Switching from hrt to combined pill

[Hrtquery]

I'm 46, on the sequi regime with evorel 75 and utrogestan. Have been trying various doses etc for the last 3 years, primarily for mood issues but I do also get night sweats.

I think it's time to admit it's not sorting me out. I'm beginning to think that I'm sensitive to progesterone withdrawal. I've always had PMT, also had appalling PND after both kids. At the moment I'm ok on the two weeks on utrogestan, but within a few days of coming off I feel intensely awful. Some months are better than others but the last one has been appalling. I feel like a coiled spring. Can't sleep, can't stop crying and don't know how to go on.

I asked my Dr whether I could just take utrogestan all month long but was told that I'd be likely to have irregular bleeds and that would be dangerous because of the risk of unidentified gynae cancers. The only other option suggested was mirena coil which is definitely not for me, due to traumatic issues with medical stuff in the past.

One option we haven't discussed is the pill. The thought of stopping any fluctuations in my hormones sounds like exactly what I need, but I had assumed I wouldn't be allowed to use it because of my age. However I recently spoke to a friend and discovered that she'd been on it for many years, now mid 40s. So maybe I'm wrong.

Does anyone have any advice or relevant experience? Have you taken the pill in your 40s and/or used it to resolve unstable mood? Are there reasons I should not consider it? Will I just be refused? I do get migraines, not sure if that's an issue. Blood pressure is fine.

Please help, I'm feeling really desperate, can't imagine surviving years more of this. I just want to experience some stability and peace.

I moved to the combined pill from HRT due to a complete progesterone intolerance when on the 2 hormone patch time of the month. I got terrible itching all over my body and insomnia so my GP tried the combined pill (don't need it for contraception as he's had the snip). It has worked to some degree. Has definitely stabilised my mood, has helped the insomnia and the aching all over. It has done nothing for the hot flushes and sweats so I am dying on days like today!

I take the combined pill, three packs in a row then four days off. Partly due to heavy bleeding, partly because of awful pmt. It’s bliss. I have been told I’m not peri menopausal but my periods never used to be like this… I’m 43 and I think I can stay on it till 50? No idea what I’ll do after that?!

@OhhhhhhhhBiscuits @Whatkatyforgottodo
Thank you that's encouraging. Do either of you get aura migraine, or was that something you were asked about when prescribing?

I moved to the progesterone for 3 weeks a month for similar reasons, feel great on it. I still have a break for a consistent bleed but not as long off it. Could that be a compromise? The stuff in the pill is probably progestin rather than progesterone. Progesterone is the one that gives all the systemic benefits that you may be experiencing so one may not replace the other.

@Hrtquery i was asked about aura migraines and I don’t think I would have been allowed to go on it if I suffered from them. I had migraines as a teenager but never with an aura so it was low risk for me I think.

@Resentful2023 hm ok that complicates things. Do you get symptoms in your week off?

@Whatkatyforgottodo right, this is my worry

You can find out if you look at the pages here: https://www.fsrh.org/standards-and-guidance/uk-medical-eligibility-criteria-for-contraceptive-use-ukmec/

The guidance changed in 2007 to no prescribing for women who had migraine with aura. I found out when the GP took me off it and told me to throw away the ones just prescribed, 6 months before I was 50 🙄

Not so much. For me progesterone helps with sleep and mood. I really felt the two weeks, sleep would go bad, etc. But 3 weeks is much more steady. Maybe try a specialist? I think the risk with continuous is not so much that it increases your risk of cancer, more that a good warning symptom of strange bleeding patterns is lost as you may have break through bleeding etc. on continuous. A meno specialist may feel more qualified to manage you through it. Or try a Facebook page for others who have experienced it. The Irish Menopause Facebook page is a total wealth of knowledge, not just for Irish women, they post from all over on it.

@Resentful2023
Thank you very much. Yes that is how the GP described the risk. I think I will ask them about increasing the utrogestan to 3 weeks, affording a private consultation would be a squeeze right now so hopefully they are open to it

Just to say at my last contraceptive check I asked how long I could keep taking the mini pill for and she said until 55. Not sure if the same applies to combined....but they initially moved me off that because of my weight.

I was on Qlaira for a while which is often recommended as a pill for perimenopause. It did help but it didn't control my symptoms as well as HRT.
It's a shame the coil isn't an option as it's worked well for me and it sounds like you would benefit for the continuous low dose of progesterone rather than fluctuations.
I hope you find something that works for you.