Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: GypsyRoseLee on June 14, 2015, 09:13:47 PM
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http://www.earlymenopause.com/bcps.htm
This is a very useful article explaining the difference between the Pill and HRT in treating peri menopausal symptoms.
The more I read the more I am thinking that really I should be on the Pill. I am still very young for all this peri nonsense, as my symptoms really kicked in with a vengeance at only 42, but looking back there were definite warning signs as early as when I was only 38.
Early menopause runs very strongly in my family. At now 44 I am the oldest woman in my immediate family to still be having her own periods. Everyone else was finished and done by 42!
I think that even though my periods are now much lighter my menstrual cycle is still quite strong, if that makes sense. Still very regular, give or take 2 days. I could definitely tell when I was ovulating, lots of clear mucus and feeling very 'frisky' etc ;) I have never had a hot sweat. I have never suffered with any vaginal dryness (often the opposite to be honest). Never had any problems with headaches.
The article I have linked to explains that how HRT is adding extra hormones, which isn't ideal when you are still producing plenty of your own hormones. So some times you will be getting too many hormones etc. And you might struggle with fluctuations as a result.
So I think that this is why pre HRT and even now 10 weeks into HRT my anxiety/depression seems to go away for a week or two, then come back for a week or two, then go away for a week or two etc, etc with sometimes random 'good' and 'bad' days dotted in between ::)
The Pill shuts down your own hormones completely so you only get the dose in the Pill at a very steady rate, and also a higher dose of hormones than is commonly available in any HRT. No ups and downs through the month. Just a few off days/PMS due to the withdrawl of oestrogen/progesterone.
I can hack a few days of PMS once a month. But this up and down all the time and never knowing when is killing. I think that waiting for HRT to stabilise me will take a very, very long time. And won't actually happen until my hormones levels drop to post menopausal levels which could be years from now (though not too many going on family history).
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Also if I do decide to go back on the Pill and it's more effective than HRT then I will have to eat lots and lost of very humble pie ::)
Because 18 months ago when I first started with peri and went to my GP describing the mood swings and the sudden insomnia and the awful random anxiety she DID mention going back on the Pill :o But I just thought she was talking nonsense and that I was far too old to go back on the Pill and very flatly refused it ::)
In a way I will be gutted if I go on the Pill and it works for me. I could have saved myself 18 months of Hell if I hadn't been so stupid!
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Maybe it will work for you Gypsy! Peri takes around eight to ten years and as the normal age for meno is seen to be 51 then I would think that you are right on target to be peri meno to be honest and not early at all. I now know that my increasing PMT symptoms in my forties were definitely peri-meno. I too didn't have any menopausal symptoms such as hot flushes or lack of libido and there is no way I would have considered taking HRT purely for the anxiety and irritability. You do sound as if you are right on track and if the pill helps then I would say give it a go! I didn't consult a doctor during those years as I hadn't really heard of peri.
Taz x
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This is really interesting !
I'm on oestrogen only due to hysterectomy and have been for years really fine but since peri I'm messed up, thank you, I'll get on reading
Annie xx
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Hi Gypsy - I think you are on the right track - because you are following your instincts, if that leads you to believe HRT is not right for you at the moment, then I would trust that.
I am not using HRT (I am 45) and have thought about it on and off for nearly six months since I had a high FSH reading and my first missed period - I then had a normal FSH reading and three 28 day cycles. Basically I know that things have changed, not even sure I am ovulating regularly anymore because like you say, I used to 'know'. I have had regular periods up until recently when two came close together. All my regular 'signs' of where I am in my cycle have gone out of the window; the cervical mucus, the slightly larger breasts, even slight mood changes etc They do come, but not in the usual order ;) I never had PMT badly or problems at all, but now that things have changed I realise there was a rhythm to my cycle that was subtle yet reliable.
I am explaining all this because I waited before taking HRT which I was advised to take immediately the FSH was high and actually by ladies on here, of course I appreciate that protection of heart and bones is an important thing but.........I would urge any woman, if possible to NOT PANIC and realise that perhaps there really is an optimum point at which HRT is really helpful and before that other remedies might be better. Because, what you say is so right, the hormones are still cycling in a random fashion and I genuinely believe there is a period of time where this is meant to occur and our body adjusts. Adding extra hormones just doesn't make sense to me unless hormone levels are very very low and I presume this is when hot flushes, night sweats etc come into full force, which is why HRT is mainly prescribed on the basis of these symptoms. I haven't had hot flushes, which I take as a sign that although my estrogen might get low and be steadily getting lower, there is enough there to cause bleeding and not have hot flushes.
Now this might be a simplistic view, but it's one that I am going with ;) I have definately had symptoms of high estrogen, but not always pleasant ones and I presume that is because progesterone is low, when there is no ovulation etc if I had added hormones then I think I would still be out of balance because as you say, my own system is still strong at some points - albeit malfunctioning quite often. At the end of the day the body is preparing to stop the system completely and finally will get the message and things will slowly wind down.
I think if the symptoms are really hard at this point the pill totally makes sense to me. Another thing I want to say is that a gynaecologist advised me that actually only quite low levels of estrogen are needed to protect bones and as long as there is still a bleed then some is being produced. My advise is basically to take things slowly but surely, appreciate that your body is changing, trust that it might actually handle things given time and explore all your options regards supporting yourself in gentle ways that don't tax your system so much. HRT is a very powerful medication and totally valuable - at the right time and dose - which in itself is difficult to manage. I have my eyes and ears open to the possibility that I will need HRT at some point, but I really don't know, the GP said I would only have a few more periods and that would be that, perhaps he is right, until that time I am holding out, because I might produce my own hormones for a while without too many really bad symptoms.
I also suffer with anxiety, but I know that is not just the hormonal stuff and the hormonal stuff does shift fairly rapidly and I am learning to sort of ignore it and keep my head looking forward to when all that stops.
I've waffled - just wanted to say trust yourself, you sound very intune with your body and I hope you find just the solution you need right now x
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Thanks for posting the link Gypsy, it looks really interesting. :thankyou:
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Hi Taz
Yes from about 38 onwards I noticed my PMS was definitely morphing into something different and worse. Starting much earlier and not ending until my period finished. Some months I was only getting about 10 'good' days if I was lucky ::)
I think while you're peri menopausal and so still producing quite a lot of your own hormones then the Pill seems to make more sense to me. Especially when you're only really reacting to the fluctuations caused by your own hormones jigging about willy nilly and the awful dips in mood and the anxiety they cause. It seems sensible to shut down my own hormones entirely and just absorb a nice, regular dosage from the Pill.
I think trying to use HRT to control these fluctuations and my subsequent reactions to them is a bit like trying to thread a needle while balancing on the roof of a moving car. Just too hit and miss.
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You're not waffly at all brightlight :)
I love the fact that there are so many women on here with intelligent opinions and observations. So far, I have never had any missed periods or even an irregular cycle yet. have just checked back through my diary and before HRT my cycle was 24 days, 25 days, 26 days, 25 days, 27 days etc, so really quite regular still.
And like you, I don't think my own oestrogen is too low as yet because I haven't had any of the symptoms associated with low oestrogen such as night sweats, hot flushes etc. But I do think my oestrogen is really fluctuating and THAT is what is causing all my anxiety and the periods of very low mood which I can get. If the periods of very low mood/anxiety were just a day here and there I could handle that. But 11 days in a row? It's no joke :(
I'm not going to rush into anything. I am still going to give HRT another 4-6 weeks to see if it can stabilise me any better. But having read that article I now understand the difference between HRT and the Pill and think that HRT is perhaps just not subtle or sophisticated enough to control my fluctuations. And that (for the time being) I need something which is going to shut down my hormones entirely to give me some respite.
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Thanks for posting this. My GP advised remaining on the pill for the higher levels of hormone due to my age (40) so it is encouraging to read something that backs this up! However, I am always a bit bemused by the claim that the pill overrides your natural cycle as I experience quite a lot of fluctuation when taking it.
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From what I understand Dorothy, the Pill shuts down your own ovaries completely (which is why it's used as a contraceptive). This means you only receive the hormones present in the Pill which are quite a bit stronger than found in HRT (which is why HRT can't be used as a contraceptive).
I think you can still get PMS on the Pill (I know I always did) because you are reacting to the withdrawl of oestrogen/progesterone when you have the 7 day break at the end of each pack. Is this when you get fluctuations or are they through out the month?
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I am with Dorothy. I am just transitioning from BCP to HRT for that exact reason. I did not take the break from the pill, and instead took it continuously as advised by my specialist. No need to have a withdrawal bleed, and therefore suffer with symptoms going on and off the pill 3 weeks at a time. Specialist informed me that if always on BCP continuously then lining is not building up and no need for a bleed. I tried three different pills as well as the BCP patch each for three months. For myself personally I was still having symptoms, but I believe it was from the different progesterone in each pill. In theory shutting down the ovaries does make sense and I believe you can do this using the 100mcg estradot patch. Also for me personally, I have come off of the BCP so I can sort out if having symptoms from the different progesterones or from my own cycle breaking through. It is all really one big experiment, and still have not found what works best. Although everything I have tried except for one birth control pill had made me feel better than not using anything. So,forward with the battle and hope I have my answers sooner rather than later.
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Really interesting article. Thank you! As you know, I am in a similar situation regarding pill vs HRT. Having read some of Hurdity's recent, really interesting posts, I now think my issue is due to the progesterone in Qlaira which isn't bio identical (the estrogen is). This would account for the timing of my fatigue and spotting (which I had, incorrectly, blamed on too little/much oestrogen). I feel so noticeably better on Qlaira in terms of anxiety that I don't want to give in easily. but the fatigue, when it occurs, is debilitating and progesterone is the more likely cause, I suspect.
My options, if I did change, are either a different, possibly stronger/single phase pill (taken without a break) or else a much stronger patch with Utrogestan. The only reason I gave up on this regime previously was the dip when I stopped the Utrogestan, so I am hoping my GP may consider a continuous regime even though I do still have periods. having now taken both 20 and 30 mg of oestrogen orally, I would definitely want to try a much higher patch than the 50 mcg I had previously.
I spent ages putting together an email for Dr Currie yesterday, only to realise she's not doing email correspondence until the end of June. I guess I should have checked this first!
And like you, I don't think my own oestrogen is too low as yet because I haven't had any of the symptoms associated with low oestrogen such as night sweats, hot flushes etc. But I do think my oestrogen is really fluctuating and THAT is what is causing all my anxiety and the periods of very low mood which I can get. If the periods of very low mood/anxiety were just a day here and there I could handle that. But 11 days in a row? It's no joke :(
Don't be mistaken into thinking low oestrogen always causes the 'typical' symptoms such as hot flushes, night sweats, VA etc. My oestrogen has been classified as low on a number of occasions (41 and lower) yet I have never had a 'classic' symptom, hence the reason I have had three years of unnecessary tests, MRIs (even a brain scan!).
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Can I ask what sort of fluctuations do you get on the Pill, Dorothy and Poppyflower?
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Ah that's interesting Briony? I always thought low oestrogen caused the classic meno symptoms.
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I gues
Can I ask what sort of fluctuations do you get on the Pill, Dorothy and Poppyflower?
I guess that is what I am trying to figure out. When I began my perimenopause journey it was HELL! Out of the blue one day I was a completely different person....long story short the sudden onset of mental difficulties were the worse. I had not ever had any of these issues in the past and really thought something was seriously wrong with me....sound familiar to anyone :P Anyhow I think the main issues for me on the pill was that I had to take the estrogen and the progesterone at the same time and was not ever able to discern if I was still having issues due to one or the other. I am pretty sure however that it was the progesterone in the pills. some of them were ok, and some sank me into a deep depression, and I did not realize until I came off that it was from the pill! With that being said I really do believe that "shutting ones own hormones down" during perimenopause is probably the way to go and I am going to achieve this taking the two separately hopefully! To answer your main question though once in a while I would still feel some fuzziness to my head, unable to wake in the morning as well as that jolting awake at about 3-4 am. once in awhile it would also seem like the other symptoms were just on the edge as you described but just did not quite break through. The pill could work really well for you as it does for others I think if you believe it could help then give it a try!
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I took the pill for many years and was on femodene until 49. Most of the time I had no idea of perimenopause. It was only in the last 4 years I noticed any changes:
shorter bleeds
oestrogen withdrawal headache on week off, if I did not drink water continually
itchy privates - tried thrush treatments for a while before I worked out what it was
thinning pubes
a sense of relief when I restarted my pills
Night sweats became a constant thing. Looking back, I had these from my late 30s and never realised what it was. It was something that I had not got round to sorting out, and did not connect it to the pill until the last couple of years.
It wasn't too bad but I was getting fed up of taking them, and the headaches were getting difficult to avoid.
After I came off, I discovered libido and that I had had cyclical constipation (didn't know any different ::))
However, I had random periods, vaginal and bladder problems and pains in the joints but the night sweats went!!!!!
I went onto vaginal oestrogen and then full hrt. Some problems go, and others appear. But I feel stable for now.
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You're not waffly at all brightlight :)
I love the fact that there are so many women on here with intelligent opinions and observations. So far, I have never had any missed periods or even an irregular cycle yet. have just checked back through my diary and before HRT my cycle was 24 days, 25 days, 26 days, 25 days, 27 days etc, so really quite regular still.
And like you, I don't think my own oestrogen is too low as yet because I haven't had any of the symptoms associated with low oestrogen such as night sweats, hot flushes etc. But I do think my oestrogen is really fluctuating and THAT is what is causing all my anxiety and the periods of very low mood which I can get. If the periods of very low mood/anxiety were just a day here and there I could handle that. But 11 days in a row? It's no joke :(
I'm not going to rush into anything. I am still going to give HRT another 4-6 weeks to see if it can stabilise me any better. But having read that article I now understand the difference between HRT and the Pill and think that HRT is perhaps just not subtle or sophisticated enough to control my fluctuations. And that (for the time being) I need something which is going to shut down my hormones entirely to give me some respite.
Gypsy. 11 days in a row isn't good at all, I am having a bit of a run of dip days right now and really hoping something shifts soon. Maybe the HRT will infact sort things out if you give it a few more weeks - fingers crossed.
Briony - now I am confused ;) I understand that we are all different and that low estrogen doesn't always show with classic symptoms; I just decided for myself that having periods still indicated there was some estrogen, albeit maybe low sometimes and probably high as well. I was getting so confused with advise that I gave this as a marker to myself.
My blood tests for FSH/LH were completely different, so I decided to almost ignore them both and just take things as they come. The heart and bones risk is, well, a risk. I don't know if my levels are low enough to be effecting those things - but again, if I am having a bleed I am going to risk presuming all is OK and was advised as such by a gynae, but.........we are all different and really, unless we test regularly or symptoms are pretty obvious I think we are almost guessing in any case. Some might disagree with me, but this is where I am at. :)
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Gypsy...if you start the pills I'll be very interested to know how they work for you. Still on the fence myself but leaning that way. I don't think estrogen is my answer at this point, unless it's only for part of the month...and that is difficult to figure out based on symptoms alone.
Tara
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I often get cramps during the weeks I am taking the pill. I also had the same discharge I used to get 'mid cycle' before I went on the pill, although that has gone in the past couple of years. Sometimes I get all the PMS symptoms before I start my break, and then I can't wait to start it as I know they won't go away until I do. Whenever I have been advised to take the pill continuously with no break, I have had bleeding on a monthly basis, not as heavy as on a normal pill break but it goes on for a couple of weeks and I get all the cramps, headaches, joint aches etc that would go with a normal period, only they are not as bad but last for much longer...
I can understand having symptoms on my week's break, but have never understood why I get fluctuating symptoms at other times if I am taking the same hormones daily.
In the past couple of years, I have had all the peri symptoms too - my pill break is the worst time, but I get a 'damped down' version the rest of the time.
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Briony - now I am confused ;) I understand that we are all different and that low estrogen doesn't always show with classic symptoms; I just decided for myself that having periods still indicated there was some estrogen, albeit maybe low sometimes and probably high as well. I was getting so confused with advise that I gave this as a marker to myself.
My blood tests for FSH/LH were completely different, so I decided to almost ignore them both and just take things as they come. The heart and bones risk is, well, a risk. I don't know if my levels are low enough to be effecting those things - but again, if I am having a bleed I am going to risk presuming all is OK and was advised as such by a gynae, but.........we are all different and really, unless we test regularly or symptoms are pretty obvious I think we are almost guessing in any case. Some might disagree with me, but this is where I am at. :)
I agree - it's all so confusing! :-\
My blood tests were done during my periods, when the endocrinologist recommended having them done. At that point I was anti HRT (or any additional hormones, come to that). Have always tried to 'go natural'. However, seeing how low my oestrogen was and listening to the potential harm, at 42, I could be doing to my body, shocked me into doing something pro-active to protect my heart and bones. He immediately ordered a bone scan, since I'd been having symptoms for several years (albeit not the obvious symptoms - remember up to 30% of menopausal women don't have hot flushes). On the basis of the scan results, combined with an oestrogen level of 41, taking HRT/the pill became a no brainer for me. (My bone density was 'below age average' so I have to go back in five years).
Have to say, anyone who knew me at 39 would be stunned to hear I'm taking the pill. It's so out of character and something I never envisaged, but for me, at my current age, I think it's the right decision. I was initially quite anxious about the whole thing and felt I was being a hypocrite, but my parter, who's more of a scientific/objective thinker, helped me to be a bit more rational (I suspect he was also desperate for a bit of peace - by this stage there were three of us in our relationship: me, him ... and Dr Google!). ::)
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I often get cramps during the weeks I am taking the pill. I also had the same discharge I used to get 'mid cycle' before I went on the pill, although that has gone in the past couple of years. Sometimes I get all the PMS symptoms before I start my break, and then I can't wait to start it as I know they won't go away until I do. Whenever I have been advised to take the pill continuously with no break, I have had bleeding on a monthly basis, not as heavy as on a normal pill break but it goes on for a couple of weeks and I get all the cramps, headaches, joint aches etc that would go with a normal period, only they are not as bad but last for much longer...
I can understand having symptoms on my week's break, but have never understood why I get fluctuating symptoms at other times if I am taking the same hormones daily.
In the past couple of years, I have had all the peri symptoms too - my pill break is the worst time, but I get a 'damped down' version the rest of the time.
Have you looked into some of the modern pills which have only a very short break? Qlaira only has two oestrogen free days all month. It's also bio identical (oestrogen). The only problem, for some, is that it's a very low dose of COP so may still cause breakthrough bleeding etc For anyone in our situation who's not taken a pill before, it's a good starting point, but may not work for everyone (for me, psychologically, it's been fantastic - less so for the fatigue/spotting).
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Briony, I've only ever taken the one brand - I was in so much pain before and so exhausted from anaemia due to the heavy bleeding, that once I had found something that enabled me to live a normal life, I was too scared to try any changes! I can live with what I have at the moment - I'm just bemused when I'm told I can't experience any 'normal' hormonal symptoms or peri symptoms due to being on the pill.
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I'm just bemused when I'm told I can't experience any 'normal' hormonal symptoms or peri symptoms due to being on the pill.
Dorothy - I was on the pill till I was 54.
Because it caused regular bleeds I had no idea I was anywhere near meno, certainly never occurred that I was peri.
But, from when I was 40 things really weren't nice, lots of tears (mine) and arguing (the world).
I just didn't know what was going on.
It makes sense now but it was horrid at the time.
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Limpy, My new GP agrees it is possible to have peri symptoms while being on the pill. Someone give her a medal! Pity we can't clone GPs like her. (I won't say what I'd like to do with the unhelpful ones ;) )
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The trouble is there's so many duff ones.
I did think briefly ,that we should have a thread as to what we should do with the unhelpful GPs. The trouble was, everything was a bit violent........
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I must admit, when thinking of my previous, useless, GP, I kept thinking about Dr Who episodes of my childhood, and particularly the Daleks favourite word...
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The thing that really got to me, was that GPs who I'd really liked and respected were so anti HRT.
That was such a surprise, it wasn't till I went in armed with sheets of paper that I was listened to. Well, that and it was a female GP who knew of and likes this forum.
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Limply/Dorothy - if this were Facebook, I'd be liking your above posts! ;)
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Just as well it isn't...I for one wouldn't want the world reading some of my posts and knowing who wrote them :o ;D
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Hi dogdoc
If I do decide to try the Pill I'll keep you posted. At least it's nice to know that it's there as another option to try.
Having said that I have felt SO MUCH better these last 2 days. Honestly I feel just like my old self. So much more lighthearted and relaxed. I'm actually still only on day 11 of my Utrogestan but I have already started with some spotting/withdrawl bleed so don't know if that is the reason? Or is it a coincidence?
But if HRT can give me more days like these last two I will be very, very happy.
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Hi dogdoc
If I do decide to try the Pill I'll keep you posted. At least it's nice to know that it's there as another option to try.
Having said that I have felt SO MUCH better these last 2 days. Honestly I feel just like my old self. So much more lighthearted and relaxed. I'm actually still only on day 11 of my Utrogestan but I have already started with some spotting/withdrawl bleed so don't know if that is the reason? Or is it a coincidence?
But if HRT can give me more days like these last two I will be very, very happy.
Fantastic news re the better days :-)
Interesting that you're feeling like this after being on Utrogeston for 11 days. unexpectedly, I always felt miles, better when I'd been on it a week or so ... But then had a dip when I stopped it and had a bleed. This was the main reason I changed to Qlaira as there's less of a contrast. Coincidentally I did sometimes bleed 'early' but doc reassured me it was either settling in or sign I may need higher estrogen. Only happened once or twice x