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[Alice]

Hello

As I wrote in another post I am currently attempting to transition from YAZ birth control pill to HRT.  I imagine such a transition from BCP to HRT is quite common amongst us women of a certain age!

Unfortunately, the attempts I have made this year have proven to be a disaster both for my physical and emotional health and, in desperation I have recommenced YAZ to try to stabilise my hormones again.

At 57yo it is understandable that my doctors advise the change to HRT but the trial and error involved seems dangerously unscientific and I am trying to make sense of the options so I can make a good choice without wasting more time feeling physically unwell and emotionally suicidal.

After trialing most products available in Australia - including  Estradot, tibolone and bio-identical hormone compounded creams, I have discovered a strong progesterone sensitivity and that no combination really suits.

Currently my thinking is that, as I tolerated synthetic progesterone in YAZ (3mg drospirenone per day balanced with 20mcg Ethinyl Estradiol) very well and as bio-identical progesterone is not licensed for prescription in Australia, I should stay with drospirenone and introduce a bio-identical estrogen.

Angeliq produced by Bayer, who also make YAZ , have such a product however the balance of estrogen (1mg) to progesterone (2mg) in the tablet prescribed in Australia  is way progesterone dominant and left me feeling dangerously suicidal on my first trial.  My doctor has advised taking some extra estrogen to balance the mix - but how much do I need to equate to 20mcg that seems to work?

I contacted Bayer in both Australia and Germany to ask and they advised me that neither they, nor their scientists who made both products, knew the equivalency or comparison between Ethinyl Estradiol and Estradiol in their pills.  This struck me as highly incredible that scientists of such a high caliber pharmecuitical  company are unable to answer the question - so I now ask you perhaps more knowledgeable ladies:

Does anyone know the rough equivalent comparison between Ethinyl Estradiol and Estradiol?

If I am able to find an answer, I will be able to, hopefully, find an estrogen/progesterone balance that suits me and does not cause debilitating side effects.

On the side of logic, as synthetic progestin is, in my understanding, supposed to be the more dangerous of the two hormones and more likely to cause a stroke, it seems odd that I am advised to reduce estrogen and stay at more or less the same level of progestin as YAZ.

This HRT 'experiment' really does my head in!

[Kathleen]

Hello Alice and welcome to the forum.

I admire your scientific approach in trying to balance your hormones and share your frustration at the seeming impossibility of it all! Fortunately there are many knowledgeable ladies on this site who can advise you, including some who are using a bcp instead of HRT, and I'm sure they'll be along soon.
You are also not alone in struggling with the physical and emotional problems of the menopause, I'm 59 and using a patch atm but this hormonal rollercoaster continues to be bumpy ride.

Wishing you well and keep posting.

K.

[Briony]

Do you have access to Qlaira or Zoley? They are very much 'half way houses' - bio identical contraceptive pills designed to bridge the phase from BCP to hrt. Qlaira averages 2 mg of estrogen with only  two blank pill days. I know less about Zoely - I think it's got slightly less estrogen and is monophasic?

[Alice]

Thank you for your validation and support Kathleen.  Yes, the instability and effects of hormonal shifts are commonly shared.  I appreciate your response.

Briony, Qlaria is available in Australia and I think Zoley.  I agree Qlaria would be a good option if my attempt to reduce YAZ and introduce bio-identical Estradiol gradually fails.

Interestingly, the Australian Broadcasting Corporation tonight broadcast a first run program ' Catalyst' on how  hormones effect  the female sex drive.  It confirmed my experience of the BCP stalling sexual response in some women - like me.  The program also discussed testosterone and many other issues pertinent to the menopause.

I don't think I am able to link to the program for  international viewers, but here is a transcription  if anyone is interested in reading.

http://www.abc.net.au/catalyst/stories/4343811.htm

Hope that link works!

[peegeetip]

"Currently my thinking is that, as I tolerated synthetic progesterone in YAZ (3mg drospirenone per day balanced with 20mcg Ethinyl Estradiol) very well and as bio-identical progesterone is not licensed for prescription in Australia, I should stay with drospirenone and introduce a bio-identical estrogen."

The simple answer is yes.

The prog your given in Yaz is not available in HRT products (not in the uk) and its a more modern prog with less side effects - hence it works for you.

Given your 57 and have been on this during peri/meno then any change to HRT will drastically alter your intake of Estrogen.

As you point out the doc's science is lacking and a bit hit and miss.

Stick with Yaz if it works and just get on with life

 

[Alice]

I like your attitude peegeetip!

Will do!  (Get on with life that is)

This HRT business and trying to do the right thing to protect our future health and prolong the security of our families is such a minefield.  I know we all know it and are living it.

Thanks to this fabulous website for being the intelligent support that is so hard to find elsewhere.

[Hurdity]

Yes Alice the same HRT product you describe (Angeliq) which contains drospirenone - is also available in UK as part of HRT. I can imagine that 1 mg is nowhere near equivalent to the oestrogen in Yaz - after all CCPs have a high dose oestrogen and progestogen in order to suppress ovulation - which of course in your case is not needed since at 57 you will be post-menopausal. If your doc will allow extra oestrogen along with this pill then see if you are allowed to take 1 mg extra oestrogen? Of course it has to be guesswork because doses are not personalised and the products we may desire are not available!

I'm actually quite surprised that the dose of dros. for HRT is only marginally less than for the CCP which is a much higher dose of oestrogen - which is presumably why your doc says it's OK to have more oestrogen?

There is bound to be a period of time during which you may experience side effects but I think you and your doc are wise to gradually come off the CCP due to increasing risks with age, especially with the synthetic oestrogens.

If you do go down this route I would want to have a regular uterus scan to chekc the lining is not building up - since it would be an unlicensed dose (well in UK anyway).

Hurdity x

[onsamui]

In the last 12 months I decided to go back on Angeliq HRT.  I originally came off it as I had problems with breakthrough bleeding and headaches etc.  I have tried various preparations.  I had an early MP, 44, (now 60) and am similar to my mother in health patterns (she has osteoporosis).  Mum was taken of HRT  due to the health scare a many years ago and I have watched her health deteriorate from the withdrawal of the HRT.  I have found that if I take 2 tablets a day I feel so much better, no headaches, no bloating and feeling like I am or getting a bleed.  I have also suffered from depression which started around the time I went through the MP and that lifts on the higher dose.  The dosage seems similar to INDIVINA 2+5* medium dose HRT.  I travel around a lot and ran out of Angeliq in Cambodia and used YAZ instead and found that suited me as well.  I don't get to see my GP often due to being abroad but generally find Dr's clueless with hrt and suitability (brother GP included), and feel I have a good 'handle' now on what suits me.