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Hi all

Advice much appreciated

I'm 45, perimenopause assumed due to symptoms so GP started me on patch and provera (utrogestan tried but didn't work for me)

Third cycle and forgot one provera tablet on Friday night - I'd eaten something that disagreed with me and couldn't keep anything down. Tablet went out mind.

Tea time last night, started spotting - day 23 of cycle.

Pre trying HRT my cycle was anything from 22 to28 days. Since starting it's been closer to 28.

So...

Could missing one tablet cause the spotting?

Could this be an early period?

I took tablet last night as thought it was best to oppose the patch and NHS advice says to continue with next dose.

I had scan in Sept all clear apart from two small fibroids, lining ok -GP considered it "normal" scan. Smear due in Oct.

Suffer massive HA and having a lot of family stress atm which I know won't help!

Thanks in advance.

A couple of months ago I agreed to move from sequi ( patch and utro/norithisterone) to try a conti regime. I tolerate norithisterone better than utrogestan so am on 100 everol and 3x norithisterone tablets.
Physically all seems well for the first month.
In the last 2 weeks of the second month I have had crushing tiredness- absolutely crushing- so much so that I have to sleep for 2 hours everyday when I come back from work.
 I have no desire to go and do anything. My nipples are very sore and I am covered in spots - face and body.
Sex drive has disappeared - unheard of for me.
I am wondering whether I should stop the conti and go back to sequi and see if these issues stop.
Has anyone else had similar?
My life feels so pointless and flat.
Thanks😔

Thanks.
I am wondering if it is the conti regime that is doing this. I am also extremely tired all the time. Mood isn’t great.

Thanks ladies for replying. Looks like the doctor I saw was probably doing the same as yours Jules in following the guidance. The spotting has now turned into a bleed, been 2 weeks now, I’m just hoping it’s not going to be like this till I go for the scan on the 29th.
Every morning I keep thinking should I not take my hrt to see if the bleeding stops then I end up taking it as I’m worried about the hot flushes etc returning.
Anyone had a similar experience? X

Hi all me again

So as yiu know last week I was using the gel for 5 days, had a blood test Friday and it was 1630.

Now I know I've had a huge dip hence all the terrible anxiety, especially in the morning and heavy crying.
My friend advised just sticking to the patch which I know you ladies advised which I have.

So I was on 65mg before I had all thus crying, do you think because my levels shot up from the gel I should stay on 75mg patch (as advised by NAS i think) and carry on with it as I'm still low flat mood, physical anxiety.  If this was you woukd you lower the patch or keep to 75? Because I feel like I'm fluctuating xxxx

It's The Change - does what it says on the tin  .  After my periods disappeared I didn't stop carrying protection for 5 years ....... on an in case basis!

How do U feel overall, make sure that you don't become anaemic.

Thanks for your reply 👍
I feel ok to be honest apart from putting on weight, not sleeping much, hot flushes etc etc lol. I had blood test done and my haemoglobin and haematocrit is constantly rising

It sound quite normal for peri to me. I had this happen a year ago and bled for 5 weeks. Because you gone a while without a period, the lining builds up and then when you do eventually have a period, it can be heavy or light and be prolonged. I really don’t think it’s anything to worry about, but if you are concerned then have a word with your GP. Hope this goes some way to reassure you that all is probably normal and just the joys  of this time of life for us

I think I will wait and see if goes on too long then I will see the GP

Thanks for your reply. Yes I'm glad of the reassurance it's not just me.

It’s definitely not just you. I felt that way when it happened to me. Mine was a light bleed like yours. I did visit the GP, but she wasn’t worried and mine eventually stopped on its own. Some GP’s will send you for a scan just to check everything is ok and some will just keep an eye on it for a while like mine. If you’re worried ask them for a scan to put your mind at rest

Sleep problems were my most serious symptoms, leading me to start continuous hrt although I was still having periods.  I was waking up at 2 or 3 am feeling like I had just had 2 shots of espresso, couldn't get back to sleep, and getting so exhausted during the day I couldn't work or exercise normally.  Sequential hrt is probably what is recommended for most people who are still having periods but apparently, the practice I go to gives continuous hrt to many perimenopausal women who have more serious symptoms, including more serious sleep disturbance.  I'm going to list out all the sleep options that I know, but depending on the seriousness of your sleep problems, different things might be right for you.

My doctor recommended continuous hrt because the (oral) micronized progesterone helps with sleep.  My understanding is that both estrogen and the (oral) micronized progesterone can help, and micronized progesterone affects GABA -- when I started taking 200 mg micronized progesterone a night, within two days I went from waking up at 2 or 3 am to sleeping until 6 am.  Taking a higher dose of progesterone every night did eventually cause other (less serious) problems for me, but everyone is different, and my doctor said she does have success putting some people who still have periods who have sleep problems on continuous hrt.  It's also possible to take 100 mg micronized progesterone for the first couple of weeks, and 200 mg the second couple weeks, so it is in effect a sequential regime, and this may be more typical.  My doctor also told me higher doses of estrogen in peri are often necessary to repair broken sleep.  For some women, taking sequential hrt with the progesterone only in the second half of the cycle may be enough to help with sleep.

Sounds like you already are on hrt, but for others who decide to try hrt, my experience was that the micronized progesterone helped with sleep within a couple nights.  The estrogen effects on sleep seemed to take more time to cohere, and it does take some time to arrive at the right dose.  For me, HRT treated many symptoms I didn't even know were being caused by hormones, and it helped more than anything else with sleep.  My doctor thought doing anything but hrt for hormone related sleep issues was not addressing the real underlying problem, and she said this was the place to start.

I went through the threads on this forum and saw others mentioned trying melatonin, CBD, and antidepressants with some success.  I do think antidepressants are often prescribed for this issue.  Some antidepressants are particularly good for sleep, although many of them may help.  Mirtazapine is one that is often mentioned (Remeron).  Trazadone is also often mentioned. 

For those who don't want to take hrt or anti-depressants, there are herbal preparations that help with hormones that may help with sleep.  I have heard of people taking vitex berry and black cohosh, as well as other formulations, but I haven't tried any of this as my doctor said hrt would likely be more effective for my level of problems.

Others also mentioned sleep hygiene issues, including getting plenty of exercise; getting lots of exercise does help me with sleep.  The sleep hygiene conversations can feel a bit invalidating if your sleep hygiene is already good because hormones are definitely involved, but trying all the tips was helpful to me to see the other factors that influence sleep, even though hormones began the problems.  There is a lot on the web about sleep hygiene and there are even some CBT sleep hygiene programs / apps on the web that could be useful, although this isn't addressing the hormone component, which for me was important.  It is worth thinking about, especially if you go on hrt and this isn't enough.

Drinking coffee was something I had to take a new look at in the sleep hygiene department that some may not know influences hormones.  Coffee (and even green tea) don't just influence wakefulness, there is research suggesting they also affect our hormone levels (and these effects might be helpful or harmful and may be different for different women).  I used to drink fully caffeinated coffee and at times during my work on sleep I had to eliminate caffeine entirely.  More recently, I've been able to have smaller amounts of caffeine than I used to drink -- less than 1 cup of coffee a day -- but I have to be careful to monitor how late in the day it works to have caffeine and still get a good night's sleep.  The rate of eliminating caffeine from the body is different for different people.  I noticed that at different points in my cycle, and different hrt doses, caffeine was affecting me differently.  Sometimes I could tell it wasn't a good idea because I already felt wired.

I can't take antidepressants, but got in the habit of taking a tryptophan supplement at night, which was helpful for me.  I recommend being careful to get tryptophan and not 5-htp, as 5-htp can keep some people awake.  Both are helpful with serotonin and might be an alternative to antidepressants, although their effects are much less pronounced.

I also tried a lot of other supplements, in addition to the tryptophan.  I have been taking magnesium at night, which is really helpful for me.  There are lots of different forms of magnesium, so it's worth reading and experimenting and seeing which form is best for you. 

I also tried GABA supplements, and lavender sleep supplements, which didn't particularly help me, but seem to have been helpful to some others.  I tried L-theanine and Relora, which might have helped me some?

I tried gabapentin (this is a drug not a supplement), which I don't like to take every night as I find it sedating/depressing the next day, but it is excellent for me to be sure I will sleep after a night of poor sleep, and I have minimal side effects if I don't take it 2 days in a row.  I only take 100 mg, but it comes in larger doses for people who tolerate more.  Some people take it regularly for sleep (not intermittently like me), and some have found it helpful for hot flashes.

Some people on the forum have commented on the risks of benzodiazepines, which I agree with in terms of taking regularly, but right before my period my sleep is absolutely horrendous, and if I have a night where I don't sleep at all, the next night I take .5 or 1 mg of ativan, being careful never to take it 2 nights in a row.  This has worked for me in terms of not developing dependence on it, but putting a cap on how horrible sleep problems can get.  Its effects on sleep wear off if you take it regularly, and as others stated, it is possible to develop dependence and have a hard time getting off, so it takes a measure of discipline and is probably only justified for occasional use if there are serious problems and you feel you can be responsible with it.  Doctors often don't want to prescribe it if there is any kind of addiction history, and it is probably a last resort only for occasional use for most people.

Maybe others can add if there are things I missed; when I searched the forum for "insomnia" and "sleep" I found lots of threads, but it was hard to find a good summary in one place, and I want to help the sleep deprived! 

Best of luck with it; the sleep problems are hard. 

Warmly,

karab

Hi Kathleen,

Thank you so much for your warm welcome , I’m comforted to know I’m not the only one who hasn’t had the success I’d hoped for on hrt , like you I also suffer with ongoing anxiety it’s not severe like when it first started but I’ve never really been free off anxiety it’s like a background thing always there sometimes worse sometimes not so much I do take an AD , I’m still suffering the headache pressure and spacey lightheaded feeling which eventually leads to heightened anxiety.
I made the decision to reduce my dose in hope it will maybe improve that symptom I’m 2 weeks into the reduced dose and not feeling any improvement yet , I know I need to give it longer, you are so right it’s a hard row to hoe .
Thank you for your kind reply , I hope you get some improvement on your low/medium dose I’m hoping the lower dose works for me .
Take care  and wishing you well.

I haven't worked out what causes my bloating