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[MIS71MUM]

Hello - just after another bit of advice please.

I stopped taking Femoston 1/10 in early November 2015 because I felt my mood dipping at the start of the grey tablets.  Therefore as I am currently been treated for anxiety and depression, I didn't want anything to make me any worse, so packed them in.

Over the last few days, I have had the lightest period i've had in 30 years!  So now I've stepped off HRT, it's time for me to decide the next course of action. 

It's been difficult to say whether my dip over mood over the past couple of months has been down to hormones, because I haven't had a normal cycle.  But now I have had a period, what does that tell me about where I am in the menopause?  As my worst symptom is anxiety, I am hoping to resolve this with HRT rather than the AD's that I am currently on.

Any advice would be much appreciated.

[Dancinggirl]

Very difficult to advice Mis71mum as you are clearly still peri menopausal and your hormones will possibly continue to fluctuate for some time. The peri stage is particularly challenging because of these fluctuations.
At the age of 40, when I was still peri meno, I was put on Oestrogel (just one pump per day)  and then used a separate progesterone for 10 days each month (I can't remember which one) to induce a withdrawal bleed.  I never liked the progesterone phase as I got PMT and then a painful bleed but this HRT regime did keep me relatively stable for nearly 10years and I just slightly increased my dosage once I felt I was post meno and needed a top up. I always had issues with my periods when I was young so in a way this HRT regime just maintained things as they should have been - I just accepted that for a few days each month I felt a bit crap as I did when I had a natural cycle.
What you should do I really couldn't say but maybe you need to give yourself a break and see how things go.  If the flushes and night sweats are bad try HRT again but if it is just anxiety that plagues you (anxiety is the most difficult meno symptom to control, particularly in the peri stage) then maybe concentrate on some CBT and Mindful meditation with a good diet and regular exercise like walking. If ADs/SRRIs can help then don't rule these out.  I really don't think we can expect to feel good every day - just tackle each day as it comes in a positive way. DG x

[GypsyRoseLee]

Hi Mis71Mum

I started Femoston 1/10 2.5 weeks ago, at the same time as my period started. For the first 4-5 days I felt very low and pretty anxious. But my own oestrogen was at it lowest level too. Then my mood really lifted and I felt really good for the next 9 days. I'm almost certain I ovulated on days 13/14 of my cycle because my libido really perked up and I had quite a bit of 'egg white' down below.

But I then started on the grey tablets at the weekend and within 8 hours started to feel jittery. I woke up the next day feeling very low and unable to take any pleasure in anything. Quite anxious too.

I've been like this now for the last 3 days and it's really miserable, as I'm sure you know only too well.

So, not hugely surprisingly, it looks like I'm going to be intolerant of the type of progesterone in Femoston. I don't know if I/we would fare better on 2/10 as at least you'd have twice as much oestrogen to oppose the progesterone?

But, if either Femoston is going to make me feel like this for 2 weeks per month then there's really no point in taking it, as I was getting 2 rubbish weeks a month 'before' taking HRT!

I am seeing Annie Evans in 7 weeks and I intend to ask her about oestrogen gel with separate Utrogestan, and whether to take it vaginally for just 7-10 days? I think this will be the regime that can give me the most amount of 'good days' per month.

Like you, I've always had PMS, and could cope with feeling irritable, on edge and flat for a few days per month. But how I feel now, during peri, is so much more extreme. I noonger ever feel irritable, just intensely low and quite desperate + the nasty anxiety, which I never had with PMS (though did have extreme anxiety when I had PND, interestingly).

Maybe the gel and separate Utrogestan could be the best fit for you too? It's bio identical to our own progesterone, and taking it vaginally (less side effects and because it goes right to the spot you can take lower dose), and taking it for fewer days, of course. It will probably be better than how you are now, at least?

[Hurdity]

Hi Mis71Mum

I thinkj we've discussed before that you do really need to be on HRT if your periods are becoming light and further apart as you will be nearer menopause and at your age you need to take it to protect your heart and bones and general health. The challenge is finding the right one for you.

Is this light period the first you've had since early November? If so it does imply your own oestrogen levels are falling and this could explain your drop in mood. Most women do expect some sort of mood dip or change when on the progestogen phase of HRT. The important thing is for this to be no worse than when you had natural periods ( if you were able to cope with this) and for you to feel much better on the oestrogen only part of HRT than without it (re mood, flushes and sweats).

At your age you should really be on a higher dose anyway eg Femoston 2/10, if your oestrogen levels have fallen. I agree with the others though - an oestrogen patch or gel with separate progesterone (Utrogestan) might well be what you are looking for. Utrogestan is not without its side effects - but if you're lucky you will just get a bit of sedation, tiredness etc as you would with a normal period, without serious anxiety low mood that is worse than when you were fertile.

Although ADs have their place, they should not be used for hormonal anxiety/depressive mood, and especially at your age when oestrogen replacement is the recommended first line of treatment.

Hurdity x

[GypsyRoseLee]

Hurdity, before HRT my periods had been much lighter for about a year (so 18 months ago). So does this mean I will be near menopause now?

But, if anything my periods were slightly closer together. 25/26 day cycle rather than 28/29 days.

[Mary G]

Mis71Mum, I also agree that you really do need to be taking oestrogen at your age, you are far too young to be deprived of it not only for symptom control but the other health problems that Hurdity has mentioned. 

I would urge you to start using the oestrogen gel (which is flexible and you can adjust the dose to suit your needs) on its own to try and improve your overall mood and then add in bio identical Utrogestan taken vaginally - it has fewer side effects when taken in this way.  The oral HRT you were on before contains synthetic progesterone which is notorious for causing low mood and the other problems you describe and they undo all the good work the oestrogen does.  Also, I think the dose you were on was too low and probably not doing very much - I found this dose to be completely ineffectual. 

Having come off your previous HRT regime, now would be a good time to start with this new preparation which I think will work far better at controlling symptoms and really should be your first port of call to combat the anxiety. 

[Mary G]

GPS, my periods were lighter at the end and only three weeks apart for several years.  The very last period was just two weeks apart.

[MIS71MUM]

Hi Ladies

Thank you for all your replies. By far, the worst symptoms for me are cognitive; brain fog, lack of concentration and anxiety. Which as you said GRL is like nothing I've ever experienced before.  It feels like something terrible is about to happen at any moment and then I worry about losing control, if that makes sense?

I have had 7 CBT sessions and have another 5 remaining.  My therapist has said that the anxious thoughts and the fact that I didn't know how to handle them, has lead to my depression.  So in terms of therapy, I am work in progress!
 
When I started F1/10, it initially stopped the anxiety but it gave me PMT which I realised that I hadn't had for a while. By the third month it gave me racing thoughts so I decided to give it a break. When I restarted it the 2nd time, it was much better and increased to F2/10 but that then gave me severely heavy periods which left me with ferritin levels of 6.

This is going to sound daft, but as i haven't had a period in the winter for 6 years, could there be any merit in taking HRT for winter months only? As my periods have been regular during the summer months. I know that sounds a bit odd btw?

Now I feel ever so slightly settled onto the AD, I feel ready to try and find a HRT to suit me, hoping that I can then withdraw the AD. I am now returning to work on a phased return after being off for 4 months, so I am taking baby steps.  This whole situation has left me totally low in confidence and I'm absolutely terrified in doing anything that may cause me any setbacks.

GRL - good luck with your appointment with Annie Evans.

[GypsyRoseLee]

That's good to know MaryG. I just want to be post menopausal so that my hormones get much more stable.

I can handle feeling crappy for a few days per month. But for 10 - 14 days per month is just so miserable.

[Hurdity]

Hurdity, before HRT my periods had been much lighter for about a year (so 18 months ago). So does this mean I will be near menopause now?

But, if anything my periods were slightly closer together. 25/26 day cycle rather than 28/29 days.

No this doesn't necessarily follow but could do if I understand correctly!  Did you mean you had short cycles up until 18 months ago, and started HRT then? You may be well into peri now if so.

The classic pattern is for periods to become closer together wheile you are still ovulating - and some hormonal changes occur during this time - the gynaes classify this as the late reproductive stage - not even the start of peri-menopause which they say is when the cycle starts to lengthen and you get irregular cycles some of which are longer than 28 days. I'm sure not everyone fits into this neat category. the fact that they were lighter I presume is a reflection of the shorter cycle although sometimes you get increased oestrogen peaks at this stage so I've read. How long the erratic stage takes is not possible to predict ie it is variable (look at the Table on p5 of the paper below)

Here is the paper about it: http://www.imsociety.org/downloads/email_downloads/2012_02_16_1773491/straw10.pdf

"GPS, my periods were lighter at the end and only three weeks apart for several years.  The very last period was just two weeks apart."

Mary - do you mean that you then abruptly stopped and had no periods for a year - or do you mean the last natural period before starting HRT? You would be very unlikely to have been near menopause at that point with the closer together periods - although maybe some woman stop abruptly like this - is is not the normal pattern of reproductive ageing though. 

Mis71Mum - it seems very odd not to have periods in winter! Why not give the HRT a try and if it makes you feel better then keep it going. If you find you feel worse in the summer then give it a break?? Good luck with your return to work.

Hurdity x

[GypsyRoseLee]

Thanks Hurdity.

My periods had been much lighter and slightly closer together for a good year before I started HRT. Plus they only lasted 2-3 days (had always been 5-6 days before). And even on 50mg my bleeds were still light, and still only lasting 2-3 days at most.

[Mary G]

Hurdity, I went through the menopause at 100mph!  My last natural period was in 2006 when I was 44.  I've checked my records (I diarise everything) my periods became very light and three weekly in 2001 and in June 2004, the silent migraines started before a period - my oestrogen and progesterone levels must have dropped therefore the synthetic progesterone in the Mirena became dominant and caused the migraines.  Before my last natural period in 2006, my periods had became two weekly, then I had a couple of 5 weeks gaps and then they stopped completely. 

I had a Mirena coil at the time and having had it changed in 2005, I thought that the formula had been altered slightly and perhaps that was why my periods stopped completely (it does say your periods can stop completely in the literature) but blood tests a year later in 2007 revealed I was post menopause and I didn't have another period until I started HRT.  I didn't have conventional menopause symptoms like night sweats or hot flushes but I did have vaginal irritation, the silent migraines and my internal thermostat was not working as well as it should so I realised that something was not quite right and that is why I asked for the blood tests.  I took a break from HRT in 2009 and didn't have any periods until I went onto the gel. 

From what you have said, it sounds as though I skipped the perimenopause altogether.  My aunt had an abrupt menopause aged 45 so perhaps it runs in the family. 

[MIS71MUM]

I think I am going to give myself another 4 weeks off the HRT to see if my periods are still regular albeit much, much lighter.  Also this way, I can see if mood relates to my cycle at all.  Will then make a decision.

Just one really daft question - if I was to take a sequi HRT, how do you know when you have become post menopausal? 

Yes it's really weird that I don't have periods in Winter, the only thing that I can think of as to why I have one now, is because of the Vit D I am taking.  Not sure if that's me over analysing things again.  But I have always thought I may have SAD.

Thanks again for all replies and Good Luck GRL, I always look for your posts, see keep me updated with your visit to Dr Evans.

[Hurdity]

Mis71Mum The answer is you don't, but does it matter? 80% of women have reached menopause at age 54. Some decide to go onto conti HRT at this point and others don't. Some try to stop to see if symptoms return while others don't. You would only know if you were truly post-menopausal by waiting 12 months and seeing - but most women don't bother with that! I started HRT at age 53 but was not yet at menopause - well I might have been - my previous period had been 5 months earlier so it could have been my last, or maybe not? I'm obviously post-menopausal now at 62 and also tried coming off HRT when 58 but symptoms returned so still on it...

Mary G - if you had a Mirena from 2005 then 2006 wasn't your last natural period as such - because in many women and especially towards menopause, as you say the Mirena can stop periods completely so in women like this - it's impossible to say whether you are at menopause or not from periods if using a Mirena. if you didn't have the Mirena in, then your last natural period would have been later. Re the blood tests - these are also not a reliable test of menopause since FSH levels can go into the post-menopausal range even while peri-menopausal which is why doctors now go on symptoms and periods as guidance. The fact that you didn't experience flushes etc could simply have been that your oestrogen levels were not low enough - I didn't start to get them until I had stopped periods for about 3 months or so - and then they stopped when my periods came back again. if you went one year without periods in 2009 then you could definitely say you were post-menopausal then - but one cannot know the date because you had the Mirena and then you were on HRT. If you just went a few months without a period then you may still have been late peri. I think you may well have skipped the peri-menopause in terms of symptoms because you started HRT (which prevented your experiencing symptoms) and had a Mirena (which masked what your natural periods would be doing).  As you say there may also be a genetic compnent to how menopause is experienced but what I have said above does still hold true. It doesn't really matter though now - as long as you are feeling well

Hurdity x

[Mary G]

Mis71mum, good luck with the experiment but please don't suffer if you feel bad after a month. 

Hurdity, point taken, I suppose I will never know whether or not I was truly post menopause in 2007 but I must have been when I took a break from everything in 2009 and had the Mirena removed.  Even then, I didn't have hot flushes or night sweats just the vaginal irritation and poor temperature control - breaking into a sweat more easily than I should have and sweating in air conditioning which is always a bad sign.  I now feel better than I have since the mid-1990s (I had the first Mirena fitted in 1998) but that is probably partly due to having a good dose of oestrogen and having the Mirena removed which I now realise caused low mood, breast discomfort and the dreaded migraines.

Hope my experience is helpful to others.