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[AG]

Hi All,

I have found this forum very useful for helping with making sense of peri menopause symptoms in particular. I have essentially since the beginning of this year had batches of fairly severe symptoms, which have at times improved but been replaced by yet other symptoms. I am 48 and this year have had only 3 irregular periods. Currently, a near 3 months gap again, and I am inclined to wait to "clock up" a 12 months gap to then go on continuous HRT if symptoms persist as I have had issues with low iron levels and the one benefit I do have right now is reasonably iron levels.
A hormone check a few months ago (although somewhat unreliable due to hormone fluctuations) at beginning of a period showed oestrogen below 20 and FSH above 32 units. Current more troublesome symptoms are more hot flashes (probably partly due to hot weather recently), some heavy and floppy feeling in limbs, balance problems at times, ring tone in ear, some nausea but that has receeded with a low dose of magnesium. Mild headaches and other bits and pieces just enough to be annoying. I am reluctant to try sequential HRT due to blood loss and rather try continuous HRT but for that I would have to wait another 9 months (at least). If symptoms tend to get milder towards end of peri menopause I could cope with not going on HRT (or then going on continuoues HRT). What are your experiences or recommendations? Anna
 
 

[Dotty]

Your periods could carry on for years so it's hard to say when you would be able to start continuous hrt. X

[Hurdity]

Hi AG

Since some bleeding is to be expected in the first few months of continuous combined HRT, then a good option for you would be the Mirena coil - this is designed eventually to be no-bleed even with women in peri-menopause ( depending on your own hormones of course). The advantage also is that less of the progestogen is absorbed systemically than some of the tablet HRT types anyway. Then you could start on a low dose oestrogen ( patch or gel - not tablet if you get nausea) and see how you get on - so after the settling in period of time (when you might get a bit of bleeeding) - this could do the trick. Over the following few weeks and months you could gradually increase your dose to one that eliminates the hot flushes (are you in US btw as you mention "flashes"?) and hopefully many of your other symptoms.

I presume you make sure your diet is rich in iron and have been taking a supplement? You can always take the occasional dose eg weekly if you get a bleed which is what I do ( Floradix herbal iron tonic once a week or so).

Hurdity x

[Dancinggirl]

I agree with Hurdity entirely - the Mirena would be your best non bleed option.  Why are you worried about using sequential HRT?  The withdrawal bleed shouldn't be too heavy and I doubt it would cause anaemia. Many women choose to be on a sequential HRT, well into post menopause, because being on a conti HRT can give more side effects and can bring erratic bleeding.
My best HRT regime( having tried just about everything)  was Mirena with Oestrogel.  DG x

[AG]

Hi,

Many thanks for your replies, very helpful. This is worth keeping in mind, I was not aware of the Mirena coil option, and potentially if sequential HRT does not usually give too much blood loss that may also work. For now I am planning to wait until later this year but if symptoms persist as they have go on some form of HRT in a few months. I have previously taken iron tablets (besides an iron rich diet) but tablets seem to cause lots of digestive issues. I cut down on caffeine a lot which helps with hot flushes (I am not from US but originally from Continental Europe) and some magnesium is useful as well. Anna

[AG]

Hi all,

Thanks again for all your replies. I am now also considering sequential HRT and am planning to go back to GP in the next weeks or so to discuss options, and possibly a referral to a specalist clinic as well. One thing I did notice when I took oral contraceptive pill for a few weeks more than 25 years ago is that I reacted very strongly to the hormones and had to stop taking it. Maybe more recent such pills are better but I suspect I may need a low dose sequential HRT to start with, possibly as patches rather than tablets. For patches I found EVOREL SEQUI and FEMSEVEN SEQUI listed under "Treatments", but both are on the "medium" scale. I am keen to start with a very low dose as I seem to react strongly to hormones and their fluctuations in particular. Mirena is an option potentially but having thought about it I may rather try something that can be removed/omitted quickly if it makes things worse rather than better.
Are there any non HRT options to treat hormone fluctuations that have worked for anyone? I may even be mostly "fine" with low oestrogen etc as I think it is the fluctuations that really trouble causing "phantom period" PMS pretty much most of the time. Nearly 3 months since last period and keep feeling that period is imminent but have been like this for months.

Thanks for any replies, Anna

[SueLW]

Low oestrogen levels are horrible.  And if you let your body wear down to low levels it will take a lot longer and cause more problems trying to bring them back up.  I speak from a current position of experience on this!

The birth control pill has very much higher levels of hormones in it (to stop ovulation) than any HRT, so you are not comparing apples with apples by thinking back to your reaction to the pill. 

During peri you need an HRT that will iron out the fluctuations a bit.  Some of those fluctuations can be big.  So by all means ask to start on a low dose, but you might need to move to a medium dose to get those flushes under control.  However, try it and see. 

I had a Mirena for birth control and apart from feeling sad and bloated for a couple of months at the start (with spotting) it settled down and didn't give me a moments trouble from then on. 

[AG]

Hi,

Many thanks for your reply. I was not aware of the different levels of hormones between BC pill and HRT, so I may very well be fine on a low to medium dose of a suitable HRT. Anna