Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Darlingbabs on May 28, 2018, 07:14:58 AM
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Hi, I'm new and was hoping for some help. I've been put on estrogel for horrible anxiety and depression in perimenopause (age 38). First it was 2 pumps and then 4 but it still hasn't stopped me ovulating (which is where all the horrors begin for me for about 10 days). So I am thinking of weaning myself off it....I was wondering how you do this? Also has anyone ever been on more than 4 pumps to stop ovulation? Thanks so much
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Good morning Darlingbabs
:welcomemm:
Unable to help with your problem but didn't just want to read and run.
I am sure someone will be along to help but as its a bank holiday weekend it may take time.
Lanzalover x
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Hi and welcome to MM Darlingbabs
Are you seeing a specialist gynae ?
If you are peri meno so young then you will need HRT - it's fine to simply drop down to 2 or even one pump per day - it's fine to do this but you may feel better or worse - until You try you won't know. Finding the right level that works for you can be tricky.
I had a premature menopause like you and never felt good on high doses of oestrogen. What progesterone are you using?
Some women need an AD/SSRI alongside hrt to control anxiety.
The doctors can prescribe Zoladex to shut down your cycle and simply add in HRT to balance things or you might do better with a Mirena fitted with the gel alongside for oestrogen to give a more constant hormone balance.
DG x
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Hi @dancinggirl thanks for your reply. My situation is this; I had been on depo provera from 16 to after having kids,felt fine when pregnant but started to get panic attacks at 24 so went on an ssri which I went on and off until after I had my kids then stayed on it as got PND with the kids. 3 years ago I came off depo provera and began to get regular periods for the first time in 18 years and it was then that I started to notice that my anxiety and panic, and more recently depression too would hit me suddenly at day 14 when I ovulated and would stay for around 10 to 14 days until my period started again when normality would generally resume in terms of mood. Initially I thought it was something to do with my SSRI not working so,over the last year I tried various different ssris and combinations but nothing improved. In Nov I went to the hormone Health clinic in London and was put on 2 pumps of estrogel and 12 days utrogestan. Every time I took the utrogestan I felt so depressed I could barely leave my bed (which is odd since depo provera is progesterone and I was on it for years) so I came off that after 3 months, had my estrogel put up to 4 pumps but, 2 months into this regime I am still cycling so still feel the same. I plan to have the mirena put in tomorrow as I know I need to have the progesterone but am pretty terrified it's going to tip me over the edge. I actually feel worse on the estrogel I think (possibly because it's giving me higher levels of hormones but not actually stopping my cycle). So, my options appear to be a. See what happens with mirena and estrogel 4 pumps - maybe that could shut down my cycle b. Wean self off estrogel (any tips on how to do this?) And just have the mirena c. If mirena sends me mad for more than 2 weeks then get it taken out, sack off hormones for good and increase ssri (already on quite a high level of this) d. Ask for estrogel to be put up even higher to 6 pumps and find some way to get progesterone into myself without going crazy. It's a total nightmare but I am wondering if having the estrogel should be making me worse?
Any advice gratefully received....I wonder if it's just change that I am sensitive to as opposed to progesterone itself?
I did get some bloods taken in the luteal phase last week - day 24 of a 28 day cycle and my FSH was 2.1 (range 1.7-7.7), my progesterone was 18.8 (5.2-71.9), testosterone <0.4 ( 0-1.8 so seems very low), FHBG 154 (27-146 -lower than should be) and estradiol of 626 (122 - 1094). Don't know if these mean anything to anyone?!
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You are clearly getting some good advice and treatment.
Weaning off the oestrigel will be easy. You can either drop down to 2 pumps per day straight away for a week or so and then drop to 1 pump per day for a further couple of weeks or go cold turkey. I think in your case a slower withdrawal may be advisable to allow your body time to adjust. Your oestrogen levels don't seem overly high and if you are peri meno then even one pump of gel per day may be advisable but you do need to see what your doctors advice. If your oestrogen levels get low then at your age you need the oestrogen to protect your heart and bones for the longer term.
Don't be frightened of the Mirena - it's good to try this as it may give the stable effect you need. I found Utrogestan really tough to tolerate and the Mirena was good for me. Just expect a few issues to start with while your body adjusts. Let us know how you get on and I would be tempted to stick with one pump of Oestrogel per day if I were you but ask your doctors about this. Good luck. DG x
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Perimenopause is not the same as an early menopause though, and the treatment for both can be the opposite.
Peri can start from about 35 and it can be very gradual for some where you just feel a bit off until it gets worse and worse but you will still have your periods. An early menopause is when you stop your periods at an early age (late 30s, early 40s). The latter may signal a true oestrogen deficiency but the former is likely to be a progesterone deficiency or just crazy volatility!
Utrogestan is a funny one, it's meant to be natural progesterone and nothing else but I tried it the other day and I felt drugged, like when you take Diazepam (I am very sensitive though!) and I don't think I've heard one woman here say they feel good on it. Progesterone cream (for use on its own only), on the other hand, makes you more energised, rebalanced, calmer, clearer and more motivated.
Something just doesn't seem right there with this Utrogestan product.
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Dangermouse - I know you are a big fan of compounded hormones but these are not licensed or considered safe by the vast majority of the medical Profession.
I had an early meno with the peri stage starting in my mid 30s and went post meno by 40. It was the oestrogen that helped me through the peri stage but the progesterone was always very tough.
Whether peri menopause in you 20s,30s,40s or 50s, it is the fluctuating and declining oestrogen that is the predominant cause of menopausal symptoms. You have found that a small dose of this compounded progesterone has helped you but for many, many women progesterone is the hormone that they cannot tolerate. I personally would love to be back on hrt if I didn't have to have progesterone.
Utrogestan does have a sedative effect - though it seems many women find using it vaginally can reduce side effects.
Poor Darlingbabs is quite a complex case as there is a history of hormonal issues. She is getting some good help and advice from the professionals - she is just needing us to help her with one or two aspects she doesn't fully understand.
I do hope you have read the ‘Perils if Peri' article that is under ‘Quick links' in the ‘All things menopause' section of the forum. It really helps everyone understand what goes on I the peri stage. DG x
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@dancinggirl thanks for the input,I really appreciate it
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I can't help but mention what I am using in the context of my responses, I have already suggested the Mirena or mini pill to Darlingbabs other post (as she felt so good on Depo) so apologies if my post is looking as if I am trying to promote compounded hormones?!! I truly am not.
If you are still having regular periods through, then it's very unlikely you have an oestrogen deficiency. Even John Studd recognises that and that's why he uses high levels of oestrogen to over-ride the cycle rather than a small amount to add to already, sometimes too, high levels.
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@dangermouse thank you. I do still have regular periods and am on 4 pumps of estrogel. When you say DR studd uses high amounts of estrogen to override your cycle,how much does he use? Presumably a lot more than 4 pumps? Also is there anything negative about having more than 4 pumps if you also have the mirena (for example?)
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I'm pretty sure the 4 pumps is the over-riding dose but I think some have mentioned here he's told them to go higher if necessary. It's similar to the BCP where that also overrides the cycle due to the strong synthetic oestrogen.
Saying that, I used to be on the BCP when younger but when I went on it to override my peri fluctuations they still poked through AND I still ovulated! Oestrogen can spike very high in peri, much higher than for young women. It's an exhausting time.
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If you have the Mirena you could well try really high doses of oestrogen but at this stage I would try the low dose I suggested you gradually reduce down to and then perhaps, if your doctors agree, try going back up gradually to see if you can find a ‘sweet spot' that helps you.
Do consult your specialists about what you should do - we are not medically qualified so we can only offer up ideas and things to consider.
A softly, softly approach over time is often the best strategy - don't expect miracles over night and don't rush to change everthing at once. Give your body time to adjust to each change. DG x
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Thanks both. So I am on 4 pumps at the moment. Dancing girl do you think maybe weaning myself off it slowly and seeing what goes on with just the mirena and then, if no good, asking the doc if I can go onto a higher level of estrogel?
Or should I be trying a higher level of estrogel first as I am already halfway there?
My overriding feeling is that, so far, estrogel has made me feel worse but,again, I wonder if that's because it's not enough to stop me ovulating but is adding to my natural estrogen levels, therefore making fluctuations even greater?
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It's very difficult to advice you but if the big dose isn't suiting you now, it would probably be better to drop the dose as I suggested before. Why not drop down to 2 pumps per day for 2 weeks and see how you feel and then drop down to one pump per day for another 2 weeks if you feel the 2 pumps is not helping. By doing things slowly and in stages you can better gage how you feel. Once the Mirena is fitted you may get a bit of a progesterone surge for a week or two so to have some oestrogen to balance this may be helpful.
Once the Mirena is settled and if you are just using 1-2 pumps of gel per day, then if your mood is still all over the place then discuss the option of using a much higher dose of Oestrogel with your doctors. Hopefully when you have the Mirena fitted they will discuss with you what you should be doing with the gel dosage. You are clearly so anxious about all this but you are getting good treatment from you specialists and I think you should try to follow their advice and stick with it to allow your body to adjust.
Bottom line, we are all different, so what ever I suggest, it will be down to you to find your own way as I can only suggest what I have tried. Hopefully the Mirena will give the consistency you need - it's going to be a process of elimination so don't change everything at once - just one thing at a time. DG x
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Perimenopause is not the same as an early menopause though, and the treatment for both can be the opposite.
Peri can start from about 35 and it can be very gradual for some where you just feel a bit off until it gets worse and worse but you will still have your periods. An early menopause is when you stop your periods at an early age (late 30s, early 40s). The latter may signal a true oestrogen deficiency but the former is likely to be a progesterone deficiency or just crazy volatility!
Utrogestan is a funny one, it's meant to be natural progesterone and nothing else but I tried it the other day and I felt drugged, like when you take Diazepam (I am very sensitive though!) and I don't think I've heard one woman here say they feel good on it. Progesterone cream (for use on its own only), on the other hand, makes you more energised, rebalanced, calmer, clearer and more motivated.
Something just doesn't seem right there with this Utrogestan product.
Just for anyone reading - to reiterate about Utrogestan....
There is nothing "not right" about it at all - in the sense that it is progesterone aka progesterone and structurally identical to that made in our bodies and exactly the same as in progesterone creams!
As I have said many times on the forum, progesterone is a very unstable molecule in the body and when we take it exogenously (from outside the body) this is completely different from when our own ovaries pumped it out all the time from the corpus luteum after ovulation. Because it is unstable, it is metabolised quickly and we only take it once a day. It therefore needs to be taken in suffuciently large quantities so that after digestion ( when taken orally) and then metabolism by the liver, there is sufficient in the blood stream to be carried to the uterus to protect it from overthickening from the oestrogen we take as HRT. It is the large dose (leading to large doses of the metabolites) that is somehow "not right" for some women.
Taken orally there are many more metabolites (metabolic breakdown products) than when used vaginally and it is these metabolites especially which can give rise to the unpleasant sdie effects - linked to its sedative effect. At the quantities taken orally this part of it does act like a drug - but has to be like this because of the womb protective effect. So yes - the metabolites from progesterone I think act on the same receptors as some of those drugs you mention (?GABA receptors I think - from memory - bit hazy here...). This is why it should be licensed to be used vaginally as part of HRT in UK as it is elsewhere in Europe, and the doses necessary to keep the womb lining thin, reduced accordingly.
The fact that prog cream doesn't make you feel like this is due to: 1. It is absorbed transdermally therefore fewer metabolites (same as with vaginal utrogestan) 2. The dose absorbed is much lower and insufficient to protect the uterus - otherwise some side effects would probably be felt.
Hurdity x
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Darlingbabs - you mentioned feeling fine on Depoprovera? This contains MPA which is the same as Provera - the other progestogen licensed for use with hRT so another thought would be to try this as your progestogen. Not sure how different you would feel from taking it orally than as an injection and whether the side effects would be greater?
The other thing is you are talking about pumps of oestrogen - but it all depends on how much you absorb. Without blood tests you don't know whether this is working well for you. Women do vary in how much they absorb from the different methods so have you had blood tests ( I know these are unreliable and vary greatly - but might be a guide?)? If it turns out you don't absorb gel well then a patch might help? I can imagine it must be quite difficult spreading 4 pumps of gel - and less is absorbed if it's spread too thinly over a very large area as well (ie if it dries too quickly before being absorbed).
Mirena sounds like a good idea to try too....
Hurdity x
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Thanks hurdity,all really helpful. I have replied on my jaydess/mirena post as I didn't get given either in the end but have come home with loestrim and instructions to come off estrogel. I have everything crossed that this does not tip me over the edge!
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Perimenopause is not the same as an early menopause though, and the treatment for both can be the opposite.
Peri can start from about 35 and it can be very gradual for some where you just feel a bit off until it gets worse and worse but you will still have your periods. An early menopause is when you stop your periods at an early age (late 30s, early 40s). The latter may signal a true oestrogen deficiency but the former is likely to be a progesterone deficiency or just crazy volatility!
Utrogestan is a funny one, it's meant to be natural progesterone and nothing else but I tried it the other day and I felt drugged, like when you take Diazepam (I am very sensitive though!) and I don't think I've heard one woman here say they feel good on it. Progesterone cream (for use on its own only), on the other hand, makes you more energised, rebalanced, calmer, clearer and more motivated.
Something just doesn't seem right there with this Utrogestan product.
Just for anyone reading - to reiterate about Utrogestan....
There is nothing "not right" about it at all - in the sense that it is progesterone aka progesterone and structurally identical to that made in our bodies and exactly the same as in progesterone creams!
As I have said many times on the forum, progesterone is a very unstable molecule in the body and when we take it exogenously (from outside the body) this is completely different from when our own ovaries pumped it out all the time from the corpus luteum after ovulation. Because it is unstable, it is metabolised quickly and we only take it once a day. It therefore needs to be taken in suffuciently large quantities so that after digestion ( when taken orally) and then metabolism by the liver, there is sufficient in the blood stream to be carried to the uterus to protect it from overthickening from the oestrogen we take as HRT. It is the large dose (leading to large doses of the metabolites) that is somehow "not right" for some women.
Taken orally there are many more metabolites (metabolic breakdown products) than when used vaginally and it is these metabolites especially which can give rise to the unpleasant sdie effects - linked to its sedative effect. At the quantities taken orally this part of it does act like a drug - but has to be like this because of the womb protective effect. So yes - the metabolites from progesterone I think act on the same receptors as some of those drugs you mention (?GABA receptors I think - from memory - bit hazy here...). This is why it should be licensed to be used vaginally as part of HRT in UK as it is elsewhere in Europe, and the doses necessary to keep the womb lining thin, reduced accordingly.
The fact that prog cream doesn't make you feel like this is due to: 1. It is absorbed transdermally therefore fewer metabolites (same as with vaginal utrogestan) 2. The dose absorbed is much lower and insufficient to protect the uterus - otherwise some side effects would probably be felt.
Hurdity x
Interesting. So does the vaginal route not cause any grogginess or is that more to do with it being a very high dose?
I wonder if you could also use it sublingually by breaking the capsule.
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Hi dangermouse
There should be much less grogginess even with the same dose of progesterone used vaginally. The paper I go to about this says there are 30 different metabolites from oral dosing, one of which is pregnanolone that causes the sedative effects:
"After oral administration, progesterone can be
metabolized to more than 30 metabolites, among
which some exert specific physiological activities
The most important pathway is the formation
of 5a- and 5b-pregnanolone which exert
considerable sedative effects after binding to the
GABAA receptor."
This is from Kuhl 2005: Pharmacology of estrogens and progestogens: influence of different routes of administration
Interestingly a buccal method is mentioned in this same paper - which I presume is sub-lingual - but this must have been experimental only as I've never heard of it given this way. However it was a specially made suspension so i doubt the utrogestan - micronised progesterone - would work in the same way - well not to protect the uterus anyway. Might be worth a try and see what happens?
Sorry Darlingbabs - bit off topic here!
Hurdity x
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No worries. All very interesting x