Taking the Pill for perimenopause symptoms

[Kontiky]

I still have regular periods but they have been very light for the last year. I've also been suffering with poor quality sleep and sometimes full blown insomnia which is horrible. I've also been getting very achy joints especially my ankles.

No hot sweats yet, but I am often crippled with depression which just comes and goes out of the blue. I'm also suddenly suffering with anxiety which I have never had before.

My GP started me on HRT just over 2 months ago. Estradot 50mg patches and separate Utrogestan for 12 days a month. So far I am not that impressed. I'm still getting poor quality of sleep and I'm still suffering with stretches of extremely low mood which can last from 1 to 7 days at a time. Then I feel fine again. Still getting some anxiety but at least the achy joints have gone away I suppose, but that's all.

Basically I'm no different to how I was pre HRT and it's driving me mad as I never know how I'm going to feel from one day to the next.

I have read on the Internet that the hormones in the Pill are stronger than those in HRT and are better at stopping your own hormones from fluctuating so much and causing all these bastard problems. I haven't taken the Pill in over 10 years but I'm desperate to find some peace of mind again and to feel balanced and calm.

Has anyone tried this method?

[pinkfrocks]

why don't you try swapping the patches for gel? That way you can try different doses- 2 pumps = 1.5 mgs, and 4 pumps = 3mgs which is very high but maybe what you need in peri when you are young? You could experiment...?

[Kontiky]

I was wondering about the gel pinkfrocks. The fact that one of my patches just fell off last week has made me wary of them. Plus, I've also had a couple of patches which have just refused to stick on even though I have applied them to clean, dry skin with no lotion or anything on it.

Do you get a pretty quick reaction to the gel, so if you for example woke up feeling low and gave yourself an extra pump would you feel better that same day?

I also think that maybe I need slightly less oestrogen during the first half of my cycle because I am still producing my own hormones, but then need a much higher dose in the second half.

Are you able to phase its use in this way, or do you have to stick to the same dose every day?

[pinkfrocks]

You can really do what you want with it but I doubt if changing the dose daily will give you a constant level to help symptoms. I have never used it for anxiety or moods but all I know is that at times i have had to increse the dose slightly for a few weeks then decrease again to control symptoms like flushes. I doubt if a day or so either way will make any difference- you maybe need a week or more at a certain dose to see any difference- question for your dr perhaps? Have you thought about seeing a meno expert as you seem to be suffering a bit?

[Kontiky]

Thanks pinkfrocks.

My doctor is actually a gynaecologist with a special interest in menopause. He told me that the patch and separate Utrogestan were an excellent combination for peri menopausal symptoms.

But I will have been using them for nine weeks this week and I am still very, very up and down. Checking back through my mood calendar I can see that my mood has still been all over the place since being on HRT. Sometimes nice and normal for a week at a time. Other times I have still felt dreadfully low and anxious. No real pattern to it so it's unpredictable.

I'm wondering if the HRT works well for things like hot flushes and the aches and pains and headaches associated with menopause (which I've never had yet), but isn't nearly as effective for mood swings and anxiety?

But I still think my depression/mood swings and anxiety must be hormonal or something because they can totally disappear for up to 2 weeks at a time.

[pinkfrocks]

Patches and gel with Utrogestan are pretty much the same thing. I was given gel because my dr said it was easy to tweak- start with 1 pump or less and see how much you need to keep symptoms under control.

The info that came out from NICE last week on guidelines stresses that drs should take into account women's emotional health as well, and prescribe HRT for anxiety type issues as well as other meno issues. Check that just to make sure- with the links to the NICE info here.

My dr's guide says it 'may help low mood'.

It ought to help mood swings IF these are hormone-related because it's giving you a steady level unlike our own hormones during peri.

Have you and are you doing all the other things to help with low mood, such as suggested by MIND (charity) one of which is exercising and especially outside in green spaces? Have you had a proper assessment of your moods to ascertain if they are hormonal or if you have other issues like anxiety and depression that are coinciding with peri meno but not caused by hormones? I only ask because none of my friends (and we are all peri or post meno) have experienced any moods like you describe except maybe the odd day feeling a bit low.

[Kontiky]

I've wondered myself whether it's just normal depression and anxiety but then how can it disappear for up to two weeks at a time?

Also the only other time I have experienced depression and anxiety like this is when I had PND years ago. So I can only think it's hormonal really.

[DayLillie]

Some people find that if they warm the patches up first, they stick better. They hold them in bed, or put them down their underwear until they are nice and warm. Have even heard of people using a hair dryer!

[pinkfrocks]

Are you trying any of the recommended strategies to help- regardless of whether it is hormonal or not?

In your shoes, I'd give the HRT another few weeks- most consultants say allow 3 months. I'd also consider upping the dose - so maybe changing to gel would make that easier.


But I think you ought to be discussing all of this with your consultant and they ought to arrange an assessment perhaps of your mental health with another consultant.

[Kontiky]

I have discussed my mood swings with my consultant and he assured me they were caused by fluctuating hormones. I was always prone to PMS before so he said I was a typical candidate for hormonal mood swings/depression when I became peri menopausal.

I am prepared to give the HRT another few weeks, but after that I will have to reconsider my options. Perhaps try the Pill or maybe try anti depressants?

I don't think I need to seek advice from another consultant about my mental health especially. It's quite obvious what is causing my problems. I belong to other menopause forums and there are hundreds of women who have experienced extreme examples of mood swings and also anxiety due to the peri menopause.

[pinkfrocks]

well then your HRT should sort it if it's caused by your fluctuating hormones. If your consultant thinks the Pill would do a better job then he should prescribe it- he's the expert.

[OccamsLadyshave]

Hi OP

I'm on the pill as HRT. I'm on Loestrin.

I started with peri symptoms 11 yrs ago now, and to start with I pretty much self diagnosed, as the blood tests were inconclusive, but did need some contraception too so requested the pill. I came off it about 4 years ago and that's when my symptoms became much stronger, and my blood tests showed I was in meno.

I've been back on the pill for just under 4 yrs and it is great. No meno symptoms, no periods in my week off, and the weight gain around my middle that I got when I was off it has gone.

The down side is that during my week off the hot flushes and sleeplessness come back with a vengeance. I also get really bad headaches during my week off. And in fact if I miss one pill by more than 12 hrs. I think of them as hormone withdrawal but not sure how scientific this is!

Should say I'm 40 now and started with symptoms age 29. Was confirmed in meno age 36 (on my birthday! Great news!). I think because I'm younger my Dr was happier to let me have the full dose. Apparently the pill pretty much mimics the natural level of hormones, whereas HRT is more of a top-up.

[Kontiky]

pinkfrocks my consultant did mention the Pill as one possible avenue to explore but I was reluctant to try it, as I believed that I was 'too old' to take it.

But I have since read up on it, and so long as you're not overweight and don't smoke then the risks of taking the Pill after you're 40 are negligible.

Certainly I would have to weigh up the balance of quality of life verses slightly increased risks etc.

[Kontiky]

Hi Occamsladyshave (love your name )

Do you mind me asking what symptoms made you think you were peri menopausal, and why you came off the Pill when you were 36?

I've never had a hot flush yet, but I started experiencing really poor sleep and bizarre anxiety and feelings of dread and doom about 18 months ago. These feelings really scared me at first because they lasted for up to a week at a time but then would disappear as quickly as they came, and I would feel perfectly fine again for a couple of weeks. It was so strange.

I also started to have very painful aches in my ankles and thumb joints which lasted for weeks at a time. This was at exactly the same time that I noticed my periods were suddenly much, much lighter and were getting closer together.

Because I could feel perfectly normal for several weeks at a time I didn't bother seeing my GP for ages. But then I came across an article on the Internet about peri menopause (had never heard the word before) and I recognised myself and my weird symptoms straight away

I went to see my GP and had blood tests done but they were 'within normal range' but my GP still referred me to a menopause clinic. The consultant told me he'd seen women in their 40s with my exact symptoms thousands of times before and started me on HRT just over two months ago. He promised me I would feel much better quite quickly, but I'm still very up and down with my weird symptoms coming and going all the time.

[DayLillie]

Occam - the headache during the week off is oestrogen withdrawal. The way to avoid this, I found, was to make sure I never got thirsty at all during my week off. Always have water at hand to drink, as well as the usual 'tea breaks'. It is really easy to get caught out during hot weather or if you go out.

Another way to avoid it is to be prescribed oestrogen for the week off, but I have only ever read about this and never heard of anyone actually having this.

There is a new pill called Qlaira which has a sort of oestrogen in it that is used in hrt, which is more like our own. It also has a shorter pill-free time. It is a phasic pill - there are different doses at different times of the month. The downside is that it is way more expensive to prescribe.

I was quite happy on the pill until 49. I don't miss the headache though- this got worse over the last 4 years.

[DayLillie]

kontiky - I had symptoms similar to yours after coming off the pill (I even had some whilst on the pill) plus urogenital ones. Keep a diary of your symptoms, so you know exactly how things are going when you see your consultant-it helps with the menopause brain issues. HRT may require some tweaking until you find it suits you.

[Kontiky]

Thanks DayLillie

I have kept a mood diary for quite a few months now, and there's no real definite pattern to my mood I don't think? Well, sometimes there seems to be but it's not carved in stone.

But prior to starting HRT I noticed that my PMS was just lasting longer and longer each month. Starting just after ovulation and not going until my period actually finished! And the PMS was much more severe too. Very depressed mood, total apathy, desperate craving for carbs and sugar etc. But the anxiety was new, never had that with PMS before. Though I suffered with the same anxiety terribly when I had PND years ago.

What did you do to help your symptoms after coming off the Pill?

[OccamsLadyshave]

Kontiky - you asked what symptoms I had. My history is that I had chemo for cancer as a teen, and one potential side effect was early menopause so I suppose it was in my mind before it all started.

I had DD when I was 27 and my periods came back regular as clockwork afterwards, until when I was 29, when they first started getting closer together. I was immediately worried so I went to GP who said I was "too young for an early menopause!"

I was then TTC for a year or so until my relationship ended so I suppose I was more alert to my cycle. In my early 30's I had some very short cycles, and others where I had ovulation signs twice within a 6-week cycle. I read that this was my body trying to ovulate but not quite getting there! So I had phases when my cycle was as short as 16 days and others when it was 3 months. I then went on the pill, but wasn't really having any other signs at that point. I came off it because I was on Yasmin and started to have the bad withdrawal headaches. I read up on Yasmin and thought I'd be better off not on it.

That was actually when I was around 34. I was 36 when I went back on it. I had around 18 months not on it, and I had every meno symptom under the sun. Hardly any periods, but occasional flooding. Night sweats, anxiety, a bit of depression, although never for more than a day or two. Not even sure depression is the right word - just an overwhelming urge to not see or talk to anyone. Also really bad mood swings.

I also suddenly gained about a stone within a few weeks, due to constantly feeling hungry even straight after I'd eaten. It was this that prompted me to go back to GP, as I was worried it might be diabetes related. He did tests that showed I was into menopause blood levels.

I haven't tried HRT other than the pill so I can't really compare but I'm happy with the pill. Apart from anything else I don't have to pay prescription charges which is a bonus given I'll be on it until my early 50s!

[OccamsLadyshave]

DayLillie - that's interesting. I do try to make sure I don't give myself any headache triggers during my week off - try not to get thirsty or hungry and I gave up drinking a while back too and cut back on caffeine and I feel that helps.

I also run 3 6 packs together so I don't have as many weeks of feeling like crap.

[DayLillie]

When I came off the pill, I was trying to be as healthy as possible so trying to eat a good balanced diet with low gi (not too much sugars and refined stuff) and whole grains, pulses, and lots of fresh veg etc. and going to dance classes about 3 times a week, and walking with a friend. I am sure this helps, as if I 'relapse' I do not feel so good.

The exercise helps with the adrenalin side of anxiety and if I feel I am getting feelings of high adrenalin, I find myself something simple to do that involves physical activity, like gardening, but does not tire me too much, and avoid things like driving and shopping which do not help.

I had to go on a progestogen only pill, which did not cause the problems I expected, but did give me dreadful constipation, as well as sore boobs and privates, so I gave up on that. I had night sweats on the pill for years, and expected to have flushes and the whole works, but they went away! I only have them occasionally now and have had years of practice at dealing with them, so no sweat!!

I had vaginal oestrogen for the urogenital problems, and started on full hrt a year past May. It is not perfect, but I sleep well now, which is a blessing. It helped with the joint pains. Perimeno symptoms do show through, so I have had a blip where bleeding was a bit muddled, and a couple of months of breast soreness problems. It is fine atm though.

The other thing that has helped with the joint pains is vitD3. I discovered I was low when I had a blood test for arthritis. It has also helped lift my mood in a subtle ways.

[DayLillie]

The prescription charge thing is definitely a bonus! I have to pay two charges every three months for hrt because it has two different sorts of pills in in

I had hoped I would be through menopause when I came off the pill, as I had had symptoms over the previous 4 years that things had changed. However, it all came back 9 weeks after I gave up on the Progestogen pill.

Comparing the hrt and the pill, I would say it is swings and roundabouts. There were aspects about not taking anything that were really good too. Shame you cannot just pick and choose the bits you like

[Cantwaittogonholiday]

I'm on Qlaira as HRT, its also a contraceptive. It has done a really good job for me in controlling mood swings, much better than the HRT I was on before.

I still get a couple of down days a month, but nothing like before.

I was pretty desperate so quite happily switched from the HRT I was on to the pill. I'm 45. But in my 20s and 30s I had quite a bit of trouble with mood swings on the pill so had gratefully come off it when OH had vasectomy. But maybe they've got a bit better at delivering hormones via the pill these days.

[Kontiky]

That's interesting cantwaittogoonholiday.

Can I ask how long you tried HRT for, and how it made you feel? Did your GP recommend changing to Qlaira?

I was on the Pill for nearly 20 years and used to get PMS every month. But it was child's play to the awful depression and anxiety I'm getting now. I can feel absolutely fine for a couple of weeks then boom I am sunk into a well of despair and anxiety and there's nothing I can do to shake myself out of it.

[Cantwaittogonholiday]

Trying to remember, I think I was on Prempak C for about 6-8 months. It had really helped with lots of symptoms that I had quite badly, anxiety, insomnia and constant low level bleeding. It perked me up no end in fact.

However I went to doctor and explained that I was feeling really down for about 2 weeks out of every month. I kept thinking it would get better but it didn't.

So he suggested trying Qlaira - and it helped almost immediately with the mood swings. I do still get them, but its vastly reduced. He said it was designed to mimic the natural cycle. Also other symptoms still mostly gone.

[Cantwaittogonholiday]

Sorry, meant to say, the symptoms of despair and anxiety sound very familiar to me so you have all my sympathy. And its hard when you feel like that to think that anything will make it better. I think that's one of the reasons it took me a while to go and see the doctor again.

But my husband gently pointed out that lying on the bed crying for 2 weeks out of 4 wasn't really normal for me (I exaggerate - but not much)...and maybe I should get back to the GP and see if there was anything.

I'm so glad I did.

[Kontiky]

Thank you for being so honest Cantwait.

How long did you suffer on HRT for? I must admit I am doing my best to put a brave face on it, but I ended up in tears yesterday again. I'm dragging myself through the days but feel very flat and hopeless.