Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Niamh on January 16, 2016, 08:25:48 AM
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So I'm totally confused and feeling very fed up today! After a few really good weeks im back in an anxious state, poor sleep and low mood...I use ostrogel and had been on 3 pumps but dropped it to 2 myself a month ago as I felt I was getting anxious, jittery, wired etc on it and all calmed down. I saw Prof Studd on thurs for my 3 month review and as I'd been in such a good phase he seemed unbothered by this previous dip and actually said he didn't know what caused it...he told me to take the ostrogel back up to 3. So I did yesterday and all these symptoms have come flooding back. Does anyone else get this if there ostrogen goes too high? I'm worried about dropping it to 2 as he wants me on higher dose presumably to suppress my own cycle and also he's treating osteopenia he picked up on a bone scan. I'm 41 and really seeing him for pmt so on utro 100 mg x 7 days (im prog intolerant) and testim gel. Ive considered emailing Dr annie Evans as prof Studd isn't very good at answering my questions although I know he's a brilliant man and not good at answering email either! Has anyone used this service... Thanks x ps ive dropped the ostrogel back to 2 today as felt good on this but worried this might be my own cycle mucking about in the background how can I tell though!?
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Hi Niamh,
I use mirena coil and oestrogel, I'm 51 and menopausal. I started using one pump oestrogel for first 5 weeks, then upped it to two a week ago, as I was still getting hot flushes on waking.
I have had four days this week where my mood has been awful, I've felt withdrawn and snappy, I too have been wondering if the extra oestrogen has caused this, but think I might give it a while before I decide if it is the case.
I know we are using HRT for different reasons, but I too wonder if too much oestrogen has an effect in mood.
The other thing that I have debated is, I do the 5:2 diet, and I think if my blood sugar drops too low, it effects my mood also.
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So I'm totally confused and feeling very fed up today! After a few really good weeks im back in an anxious state, poor sleep and low mood...I use ostrogel and had been on 3 pumps but dropped it to 2 myself a month ago as I felt I was getting anxious, jittery, wired etc on it and all calmed down. I saw Prof Studd on thurs for my 3 month review and as I'd been in such a good phase he seemed unbothered by this previous dip and actually said he didn't know what caused it...he told me to take the ostrogel back up to 3. So I did yesterday and all these symptoms have come flooding back. Does anyone else get this if there ostrogen goes too high? I'm worried about dropping it to 2 as he wants me on higher dose presumably to suppress my own cycle and also he's treating osteopenia he picked up on a bone scan. I'm 41 and really seeing him for pmt so on utro 100 mg x 7 days (im prog intolerant) and testim gel. Ive considered emailing Dr annie Evans as prof Studd isn't very good at answering my questions although I know he's a brilliant man and not good at answering email either! Has anyone used this service... Thanks x ps ive dropped the ostrogel back to 2 today as felt good on this but worried this might be my own cycle mucking about in the background how can I tell though!?
How old are you? If my oestrogen levels get high then my breasts usually get swollen and achy.....have you noticed anything like that?
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I have this problem I have an oestrogen patch as I had a full hysterectomy three years ago but I can honestly say that getting the right dose is a pain if its to high anxiety is so bad if its low the flushes come back cant win !
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Hi
When I was 42, I was given 50 mcg patches (similar to two pumps of gel I think) and had both good and bad days. I later discovered this was because it was adding to my own hormones (so at times pushing me too high) rather than controlling them. Ironically, the answer was to double the dose as you need at least 100mcg patches (4-5 pumps of gel) to actually suppress ovulation. (Remember this is still less estrogen than in a synthetic BCP). I suspect this is why Prof Studd is encouraging you to take a higher dose.
If you're only 41, I would also recommend looking into the bio identical BCP pill Qlaira (see my previous posts on this: http://www.menopausematters.co.uk/forum/index.php'topic=29562.0). I had very good results with it and do, to some extent, regret stopping it.
This could help explain why ovulation suppression is best for PMS: http://www.pms.org.uk/assets/files/guidelinesfinal60210.pdf
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Hi Niamh
I was wondering how you got on with Prof Studd?
I think you might be reacting to the actual change in your oestrogen level? I would give your body a couple of weeks to adjust to having more oestrogen then re assess.
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That's all really helpful....
Briony do you know what the prog is in Qlaira? I'm prog intolerant so I'd be worried about that bit of it....Im also getting in a state about whether my natural cycle has been suppressed or not as I keep getting these grotty patches I think not but 3 pumps makes me feel awful, I'm really not sure what to do...so annoying when ive just seen Prof studd and said how good I feel, typical! No point in going to my GP as she's clueless I guess can try Prof Studds office for a response but I'm sure he'll say use 3 pumps maybe I just need to brave it out and stick with 3 as you say GLR and it will calm down....x
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I also slept atrociously last night just couldn't get to sleep or stay asleep so this is heightening my anxiety and low mood today urgh 😩x
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The prog in Q is Dienogest. It is a newer one. Popular in France and Germany.
I would be very surprised if two pumps of gel is enough to suppress ovulation. In the PMS guidelines it suggests 4 is required. Therefore, you are probably experiencing fluctuations caused by the gel and your own system combining? I am on 100 mcg patches, equivalent to 4 pumps, and am not convinced it is enough to suppress ovulation. (Originally 200mcg was recommended).
It's an unusual way to suppress ovulation - it's usually the prog in the combined pill which helps achieve it - hence why such a high dose is needed.
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Thank you :)
http://www.studd.co.uk/pdf/gally%20suppresion.pdf
Just been reading this and Studd says 1-3 pumps can be used to suppress ovulation for Pms so confusing im going to call his office Monday! Still doing 2 for today as have felt ok on this x
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Sorry meant to also say...if I was ovulating though surely I'd be getting my own periods breaking through and ive not had this...x
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Iam confused as Studd himself has definitely suggested 4 pumps for suppression elsewhere in his literature. That's why lower doses can be problematic for ladies with peri menopause (it tops up but doesn't control). Nick Panay and NAPS also state 3-4 pumps / 100 mcg as being necessary. The reason I think I still ovulated on 100 mcg is because I've just had physical PMS symptoms pre bleed - spots, tummy ache etc. but didn't with the pill. The bleed is more like a period too, if that makes sense?
Have y thought about emailing DR Currie who oversees this site? I found her really helpful. £25 well spent. X
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I'd love to email her how do I do it? Thank you :)x
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On Studd's own website, he says 2-3 pumps twice daily. http://www.studd.co.uk/pms_various.php This is in line with everything else I've read regarding suppression of ovulation. You really do need a fair dose for it to occur. Anything less and you will still get fluctuations caused by your own hormones breaking through (as a number of us in peri menopause have found with lower dose patches, for example). Interestingly, he says ovulation wont always be suppressed in month one, and you may well feel worse before you feel better. That makes a lot of sense. Trouble with me, I always want immediate results! ::)
To email, go to the home page and then scroll down, if that makes sense.
B
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Great found it and done it!
So why did he put me only on 3 then?!? Even more confused...trouble is 3 I felt great on to start with only started causing problems after about 2 months so dropped to 2 then felt good tried 3 again yesterday felt bad again 😳
So damn confusing!
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I agree re the confusing bit. I think most people on here would, in fact!
I'm trying to persevere with the high patches as I know I have to feel worse to feel better. Emotionally I have felt well on them, but physically, a lot of the weird symptoms I had ages ago - pains, tingling etc. have come back in month two. I am wondering if the 'feeling worse in order to feel better' phase Studd mentions has just come late to me?
I suspect that on three pumps you are not suppressing ovulation which means that when your own estrogen is high, your'e going to be incredibly high. It's near enough the highest dose you can take without suppressing ovulation. The weird thing is, moving to 4-5 pumps - which sounds so much higher - would probably even out to be less as you would not have the ovulation-induced highs, if that makes sense?
Good luck.
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So much better night on 2 pumps apart from my toddler waking with a cold typical! Staying with 2 but emailing Dr Currie and then I'll email Prof Studd too. Thanks for your support. Does Dr currie email you with an email address ive paid but don't know what to do now?
Thanks x
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I think that's a sensible choice. With two, you should be OK most the time, as even if your estrogen rises, the additional gel shouldnt put you too high. Ironically, if you go up at all, you'd probably be better on 2-3 daily, like that document says, as this will prevent you ovulating at all. (Obviously I am not saying do this - just speaking hypothetically, assuming I have understood the NAPS literature correctly!). With 3, I guess you will still ovulate so your highs will be very high!
After I'd paid, I had an email a day later to which I had to reply, if that makes sense? Dr Currie replied about 4 days later.
Will be interesting to see how you get on x
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Agree with Briony. Another thing to consider is that if you prefer to stay on 2 pumps over all, you could do this for, say, 3 weeks each month? Then increase to 3-4 pumps when your own oestrogen is at its lowest?
I actually think it makes more sense to reverse HRT dosage if you still have a menstrual cycle. So much more oestrogen during 2nd half of your cycle to stop the rising progesterone causing the PMS symptoms. Followed by less oestrogen on days 3-14 when your own oestrogen is rising.
I'm pretty sure the only reason I felt so well again on week 2 of Femoston was because my own cycle was working normally, oestrogen rising, increased libido, then definitely ovulating.
I think my taking Femoston was neither here nor there. Then just 2 days after ovulating I had to start the combined section of Femoston and my feelings of wellbeing and optimism disappeared within 12 hours.
I've had a couple of 'alright' days since then. But generally I've been feeling very grey, no optimism, anxious. Basically I just want to huddle on the sofa watching mindlessly unthreatening TV. I don't feel like I'm dying with dread, but neither do I feel like I'm living either.
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So it says 2/3 pumps twice daily, so in fact that's 4/6 pumps per day?
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Wow that's a massive dose Prof S definitely didn't prescribe that!! I don't know why he's given me 3 pumps if that doesn't suppress my cycle then sigh so I guess I do what I feel best for now and I'll see what Dr Currie thinks!
Ladies you've all been so helpful :)
The trouble with using the ostrogen differently at different times of the month just won't work for me ive always had a very irregular long cycle so I never know where I am and don't now!! Ive had no other bleeds except post my utro phase which is why I thought my cycle was suppressed!
GLR think my mood is similar to you now suddenly feel flat not totally awful but slightly knotted anxious stressed feeling and just not loving life as I was just a few days ago :(
X
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It is a high dose for hrt, but if you're wanting to suppress ovulation, then you're really mimicking a BCP rather than 'topping up' what's missing, so it's hard to compare the two, if that makes sense?
That said, I too think 5-6 pumps sounds like a very high dose. I'd to go by the NAPS recommendations, if anything, as they based on research from a wider range of specialists. Nick Panay is/was the Chairman of the National Association for Premenstrual Syndrome, as well as being a well regarded gynaecologist in his own right.
The end of the page is a useful summary:
http://www.guidelines.co.uk/naps/pms
Ditto page 11: http://www.pms.org.uk/assets/files/guidelinesfinal60210.pdf
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Mmmmm interesting I was thinking of switching to seeing Nick Panay instead of Prof S...do you know what he's like or anyone who's seen him?x
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Have only ever heard good things about him, but have no personal experience. Have you tried a forum search of his name?
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Niamh, yes I feel exactly as you describe 'slightly knotted, anxious' which is very accurate. And I can't take any pleasure in anything at all, just feel flat and a bit hopeless inside. I can still function (well, exist) perfectly well, but I don't have that nice sense of wellbeing and optimism that I associate with more oestrogen.
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I have seen Dr Annie Evans she is lovely. I no ladies who have seen Proff Studd,Panay and Evans and all prefer Evans.
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Thanks I'd like to see Annie but Bristol is other side of the country sadly :( x
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Not sure where you are but she's also based in Devon/Cornwall area
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Surrey :( I contacted get office about a phone consultation but she only does follow up by phone might be able to do Bristol but it's a bit tricky. I'm emailing Dr Currie and then I'll see x
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I'm.sure I read somewhere that Annie Evans had a problematic menopause? So she's hopefully more sympathetic than Panay or Studd.
Personally, I know before this rollercoaster began for me I was rather dismissive of people with anxiety or depression. I honestly believed that if they really wanted to get better then they could 'think' themselves better. I can never, ever think like that again.
I am endlessly sympathetic to anyone suffering these peri symptoms now.
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Hi GLR when do you see Dr Annie, I'll be interested to see what she says as I think we are v similar. I think Prof Studd regime is really good and it's just getting the ostrogel bit right, so frustrating as its so close. When I feel good it's better than ive felt in years :) hoping Dr Currie can help a bit but I will email Studd too I just expect a brusque reply! X
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I see her at the start of March. Can't wait. If she can cure me then I will send her an enormous bouquet!
Also I have a new, really fantastic GP who is very sympathetic but unfortunately isn't very knowledgeable about HRT get, though she is reading up on it a lot as she has inherited lots of middle aged women from previous GP.
She actually listened to me and acknowledged that I knew my own body and symptoms best. She also recognised that some women simply cannot tolerate progesterone and that 'it can send them a bit psycho' (her words).
She was the one who started me on Femoston 1/10 nearly a month ago, as she said it was mainly well tolerated. I've only had 9-10 'good' days on it this month, so it hasn't really worked that well. And these last 10 days on the combined tablets I have felt very low again, with added anxiety, can't relax, no sense of well being etc. I am still functional but it's pretty miserable.
But I see her again this week and she hinted that I could increase to 2/10 if needed.
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It really sucks doesn't it! Sometimes I wonder if my expectations are too high and this is as good as it gets but surely not?!? I feel awful today im so confused. I'm emailing Dr Currie today and im seeing when Dr Annie is free I need someone to listen and answer my questions and help me through this there must be a solution. I feel close as the utro part is ok just keep getting these awful dips :(
I hope your appointment goes well keep me posted
I think ill try 3 pumps again after all surely Prof Studd knows what he's talking about....?!? X
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Niahm, just a thought - have you thought about separating the doses, one morning and one evening? It might make it a little easier to tolerate the 3 pumps over 24 hours?
GRL, have you finished the combined bit yet? It will be interesting to see if you feel better or worse when the prog is out of your system. With the higher dose, dont forget that the prog stays the same (I think?) so at least the prog to estrogen ration will be better? Did your new GP mention Qlaira at all? It's very like Femoston 2/10 in some ways, though you get a more frequent prog dose to avoid the ups and downs.
I agree with what you say about our expectations. I honestly thought I'd be totally back to normal once I took HRT/BCP. My only hope is that our problems are worse now because in peri, no two months are the same. Perhaps, as we head into full menopause, things will be more consistent (albeit consistently low!) .
B
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I tried as high as 5 pumps and didn't stop ovulation so I was so high it was not tolerable. My own hormones kept kicking in no matter what one I tried. I find high symptoms worse than low headache, sore breasts, anxiety and floods of tears. I hope you get answers but I have found relief going lower I am now on a low dose patch and getting treatment to suppress my ovaries not to ovulate x
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Hi Donna thats really interesting ive had a reply from Dr Currie and she has potentially suggested this, what treatment did you have to switch off your ovaries?
Interestingly from yesterday afternoon my mood lifted significantly and slept much better, it's like the 3 pumps is too high, I react to this and react to the drop back to 2, it stabilises after a day or two and I feel better, well that's my theory!
GLR this is Dr currie reply might help you too, btw im seeing Dr annie on 4th March at 11.30 if all this is ongoing im worried about trying 4 pumps as I react to 3 so sticking with 2 and if things still go very up and down Dr annie it is, I'm emailing Prof Studd too about it all!
Thank-you for your question and I am sorry that you are having these problems. This stage can be very difficult with changing hormone levels. At times the estrogen can be topping up hormone levels and at times suppressing. It can be so difficult to understand whether the stage is PMS or leading into perimenopause and it may require time to see how it evolves. PMS often worsened with the hormone fluctuations of the perimenopause.
To fully suppress the hormone ups and downs, you often need a high dose of estrogen, eg 4 pumps of gel or a 100 strength patch. It would be worth trying this. The beauty of using a gel is that you can adjust the dose easily.
The Utrogestan is to protect the womb lining from being stimulated by the estrogen (apologies if you know that already!). It does sound as though you have sensitivity to progesterone and so it is good that you feel OK when taking the Utrogestan. The usual dose for protection of the lining is 200mg taken for 14 days per 4 week cycle. It is likely that the lower dose has been recommended to minimise your exposure to it. If you have a regular bleed after taking it then it is being effective.
Therefore, overall, suggest trying higher dose of gel to provide steady estrogen levels. It is trial and error.
If this proves to be unhelpful, it is sometimes useful to take treatment to switch off the ovaries altogether --this leads to a temporary menopause but at least ensures stability and no hormone fluctuations. HRT can then be added back in in a medium dose, rather than needing high dose.
I hope this is helpful.
Best wishes
Heather
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Thanks for sharing that Niamh :)
It's true that it's all trial and error isn't it. I think even 'settled' ladies still have good and bad days, that's just life isn't it ;D
how about trying 3 pumps one day and 4 the next? remember I said that 100mcg was too much for me but 75mcg isn't quite enough?
I always think that it's great there are varying strengths of hrt but not QUITE enough. For instance, thyroxine comes in differing strengths doesn't it? And people are always having their dose adjusted :D
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That's great Niamh (ie sharing that answer) - I think we need to pin it up somewhere!
Nina - oestrogen patches and gel do actually come in as many doses that you want really - patches go from 25 mcg to 100 mcg and sometimes more than one patch can be used. Gel can be used from half a pump up to almost unlimited (within reason)!
There is no doubt that pretty well all of us feel great on our own oestrogen during our menstrual cycles around the time of ovulation when levels are mostly way higher than HRT. The most difficult thing is trying to find the right amount of exogenous oestrogen ( taken from the outside) that makes us feel good! It would be too much to replicate these levels (ie the high levels at ovulation peak) all the time as we only experience consistently really high levels (much higher than during our cycle) during pregnancy when our progesterone levels are also very high - so this is a particular scenario. HRT was originally designed to provide approximately the amount of oestrogen that is average over the whole cycle - ie not too low, not too high - so I read somewhere. The actual level at which this sweet spot is found also varies. Reproducing this by adding back a constant amount of oestrogen through the skin can only crudely approximate what happens naturally - especially when our whole endocrine system is very complicated with delicate feedback mechanisms etc - and is such a challenge!
Good luck to you all in working out what you need to feel better for most of the time :)
Hurdity x
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Thanks for sharing that Niamh. I see Dr Annie the day before you! Shame we'll miss each other.
I have always thought that trying to control our fluctuating hormones with HRT is like trying to pin the tail on the donkey, while riding in a dodgem. Totally shutting off your ovaries makes good sense because then your own fluctuations are totally removed from the equation.
But I think there's someone on here who tried this treatment and her low mood and anxiety were even worse, which worries me a lot.
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Hurdity..very happy for this to be shared :) also thank you for your lovely reply I always find your posts so helpful for keeping my expectations in check. You're right no perfect solution and after all we all had good and bad phases before all of this! For me I think 2 pumps is my best dose for now and I'll see what Annie says
GLR oh what a shame I hoped we could say hi to each other....we can share stories after though...agree about switching ovaries off 😳I reckon I'm very close to my best place for now ....I just would like a more supportive consultant through this journey and think Annie might suit me better from what I've heard. I'm sure she'll sort you out too. Im going to actually reduce my testosterone dose now as it came up quite high now in my blood tests and wobder if some of my moodiness, short temper is to do with that or could just be my 2 boys driving me nuts lol x
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Niahm Thanks so much for sharing this. I am sure it will help many people (and I am relieved to see I did advise you correctly re the number of pumps needed to suppress ovulation; I'd have hated to mislead you!).
Donna Your experience with 5 pumps is really interesting as I think I may be in a similar situation (taking patches equivalent to 4-5 pumps). The weird thing is, I was fine initially, but after about six to eight weeks, I seemed to have suddenly started having weird symptoms which I suspect are due to fluctuations (ie the 100mcg arent enough to control my own stubborn hormones). I have intermittent fatigue, light-headedness, pins and needles in my feet and just a general sense of 'oddness'. Today I noticed I was very emotional/anxious too, which I dont usually get to such an extent. What symptoms did you have when your high dose estrogen wasnt suppressing ovulation?
What have you now taken/had done to suppress ovualtion?
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I had the same experience was on 175 estradot and felt great for 8 weeks then it's been a spiral since then. I have the marina coil so don't have to worry about progesterone. I have been getting implants to shut off ovaries and have been having similar problems. I can be great for a few weeks then go haywire again. My consultant has been amazing and he is nhs. Two weeks ago I started using a nasal spray instead of implant. The only problem is it initially increases estrogen before shutting down which usually takes two weeks. I have had no hrt for 5 days now and waiting to go low before restarting patches at a low dose. I am only 43 and it has been 5 years so I need hrt as osteoporosis also runs in the family. I think in the beginning I got relief as I needed the estrogen then I had mistaken the symptoms of high estrogen for low and we kept increasing doses. I can now feel the difference between the two. Good luck x
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Donna can you tolerate progesterone ok? Thanks for sharing this its really interesting. X
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I had premerin right at the beginning and another conti that didn't work then been on the marina since then. I've not had any trouble with it but I only stopped bleeding a few months ago but I believe this was because my estrogen was too high x