Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Gilla999 on March 12, 2021, 06:26:59 AM
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I thought I'd post this in a new thread. After 3 months on the contraceptive Pill Zoely for Perimenopause cyclical debilitating insomnia and night sweats I am suspecting that my own hormones have not been fully suppressed, as I am still experiencing cyclical insomnia, night sweats (though they have improved somewhat) and cramps in the mornings during these episodes which are 4 weeks apart.
I have no idea where to turn or what the next step is. I've read that if the cycle is not being fully suppressed you need to increase the Progestin? But have heard others talking about topping up with Estrogen HRT.
I know it's a long shot as most people here are on HRT but does anyone have any experience with this? xx
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Hi Gilla999,
I was put back on a low dose combined pill 20mg that worked previously but unfortunately now that my hormones are fluctuating, I think late peri the pill didn’t work this time and we tried adding extra Estrogen but it didn’t work, apparently the pill can affect the natural Estrogen, not sure if it does. I have stopped taking the pill and now just on the hrt and hoping I can get it to work because I’m still very ill like you with awful symptoms, I don’t sleep any night without help so I’m desperate to find a solution. It may work for you though as we are all so different.
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Thanks for the reply Floo - sounds like you're going through exactly the same thing as me - it is so awful. How long have you been taking the HRT for and what dose are you on? I think I'm going to try switching from Zoely to Qlaira and see if I get any joy from that as a first step. If not then perhaps I need to think about giving HRT another go and sticking with it... x
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Hi,
I only stopped the pill 10 days ago so early days. On 5 sprays Lenzetto at the moment as we think I don’t absorb it well but waiting to see if stopping the pill makes a difference to the absorption. I didn’t absorb gel well if at all. I may do a blood test in a couple of weeks to work out if I’m absorbing but it’s difficult to know when your hormones are fluctuating so much. Just hoping peri he’ll ends soon, it’s been 9 years but the last 2 from hell. Have you tried the higher dose combined pills?
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Good luck with the spray, I really hope it helps you.
Which kind of pills do you mean by the high dose ones - things like Microgynon? X
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Yes, the usual combined pill with synthetic estrogen, they are high dose compared to HRT but in my experience your own hormones are still declining and fluctuating so you still get symptoms breaking through which i have found out. Good luck I hope you find a solution soon. It should be better on the other side I'm told.
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I was on Ovranette for years to correct hormone imbalances and I always felt it didn't suppress my cycle fully. I would get cramping, bloating etc on a monthly basis. My GP was just 'that's your imagination - the pill suppresses your natural cycle so it's impossible for you to be feeling these things'. But it wasn't as though I was expecting them to happen - I'd be wondering why on earth I had these cramps and why I couldn't do my jeans up and I was bulging out of my bra...and then I'd look at the calendar and realise I'd been the same a month previously...
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Hi Gilla999,
The estradiol (hemihydrate of valerate) in Qliara, Zoely or HRT will not surpress your cycle, it adds to your own hormones. It's just not potent enough. According to Nick Panay you'll need 30 mg of estradiol to surpress your cycle. For some the topping up is enough, for others not so much.
Birth control pills which contain ethinylestradiol, a synthetic estrogen, and a progestin are more potent and can surpress your cycle. If they work properly.
Every progestin has it's own properties; some are more potent then others, some are more androgenic then others of have other properties like antimineralocorticoid and glucocorticoid activity. If you search the name of the progestin on Wiki you can see the differences.
Progestins do matter and they can give side-effects or benefits on their own.
It's confusing that both Qliara and Zoely are also named contraceptives when they are so different from synthetic birth control pills.
It's trail and error I'm afraid.
Alicess X
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Thanks Alice - now I'm totally confused :-\ I read that the estrogen in Zoely is the equivalent of 50mcg of the synthetic estrogen and that if your cycle isn't being suppressed it's the progestin that needs to be increased, not the estrogen?
Admittedly this information I've pieced together myself off the internet because (a) I'm desperate and (b) I'm getting no help at all from GPs or the like. I even paid to see a menopause specialist who flat out told me there's nothing wrong with my hormones, despite all of my symptoms happening cyclically, always.
This is what I found:
- "... 0.625 mg conjugated estrogen is equivalent to 1 mg estradiol, 0.05 mg ethinyl estradiol, or 1 mg 17B estradiol
- "It may be due to the particular pill being insufficiently strong to consistently suppress ovarian function. In this case, changing to a BCP with a stronger progestin and a longer half life should resolve the problem."
Did you speak to Nick Panay yourself? I would fork out the money if I thought it would be worth it!
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Surpressing ovulation isn't enough to surpress the fluctuations, you still need sufficient estrogen. On top of that progestins are anti-estrogenic.
The right progestin can make a difference though.
Synthetic BCP's contain 0,030 mg of ethinylestradiol, your information about 0,050 mg being equivalent to 1 mg estradiol is simply not true.
Where did you find this information?
https://en.m.wikipedia.org/wiki/Ethinylestradiol read chapter Pharmacodynamics
https://en.m.wikipedia.org/wiki/Pharmacokinetics_of_estradiol
I didn't speak to Nick Panay myself unfortunately. I understand you are desperate but don't let doctors, GP's and so called specialists discourage you.
Alicess
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Alice, thanks so much for the links. The link to where I saw the equivalent is here:
https://www.medscape.com/viewarticle/413884
I couldn't work out the Estrogen equivalents from your Wikipedia link - it's all so complex! If you need at least 30mg Estriadol to suppress your cycle fully, I'm trying to work out what that equivalent of synthetic Estrogen is so that I can choose another contraceptive Pill to try - I ideally want to start this weekend. I had been planning to switch to Qlaira today as I have a prescription but it sounds from what you're saying like that's not going to help me either?
I really appreciate your help x
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Read the chapter about Pharmacodynamics at Wiki Ethinylestradiol. Sorry, I'm pressed for time otherwise I would explain it myself.
I think Qliara can cause more upheaval because it contains different doses of estradiol and progestin
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Gilla. I feel your pain. Many a time over the last 3 years I've been down the rabbit hole of desperate Google searching. I don't think I'm ever any further forward...
Firstly. If you can, step back. I know you feel desperate, but only a week or so ago you told me things were going well. Could you manage through this blip every 4 weeks??? If the in between times are better???
You know I've tried many combined pills over the last 12 months and had a bad time on all of them. They just don't seem to suit me anymore.
Although, I do admit, I had read about suppression before moving to microgynon and it is the reason I stuck with artificial estrogen and at 30mg. I am still hopeful.
The only other thing I can say is I was on cerazette (mini pill) for years. Its the one that has sufficient progesterone to suppress ovulation. It stopped my ovulation and periods. When I tried it to sort this jess out, it stopped ovulation and periods, but boy I could feel my own cycle going up and down badly in the back ground. I guess we're just in such an unstable phase that we feel all that.
If you do switch, I'd go for a 30mg estrogen pill. I tried 20mg but it meant the progesterone affects are stronger as they never reduce the progesterone (prob because that's needed to stop ovulation}.
Xx
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Maybe you had a better night???
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Crispy thanks so much, I have also been trying to remind myself that not so long ago I was saying things were much better. But the last few days have been SO bad that I just can't go through this every month - I've had to take another week off work. The cramps I've been getting at the same time as it happens really makes me think that my own hormones are still going on in the background, though I am also very aware of the desire to want to find a reason and fix it. And I am sure there is also a psychological element to it now that it's become A Thing.
The Google rabbit hole is so accurate and I hate doing it this way, but it is purely because I've felt like GPs have been no help whatsoever.
Funnily enough I have thought about you over the last couple of days and whether I should join the Microgynon rage crew ;D I chose Zoely specifically because of the natural Estrogen and therefore the lack of side effects, but I had no idea it wasn't as potent as the synthetic Estrogen and what that might mean. I have managed to get an appointment with a GP later this afternoon who specialises in female health and I'll ask her advice on which to switch to but I agree that I'm definitely going to go for something along the Microgynon lines.
How have you been feeling the last few days? Is there a reason that you chose a Pill with one of the second generation Progestins rather than newer ones? Or did you just go for it as you've been on it before? xx
Thanks Alice also for your help, I wouldn't have had a clue about the potency without it!
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Gilla, remind me, are u taking any breaks at all or straight through from say 1 on zoley.
Yes, I agree if you are having to take time off then it can't go on. I just wonder if u should wait it out one more cycle, just to see? I've chopped and changed for the last year, and it's never been easy. ???
How was your appointment??? I so share your frustration. I've had appointment at meno clinic and they just say try all the pills or ring or patch. My gp suggested I try the best of the bad bunch.
So I started my combined pill journey 14 months ago. I started on gederal (marvelon). Same prog as the mini pill so assumed I'd be fine, but it gave me severe migraines. Thd lower estrogen dose (20mg) didn't make me feel good. So I tried microgynon avd was left grumpy abc aggitated, so stopped after 6 weeks. Then I tried millinette. Dud the full 3 months, but never felt well and felt so much better the day I stopped.
So, the newer prog don't seem to work for me - my hunch is they don't balance the estrogen enough and I get poisoned. I have also dappled with the patch, but I felt poisoned straight away with that. So that's why I'm back on microgynon (my best of a bad bunch). Its also meant to be one of the safest - a good thing at our age. I pushed for microgynon itself, I ding want geverics.
So that's me 8 weeks in. I would say the rage has calmed (fingers crossed). I'm still very aggitated and a bit narky, but defo not as ragey. I've been feeling quite tired, achy and heady the last week. But, as you know, I'm not sure if thst was my covid jab or not.
But whatever my symptoms, they don't seem cyclical, si that might be a good sign?!?!. Although they're more constant 🙈
I really hope you got some decent advice...
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I've been going straight through on Zoely, haven't had any breaks!
Funnily enough in searching the site for something earlier I came up with some of your posts from quite a while ago and thought to myself what a long journey you've been on - it must have been bloody awful.
Thanks for the info Crispy, this is all really useful. I know everyone is different but it's really helpful to hear other's experiences of different Pills. I've decided to go for Yasmin - for now. I collect it tomorrow morning and will start it then. I chose it just because of the strength of Estrogen, being an estrogen dominant pill, plus having a less androgenic Progestin. I remember taking it years ago and stopping after a couple of weeks due to side effects but all things are relative - side effects then compared to what I go through every four weeks now would be preferable! I was thinking if I really don't get on with Yasmin then I'll try Marvelon. Unlike you I don't tend to have problems with the Estrogen in things (except for the crazy boobs) it's the Progesterones I struggle with (raaaaaage!)
I'm so glad to hear your rage has evened out a bit - I know it's easy to say but you're still in a relatively early stage of taking it so I am absolutely sure things that are side effects will continue to get better as your body adjusts to it. (I may need to remind myself of this when I'm going through side effect Yasmin hell and wondering how it's "only" been 8 weeks.)
Trying not to feel like I'm back at square one and think it's all positive steps...
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Great, I'm glad to hear you have a way forward. Was the doctor of any use??? Shed any light on what might be going on??? And the differences between the different pills?
I don't think I've ever been on yasmin. Yes, grit your teeth and try and get through any side affects. I've been so determined to do that this time.
Yes, I've been on an immense journey, but my hrt trial was horrific, so I'm assuming my own estrogen still very high at times (although defo low at others!)
Funnily enough I was on gederal (marvelon) only 4 years ago, but they took me off it because I got migraines in the pill free week. Gp so desperate now, that they don't care about that as I won't be taking breaks, but now gederal doesn't suit me only 4 years later... I loved it 4 years ago. So crazy. I suppose it might have evened out but the migraines last year were soooo bad and so frequent thst I couldn't stay on any longer. I also remember intense boob pain. They were agony. I've got slight pain on and off with micro, bug nothing really.
Interestingly on no pills at all from Sept to Dec, I got frequent migraines. Not one since starting micro... Woo hoo. Every cloud.
When are you going to start???? X
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The GP was pretty useless! Not as bad as some, but I've never spoken to anyone who has had an in depth knowledge of the different Pills etc. I asked her what she thought about Yasmin as a starting place and she said ok. She didn't have a clue about which Pills would be more likely to suppress hormones vs others. I have managed to get on the waiting list for a gynae lady near to me so hopefully will be seeing her around mid April.
That's interesting that a Pill doesn't suit you now when it did four years ago, I wonder if it was to do with differing levels of your own hormones? I find it soooo frustrating that we are left second guessing things all the time, there should be a way of easily measuring our own hormone levels all the time so we can correlate symptoms etc instead of blindly trying to work it all out! Boob pain is classic Estrogen dominance so it would make sense you don't have it as much on Microgynon which is a prog dominant pill. I'm sure I'll get the boob pain back with Yasmin but hopefully it will subside in a couple of months. I start taking it this morning! It is such a shame that Zoely didn't work out as apart from the digestion issues it really was pretty much symptom free - if I was in my 20s or 30s and not in perimenopause hell I would definitely recommend it
Thanks again for all the support Crispy, honestly without this forum I don't know what I'd have done!
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I totally agree, it is impossible to find someone with expert knowledge on how these artificial pills help/hinder us. Even the meno clinic just told me to keep trying different ones before hrt?!?
So, good luck with yasmin. Fingers crossed for you. Hopefully you'll get an easier ride of it as you already have some extra hormones in your system trying to suppress.
I do think for the most part, most of the 30mg estrogen pills I've tried suppress my system significantly. I think what I end up with is side affects... But, given that never used to happen, maybe it is actually that my own are not suppressed and it is indeed the double dose that causes me issues. Who knows...
Microgynon does seem to be the best of a bad bunch for me. It certainly gives me less physical symtoms in terms of migraines, nausea etc... But the prog is harsh and is still affecting my mood and the way I feel. Today however, I think I can say that my miserable state this past week was due to covid vaccine side affects... So I'm really pleased about that.
Will keep plodding on and see where I go...
Keep updating. Good luck xx