Evorel sequi - what's in my future?

[Caerulea]

I'm 46, periods still regular though lighter & shorter at 5 days. Ovulation still happening.

Hair shedding like crazy (bloods, thyroid all fine)
Scatty af
Don't seem able to tolerate warm temps anymore
Negative levels of libido
Multi-tonal tinnitus
I feel thick & muggy, everything is too much & I want to go sit in a dark room by myself for like a week.

Etc etc

After a uti a month ago my GP suggested having a chat about HRT as it was my first UTI & she suspected hormones might be at play. Saw her this morning & she's put me on Evorel Sequi. Years ago I tried multiple contraception pills but each one made me mentally ill in one way or another. The nurse determined I just couldn't tolerate hormones so I ended up with the copper coil - which is out now cos it made me severely anaemic after 10 years of 10 day long, heavy af, periods.

GP thinks I'm just highly sensitive to hormonal changes hence feeling the effects of oestrogen being messed up much earlier in my journey to the blissful period-free days of the future.

Is this all very normal? So much of what I have read is from women who have already had changes to their cycles or stopped periods entirely, which isn't the case for me.

Just feel very tired & lacklustre & would like my hair to stop falling the Fuck out. Would be nice to start feeling sexual too.

The oestrogen in the patches is what's called body identical, which means it's identical to what your own body produces, not the same as what's in the contraceptive pill. On the other hand the progestogen in the combined patch during the second half of the month is not body identical so it may or may not suit you if you're sensitive to progestogen. You really can only try it and see if you feel better or worse.

There is body identical progesterone, comes as a capsule and can be taken orally or vaginally. You could be fine on that.

Oestrogen thickens the womb lining and progestogen prevents that, so you need to take one if you're on oestrogen hrt. You'll know soon enough if you feel a lot better the first 2 weeks of the month when you're on the oestrogen only patch and dreadful when you're on the combined.

The amount of hormone in hrt I think is quite small compared to the pill. The pill is designed to override your system, hrt tops it up, it's more like taking vitamin d or b12 if your body is having trouble making those itself, whereas the pill is strong enough to interfere with what your body does naturally.

There are women who don't tolerate progestogen and I believe there is the possibility of using less of it under strict medical supervision, for example for 2 weeks every three months rather than 2 weeks every month.

Utrogestan capsules are the first port of call, then duphaston is supposed to be the best of the non body identical options. That's what I'm on, I find it more tolerable than Utrogestan. Some women absolutely love Utrogestan and find it calming and sleep better and a good anti inflammatory.

Your periods lightening indicates your oestrogen is low. Progesterone is the first hormone to start going low and often heavier periods result as the oestrogen becomes unbalanced and the womb lining builds up too much. But it sounds like you are past that stage.

I had issues with the pill and never used hormonal contraception apart from a brief period after university. I was worried that this would make me unusually sensitive to HRT but I have been using evorel estrogen patches and utrogestan progesterone absolutely fine for a couple of years now, starting at 50.

I'm only on the lowest dose patches as that has always been fine to get rid of the hot flushes for me. Does also help with hair shedding and anxiety which were the only other symptoms I had. I also can't wear non cotton clothes anymore and still have a tendency to over heat, but think it has also helped ease that. I quite like it really as i used to be freezing in the winter, now can sleep with the window open!

I did find the utrogestan harder and it took a good 6/7 months to get used to it, but fine now.

Sounds like it would suit you potentially, you can start super small on the patches.

I had terrible experiences on the combined pill, mini pill and mirena coil to the point that I put off going to see my GP about HRT for about a year but I've been absolutely fine on the Everol patches. I'm just about to switch to the gel and progesterone pill because the patches keep falling off and irritating my skin so hoping that works just as well!

@Apileofballyhoo goodness, the knowledge!! That makes perfect sense on the difference between the pill/s & HRT, thank you.

On this -

Your periods lightening indicates your oestrogen is low. Progesterone is the first hormone to start going low and often heavier periods result as the oestrogen becomes unbalanced and the womb lining builds up too much. But it sounds like you are past that stage

I've actually no idea whether it's hormone related or not, the moment I had the coil taken out my periods went from the 10 day shitshow to the 5 days it is now. Cycle length hasn't changed, nor when I ovulate. But the coil could have masked changes so I came off it having already had changes I guess? Prior to the coil this is what they were like so I just assumed I'd gone back to that?

My mum's periods didn't stop till later in her 50's so I'm not expecting mine to give up any time soon, but not sure if that's an old one wives tale 🤷🏼‍♀️

Thank you for that, it's what I needed to hear. I've not spoken to anyone who's been completely intolerant of hormonal contraception - GP at the time said it was copper coil or hysterectomy, nothing else was suitable. So I've been wary of HRT (for me, not in general) too.

Thank you :)

Anxiety is an issue for me, been on low dose sertraline for a few years which works really well but definitely had moments where it feels like it's suddenly not working, then it's fine again. GP suspects it's been masking (helping!) some of the anxiety symptoms of my hormones dicking about

Your GP sounds like they are pretty good at recognising symptoms, a lot of them can be dismissive so I think you're onto a good thing there. Hrt can be quite the roller coaster till you find what suits you, dosage and types might need to change but it's been life changing for me.

@Apileofballyhoo* *

duphaston is supposed to be the best of the non body identical options.

Great post but just to add that Duphaston (dydrogesterone) isn't available in the UK (only in Ireland) as a separate tablet. It's only available as part of Femoston tablets.

I also struggled with hormone contraceptive but it's fine on these patches OP. It's so nice not to be plagued with hot flushes. Im loads less miserable than I was.

I pop the new one in my bra for a bit before opening it to warm it up first. It doesn't fall off then.

If anyone's got any tips to get the sticky squares off the rump when you're done with that patch I'm listening though

That's a shame @JinglingSpringbells , I wonder why it's not available separately. I still don't love it and I wish I could use utrogestan but it just makes all my symptoms come back.

a bottle of cheap baby oil and some cotton wool!

Anxiety is an issue for me, been on low dose sertraline for a few years which works really well but definitely had moments where it feels like it's suddenly not working, then it's fine again

It's quite likely that the anxiety you had was peri and HRT should have been on the menu then.

Dr Louise Newson has masses of evidence on this where she says that SSRS don't work for peri when it's hormonally based anxiety.

Interestingly the latest NICE meno guidance is out today and again it says no SSRIS for peri-women, without trying HRT first.