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[Briony]

Apologies is I am going over old ground, but I am keen to know what causes fatigue? Is it low oestrogen, high or the fluctuation between the two?

My initial symptoms have improved massively since taking HRT and then the pill. However, I do still get periods of really crushing 'stops everything' fatigue, often just for 30 minutes or so up to a few hours. Given that I had severe fatigue when I knew my oestrogen was low (41pmol), I assumed more oestrogen would mean less fatigue. However, if that is the case, why do many women have extreme fatigue at the start of their pregnancy (when I assume hormones are on the increase?). It's so confusing.

This time around, as before, the fatigue has occurred at the end of an old pack of Qlaira and the start of a new pack - ie when you have two days of low hormones, two days of none and, two days of the highest dose (it's also when my 'natural' period would have occurred, time wise). I get no others problems with Qlaira, and mentally, I feel a lot stronger, so I really don't want to stop taking it  - but am wondering whether in fact I need an even higher dose of pill/HRT? Perhaps it's the fluctuations in the dosage so a constant high dose HRT would be better? 

Has anyone found their fatigue has got better or worse with an increased oestrogen dose? I am 43, so at an age when I would have assumed I need more oestrogen rather than less. However, having always had irregular periods (and so lower oestrogen?), perhaps it's too much for my body?

Just read this through and it's not very coherent. Sorry -  hope it makes sense to you! x

[dazned]

I believe it is the fluctuations between the  2 I.e. the "dip". in peri this worse as your own hormones are chipping in willy nilly so is up and down like a roller coaster. Not good at all.   

[GypsyRoseLee]

The more I read and learn the more I am starting to think that it is the subtle changes in oestrogen levels which cause all this awful anxiety/exhaustion/depression etc rather than just having low oestrogen per se.

If having low oestrogen was a problem then every post menopausal woman in the world would be suffering and clearly they aren't. In fact most report feeling much happier and more content than when in their 30s and 40s 

I wonder if maybe Qlaira is too gentle for you? Maybe you need a standard version of the Pill to just knock your own hormones out completely and stop any fluctuation? It's certainly something I am seriously considering as you know?

The fact that my mood seems to dip 2-3 times a month makes me suspicious that it's the CHANGES in hormone levels which are causing my anxiety/depression. And the fact that my anxiety/depression can disappear/appear in just a few moments leads me to believe that only a tiny change in hormone level can immediately trigger a reaction. 

[Briony]

Think I feel the same as you both - it has to be the fluctuations? Which would make sense for why you can feel fatigued in pregnancy. I think I may ask my GP for something stronger - though not convinced she'll oblige as I'm such a high risk. I wonder if a high dose HRT is less of a risk? Ie if delivered transdermally rather than orally?

[GypsyRoseLee]

You could have contraceptive implants Briony? They would be considered transdermal wouldn't they?

[Limpy]

You could have contraceptive implants Briony? They would be considered transdermal wouldn't they?

Not sure if contraceptive implants would be considered transdermal.
They go under the skin.

"A transdermal patch is a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream"

[CLKD]

Also implants are difficult to remove 

[Sazduggs]

Oh my god, I feel the same! The last few days have been horrendous! I have had 2 crashing naps today, thought it might be narcolepsy!!! It's always worse during the day, mid am and mid pm and worse 1-2 hours post food, I keep wondering what it is and fluctuations sounds about right. I'm generally low in mood when it happens, I've been on 2 evorel patches for 4 weeks now so I guess it's still settling in xxx

[Hurdity]

Briony - the fatigue/tiredness in pregnancy is due to the high levels of progesterone. High oestrogen does not cause fatigue at all! In pregnancy we eventually have very high levels of both hormones - far higher than at any other time during our menstrual cycle.

The Qlaira pill is mimicking the natural cycle to some extent - so you stop the high dose of oestrogen and progestogen (after Day 24), and then have two days of lower dose oestrogen and then two days of no hormone. This is what happens during your cycle - but with Qlaira it is condensed into 4 days rather than two weeks! Any feelings you experience from Day 25 onwards until a little while after you start Day 1 again - are due to the oestrogen dip and/or progesterone withdrawal - both of which are normal pms. HRT is not a magic cure and it is unrealistic to expect it to eliminate all symptoms completely. If you only get pms and this is no worse than you experienced during your fertile years - then hopefully you are feeling OK and better than you did when not having any extra hormones?

Do hope you feel better soon and manage to feel better overall so that you feel it is worth being on this pill! Personally I wouldn't want to go on one of the others at this point because of being both synthetic oestrgoen and synthetic progestogens!

Hurdity x

[Briony]

Thanks Hurdity. Can't believe I left progesterone out of the equation altogether! (A little knowledge is ...)

Reading your post prompted me to read more widely, and I can now see that I've only been thinking about half the picture ... and, in doing so, have gone down some blind alleys, for want of a cliché or few.

I do acknowledge that some symptoms are inevitable - and without a doubt, psychologically, the Qlaira has helped massively compared to the pre hormone days. I can even put up with the  spotting, aches and sore breasts. What I am struggling with though, is the random  and very crushing fatigue. When it strikes, it is both debilitating and frightening. I hide it as best I can at work, but it's not easy and I end up feeling terribly guilty for not working as productively as I should have done.  What makes it worse is that it is nearly always accompanied by the chills and slight nausea/dizziness - often quickly followed by increased spotting (more like a light period than a spot). 

Strangely, pre all this hormonal chaos, I  never really had PMS. In fact, my periods were always irregular and symptom free until three years ago when I had a miscarriage at 40. Perhaps I should have appreciated how lucky I was more in the past and had more sympathy with those who were suffering. I never realised hormones could be so evil!   

[Hurdity]

You shouldn't underestimate the effect of large doses of synthetic progestogens on your system! I took norethisterone a couple of summers ago ( or was it last year?) at suggestion of my nice (gynae) GP ( not the unsympathetic general one) because I'm on a long cycle - and it made me feel really odd - had dramatic effect on my blood sugar - I think during the withdrawal phase but can't remember exactly. It was so bad I went to the dcotor thinking there was something wrong with me as twas worse than my usual low blood sugar episodes. I know it's not the same as chills/crushing fatigue etc, but just saying it had a huge effect and was the first time ( since taking the pill for a year when I was about 23) that I had taken hormones orally - and especially the progestogen.

If you never suffered form pms then it must be the combination of hormones you are taking. Even so hopefully you feel generally better overall?

Great to read more widely but beware of some US sites and practitioners geared towards the US market and those who pay for their healthcare and may be persuaded into all sorts of things. Unfortunately these sites are also available to us - many are advocating unproven theories in an attempt to sell - guess what - progesterone cream and the like! Best to look at the orthodox menopause societies, peer reviewed journals, and text book stuff. I hope you don't mind my saying - I'm sure you and everyone are aware by now!!

Hurdity x

[MrsMopp]

I was tired before I took HRT and I'm tired 2-3 months in.  Maybe it's something else entirely 

[GeordieGirl]

Whilst looking at hormones, it's worth considering a vitamin B12 supplement - it helps beat fatigue.
I've just posted on another thread (or quite a few actually) about how diet has really boosted my energy levels too, I've more energy now than I've had for years - and absolutely loving it 

GG x

[Briony]

You shouldn't underestimate the effect of large doses of synthetic progestogens on your system! I took norethisterone a couple of summers ago ( or was it last year?) at suggestion of my nice (gynae) GP ( not the unsympathetic general one) because I'm on a long cycle - and it made me feel really odd - had dramatic effect on my blood sugar - I think during the withdrawal phase but can't remember exactly. It was so bad I went to the dcotor thinking there was something wrong with me as twas worse than my usual low blood sugar episodes. I know it's not the same as chills/crushing fatigue etc, but just saying it had a huge effect and was the first time ( since taking the pill for a year when I was about 23) that I had taken hormones orally - and especially the progestogen.

If you never suffered form pms then it must be the combination of hormones you are taking. Even so hopefully you feel generally better overall?

Great to read more widely but beware of some US sites and practitioners geared towards the US market and those who pay for their healthcare and may be persuaded into all sorts of things. Unfortunately these sites are also available to us - many are advocating unproven theories in an attempt to sell - guess what - progesterone cream and the like! Best to look at the orthodox menopause societies, peer reviewed journals, and text book stuff. I hope you don't mind my saying - I'm sure you and everyone are aware by now!!

Hurdity x

Good point, Hurdity. There are some very subjective sites out there, especially the American ones!

[Briony]

Whilst looking at hormones, it's worth considering a vitamin B12 supplement - it helps beat fatigue.
I've just posted on another thread (or quite a few actually) about how diet has really boosted my energy levels too, I've more energy now than I've had for years - and absolutely loving it 

GG x

But do get it tested first. I initially assumed all my issues were down to low iron or B Vits - thanks to Dr Google - and bought a well known women's supplement.  When the GP did a blood test, I had ridiculously high levels of B12 which he said could actually exacerbate the problems I was experiencing. Lesson learnt the hard way ! x