Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Lou23]

Hi everyone. This is my first time posting. Very new to HRT but am really struggling with it. I’m 45. Perimenopausal and respond well to estrogel but micronised progesterone has been horrendous (orally and vaginally) so I’ve been prescribed slynd. 5 days in and I’m thinking of giving up because I’ve been so dizzy/brain foggy. I haven’t been able to run without feeling dizzy which is very unusual for me as I’m quite fit. So alarm bells are ringing. 

I’m petite, and do seem to have bigger reactions to drugs etc. wondering if anyone else has been in a similar situation and had any success with other hrt? I’m scared of mirena. Have a tilted uterus and already know from the micronised progesterone that it has a big effect.
Thank you x

[bombsh3ll]

Slynd (drospirenone) is a diuretic.

It dehydrates you and drops your blood pressure.

Some individuals get on really well with it but it is more suited to heavier women and/or those with higher blood pressure or prone to fluid retention.

There are plenty of other options.

Have you been on any kind of birth control in the past that you liked?

[Lou23]

Thanks so much 🙏 I was on dianette for quite a while which suited me quite well. I was maybe a little moody on it, but didn’t have any other side effects.

[bombsh3ll]

Ok, dianette contains cyproterone acetate which unfortunately isn't available as a standalone progestin.

I take Zoely (continuously, active pills only), which is a combined oral contraceptive pill with Nomegestrol acetate, a really kind progestin.

This is also not available as a standalone but at 45 you could get Zoely at least up to 50 and a combined pill is better than menopause hormone therapy in many ways as it gets rid of your own cycle and adds back a stable daily dose of hormones. No upa and downs and no bleeding.

If you are really wedded to transdermal estrogen, other oral progestin options include

Desogestrel 150mcg daily (unlicensed but supported by the BMS based on available evidence). In pills cerazette, mercilon and marvelon
Dydrogesterone 10mg (recently licenced in UK, NHS availability patchy)
Norethisterone
Provera
Dienogest (unlicensed but previously available in a combined product for endometrial protection)

[Konijntje]

5 days is an very short time, especially if you are progesterone intolerant. I’m on dienogest now, but the first few weeks were quite difficult, I had extreme fatigue and just the idea of working out was impossible. Before the dienogest + oestrogel, I tried Drovelis, which contains drospirenone, just like Slynd. I also had fatigue and dizzyness the first few weeks (less than on dienogest), but those subsided a bit after 2 weeks and completely after 4-6 weeks. So, I’d advice to give it longer if you feel it’s better moodwise than progesterone.

Side effects are to be expected. For me, the diuretic effect of drospirenone gave me an eczema flare up, so that is why I eventually switched. I’m now 6.5 weeks in on dienogest and still have some side effects, but it is my last hope for hrt, and it’s ok for my mood, so I’m keeping with it for now. Lots of people say that the 4th generation progestins (drospirenone(Slynd) and dienogest) take 3-4 months to really completely settle.

[Lou23]

Ok, dianette contains cyproterone acetate which unfortunately isn't available as a standalone progestin.

I take Zoely (continuously, active pills only), which is a combined oral contraceptive pill with Nomegestrol acetate, a really kind progestin.

This is also not available as a standalone but at 45 you could get Zoely at least up to 50 and a combined pill is better than menopause hormone therapy in many ways as it gets rid of your own cycle and adds back a stable daily dose of hormones. No upa and downs and no bleeding.

If you are really wedded to transdermal estrogen, other oral progestin options include

Desogestrel 150mcg daily (unlicensed but supported by the BMS based on available evidence). In pills cerazette, mercilon and marvelon
Dydrogesterone 10mg (recently licenced in UK, NHS availability patchy)
Norethisterone
Provera
Dienogest (unlicensed but previously available in a combined product for endometrial protection)

Thank you so much for replying. Can I ask how your mood has been with Zoely? It sounds like a great option at my age -  but I've read quite a few horror stories! I do get quite down at times so it's a bit of a worry. But I guess this might just be the perimenopause symptoms. 

[Lou23]

5 days is an very short time, especially if you are progesterone intolerant. I’m on dienogest now, but the first few weeks were quite difficult, I had extreme fatigue and just the idea of working out was impossible. Before the dienogest + oestrogel, I tried Drovelis, which contains drospirenone, just like Slynd. I also had fatigue and dizzyness the first few weeks (less than on dienogest), but those subsided a bit after 2 weeks and completely after 4-6 weeks. So, I’d advice to give it longer if you feel it’s better moodwise than progesterone.

Side effects are to be expected. For me, the diuretic effect of drospirenone gave me an eczema flare up, so that is why I eventually switched. I’m now 6.5 weeks in on dienogest and still have some side effects, but it is my last hope for hrt, and it’s ok for my mood, so I’m keeping with it for now. Lots of people say that the 4th generation progestins (drospirenone(Slynd) and dienogest) take 3-4 months to really completely settle.

Thank you so much for replying. I know it's a short time and I was planning to keep going, but 36 hours after a dose (I was planning to change timing from am to pm) I've still been feeling very faint. I played netball and I had no power whatsoever - and when I did have a little run I had to stop.  Really unlike me as I'm usually fairly fit and speedy - the only advantage I have in netball with being so short ;-) . Can I ask about initial side effects on dienogest please? I'm mostly worried about mood and brain fog.

[Konijntje]

The fatigue and brain fog was really bad on dienogest the first few weeks, worse than on drovelis (drospirenone/estetrol). However, it doesn’t have the diuretic effect, so if that is what is bothering you, it might be a good one to try. The other side effect that doesn’t seem to go away, is acid reflux, I’m familiar with that anyway, but even with a PPI (that I started again), it has not completely subsided. Like I said, I’ve read a lot of reports that it took multiple months for side effects to subside (dienogest is often prescribed for endometriosis, so most reviews are from people with that).

I do feel those progestins are very different on my mood than the others I’ve tried (progesterone, dydrogesterone, levonorgestrel), much better, I get extremely low mood from progesterone and very anxious from the others. With both drospirenone and dienogest it’s more of a slightly lower mood than baseline, so quite tolerable if it means I can use oestrogel.

I do think the anti androgenic effect might have an effect on my overall energy though, so I’m thinking of experimenting with dhea (or ask for testosterone, but I’m in the Netherlands and it is very unlikely they’ll prescribe).

As you can see, I haven’t tried some of the other progestins, because of the increased breast cancer risk, I know it’s small, but with my family history, it’s one I’m not willing to take. I’m also 50, so that makes a difference.

Dienogest is also available in combination with estradiol as Qlaira, which is a multiphasic birth control pill, there are days with only estradiol in that one too. I get nauseous from oral estradiol (especially when the dosage goes up and down), so that is why I’ve opted for dienogest + oestrogel.

[bombsh3ll]

Zoely is very neutral on mood, I haven't had any problems with it and it is favoured by specialists treating women for reproductive mood disorders such as PMDD.

It is certainly worth a try especially given the other options you have tried.

Unlike progesterone and drospirenone it has no antimineralocorticoid toxicity so doesn't hurt your blood pressure.

A combined oral contraceptive pill taken continuously in perimenopause wins hands down over sequential HRT for quality of life in my opinion, by keeping you bleed free and hormonally stable.