank you so much!

[Hurdity]

Hi Willos

Femoston is a tablet HRT but the progestogen is better tolerated than many. Dydrogesterone - the progestogen in that pill is a synthetic one and very closely related to our own progesterone but it is more stable in thebody and can therefore be taken at far lower doses than bioidentical progesterone, like Utrogestan.

I only know from anecdotal evidence on this forum that over the years many women have reported taking it at your stage - while still having regular periods, and very early peri-menopause - and doing well on it. It provides an oestrogen top up when levels become low at the very end and beginning of the cycle.

Re peri-menopause - the medical definition is there as a guide for medical practitioners in order to help decide whether the symptoms experienced are more likely to be due to menopause than something else. If periods are still regular it is more tricky. Treatment options recommended by NICE in 2015 (though I haven't read the updated guidelines in late 2024) were based on this. HRT provides replacement oestrogen at the point in the cycle when the crash can lead to unwelcome symptoms. With late reproductive stage sometimes HRT doesn't work because it;s not always clear what's happening and what exactly is the cause of the symptoms. eg oestrogen spikes, oestrogen crashes, progesterone crashes - which become very pronounced during early peri-menopause but can start even before periods become irregular However if you've started to get symptoms  and are already feeling better some of the time that's a good sign.

Good article on peri-menopause: https://www.menopausematters.co.uk/magazine/pdf/Article%20-%20Perils%20of%20the%20Perimenopause.pdf

Periods becoming closer together - sign of the Late Reproductuve stage but if that was a year ago you may well have transitioned to peri proper, though interesting that your periods are still predictably out of sync rather than starting to becone a bit more random?

In terms of risks of stroke or clots from pills. The combined pills I mentioned are not the same as the CCP that women take when younger just for birth control. Those types contain a very strong synthetic oestrgoen which may increase risk in some women. These two I mentioned contain estradiol - as I mentioned, a bioidentical oestrogen (one of the pills has estradiol valerate which is converted to estradiol in the body) - which does not carry the same risk. In any case you are still young. If you have no other risk factors for stroke or clots ie are not overweight, and eat a healthy diet, take plenty of exercise, don't smoke and moderate alchohol, or genetic factors then no reason at this stage not to take these tablets.

Zoely is a weaker one ie with lower odse oestrogen and I'm not sure that is really sufficient if it shuts down the cycle so personally I would go for Qlaira but only on that basis!

In the first instance though, if you are really suffering progestogen side effects - then perhaps try Femoston and see how you get on? You have plenty of time for experimentation!

Hurdity x

[Willos]

Thank you so much Hurdity for all of this information.  So, so helpful.

May I trouble you for one more thing?    If I am suffering badly with anxiety, do you think the Femoston or Qlaira are likely to get rid of it?  I just need something to keep the brain fog away, stop the anxiety and allow me to get regular sleep.  I know it will be a bit of trial and experimentation, but these factors are what it what I am so struggling with right now.

Thanks once more x

[CLKD]

How does the anxiety affect you?  A dedicated anti-anxiety medication can be taken alongside HRT. There are I believe a couple of anti-depressant medications that can ease anxiety as well as Propranolol to take regularly to ease early morning surges.  Bachs rescue remedy mouth spray worked for me too.