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[TheMidnightSkulker]

Hello everyone! My, you are all looking lovely today!

Unlike me. I'm hoping HRT will solve my water retention problem, but I'm in the UK and I am not sure what to expect.

This issue has been driving me crazy for a year and a half.

tl;dr

- I was on Yasmin for decades, which contains 3mg drospirenone and 30mcg ethinylestradiol.

- I stopped Yasmin in July 2021 and have had hideous water retention ever since.

- All other causes have been ruled out by my GP and optician, it is definitely hormonal.

- On 2 occasions, I went back on Yasmin for 1 pack. On Yasmin, symptoms vanished. Off Yasmin, symptoms came back.

- I'm told HRT is the only thing that will help, and I'm coming up on 1 year since last withdrawal bleed (last Yasmin pack was about this time last year), so I can finally FINALLY ask for HRT.

- But the only HRT product with drospirenone is Angeliq, which you can't get in the UK.

- SCREAM

In the circumstances, what might I do, and what might I expect?

======

MORE DETAIL:

In July 2021 I stopped Yasmin, which I had been taking (previously Dianette) for decades, to control acne.

Every pill-free week, I would fill up with water, causing puffy eyes and headaches.

I thought the headaches were migraine. Anadin Extra was the only painkiller that even partially helped.

But late in the game I realized it was making the headaches worse, because the headaches were caused by water retention, and Anadin Extra not only doesn't do anything to address water retention, it actually makes it worse.

I achieved near-complete symptom relief by drinking parsley tea, and at most one dose of Anadin Extra on one day of the pill-free week.

Then came July 2021 when I stopped Yasmin.

I experienced the usual symptoms of the pill-free week, but going on FOREVER.

- GP ruled out any other medical cause of the water retention. Yes, they did.

- Optician ruled out any problems with my actual eyes. It's not an eye problem.

- No, it's not allergies.

- It's the hormones.

- It is the hormones.

- It definitely is the hormones. No possibility of error.
-- Experimentally, I went back on Yasmin for 1 pack. Symptoms vanished, including eyes de-puffed. Finished the pack, symptoms returned.
-- Tried again with a second pack of Yasmin. Symptoms vanished. Finished second pack, symptoms returned.

At this point, people usually say "it's probably worth trying to figure out the cause of your water retention, so you should probably go to your GP and also your optician to rule out any more sinister cause." This is great advice, but I would like to emphasize that I already did this, and both my GP and my optician assured me that there is nothing else going on. I am very sure that this problem is hormonal and not the result of any other underlying disease.

The GPs said there wasn't much they could do until I qualified for HRT. They were curious, so said to keep a diary of home remedies to see if anything at all was helpful.

I tried to approach this systematically and titrate remedies in one at a time, but the headaches were so bad I couldn't go a full day with no interventions. I would always end up chugging parsley tea to relieve the pressure inside my skull.

I could go into detail here, but basically I had a year of adding in and dropping (but mostly adding) one herbal remedy after another.

This got me to about 50% improvement.

I tried: HRI water tablets twice daily, parsley tea daily, Nutra Release tea daily, nettle or peppermint tea or some other tea daily (didn't work), vitamin B every other day (daily vit B caused me diarrhea), black tea (seemed to work very well in some circumstances but not others, never really managed to systematize that one), more dandelion root, drinking more water, drinking less water, drinking some water, drinking no water.

And yes, OF COURSE I did all the lifestyle stuff that's common knowledge, all the cold compresses and the avoiding salt and the pillows and the sleep hygiene and yadda yadda. OF COURSE I did these things. It's called common knowledge because everyone knows it, including me.

In particular, I exercise daily and take magnesium glycinate. This is awesome for preventing the stiff joints that I suddenly started to get immediately after stopping Yasmin.

Exercise and magnesium are necessary, but not sufficient. I'm still puffy.

Sleep hygiene doesn't help. In fact, the better I sleep the puffier my eyes, because I'm lying down for longer. If I sleep less than three hours a night, I improve dramatically, because I'm vertical for a longer part of the day.

No, I can't sleep on my back.

It's possible that if I bought a $400 pillow to train myself to sleep on my back, it might work, but I'm not going to do that.

I have tried other, cheaper pillows, but all I got was neckache. I'm done trying to sleep on my back.

I have sometimes had a couple of days of looking almost normal, and thought I'd cracked it - but I then go right back to being puffy again.

A few months ago, the puffiness seemed to not only not be improving, but actually getting worse.

While I was considering my options, I suddenly got food poisoning. I woke up the morning afterwards looking normal - because I was dehydrated. Of course, I stopped all the herbal diuretics. Then I waited to see what would happen.

Gradually, I reinflated over a span of about two weeks. I then tried reintroducing one herbal treatment, the HRI water tablets, for one daily dose (instead of two). I immediately got much puffier. I stopped the HRI and improved a bit, but not totally.

Is it possible the herbal diuretics were making things worse all along?
Maybe, but I'm pretty sure they weren't. I think they were helping for about a year or so, and then something changed, and my water retention improved, but didn't totally resolve.

How do I know this?

I know because I don't have the headaches any more.

I also don't have any noticeable lower body oedema.

It's just my eyelids now. I LOOK LIKE A FROG.

And... I thought I was improving on the new, no-intervention regime, and maybe I was for a while, but now I'm getting worse AGAIN.

And now any remedy I try makes it worse still. I tried HRI water tablets for three days last week, got dramatically worse again. Stopped the HRI tablets and DIDN'T GET ANY BETTER.

The Yasmin would make this ALL go away.

But I'm never getting my Yasmin back, and it seems that there's no HRT available in the UK with the same profile as Yasmin.

Does anyone have any suggestions as to what I might do, in the circumstances?

[CLKD]

 

[sheila99]

I don't know enough about this to help but if you believe it's hormonal why do think drospirenone is the only thing that will help? And I'm not sure why you need to wait until you've been bleed free for a year before you can start hrt? Can you give us some more info such as age and other meno symptoms?

[TheMidnightSkulker]

if you believe it's hormonal why do think drospirenone is the only thing that will help?

Great question. I don't know if drospirenone is the only thing that will help.

My reasoning is that the water retention appeared when I stopped Yasmin, and disappeared when I temporarily restarted Yasmin. My assumption is that HRT with a similar profile to Yasmin is what will help. And drospirenone is reputed to reduce water retention.

If there are other HRT products that will reduce water retention, I'm eager to hear about them. I seem to more often hear about HRT increasing water retention, and this is an effect I want to avoid.

And I'm not sure why you need to wait until you've been bleed free for a year before you can start hrt?

Because that's what the GP said.

Can you give us some more info such as age and other meno symptoms?

Age 52. I think, but cannot prove, that I went through meno while still on Yasmin.

The predominant symptom is the water retention, from which a number of other symptoms (I think) come downstream: stiff and achy joints. These aren't a problem if I exercise daily and take magnesium supplements. It's just that I used to be able to (appear to) get away with skipping exercise, and I never needed magnesium before.

My blood pressure is higher off Yasmin and lower on Yasmin, and it is also higher when I'm retaining water and lower when I'm not.

I was under extreme stress when I went off Yasmin and for much of the time since 2020. It's not the kind of prolonged stress I've experienced before, so I can't say whether my increased state of nervousness was primarily a meno symptom, or was due to the given circumstances. However, things are just beginning to get less crazy, and I also am beginning to get less crazy.

I've had the occasional night sweat or hot flash, but they didn't really bother me.

I also had a ravenous appetite at first, but I could chalk that up to stress eating.

My waist measurement and tum circumference have increased, which displeases me, but I think it's an unavoidable redistribution of fat.

[CLKD]

Have U had an appt with a dedicated menopause clinic?  Not a gynae..  Why can't you get 'Yasmin', I got lost on the way  .

Usually we are advised to wait for 12 months bleed free B4 we consider that we are into menopause. Nature however can throw in a curved ball and we have to start counting from 1 again  .  I hated water retention, troublesome in the 10-14 days prior to a bleed.  I don't know how it went away  .  Tea can cause it, I am unable to drink any after noon as a) it tastes different and b) I get wind and bloating. 

HRT can be started ASAP if necessary: helps protect bones and heart health. 

[TheMidnightSkulker]

Have U had an appt with a dedicated menopause clinic?  Not a gynae..

No, and I assume I will not be able to get one.

Why can't you get 'Yasmin', I got lost on the way  .

Because I'm too old.

Usually we are advised to wait for 12 months bleed free B4 we consider that we are into menopause.

Yes, that's the GP's criterion, and in a few days I will be able to approach the GP for HRT.

Nature however can throw in a curved ball and we have to start counting from 1 again  .  I hated water retention, troublesome in the 10-14 days prior to a bleed.  I don't know how it went away  .  Tea can cause it, I am unable to drink any after noon as a) it tastes different and b) I get wind and bloating.

I'm not a habitual tea drinker, but I've never found that black tea makes it worse. Ah, how everybody is different.

HRT can be started ASAP if necessary: helps protect bones and heart health.

Yes, well, hopefully the GP will let me have it now. My question is what kind is likely to help me, given that my biggest complaint is water retention.

[sheila99]

I'm not convinced you gp knows much (or anything) about meno given she seems to think you can't have hrt until you're meno. If you find she can't help you can ask for a referral to an NHS menopause clinic though there may be a long wait. We all react differently and what suits one person may not suit the next so it really is a case of try it and see. It's likely that any hrt will help assuming it's caused by meno. Transdermal is safer than oral so you could try a patch or gel.

[TheMidnightSkulker]

I'm not convinced you gp knows much (or anything) about meno given she seems to think you can't have hrt until you're meno.

Maybe not, but all the GPs at the practice say that. I've been with this practice since I was a child, they have never referred me to a specialist for anything, and they probably won't start now.

If you find she can't help you can ask for a referral to an NHS menopause clinic though there may be a long wait.

I see what you're saying, but I've already waited 18 months. I'm a performer, so the change to my appearance has meant I haven't been able to book jobs. I'd rather approach the GP with the right questions to be able to take effective action now, instead of asking for the opportunity to wait another few years (which I think they would refuse anyway).

We all react differently and what suits one person may not suit the next so it really is a case of try it and see. It's likely that any hrt will help assuming it's caused by meno.

The impression I get from everything I've read, is that most people get WORSE water retention from HRT.

Rather than spend months or years eliminating unsuitable HRT treatments by trial and error, I'm hoping to home in on the HRT product that will make my situation *better* instead of worse - *if* such a product exists.

Everyone also says BCP makes water retention worse. In fact, the GPs said that I'm an unusual case because nobody ever gets water retention after STOPPING the pill.

Well, nobody *talks* about it, but I had the opposite experience with Yasmin. Yasmin contains ethinyl estradiol and drospirenone, which has a reputation for being a diuretic. Consistently with that reputation, my eyes depuffed and I lost pounds of water weight within days of taking Yasmin. If I were the only person in the world to experience that effect, drospirenone wouldn't be known as a diuretic.

It also seems like there is *one* (1) HRT product (Angeliq) with the same active ingredients as Yasmin, meaning Angeliq looks like the one (1) HRT product (that I know of) that would be likely to relieve my water retention. If I'm right. But it's unavailable in the UK.

This is like "Unbreakable" and I'm like "Mr. Glass", except Mr. Glass was looking for his opposite, and I'm looking for the one other person in the world who is exactly like me.

If you're out there: who are you, and what are you taking for it?

[Zoe]

Hi, and welcome!

Sounds like things are pretty frustrating for you.

Angeliq, as you will know, used to be available in the UK but is no longer prescribed because it is felt there are better and cheaper tablets available.

Your GP is entirely wrong about having to be bleed-free for 12 months in order to have HRT. This is contrary to the NICE Guidelines and there is no 'qualifier' other than a clinical assessment that says you might benefit from HRT. Many many women take HRT when perimenopausal. It is a pity you have had to wait this long to discuss trying something that could help.

Micronised progesterone is also a diuretic (utrogestan) and can actually be taken without oestrogen, but you would need to see a menopause specialist to get the best advice. Unless your GP is suddenly going to become a fount of wisdom now you have met their threshold for prescribing HRT.

If water retention is your main issue, then you are right to focus on it. And from what you say it seems to be a hormone imbalance.

I think that if there is one thing many of us have learned, it is that some GPs are totally on the ball and others haven't a clue. If yours is in the latter category, change to a GP who knows what they are talking about or go private if you can. You deserve good advice.

[Zoe]

Link to NICE Guidance: https://www.nice.org.uk/guidance/ng23

[TheMidnightSkulker]

Thanks everyone for welcoming me, and thanks Zoe for taking the time to explain all that.

From what you say Zoe, the progesterone that helps me doesn't have to be drospirenone. That's good to know, bearing in mind that the reason I was on Yasmin in the first place was because of acne. So I need to home in on one that doesn't cause acne.

I'm going to approach my GP first in a few days, and if they don't have the capacity for an appointment right now, I'll go private. The problem with going private is that I would then be stuck paying for private prescriptions into the future as it's so hard to coordinate with my GP right now. But I'll figure it out.

[Zoe]

It is difficult making these decisions relatively alone. I hope you have success with your GP. My GP was actually easier to deal with once I had a letter from the menopause specialist (private) making recommendations.

I got my first lot of HRT privately but then my GP prescribed it and so could get it on the NHS. As long as I am having a regular check in with the specialist (once a year) she seems happy to prescribe. I do buy Androfeme testosterone privately but you could also get a different type on the NHS. So it is worth trying it.

None of us should ever have to go privately, but it is how it is right now. I know women who have sold cars, jewellery and clothing to pay for private treatment. It is a scandal especially considering how much we have all paid in taxes and NI over the years and how much the right HRT treatment at the right time can save the NHS in future health needs. Rant...rant...

Hope you manage to get somewhere with all of this. Also, have never had acne on Utrogestan (micronised progesterone)! I think the worst for that seems to be levonorgestrel (progestin not progesterone). But we are all different in how we react!

[TheMidnightSkulker]

Yeah, I have ADHD so am very familiar with having to go private and work things out for myself. The treatment regime I've been on for years, is one I partly worked out for myself and then politely and humbly requested my GP let me try, and I was right, and have been stable on it for decades.

They used to require me to see a specialist (at my own expense) once a year, but they haven't made me do that for a while now.

Anyway... just a rant, it sure is frustrating trying to get any straight answers about BCP/HRT and water retention (I search on BCP for clues, even though I'm obviously not going back to BCP again in my lifetime.)

The only clear answer out there seems to be "drospirenone, therefore Yasmin (and Angeliq of blessed memory, RIP). Maybe some other progesterones? Or not. Will you be saying a big hello to your old friend acne again? Well, that's a complex question..."

What REALLY bugs me is searching on water retention, and seeing article after article like

THEY: Weight gain? Will you gain the dreaded weight? You're so so so terrified that this treatment will make you gain weight, aren't you? Well don't you worry your pretty head, little lady. Let me explain in the longest possible terms that that's a myth.

ME: Yes, I understand that some hormonal treatments increase water weight, and it's water retention I wish to avoid.

THEY: "The evidence [on fat cells] can be a bit confusing; a review¹ of available research back in 2000 found no link between low dose combined hormonal contraception and weight gain."

ME: I don't care about scale weight. I really am asking about the water retention.

THEY: Here's 2000 paragraphs of explanation about what happens when you tip the scale after starting a hormone treatment.

ME: Couldn't you just say "it's water, not fat?"

THEY: Sweetie, that distinction is far too subtle for you.

ME: JUST TELL ME ABOUT THE WATER

THEY: Ooh, I see you also suffer from mood swings. Calm down dear.

ME: [pulls gun]

THEY:  "Another reason some women might see an increase in their weight when taking combined contraception is water retention."

ME: FINALLY

THEY: "Oestrogen affects the way our kidneys produce certain proteins³, which can have an impact on the way the body regulates water, causing an increase in the fluid kept within the body’s tissues."

ME: I know, that's why I'm asking. What am I supposed to do about it?

THEY: "This kind of water retention can also happen just before your period⁴, and is responsible for that lovely puffy, bleugh feeling some of us are so familiar with."

ME: Thanks for your sympathy, it makes me feel all warm and fuzzy. Get to the point, please

THEY: The good news is that it's likely to clear up in a few months.

ME: [waves gun around] That's what they said after I STOPPED Yasmin. 18 MONTHS AGO. I don't want a treatment that will make the water retention WORSE and then MAYBE get back to where I started AFTER A FEW MONTHS. I want something that will FIX the water retention RIGHT AWAY, like Yasmin did. [accidentally shoots through ceiling]

THEY: "If you are affected by water retention on the combined pill it may be worth talking to your doctor about switching the brand or type of pill."

ME: See, that is what I'm asking. Which one?

THEY: "Newer progestogens in some combined pills can help reduce these symptoms, and may be less likely to cause water retention than others."

ME: WHICH ONES??!!!!!??

THEY: "I needed a new heel for my shoe, so, I decided to go to Morganville, which is what they called Shelbyville in those days. So I tied an onion to my belt, which was the style at the time. Now, to take the ferry cost a nickel, and in those days, nickels had pictures of bumblebees on 'em. Give me five bees for a quarter, you'd say. Ah, there's an interesting story behind that nickel. In 1957, I remember it was..."

ME: https://images.app.goo.gl/RKrepggut48UVu6D7

[Zoe]

Yeah, I have ADHD so am very familiar with having to go private and work things out for myself. The treatment regime I've been on for years, is one I partly worked out for myself and then politely and humbly requested my GP let me try, and I was right, and have been stable on it for decades.

They used to require me to see a specialist (at my own expense) once a year, but they haven't made me do that for a while now.

Anyway... just a rant, it sure is frustrating trying to get any straight answers about BCP/HRT and water retention (I search on BCP for clues, even though I'm obviously not going back to BCP again in my lifetime.)

The only clear answer out there seems to be "drospirenone, therefore Yasmin (and Angeliq of blessed memory, RIP). Maybe some other progesterones? Or not. Will you be saying a big hello to your old friend acne again? Well, that's a complex question..."

What REALLY bugs me is searching on water retention, and seeing article after article like

THEY: Weight gain? Will you gain the dreaded weight? You're so so so terrified that this treatment will make you gain weight, aren't you? Well don't you worry your pretty head, little lady. Let me explain in the longest possible terms that that's a myth.

ME: Yes, I understand that some hormonal treatments increase water weight, and it's water retention I wish to avoid.

THEY: "The evidence [on fat cells] can be a bit confusing; a review¹ of available research back in 2000 found no link between low dose combined hormonal contraception and weight gain."

ME: I don't care about scale weight. I really am asking about the water retention.

THEY: Here's 2000 paragraphs of explanation about what happens when you tip the scale after starting a hormone treatment.

ME: Couldn't you just say "it's water, not fat?"

THEY: Sweetie, that distinction is far too subtle for you.

ME: JUST TELL ME ABOUT THE WATER

THEY: Ooh, I see you also suffer from mood swings. Calm down dear.

ME: [pulls gun]

THEY:  "Another reason some women might see an increase in their weight when taking combined contraception is water retention."

ME: FINALLY

THEY: "Oestrogen affects the way our kidneys produce certain proteins³, which can have an impact on the way the body regulates water, causing an increase in the fluid kept within the body’s tissues."

ME: I know, that's why I'm asking. What am I supposed to do about it?

THEY: "This kind of water retention can also happen just before your period⁴, and is responsible for that lovely puffy, bleugh feeling some of us are so familiar with."

ME: Thanks for your sympathy, it makes me feel all warm and fuzzy. Get to the point, please

THEY: The good news is that it's likely to clear up in a few months.

ME: [waves gun around] That's what they said after I STOPPED Yasmin. 18 MONTHS AGO. I don't want a treatment that will make the water retention WORSE and then MAYBE get back to where I started AFTER A FEW MONTHS. I want something that will FIX the water retention RIGHT AWAY, like Yasmin did. [accidentally shoots through ceiling]

THEY: "If you are affected by water retention on the combined pill it may be worth talking to your doctor about switching the brand or type of pill."

ME: See, that is what I'm asking. Which one?

THEY: "Newer progestogens in some combined pills can help reduce these symptoms, and may be less likely to cause water retention than others."

ME: WHICH ONES??!!!!!??

THEY: "I needed a new heel for my shoe, so, I decided to go to Morganville, which is what they called Shelbyville in those days. So I tied an onion to my belt, which was the style at the time. Now, to take the ferry cost a nickel, and in those days, nickels had pictures of bumblebees on 'em. Give me five bees for a quarter, you'd say. Ah, there's an interesting story behind that nickel. In 1957, I remember it was..."

ME: https://images.app.goo.gl/RKrepggut48UVu6D7

Really hope you get some clarity on it all soon. Yes, sometimes it is like there are two different conversations going on in parallel!

[Joomelbee]

aww mates! I know it's  no laughing-matter, but you made I chortle! I am currently trying Evorel Sequi and finding the progestogen half of the month a bit crazy-making, pizzaface-making, and trouserbutton-breaking. It does seem like this micronised progesterone getting pretty good reviews re these issues? Will try begging GP for some.