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[Anna30]

Hi. New here. Will try to cut a long story short. Had Mirena coil fitted over 5 years ago as periods were horrific. Heavy, painful.
After the initial 9 months of off on bleeding and IBS flares it settled and things seemed good for about 18mths. Then in 2022 I noticed I had low mood, anxiety (I’ve struggled with anxiety forever but it increased) aches, hair falling out. I was 45 then. So got Oestrogel from the doc.  Used 1 pump. 2 pumps increased my anxiety.
End of mid 2023 I noticed my mood was really taking a tumble. I was (for the first time in my life) having suicidal thoughts. So I went to a menopause specialist. She said I was oestrogen dominant and reduced my Oestrogel and gave me compounded progesterone cream. I had awful side effects the first few weeks but they passed. Mood didn’t improve much. So she doubled it. I couldn’t tolerate the side effects so stopped.
Anyway I think went au natural but 2024 was horrific. Anxiety through the roof. I had periods all the way through with Mirena but suddenly was spotting every other week. I started the Oestrogel again but nothing helped. Then thought maybe it was my Mirena giving up as it was now 5 years. Anyway I came off Oestrogel again and things did settle a lot. Although I was still spotting and had terrible persistent thrush.
So in February this year I had Mirena removed - wondered if that had actually contributed to my low mood. I had the most God awful crash symptoms. I was bed ridden for a week and it’s taken months. It’s been 5 months now and it’s still not great.
My main issue is around ovulation. I get so sick in the run up to it - nausea, diarrhoea, panic, insomnia. It passes usually once I ovulate and my luteal phase is better although PMS is an issue.
Doctor has given me Oestrogel and utrogestan. I did start the Oestrogel - just 1 pump. The utrogestan scares me though.  So if I’m honest I’ve done one month of Oestrogel and haven’t built up the courage for utrogestan although I know I can’t go without.
A big part of me feels I need my system to settle after coming off Mirena and actually it’s my oestrogen spiking that’s causing me issues so now adding more is just making me worse.
Sorry for the ramble but I feel I’m at a crossroads. I think I’m so nervous of taking hormones that might mess me up even more but also nervous if I don’t I can’t get better.
If I’m honest I’d rather go without. But what if I get a whole lot worse?
Urgh. Just needed yo type that out. I’m not sure anyone can help really.

[CLKD]

First of all    I'm going to split your thread to make it easier for me to read 

There is always help - which symptom would u like to ease with HRT? 


Hi. New here. Will try to cut a long story short. Had Mirena coil fitted over 5 years ago as periods were horrific. Heavy, painful. [mine were excrucitaing and clotty for years!}

After the initial 9 months of off on bleeding and IBS flares it settled and things seemed good for about 18mths.

Then in 2022 I noticed I had low mood, anxiety (I’ve struggled with anxiety forever but it increased) aches, hair falling out. I was 45 then. So got Oestrogel from the doc.  Used 1 pump. 2 pumps increased my anxiety.

End of mid 2023 I noticed my mood was really taking a tumble. I was (for the first time in my life) having suicidal thoughts. So I went to a menopause specialist. She said I was oestrogen dominant and reduced my Oestrogel and gave me compounded progesterone cream.

I had awful side effects the first few weeks but they passed. Mood didn’t improve much. So she doubled it. I couldn’t tolerate the side effects so stopped.

Anyway I think went au natural but 2024 was horrific. Anxiety through the roof. I had periods all the way through with Mirena but suddenly was spotting every other week. I started the Oestrogel again but nothing helped.

Then thought maybe it was my Mirena giving up as it was now 5 years. Anyway I came off Oestrogel again and things did settle a lot. Although I was still spotting and had terrible persistent thrush.

So in February this year I had Mirena removed - wondered if that had actually contributed to my low mood. I had the most God awful crash symptoms. I was bed ridden for a week and it’s taken months. It’s been 5 months now and it’s still not great.

My main issue is around ovulation. I get so sick in the run up to it - nausea, diarrhoea, panic, insomnia. It passes usually once I ovulate and my luteal phase is better although PMS is an issue.
. How is your diet overall?  The National Association for Pre-menstrual Syndrome [NAPS] advised me to eat every 3 hours, 24/7 to ease those sudden energy drops.  10-14 days B4 a period I would have similar symptoms to those U describe, I knew every waste bin in every store that I shopped in regularly: in case!  10 mins B4 a bleed began I would have to 'dash' with 'the runs', even if a period wasn't due . 


Doctor has given me Oestrogel and utrogestan. I did start the Oestrogel - just 1 pump. The utrogestan scares me though.  So if I’m honest I’ve done one month of Oestrogel and haven’t built up the courage for utrogestan although I know I can’t go without.

A big part of me feels I need my system to settle after coming off Mirena and actually it’s my oestrogen spiking that’s causing me issues so now adding more is just making me worse.

Sorry for the ramble but I feel I’m at a crossroads. I think I’m so nervous of taking hormones that might mess me up even more but also nervous if I don’t I can’t get better.

If I’m honest I’d rather go without. But what if I get a whole lot worse?
. The Change is normal but can throw up some issues that we weren't expecting!  It mayB that your own hormones are active enough that you don't require replacement right now.  Hopefully some1 will be along with advice.



Urgh. Just needed yo type that out. I’m not sure anyone can help really.

[Anna30]

Thank you for your reply.
Yes I think you’re right about diet. I have been eating well but need to keep on top of eating every 3 hours.

I think you might be right about me having enough of my own hormones around at the moment. I think oestrogen is spiking high causing the issues.

I’m worried I don’t have enough progesterone. But I’m also too scared of the side effects to take some. D’oh 

[bombsh3ll]

How old are you first of all?

If you are under 50, taking a combined pill continuously can be the best way to bypass perimenopause without any bleeding or hormonal chaos, in particular it shuts down ovulation.

Secondly, you haven't seen a menopause specialist - you have seen someone who thinks estrogen dominance is a thing, and that progesterone molecules can cross the skin in any meaningful quantity.

So you have tons of unexplored options available to you.

I would recommend making an appointment with a clinician knowledgeable about menopause and female hormones who is willing to work with you to figure out the right treatment.

[Anna30]

I’m 48. I’m under the menopause specialist nurse at my GP surgery. She gave me Oestrogel and utrogestan. But she seemed dubious if I needed it yet. My symptoms could all be my body settling since having Mirena removed as the crash I had straight after was brutal.

[joziel]

You haven't mentioned a single blood test in all that. Presumably you had high estrogen when you were deemed 'estrogen dominant'? That could just be at the time of the test - which is why tests are not reliable during peri. You should test to be sure you are not on the floor and your levels are always over 300-400pmol but if you test and it comes back high, it's meaningless if it's just one test. (If you keep testing at different times of the month and it keeps coming back high ,then probably you're high...)

You need start taking your utrogestan. There's nothing to be scared of with it, in fact it produces GABA which will have a calming effect and should help with a lot of your anxiety and sleep....

Getting this right is about trial and error, but as long as you don't make sudden huge changes, you do need to do the trial and error - or you won't get any better.

[sheila99]

Is there a reason you didn't replace the Morena? If it suited you you can use it for the progestogen instead of utro. Anxiety can be caused by both too much and too little oestrogen.

[Anna30]

I did have a blood test which showed estrogen high progesterone low. But that’s when I was on Mirena and Oestrogel. Apparently that’s normal.
I didn’t replace Mirena as it hurt so much the first time going in and apart from 18mths of it I had spotting on and off constantly and low mood.
My menopause nurse won’t do blood tests as like you say hormone levels vary so much. I’d love to get some idea to know where my hormones are though.
Maybe I need up put my big girl pants on and try the utrogestan. I’m thinking vaginally. Wish I could split it though to start low and slow.

[bombsh3ll]

At 48 my top choice would be continuous use of a combined oral contraceptive pill/patch/ring which shuts you down and gives you a stable daily dose back, eliminating any concerns about your own fluctuating hormone levels.

I take Zoely with body identical estradiol and a really kind progestin- it's great.

However if estrogen gel is your preferred option, you do need to start adding in the progesterone.

The vaginal route is a good option - if you want to start with a lower dose than 100mcg you could try and obtain cyclogest pessaries which are like waxy bullets and can be cut down to your desired dose with a sharp knife.

There is also crinone gel although accessing this would probably be even more difficult.

Finally, and I wouldn't recommend this on a long term basis because you would end up losing some of the product and potentially going undertreated, but in the short term if building up your confidence to take a full dose is the issue, it is possible to take a small syringe and needle and withdraw half the contents of a micronised progesterone capsule.

I know that people are doing this, it is probably more suited to oral use as the punctured capsule is likely to get squeezed further when inserted into the vagina, but if it was just for a few days or so to assess your tolerance to it, that could work.

Also don't forget about androgen replacement - that can be super effective for some of the neuropsychiatric symptoms as well.

[Anna30]

Thank you for this. This is all really helpful. I did think about the syringe idea just to prove to myself it’s ok but thought I was being mad.
I’m very sensitive to hormones, I’ve never really taken to any contraceptive hence don’t want to go down that route. Not convinced HRT is for me. But feel I need to try something.
Also what do you mean by androgen replacement?

[bombsh3ll]

Androgens refers to the hormones traditionally thought of as "male", primarily testosterone however women have them too and they have important functions in many areas of our health.

I used the broader term androgens because whilst most women who use supplementation choose testosterone gel or cream, taking DHEA is an alternative option which I personally use due to there being specific safety data on the use of this in conjunction with the combined oral contraceptive pill, which doesn't exist for testosterone.