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[Peri-wrecked]

Hi Lovely Ladies,

I have been in and out of this site for a good number of years, started perimenopause around 32/33, diagnosed with Premature Ovarian Insufficiency at 38 and still here juggling symptoms at 43.   Anyway, I wasn't taking any HRT with the last few years as I just was petrified of getting worse, I had tried the pill a few times and tried patches with the coil but I couldn't find any balance and my GP was treating me like a hypochondriac so I stopped going about any menopause symptoms and struggled on.  Some days good and some terrible with extreme low mood. 
Anyway, things came to a head about around March, I was put on heart medication for possible POTS because I had ongoing bouts of dizzy spells and vertigo.  A tilt table test showed a drop in blood pressure along with dizzy spells so I think I have POTS but GP wouldn't say.  Technician that did the tilt table test mentioned it and I had some knowledge of the condition as I have EDS Ehlers Danlos Syndrome and this can happen with that condition.  My own GP has always played the stress and anxiety thing which drives me mad because I am not usually stressed when it happens etc.
Anyway, i went on two blood pressure tablets and that regulated my blood pressure but I broke out in  a rash on my right arm shortly after starting the meds.  I didn't want to go to my own GP as I knew she would be too helpful so I went to a GP that has started in her practice recently.  So, I showed this new GP my rash, I explained it started around the same time as new medication, she said maybe it was that but unlikely as I should have the rash all over my body if the meds.  She gave me creams etc and while I was there I mentioned to her about a very bad pain I was having in my left foot with a long time, other GP had said the previous year that the pain was because of my shoes which I thought was rubbish but I didn't go back to her after that as she clearly doesn't listen to me.  But this new GP asked how long I had pain and I said a good year on and off, so she sent me for MRI.  Turns out I have osteoarthritis in my left foot, probably in right foot too as had similar pains in that foot with years.  I was so cross cos my other GP just constantly brushes me off.  Anyway, while in with the new one, I asked her for HRT, I told her I was tired of symptoms and she said ok, we will start low as I had trouble with previous ones, so she prescribed Lenzetto spray -2 sprays and 100mg of utrogestan to start fo 4 weeks and come back then for review.  I was happy with this and off i went, felt listened to.  A friend of mine said she was on similar and that she took the Lenzetto spray in the morning and the utrogestan at night as it can have a drowsy effect so I said i'd do the same.  I had my 4 week review last week and new GP recommended uping my dose to 3 Lenzetto sprays to 200mg Utrogestan.  So, I am still taking my spray in morning and Utrogestan at night before bed.  I haven't really noticed any improvements yet, my appetite changed a bit and had few more clear days where i got stuff done but nothing major yet.  Gp did say i could go up to 4 sprays of Lenzetto and increase Utrogestan to 300mg if i wanted but to increase slowly. 
My questions to you ladies is:
Do you take your spray in morning and utrogestan at night?  should I take them both at the same time?
Is my current does of 3 sprays and 200mg utrogestan good or should I up it to 4 sprays and 300mg utrogestan?
how long did it take for people to notice an improvement in their mood? I am struggling with low mood which is what prompted me to go back on HRT to try and help the mood.  This low mood isn't me.
Also, i still get the fluctuations in symptoms- I track symptoms and even with the HRT i get the spikes-like few days ago i got really dizzy and off balance at work where  I  feel like I'll faint but then I realised I am due a period soon (I still get a period even though I have POI) today my mood is low but that also coincides with getting my period.  I am just confused.  My friends say I need to give it a good 3 months but surely I would notice some improvement now?  How do I know if I am absorbing it properly?  Is there anyway of shutting my own hormones off?
I am sorry for the long winded story.  The last time i felt 100% was  about 10 years ago.  I feel sad as I haven't been the mother to my daughter that I imagined I would be.  I have raised her well but I feel i could have been more fun, we could have had more  happier memories, i feel when my perimenopause started she was 6 and i changed a lot.  I do my best and she wants for nothing but i feel so guilty. I have raised her as a single parent since she was 2.  I just want to be happy in mood and not always be feeling so off all the time.
I just want a magic wand to make me feel better.  I dread days off work because I have too much time to focus on how bad i feel but when I am at work I cant wait for 4pm to come to go home.  I can't win.  Years ago I loved being off work and dreaded going to work on a Monday.  It just seems so backwards now.
Any help greatly appreciated. Thank you all.

[bombsh3ll]

I am so sorry for what you have been through, particularly as I too have life-altering dysautonomia as a result of a brain injury when I was 34.

Whilst menopause sounds beyond trivial compared to being unable to stand without fainting, the two issues together really compound each other, and there is certainly no way I would entertain untreated menopause!

Whilst everyone is different, I can tell you what really helps me;

Menstrual suppression with combined pill Zoely, ie taking active pills every day, no dummy pills.

This keeps me bleed free and hormonally stable, which is a big win as I was a lot more syncopal around my periods without treatment.

Androgen replacement - I take 25mcg sublingual DHEA following reading a small case series on young female to male trans individuals with severe dysautonomia who massively improved on testosterone, and also hearing Dr Zoe Hudson speaking about her own personal experience with this.

Having a healthy testosterone level has definitely improved my access to upright posture independently of other treatments.

Fludrocortisone - titrated in increments of 25mcg to achieve a target BP of 110/70.

I have a biotronik CLS pacemaker, as having initially been misdiagnosed with POTS, when I started monitoring my blood pressure at home for the fludrocortisone, I discovered my resting heart rate was consistently in the low 40's.

The latter may not be relevant to you if you aren't bradycardic, but it has been game changing for me.

I would definitely opt for generous estrogen and androgen replacement in a bleed free regimen if I were you.

[Peri-wrecked]

Hi Bombsh3ll,

thank you for replying to me.  I am so sorry I didn't respond until now.  I appreciate you taking the time to reach out to me.  I did try Zoely pill maybe 7 or 8 years ago for a while but i felt that the fluctuations in the dosage just wasn't for me.  I think i need like a continuous full on dose that doesn't rise or fall.  I am really sensitive to my own cycle even. 
Thank you for the information regarding POTS etc.  I had the opposite to you, I had a really high resting heart rate at like 88 or more and when I used to get up in the morning my heart  rate would jump to 114 or 124 with little or no exertion.  I am on medication now for it and sometimes when resting my heart rate drops to like 57 and i get a bit faint feeling.  I have been to a cardiologist about it and he seems to think its the POTS.
I could do with changing my diet too but I don't think it is too bad to be honest.  Maybe minus a few crisps here and there and cut out wine completely I think.
I have no idea what my testosterones is at.  They don't really prescribe that here in Ireland. Judging by my lack of libido for most of the  month except and a few days here and there, i would say it is at zero.
Thank you for your message though.  It has been helpful.  I wish you strength and good health in this journey we are going through.