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[GypsyRoseLee]

I've been thinking............about those women who suffer primarily with the nasty mood swings and anxiety associated with peri menopause, but still have regular periods, and generally still get a good/normal 10 - 12 days each month once their periods finish.

If you're under 50 still, it could be argued that what they're suffering with is extreme PMS (or PMDD) rather than traditional peri menopause, and that's why they don't get the classic hot sweats, flushes, VA etc.

Now, for these women, unfortunately, many cannot tolerate progesterone very well, and it can increase the low moods and anxiety. So taking HRT can be a bit of a poisoned chalice.

So, considering they're still having regular periods, would not it make sense for them to just take oestrogen supplements/patches during the second half of their cycle, when all their symptoms tend to rear their ugly head?

I have been reading on another forum about women, diagnosed with bad PMS/PMDD being treated, by gynaecologists, with 50-100 mg patches, only worn after ovulation until their period starts. They appear to work very well.

Speaking for myself, I have none of the physical symptoms associated with Perimenopause. My periods ate now lighter, but still regular. With me it's only ever been about the sudden mood swings, low mood and anxiety. But generally speaking I always feel fine for roughly 10-12 days per month during the first half of my cycle. Then.I generally get another good few days up until a couple of days before my period starts. This is whether I take HRT or not, it makes no difference.

Just throwing the thought out there and wondering what others think? I'm seeing Annie Evans in 7 weeks and I wondered whether she'll treat me for extreme PMS/PMDD or for traditional perimenopause?

[Dorothy]

Interesting though GRL - I guess it would explain why they don't get any other symptoms.  Although, given the reluctance of GPs to diagnose peri in women under 50, even with every symptom on the list, I doubt there are many out there being treated for peri when mood swings and anxiety are their only symptoms! 

If you go down this route, let us know how you get on.  Hope your appointment is successful in helping you find a way forward.

[GypsyRoseLee]

It interests me Dorothy, and seems a sensible approach really. Taking HRT all through the month seems unnecessary if you feel perfectly well/fine for half the month anyway.

It's not a regime I would consider trying without the agreement of either my GP or Annie Evans.

But during my reading, I have come across lots of research which states that for women taking ADs for extreme PMS only need to take it during the 2nd half of their cycle. And doing this is just as effective as taking an AD all through the month.

So it got me thinking?

I have never had even a very mild hot flush or night sweat. I have never had any problems with VA or dryness down below. Never had any problems with hair becoming dry, falling out, or growing where it shouldn't etc. Physically you would never diagnose me as perimenopause, except now my periods are much lighter and my cycle has shortened slightly. But that's it, physically.

All my symptoms are in my head, so to speak. The mood swings, the random anxiety, the sudden depression that comes and goes in the blink of an eye. I also started getting insomnia, but I think that was caused by the anxiety. I don't think it happened in and of itself.

[GypsyRoseLee]

But to add, when I saw the first doctor at the Meno Clinic she diagnosed me with premature ovarian failure based purely on my history of PMS. The fact I had felt very calm and in a good mood during pregnancy. And that I went on to have PND. She wasn't interested as much in any physical symptoms, and I didn't really have any anyway.

[Dorothy]

Honestly, it's enough to drive you round the bend!  I found a list of 35 common meno symptoms and I had 34 of them (probably would have had the 35th, but as it was painful sex & I'm single, I have no way of telling!) and my first GP wasn't interested in discussing peri because I was too young!!!  You go in with a few symptoms that could equally mean something else requiring different treatment, and they label you peri.  I give up!

[Lizab]

I'm by no means an expert, but I think one issue with that would be that in peri, as opposed to normal reproductive years, you may not be ovulating, even if you're having regular periods. And as a result, you may not be producing adequate progesterone to do whatever good stuff progesterone needs to do. I believe the progesterone levels drop before estrogen levels. But I can see how if you're reaching typical age, pms/pmdd could be mistaken for peri, or it could even be the earliest sign of peri. I guess this is where knowing exact estrogen and progesterone levels would be useful.

[CLKD]

You could contact NAPS - they were really helpful with advice in the 1990s when I was really ill with PMT.  There is a magazine too.  I don't know how much menopause 'talk' they deal with but maybe they could begin linking in end of periods and menopause ……… with other advice.

[Chi chi]

I've also read about women taking AD's only at certain times of the month but I've never really understood how that could work given that it needs time to build up in the body? We're told that it can take at least a couple of weeks to start working? So if women are taking it for say 2 weeks in their cycle wouldn't it just be starting to have an effect just as they're stopping it??

[Niamh]

Hi GRL

As you know I'm being treated by Prof Studd for pmt not peri as such. He believes the way to treat it is to stop natural ovulation and hence switch off the hormonal issues I suffer with around ovulation and the 2 weeks after. As you know he's done this through ostrogel and utro, it's worked in the main and ive certainly not naturally ovulated or had a period...I can ask him more on thurs but certain this is his approach x

[CLKD]

I can't understand the taking of ADs intermittently ……. especially as some do give awful side effects until they 'kick in' properly 

[Mother bean]

Hi GRL,

Hello I am new to writing any form of response and would like to apologize if I am doing anything wrong but I felt the need to share my experiences.

I am 52 and was told I had very low progesterone in 2009 and that I had POCS (I was 45 at the time and my hubby & I were trying for a baby which happened but sadly loss in a miscarriage). I was told at the time that even though I suffered from low progesterone that I was at the time making loads of eggs for someone of my age.  Never ever suffered with any form of anxiety until Nov 2012. I won't bore you with how my journey started off ( even though at the time I didn't realize it had anything to do with the menopause cos I believed I was dying from some unknown illness) This was when the doom & gloom played its part!😪
After a few anxiety blips I was put on HRT, started with The tablets and after reading so many of your experiences and advices that I went with Oestrogel and Utrogestan until I couldn't get the stability right, so ended up with Estradot and Utrogestan which I find to being good. It got me thinking that with the fact I was told my progesterone levels were low but my estrogen was good that since my anxiety started in 2012 it had to do with low progesterone and unti yesterday I truly believed this. On the the weekend I changed my patch down to 25mg from the 50mg as I felt perhaps I was topping up with too much estrogen. Anyway yesterday having done this on the Sunday night and waking up on Monday morning feeling really flat and fed up and a little low and had no motivation. I decided to add a little dab of Oestrogel to my 25mg patch and slowly but surely felt my lowness lifted, so I added another dab of oestrogel afternoon and again my mood continued to improve. By the afternoon I decided to take off my 25mg patch and add a 50mg patch even though I had already  added the Oestrogel and again my mood really improved. I guess what I am trying to say that finally yesterday the penny finally dropped and confirmed to me that is was must have been the massive fluctuations in my estrogen that caused my hormone anxiety in 2012 and perhaps not the lowness in my progesterone that I began to think.
With what I did yesterday I decided not to take my Utrogestan tablet last night but to see how I felt and to be honest I  had agreat nights sleep ( I am already on a bleed and usually take it daily). Today I repeated by adding a dab of Oestrogel and again continued to feel really bright and full of  motivation and didn't wake up with the feeling that I could stay in bed for a little while longer.  (which generally happens when taking the Utrogestan ) I now feel now that these odd times of feeling  anxious was perhaps when my own estrogen had plummeted once again and feel now that during these times such as possible mid cycle when I thought my hormones may decline I used to add more progesterone but have now decided to try topping up my estrogen a little to help with my dips to see if this will help! I feel so embarrassed that it may have taken me nearly three years to realize that low estrogen can cause anxiety so topping up will improve how you can feel!
I am lucky that I still have some Oestrogel to play around a little with and that I don't feel anxious but feel the content and happiness I once used to experience. Big hugs to you! Joy xxx

[GypsyRoseLee]

That's really interesting to read Mother bean.

I am not an expert, but everything I have read cites low oestrogen/fluctuating oestrogen as being responsible for the mood swings/anxiety in Perimenopause.

I strongly suspect that I need lots of oestrogen in order to sat feeling normal during Perimenopause. Perhaps more than the average woman? I suspect that before peri my oestrogen levels would have been towards the very high end of the 'normal' level, as I have always been very fertile, very young looking skin, even in middle age etc.

I do know that both Prof Studd and NAPS recommended high doses of oestrogen (much higher than available in conventional HRT) to combat mood swings and anxiety caused by PMS and perimenopause.

When I used to wear oestrogen patches the highest I had was 50mg and I don't  feel they made much difference overall. I just felt even better than usual during first half of month, but still felt just as bad during second half.

I am ridiculously ruled still by my menstrual cycle. I felt great during the week prior to ovulation this month. Then mood really dipped 2 days after ovulation, which coincided with starting the combined HRT tablets. Have felt dreadful for last 3 days, with last night being particularly bad. But this corresponds with the big drop in oestrogen after ovulation. But today I woke feeling a bit better and brighter, as my own oestrogen will now be rising again a bit, to then plateau before the big drop when my withdrawal bleed starts.

To be honest I think the amount of oestrogen in Femoston 1/10 or even 2/10 is just a drop in the ocean compared to what I really need to feel as good as I reasonably can.

I am so sick of these ups and

[robotwars]

I'm finding this thread very interesting! As I was put on HRT for low mood for a couple of weeks a month, vaginal dryness, and heavy periods this is all the symptoms I had, I didn't have any hot flushes etc. I have tried so many different HRT and im now on the patches, im not sure whether its helping or not, as I still have the dryness but the periods are now hardly happening at all for the last few months, my mood has lifted slightly..... but I do wonder if HRT is what I need...........
Its interesting to read about others thoughts on this.

[GypsyRoseLee]

What dose patch for you wear robotwars?

25 mg didn't do a thing for me. Upped to 50mg and it improved my mood on my 'good' days, but still had as many 'bad' days, and felt just as bad on them.

One time, while on 50mg, my mood really dipped and in sheer desperation I applied another 50mg patch. Within 24 hours my mood started to rise.

But I never carried on down the path of 100mg patches, as the following week I switched to the BCP. Overall I felt my mood was better and more stable in the BCP. But I was taking it back to back, and after 3.5 months my mood suddenly dipped horrifically, and I was in tears for 2 days just feeling so anxious and panic striken. I think I reacted to the build up of synthetic progesterone? So I stopped taking it and went back to just 50mg patches.

But I felt very flat and low for the next 5 weeks until my next withdrawal bleed.

Am I now suffering with PMDD (which is the most extreme type of PMS) or am I perimenopausal? Or both? I don't know.

[Briony]

Really interesting discussion.

Despite a few  very low estrogen readings, my FSH has never been raised, so I have always seen my situation as extreme PMS rather than menopause.

Every doctor I have spoken to has said both ADs and hrt take time to have an effect, so continuity is the key, especially in peri menopause when everything's fluctuating and often, no two months are the same. That's why I switched from sequential to continuous hrt. (Horrible dip post progesterone phase). That said, I know some docs recommend part time patches or  HRT, as you say.

When I tried first tried lower dose patches,  I still had fluctuations and therefore didnt feel much better. Like GRL, I switched to a BCP in an attempt to suppress ovulation and had  a fair bit of success with Qlaira. However, when the NICE HRT guidelines emerged, I felt uneasy about taking a pill rather than a patch. At the same time I read the NAPS guidelines on treating PMS (do look at this if you haven't already). This prompted me to switch to 100mcg patches and 25 days of 100mg Utrogestan.

In theory, this should be enough to suppress ovulation (which is what NAPS and most of the experts agree is needed for severe PMS) however, I am not convinced it has (yet) achieved this. Month one I felt fantastic in terms of hormonal issues, but I seemed to have a normal (heavy) period. Am convinced I ovulated. (On Qlaira I didnt even need a tampon). Month two and gradually a lot of the physical symptoms I had 3 years ago (tingling, back ache, dizziness) have returned. Emotionally, I feel pretty good - far better than on a lower dose patch or Marevlon - but the intermittent aches and tingling are draining. I wonder if it's just delayed side effects or a sign I need a higher dose patch? (100-200mcg recommended for suppression). Are these aches a sign of low estrogen or a sign of fluctuating estrogen? 

For anyone who's not yet seen the NAPS guidelines: http://www.pms.org.uk/assets/files/guidelinesfinal60210.pdf