HRT, ovarian cysts, pill, prolapse, pmdd. Help!

[HRTQuestions]

I have had what I now know to be PMDD from when I was a young teenager. A couple of times a year, I didn't have the mental symptoms but then had horrific periods (passing out type as opposed to the usual vomiting etc). I had an ovarian cyst (about 9cm) removed 11 years ago and a second removed 8 years ago. I've been on cerazette ever since to try to prevent cysts and it has dealt with the PMDD. I'm constantly at a "meh" part of the the cycle, but that's worth it.

However, I have had a prolapse since DC, it was always worse in the second part of my cycle and close to period, it's now always at the "worst" setting I assume due to the pill.

Cerazette was deemed the only suitable contraception as if there were problems with more cysts, I could stop taking it overnight (compared to Implant/injection) . A known side effect of the mirena is cysts and I was told I couldn't have it.

Cerazette doesn't seem to be containing the symptoms of PMDD as well any more - can this happen as you approach peri-menopause?
I'm having random sweating episodes and more than occasionally wake up drenched in sweat.
I've had a blood test, which came back "normal", although there was a huge fuss going backwards and forwards as they weren't certain it would be valid if it wasn't on a particular day of my cycle (which is utterly random as I'm on the pill) and if my being on the pill would affect the results.

The doctor did mention HRT and if I want to try some I should make an appointment to go back and see him.
I need a list of questions to ask and want to read up before I make an appointment.

I've never mentioned the PMDD to the doctor, I'd rather not tbh, but would HRT affect this in any way? I could live with regaining the super-high-energy-focussed-and-productive days I used to get right after my period, I do miss those. But not if it would replicate the rest of my cycle!

Can I stay on the pill - what do you do for contraception if on HRT?

I'm sure I read somewhere HRT can improve prolapse symptoms- has anyone had this experience?

Is there an increased risk of cysts on HRT?

What else do I need to ask?

Because your have a complex hormonal history would your GP refer you to a menopause specialist? Or if not can you afford a private appt?

I think whoever you do see, they are going to move forward with a trial of medication and see what suits you.

The mini pill can be used as part of HRT (the progesterone part of it) but you would need a higher dose than just for contraception. (My meno consultant suggested it at one point when I was discussing changing the type of progestin I had as part of my HRT.)

So that might be the ideal solution. It's unlikely your GP would feel qualified to prescribe the right amount but he could always ask an expert or refer you.

Who told you that the Mirena was linked to ovarian cysts? Lots of women use it as part of HRT (again, it was suggested to me) and I've never heard that from anyone other than you.

I don't think estrogen is going to worsen your PMDD and you may be able to add that along with a higher dose of the POP.

Prolapse- falling estrogen levels can make any prolapse worse, so it's something to factor into your choice!

Thanks for the long answer! It was the gynaecologist (who carried out the surgery) who said the only hormonal contraceptives that was ethical to give me was the pill!
The mini pill can be used as part of HRT
thats good to know. I'm due a check up soon, so want to know what I'm talking about when I go. The blood test results were given over the phone as "normal ". Do you think it's worth my asking what the actual numbers are and what was actually tested before going? The gynaecologist is very pro-surgery and I had to push for a referral for the prolapse, he wanted me to have a hysterectomy. Would knowing my actual oestrogen levels give me an idea if this is affecting the prolapse?

there is a menopause clinic at the university hospital 40 mins away, I think it's out closest, but does warn there is a long waiting list and prefers to have people referred by a doctor rather than self.

Why not have a prolapse repair rather than hysterectomy?

I doubt that HRT can reverse a prolapse but it might stop it becoming worse. (I've known a few women who when they stopped HRT found their prolapses got worse.)

Blood tests are very unreliable in peri. Hormonal contraception might affect results.

Hrt is on the treatment pathway for PMDD anyway. Look up the Royal College of Gynaecologists guidance. The earlier stages are supplements, and a particular combined pill, I forget the name.

Why not have a prolapse repair rather than hysterectomy?
This wasn't even mentioned. He asked if he should book me in for a hysterectomy asap. Cynical me assumes he'd get paid more for it.

I've been reading lots, but I'm still no closer to understanding anything! In some places it says that HRT is much lower hormone levels than the pill but you still need extra progesterone if you take oestrogen. Some places it says you shouldn't take the pill if taking hrt and in other places it says HRT shouldn't be taken long term.

Do you have any links to reliable info?

I don't have time to leave lots of links- sorry!- but there is masses online if you want to search for it. There is a lot on the Balance website of Dr Louise Newson- use the search box on the site.

Prolapse repairs are usually always an option unless yours is very severe. Is this a private appt- hence your question about drs being paid more? If this is NHShe won't be paid anything different for what he does and privately both take about the same time.

HRT can be used for life. (again,see the Balance website.)

HRT is estrogen + progesterone unless you don't have a uterus then it's estrogen only.

You can't take the CCP and HRT together. You can take the mini pill and it can be used in higher doses as part of HRT.