Anxiety when taking Femosoton 1/10?

[Understartersorders]

Hi I wonder if anyone might be able to help me.
I was recently prescribed Femoston 1/10 by my gynaecologist after suffering increasing peri menopausal symptoms for well over a year. I’m almost 45. My cycles were getting shorter, I was having lots of spotting either side so was spotting/on my period for up to half the month. Low mood, loss of libido, night sweats. I started taking the tablets and felt much better within a few days, I was sleeping better, no sweats, my mood was better. However I am now 8 days into the grey tablets which have the progesterone in and I feel awful. My hearts racing and I feel sick and anxious most of the time. My sleep disturbance is back. I should also mention I have a Mirena coil in situ that I’ve had for three years, inserted mainly to help really heavy periods. Could it be the progesterone in the Femoston causing the anxiety? I’m at a bit of a loss but you seem to have a lot of knowledge here so I thought I’d ask.
Thanks so much in advance.

Oh my goodness- WHY are you using a type of HRT with progesterone in it when you already have Mirena? Does your GP who gave you the HRT not know about the Mirena?

You only need estrogen as your HRT because the Mirena gives you the progesterone needed. Doubling up with 2 types of progesterone is bound to make you feel a bit low and anxious!

You need to stop taking the grey tablets but also go back to your GP.

This is really bad prescribing. :(

This is a gynae who gave you that??? Beggars belief. The Mirena is licensed for at least 4 years as part of HRT so you will need it replacing if you stay on HRT.

Thank you so much for your reply. Yes she’s been my gynae for 17 years and has always been really helpful until now! She said I needed the extra progesterone because the act I was spotting despite having the mirena meant my progesterone wasn’t high enough?

I guess that's a matter of opinion and I'd suggest you ask for a 2nd opinion from another dr.

Is this a private dr if you have been seeing them for 17 years?

She is private and NHS but I’ve had various issues over the years and so I see her annually for a smear and general check up on a private basis. I’ll give her a call to discuss the progesterone issue, I just wanted to have a bit more info before calling in case it was just an adjustment thing, I’m only on the first pack of the tablets and she said it could take three months to settle.

I think one issue is you are combining two kinds of progesterone. Often ONE is enough to affect mood. It would be better in theory to ditch the Mirena and take Femoston on its own or replace your Mirena if it's not doing its job fully after 3 years. I think the license for being part of HRT is 4 years.

Is she menopause qualified and on the British Menopause Society list of specialists?

Honestly I have no idea. I assume there’s a list somewhere I can check? She’s a consultant obstetrician and gynaecologist, the subject of perimenopause came up over the past couple of appointments because I was having symptoms. She initially discussed using an oestrogen gel for part of my cycle but then because I was spotting around my period she said I needed more progesterone. She checked the mirena was in place and said it was ok for another two years. It’s really tricky because she has been really great over the years and I trust her, but now I’m wondering if she isn’t as knowledgable in this area as she should be. Doubling up on the progesterone was something I was unsure of but I deferred to her as the expert!

If you go to the BMS website there is a Specialist register on the menu - top of page.

I can see the logic in what she says but she should also be aware that they are two types of synthetic progesterone and may cause you low mood.

Gel is the preferred option now and most women use it with a natural progesterone (Utrogestan) and she could give you that at 100mgs a day for 12 days which may well be enough with the Mirena.

OR she could have given you gel and monitored the spotting. It's not dangerous in itself as it's highly unlikely you would get a really thick lining (hyperplasia) with the Mirena (in my opinion!) but the spotting could be a nuisance- maybe you need to ask her to clarify what she is worried about?

Ok that’s really helpful thank you. I can live with the spotting it’s annoying but not a major issue and has got to be better than feeling this anxious! She indicated it was inconvenient rather than dangerous but that the extra progesterone would help and if we were looking at HRT then why not try and solve that issue as well. I spoke to her rather than the GP because ironically I thought she’d be more knowledgeable but I suppose not every gynae is a menopause expert. Thanks for the advice, you seem to have a lot of knowledge on this subject and it’s something I’m just getting to grips with. At 44 I thought I’d have a few more years before I had to worrry about 😕

I don't think she has done anything terrible BUT she perhaps ought to have warned you of the overload of 2 progestogens. I'd talk to her and ask if she's happy for you to try estrogen only and see how that goes.

The two types of progesterone issue is a serious consideration.

I chose femoston because of the type of progesterone it contains (the menopause matters website is good on this), but it sounds like you're not tolerating it well (everyone's body is different).

Look up which type of progesterone your mirena coil is releasing, then (presuming you've been tolerating that we'll) look for an HRT preparation with the same progesterone.

FWIW, as an older HRT user who's just shifted to femoston conti (so progesterone all month round) it's taken about 40 days to settle - initially I had anxiety, broken sleep and painful breasts (like the run up to a period). Told myself I'd push through this prescription and if it was still bad after 90 days, I'd go back to the cyclical type.

@CaraDuneRedux The progesterone in the Mirena is unique to that- Levonorgesterone (sp) and not in any other hrt.

Ah - that's interesting, Jingling.

Loads of other good suggestions though. Getting the right progesterone for you is a tricky process, in my experience

I have had no issue with the progesterone in the Mirena; it has been life changing for me in terms of the heavy bleeding and anaemia I was suffering previously. I have left a message for her to discuss my options and will let you know what the outcome is, thanks for the advice.

Good luck and do come back with your answer! :)

So I finally got a response from her a week after calling for advice! Unimpressed is an understatement.
So she’s basically written me a one paragraph letter saying I should persist with the Femoston (although referred to it as Femoston Conti which isn’t even the medication she’s given me!) or if I still feel unwell I can go onto an oestrogen only patch or tablet (she mentions Eleste Solo 1-2mg) if I want to. Really disappointed, I wanted some professional advice and not be told to decide for myself! Now into the oestrogen only tablets on the second blister pack and feeling better makes the decision harder. Any suggestions @JinglingHellsBells ?

Hmmm not exactly helpful.

What do you want to do?

Personally, I'd ask for Oestrogel because you can change the dose yourself (it's allowed!) anything from 1 to 4 pumps a day. Younger women like you often need more than 1 mg estrogen.

Or change your gynae. (Happy to say if I know of her if you want to PM.)

@JinglingHellsBells I think I’m erring towards changing to oestrogen only. So much I have read indicates that the Mirena should provide all the progesterone I need, hopefully not adding in any extra will stop the awful feelings I had last week happening again. It’s definitely the progesterone, since I started the oestrogen only tablets a few days ago I feel much more like my old self. I think I’d prefer the gel to tablets as well, it seems to be the most natural option. Bit more of a palaver than popping a tablet but I like the idea of being able to self adjust the dose. One question, is it used every day or just for part of the month? I checked the BMS website and she isn’t on their list so presumably it isn’t her specialist area. I may well look to change gynae, I have been really disappointed with how this has been handled. If I do then I may well be asking for recommendations! Thanks again x