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[Smurph]

Hi gals, I’ve posted before and read through a load of posts. This place is amazing!! I would really appreciate a bit of advice please 🙏🏼

I’m 46 and my symptoms pre HRT were joint pain, anxiety, feeling tense all of the time, brain fog, the odd night sweat, low mood - menopause specialist suspected PMDD - I used to be in a terrible state for 2 weeks leading up to my period but that seemed to lengthen to most of the time! Specialist prescribed Desogestrel POP to stop the fluctuations which made me feel practically suicidal, so off to the docs I went (couldn’t afford another private app) and I’ve been on Everol 25 patches and cyclical Utrogestan since early June. Immediately felt strange when I stuck my first patch on and it hasn’t got any better really - the anxiety and joint pain have reduced a bit but i feel very spaced out, whoozy, vision a bit weird like it takes me longer to focus, very dry eyes, so much so that I have to practically prise them open when I wake up, sinuses hurt, headaches. Mood is generally low still but have noticed I feel better when in the Utrogestan phase, although do feel a bit tired initially. Last 2 periods have been very very heavy - changing Super Tampax every 1-2 hours and just feeling wrecked.

My question is, should I try a different patch rather than Everol if there are any? Or could I be overloading myself with Estrogen in general when I don’t really need it, hence feeling better in the Progesterone phase? My cycles had been a bit irregular in recent years ranging from 26 - 32 days. I’m just unsure whether I should be giving the Everol patches more time but it just doesn’t seem to be getting any better and I honestly feel like taking it off and just using Utrogestan continuosly but I think the doc won’t agree! Thanks in advance ladies xx

[ATB]

It can sometimes feel like things are worse initially as your body adjusts to the rise in estrogen. I wouldn’t change anything so soon, it’s only been 8 weeks? Give it another month before tweaking anything. It’s usually 12 weeks at one dose before assessing. You are on a low dose so you aren’t flooding your body with estrogen, it’s the fluctuations and changes our body reacts to most in my experience. If over 45 they diagnose and treat peri menopause based on symptoms, which you definitely had. I know it’s hard but give it a bit more time, it gets better.

[joziel]

Hi!

If you are bleeding heavily and feeling tired, it is very likely you are low in iron. This in itself can cause all kinds of weird symptoms which are similar to peri-menopause symptoms often, so it's important to find out if you are low in iron and to supplement if you are. You can ask your doctor or do a finger **** blood test via Medichecks for ferritin levels - it will say it is normal if it's over even 10, but really 60+ is best to aim for. If your doctor tests, be sure they don't just test haemoglobin - because that just tells you the iron levels in the blood. Ferritin is more indicative of the stored iron level, so ask if they can do that as well.

I highly highly (in your case extra highly) recommend you get a copy of Lara Briden's book 'Hormone Repair Manual' (for women over 40). Because she is really into using only body identical progesterone to begin with (ie not estrogen as well), especially early in peri. I can't give you links here but if you google 'Lara Briden blog cyclic progesterone' you should get up the blog posts and then read around the blog, and click other links there etc.

Basically, the first thing that happens in peri-menopause is that we lose progesterone - almost entirely. Estrogen fluctuates, sometimes very high, sometimes low. If you were 'in a terrible state' in the 2 weeks leading up to a period (which is your luteal phase, when progesterone should be high), it is likely you were experiencing that common low progesterone peri state. That is especially the case since you now feel good when taking your progesterone. She talks about using body identical progesterone during peri-menopause to support that luteal phase in the last 2 weeks. (This isn't commonly done in the UK, to use the utrogestan without also estrogen, by the way - I really think it should be - I am discovering that utrogestan is (so far) keeping my endo under control at 200mg continuously. I would far rather take body identical utrogestan to achieve this than synthetic progestins like desogestrel, which I was previously on - and which I now blame for the low estrogen state and my current situation! Utrogestan should be known to be a valid alternative for endo, not just synthetic progestins.)

If you are not sure whether you need the estrogen patch and whether your symptoms now are due to too much estrogen, you could ask your doctor to check your estrogen levels (which they might not agree to do, as you are peri and they should be treating on symptoms alone) - or you could do again a Medichecks finger **** home blood test. I just did this, terrified my levels were going to be incredibly low because they were low already on the 50 patch and I'd only reduced to 37.5 due to estrogen side effects - and my levels were 453, which is a very decent level. That made me realise that I've been having too much estrogen (I was on a 75 patch at one point!!) and no wonder I had all these high estrogen side effects. I am now very happy to be only on a 25 patch. I believe it was because I've been on desogestrel for 9 years prior to HRT and it just took my ovaries a while to wake up and get making decent amounts of estrogen again after having been suppressed for so long. So a blood test can be really useful as being just PART of the picture of figuring out what's going on.

[Smurph]

It can sometimes feel like things are worse initially as your body adjusts to the rise in estrogen. I wouldn’t change anything so soon, it’s only been 8 weeks? Give it another month before tweaking anything. It’s usually 12 weeks at one dose before assessing. You are on a low dose so you aren’t flooding your body with estrogen, it’s the fluctuations and changes our body reacts to most in my experience. If over 45 they diagnose and treat peri menopause based on symptoms, which you definitely had. I know it’s hard but give it a bit more time, it gets better.

Thank you ATB, I have a review with the doctor at the end of this month so I’ll see how I am then. I just feel so dazed as if I’m in a dream and not really present and I don’t know what the alternative to Everol would be if it’s just that it doesn’t agree with me. I’d really like to stay on Utrogestan but is there another option for a patch rather than Everol? xx

[Smurph]

When I've seen a private specialist for other problems, I've been left with a secretary's phone number. In your situation I would phone up and tell them the desogestrel was like a sledgehammer to crack a nut, would the secretary find out what alternative the specialist would try next and phone you back (as part of the service you already paid for, if something doesn't work, you go back to the shop)?
I'm surprised she only suggested one possibility to try. What is PMDD? I'd guess at pre menstrual depressive disorder?

If phoning isn't an option then I'd go for trial and error and adjust my own meds until a professional is available to do it for you. If you get better then you have gathered useful information, if you get worse camp out at the doctor's and don't leave until they see you.

I've camped in the doctor's twice in my life, once when I was pregnant and they wanted to close for the christmas holidays without giving me the results of my rubella test. Despite having had his MMR my son was diagnosed with rubella while I was 2 months pregnant with his little brother and the receptionist couldn't have cared less the worry she was causing by not giving me my own test results. The centre had closed and the cleaners were in before they finally told me I was in the clear and wouldn't have to spend the entire holidays worrying about whether to continue the pregnancy.

Sometimes you just have to dig your heels in and stop being polite about it and when you are suffering depression it can be so difficult to find the self worth to care for yourself, never mind insist others care for you as well.

Btw, I presented with almost identical symptoms age 48 and was given sertraline for depression and bisopralol for palpatations, noone thought of menopause because my periods were still normal at the time except for being very very heavy. For my periods I got tranexamic acid and iron tablets, but I was still completely wiped out every month. Sertraline worked well enough for a year, then I switched to prozac because I get 24 hour cover from prozac while sertraline effects fade too much before the next tablet is due.

PS Why do you have to take estrogen at all? If you take estrogen they insist you take progesterone for uterine protection, but not the other way around.

Hi! Thanks so much for the reply and sorry you’ve had to fight for the right treatment 

I did call the specialist when I felt awful on Desogestrel but they told me I had to just keep taking it and wait for it to settle down. I really couldn’t do that. I couldn’t function! In my initial consultation she said she wanted to stop my cycle for a few months with Desogestrel and then add Femoston Conti. It was like talking to a brick wall when I called them and they said I’d have to book another video call with the specialist which would have been another £300! That’s when I went to my doctor and she said she’d have treated me differently and then gave me Everol and Utrogestan.

Yes PMDD is a severe form of PMS. It’s bloody awful! Only had a week or so once my period was almost finished of feeling ‘normal’.

I’ve taken antidepressants for a long time - first citalopram and when that stopped working I switched to Sertraline which has definitely helped a bit with anxiety and confidence but I guess there’s only so much they can do vs the dreaded hormones.

This is what I’m wondering - do I really need the Estrogen? I wasn’t having hot flushes but I was having night sweats and anxiety etc. Ironically forgot to mention terrible memory problems!! I don’t know if that is lack of Estrogen or progesterone. So confused!! Xx

[Smurph]

Hi!

If you are bleeding heavily and feeling tired, it is very likely you are low in iron. This in itself can cause all kinds of weird symptoms which are similar to peri-menopause symptoms often, so it's important to find out if you are low in iron and to supplement if you are. You can ask your doctor or do a finger **** blood test via Medichecks for ferritin levels - it will say it is normal if it's over even 10, but really 60+ is best to aim for. If your doctor tests, be sure they don't just test haemoglobin - because that just tells you the iron levels in the blood. Ferritin is more indicative of the stored iron level, so ask if they can do that as well.

I highly highly (in your case extra highly) recommend you get a copy of Lara Briden's book 'Hormone Repair Manual' (for women over 40). Because she is really into using only body identical progesterone to begin with (ie not estrogen as well), especially early in peri. I can't give you links here but if you google 'Lara Briden blog cyclic progesterone' you should get up the blog posts and then read around the blog, and click other links there etc.

Basically, the first thing that happens in peri-menopause is that we lose progesterone - almost entirely. Estrogen fluctuates, sometimes very high, sometimes low. If you were 'in a terrible state' in the 2 weeks leading up to a period (which is your luteal phase, when progesterone should be high), it is likely you were experiencing that common low progesterone peri state. That is especially the case since you now feel good when taking your progesterone. She talks about using body identical progesterone during peri-menopause to support that luteal phase in the last 2 weeks. (This isn't commonly done in the UK, to use the utrogestan without also estrogen, by the way - I really think it should be - I am discovering that utrogestan is (so far) keeping my endo under control at 200mg continuously. I would far rather take body identical utrogestan to achieve this than synthetic progestins like desogestrel, which I was previously on - and which I now blame for the low estrogen state and my current situation! Utrogestan should be known to be a valid alternative for endo, not just synthetic progestins.)

If you are not sure whether you need the estrogen patch and whether your symptoms now are due to too much estrogen, you could ask your doctor to check your estrogen levels (which they might not agree to do, as you are peri and they should be treating on symptoms alone) - or you could do again a Medichecks finger **** home blood test. I just did this, terrified my levels were going to be incredibly low because they were low already on the 50 patch and I'd only reduced to 37.5 due to estrogen side effects - and my levels were 453, which is a very decent level. That made me realise that I've been having too much estrogen (I was on a 75 patch at one point!!) and no wonder I had all these high estrogen side effects. I am now very happy to be only on a 25 patch. I believe it was because I've been on desogestrel for 9 years prior to HRT and it just took my ovaries a while to wake up and get making decent amounts of estrogen again after having been suppressed for so long. So a blood test can be really useful as being just PART of the picture of figuring out what's going on.

Oh Joziel, I remember your posts about the horrendous palpitations yes! Same thing happened to me when I stuck another patch on thinking I needed more! Awful.

You’re a star, I am going to order that book today. This is exactly what I’ve been thinking for a while now - if I feel better on Utrogestan than Everol alone then surely it’s a no brainer, but then I read conflicting things about you actually needing more Estrogen in Peri, then I just get confused again.

I’m very tempted to do those tests, does it take long to get the results? I’m just wondering if I’d be able to get them before my review with the doc at the end of August. My doc is good but she’s very insistent sometimes and I feel so flat and pathetic at the moment so it’s hard to get my point across. I get myself all mixed up when trying to explain things and sound a bit mad a lot of the time  My mind jumps from one thing to another and I don’t even know what I’m saying! Makes being a Manager at work that little bit more stressful to say the least!

I do take an iron supplement but it may not be enough. I’ve had these symptoms tho since I put the first patch on and that was a week or so before my first heavy period so it must be the patch?! Did you feel spaced out too as well as palpitations? I just feel like I’m not with it and my vision is blurred. I’m so tempted to just take this patch off and down my Utrogestan but then will I get withdrawal side effects? And then what if the doc tells me off? Haha I sound ridiculous I know! xx

[joziel]

Smurph, everyone is different. And everyone has a different history as well, to consider. If estrogen is fluctuating loads, then adding in a stable steady dose of it can really help (as long as you don't go too high and also happen to be sensitive to estrogen, as happened to me  )  If you want to use progesterone only, you might have to accept both and then use just progesterone. Until you feel you also need the estrogen.

It doesn't take long at all to get the results. Especially if you click the option not to have the doctor's input/interpretation and just to get the result itself. It took 24 or 48hrs from when it arrived at the lab for me to get the result. You could definitely do it before the end of August, but whether your doctor would accept the results or poo poo the finger **** approach, I'm not sure. But it might at least persuade them to do a venous blood test on you, if they try to poo poo it.

Have you thought of taking notes to your doctor's appointment if you feel like you're not getting things across? I get really stressed too because I feel like there is huge pressure to accurately convey everything in a short amount of time - and my health depends on my ability to do that(!). So I find it helps to make some bullet points on a piece of paper before I go in, to be sure I've said everything.

I don't feel at all spaced out or vision blurred or anything like that. Even with too high estrogen, that was never a symptom. Could it be some kind of migraine? That can be affected by estrogen changes. If you keep having bleeding or heavy period problems, it might be worth considering the Mirena coil. Which should stop all the bleeding within 6 months and provide you with progesterone for HRT for 5 years. However, that isn't going to give you the systemic progesterone you are feeling better on (the body identical one) and an NHS doctor might refuse to give you utrogestan if you have a coil fitted because they may not agree there's a reason for it. I'm sure a private menopause GP would if you ask for it, though... I find Lara Briden really interesting because she explains all the benefits of body identical progesterone - I think it tends to be seen as just a way to thin the uterus and no use or health benefits beyond that. Whereas she explains all the other benefits...

If you have enough estrogen of your own and you don't need the patch, you won't get withdrawal effects from taking it off. If you do get withdrawal effects which last, it's a sign that you did need it after all. 

[Smurph]

Thank you Joziel, what did you mean by ‘accept both?’ Do you mean from the doctor but only use the progesterone until I need the Estrogen?

I had a look at the test on Medicheck and there is an option to go into a store and have a venous blood test so I might do that. Then maybe the doc will be more likely to accept the result. Do you think I could just take it upon myself to start taking utrogestan continuously and then tell the doc when I see her? I’m due to start it again on Monday anyway.

I’ve never had a migraine as far as I’m aware. I always imagine them as crushing headache/pain but maybe it is a kind of migraine  It feels like a mild headache but with pressure in my face and forehead, sore, dry eyes, eyes hurt a bit when I move them.    Feel a bit like I have blinkers on! Just weird. Is it possible to have a reaction to the Everol but be ok on the gel do you think?

I’m sorry for all the questions, you have been so helpful so thank you so much. Maybe someone else might see this who has also felt weird on Everol. It’s so hard to know what to do for the best. Ordered that book so thanks for the tip! Xx

[joziel]

Yes, you can just get the Medichecks thing done in a store and they will hopefully accept that more than the finger **** test.

No, even if you decide to use only the utrogestan, you don't want to use it continuously if you are getting any reasonable amount of bleeding happening - or you will get problematic constant breakthrough bleeding. The idea is to support your natural cycle, by providing the missing hormone (progesterone) not to over-ride it. So even if you don't use estrogen, you would use only the progesterone for the last half of your cycle. How to use it, is covered in Lara Briden's book and blogs and it's a bit too involved to get into here and I wouldn't suggest doing it without researching all that and reading her book - since you need to time the utrogestan to fit with your own periods.

Migraines don't necessarily have to involve headache. Some people get only visual migraines, where they get weird floaters and things appearing. Describe all that to your GP and ask if they think it could be migraine. Changes in hormones can bring on migraines. They did for me, caused by low estrogen...

It is possible you're reacting to one of the additives or adhesives in the patch but if it's the estrogen itself, it's going to be the same whatever you use.

[Smurph]

Thanks Joziel. Sounds like I’m best sticking with what I’m doing at the moment and Utrogestan cyclically. I did think that you could take Utrogestan and Everol continuously if you suffered with PMDD and withdrawal side effects after Utrogestan stage is over, but it be obviously got a bit mixed up. Not for the first time!  Xx

[joziel]

You can, but if you are very definitely peri, you might get a lot of breakthrough bleeding - unless you get the coil fitted, which is an option. (And then also take the utrogestan - if your GP will prescribe once you are on the coil.)

[Smurph]

Ahhh right, that makes sense. Maybe I could take it continuously (kind of) alongside Everol but have a short break rather than everyday so that I do have a scheduled bleed. I wondered if it was the Estrogen dominance giving me the heavy periods. They were never this heavy pre HRT. I really don’t fancy the coil. I have a wonky cervix so I fear it could be troublesome! 

[Hurdity]

Hi Smurph

Sorry to hear about your menopause woes....

First of all I would suggest you read this article from this website which talks about fluctusting hormones during menopause:
https://www.menopausematters.co.uk/magazine/pdf/Article%20-%20Perils%20of%20the%20Perimenopause.pdf

Second - if your periods are pretty regular then have you considered using one of the combined pills which menopause specialists prescribe to women in your position? These tablets contain oestrogen (which is bio-identical)  that is the same as in HRT and our bodies produce, but also (albeit synthetic) progesterone. The main thing is that they regulate the cycle but are not harsh like the pills which contain very strong synthetic oestrogen, and of course the POP don't contain any oestrogen  - and in fact desogestrel (as far as I recall) reduced oestrogen - not ideal as you approach menopause.

The two tablet types are QLAIRA  and ZOELY. Qlaira is discussed here: https://www.menopausematters.co.uk/contra2.php

As for adding progesterone, to my knowledge we only produce progesterone  in LARGE quantities to support pregnancy, and the increased progesterone begins in the second part of the menstrual cycle. We produce smaller quantities all the time and this is unaffected by menopause (as far as I understand).

And yes current thinking is that we only need it in larger quantities if taking HRT, to protect the uterus, because large quantities of oestrogen will cause the lining to thicken.

And yes if periods are regular and very heavy or only the occasional one skipped and very heavy, then adding progesterone during the second part of the cycle replaces the progesterone that is not produced during anovulatory cycles.

So yes oestrogen dominance in the proper sense of the term, during peri-menopause, can lead to heavy periods for the reasons given.

There is a whole industry that has built up around the fact that we need progesterone per se as part of feeling good or for balance but to my knowledge there is no evidence that replacing it in the majority of women (in the absence of oestrogen) will have any effect other than on the uterus ie doesn't alleviate other menopause sysmptoms. I understand that a small minority of women may benefit (according to Dr Elizabeth Vliet who has also written a book some years ago now "Screaming to be Heard").

Do give the pills mentioned some consideration - they will regulate your cycle and bleeding and should help stabilise your moods. You really don't need the anti-depressants for hormonal reasons.

Hope this helps

Hurdity x

[Smurph]

Hello Hurdity!

Thanks v much for your reply 

I have looked into the pills you mentioned but I’ve read so many mixed reviews about both that it’s a bit daunting. I think I’ve been traumatised from that god awful experience of Desogestrel although I know it’s not the same as those you suggested. I just have it in my head now that anything synthetic is going to make me go downhill fast (sounds dramatic I know  ) and I do like taking Utrogestan so it’s tricky for me to know what to do for the best. I guess I can only give it a go and see how I get on. I will look into them a bit more and mention them to the doc when I see her in a few weeks time.

Thank you for your advice, it’s much appreciated xx

[Hurdity]

Well maybe worth a try!

Let us know what you decide and how it goes

Hurdity x