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[jasper]

Hi all,
I posted a week or so ago about the fact that I had been advised to move from Evorel 75 (estrogen only for last 5 months as my cycle was still strong and I was still having periods) to the Zoely pill (bioidentical estradiol and nomegestrol). I had been feeling better on the patch in 2nd half of my cycle but worse in the first half!) and specialist feels I need to totally cut out any hormone variation to see what happens (hideous migraines, joint pain, fatigue etc).  Obviously adding in progesterone is new and I am pretty worried about how I will cope. I haven't been on the combined pill since I was 33 (now 47) and although I coped fine then, obviously things are very different and my health is much more precarious.

I know there is limited experience of Zoely here but I would also be interested to hear from any others who have made the switch from transdermal forms of HRT to the pill? Today is day 2 and I feel like roadkill (though this is something that happens to me quite often anyway so I cant be sure it's the changeover. I am also on day 5 of a migraine (I decided I might as well move over yesterday regardless as any changes to hormones make my head worse and I had a bad head anyway).

Would it be normal to expect things to get worse before they get better?

thanks a lot to everyone on this board who has been so helpful. It is a lifeline and I've found all the advice and support so useful even though I am technically not in peri yet.

[Mary G]

Jasper, I've just been reading your other thread and I can see what Professor MacGregor is trying to do and it makes a lot of sense.  I was also able to take the pill in my 20s without getting migraines and you may remember that I too started suffering with (silent) migraines when my oestrogen levels started dropping - I had a Mirena coil at the time.  I eventually worked out that my migraines are triggered by a combination of synthetic progesterone and low oestrogen levels.  However, this does not mean that your migraine trigger is the same and it is very likely that a combined pill will act as a stablizer and get you on an even keel.  As Elizabethrose has said on another thread, hormone fluctuations are bad news for migraine sufferers.

This sounds like a very good option for you and please let us know how it goes. 

[jasper]

thank you Mary G :-) Hoping you're right! I don't know if Nomegestrol is any easier to tolerate than other forms for synthetic prog - Zoely seems to be the only pill with it in as far as I can tell. I am pretty worried about the risks of taking oral pills but am at a point where I don't feel I have much choice. Fingers crossed.....

[Hurdity]

Hi jasper - sorry to hear you still felt rough on HRT. If you were still having regular periods then 75 mcg was probably quite a high dose to take all the time. I have no experience of the effect of adding a fairly high dose of oestrogen to an existing cycle but perhps this did not suit you inj the first half of the cycle when oestrogen is hihg ( well after the first week anyway). The reason you felt good in the second half of your cycle would most likely be because you were topping up your oestrogen which is typically low during the second half of your cycle.

I don't know if any gynaes prescribe oestrogen for half the month in women like you but taken like that should even out the oestrogen fluctuations somewhat - until you became properly peri-menopausal and need extra oestrogen for the whole month. I seem to remember one or two women on here having this regime?

My gynae GP told me that low oestrogen causes headaches, also specialist told me that low testosterone causes headaches - and all this in addition to headaches being caused by sudden increase in oestrogen, sudden increase in progesterone, and sudden fall in progesterone (giving the classic pmt tension headaches/migraines). No wonder we feel rough half the time!

Hope it works for you

Hurdity x

[jasper]

Thanks Hurdity,
I'm on day 3 of Zoely and so far so good in that I seem to be coping with it but obviously it's early days.  I already tried using Evorel only pre/during period but I can't cope with any change in estrogen so that was a disaster. My situation is complicated by chronic Lyme so it's not always easy to tell what is causing what, but I do know that hormone fluctuations are the straw that breaks the proverbial camel's back for me. Lyme can further mess with thyroid and sex hormones so that adds to hormone fluctuations already likely in my 40s.

I think you are right about why on the patch I felt better the week before my period and worse after. I also wonder though if my system needs some progesterone too.

I will just have to wait and see. Does anyone know how soon you would have issues with the combined pill of it was going to be a problem?

Thanks

[jasper]

Of course I spoke too soon Days 4+5 I feel like roadkill :-( Crushing fatigue on top of the usual, brain fog, head pressure/headache.  I've also developed reflux!  Is it more likely to be the addition of the progesterone given that I am not used to taking any? Does anyone know how 1.5mg of oral estradiol equates to an Evorel 75 patch? Is it actually double or less because of means of delivery?

I would be really grateful to hear from anyone who has started the combined piill (even if not the same type) in perimenopause and if the side effects were temporary or not? I know I have to give it 3 months, its just so depressing to go from at least feeling good one week a month on Evorel to feeling like this!

thanks as always

[Mary G]

jasper, sorry you are feeling rough.  You said in your original post that while taking oestrogen only, you felt better in the second half of your cycle which is when your own oestrogen levels would drop and you would have higher progesterone - I think.  This sounds like the complete opposite of the problem I have with (synthetic) progesterone intolerance.  Just before my periods stopped, I always had migraines just before a period - I had a Mirena coil at the time.  Could it be that you are intolerant to high doses of oestrogen and do you get more migraines at this time?

This is just a thought but I knew someone who used to take oestrogen for two weeks before her period so this could be something you could consider and run past Professor MacGregor.

In the meantime, you might as well see if you get any improvement on your current medication because it might settle down after a while.

[jasper]

Hi Mary G - thanks for your thoughts.  My worst times of the month have changed depending on what I am taking... When I was not supplementing hormones at all then I had standard pmt migraines starting around day 16 and often bad til about day 10! A couple of years ago I was given testosterone gel by Panay (as mine is on the floor) and this just moved my worst migraines to just after my period (and made them harder to treat). The Evorel patch has resulted in me feeling worse around ovulation (when I used to start to feel better) but better before my period, and then worse after my period (like the testosterone)!

I want to try to give the Zoely a good try even though it is making me feel so much more tired and pretty awful generally at the moment, but the gut problems are really worrying (reflux, bloating, stomach ache) as I am not sure this is the kind of thing that will go away? If I cant tolerate oral hormones then I suppose my only option is to try and get my patch dosage high enough to stop ovulation but at 75 my hormones were still doing their own thing, which is why Anne Macgregor wants to try to stabilise the levels completely.

Anyone had gut problems when taking oral hormones? Did it get better??!! thanks

[Belladonna]

50 mcg patch is supposed to be equivalent to 1 mg pill, so yes you should be getting the same amount as before.

I also moved from patch to pills. But my situation is a bit different, I'm 34 and my ovaries stopped working 3 years ago. I was on a 50/250 patch and not getting enough estrogen and after 2 years I had severe low estrogen symptoms. Was put on Yasmin bcp and at first I felt so much better! But after a month I started gaining weight, lots of weight, despite restricting my calories. Felt swollen and my migraines were out of control.

I stopped the pills a few weeks ago and since then have been trying to get hold of my gyn but no luck! I'm so pissed, I've called the hospital four times and they promise a gyn will call me back but they still haven't! And I feel like shit. Back on the patches as I was afraid of getting a stroke on the pills.

I started with one patch but on 2nd day had anxiety and hot flashes. Lost 1 kg though. But felt I needed to increase my estrogen so put two patches on. A couple weeks on and I have gained 2 kg more! Despite being on a diet. I am going to try one patch again to see if I can get rid of all this awful swelling.

Really hate this whole hormone shit, I feel awful and the doctors can't even be bothered to talk to me for 5 minutes.

[jasper]

Hi Belladonna,
Sorry to hear about your problems with the pill.  I definitely felt like my legs were puffy on the Evorel patch, not so much yet with the pill, but it's early days so I can't tell re the weight gain.  Totally agree about the stroke risk - just so desperate now :-( However today (day 7) I woke up with a migraine so don't know if that bodes badly for Zoely (luckily my gut is not as bad at least today). It is such a minefield and so hard.  I do hope you get some answers from your gyn soon. x

[Belladonna]

How are you getting on Jasper? Is the Zoely working for you? Do you skip the placebo pills?

I still haven't heard from my gyn but have an appointment in a few weeks so guess I'll just have to wait... Have given up calling them. At the moment I'm back on the 50 mcg patch. Still haven't lost the weight I put on from Yasmin.

I looked at Zoely as an alternative for me but am scared to try because it lists acne as a side effect in more than 1 in 10.  Then among common, migraine and the dreaded weight gain... But all HRT and BCP seem to have weight gain as a side effect.

[jasper]

Hi Belladonna,
I think those side effects are listed in pretty much all pills/hrt aren't they? I am on about day 19 so early days still but yes I was told to take it back to back without a break. I have been having trouble with headache/neck pain for 5 days now which is really depressing but tbh the heaaches were like that before, just no improvement. The joint pain is better but I don't know if the Zoely is currently making my neck pain worse.

I though Zoely was meant to be good for acne?

[jasper]

Has anyone at all got any experience of combined pill or hrt exacerbating neck pain? Just don't know what to do, but not convinced it's a coincidence :-(

[Hurdity]

Could it be the effect of the high dose of progestogen?

Hurdity x

[jasper]

Hi Hurdity - this is what i'm wondering. Its all been complicated by a cold virus (now better) for last couple weeks which could also cause worse headaches for me.  I do remember that when I first started Evorel I had a stiff neck so I just don't know what is causing what! This is worse though and not stiffness but a constant muscle pain that is making my headaches worse and I'm taking too many painkillers (which will lead to rebound headaches).  I emailed specialist and she says cold more likely to cause the pain but given that I know Evorel did things to my muscles, I am dubious. Odd thing is that the knee pain that I got on Evorel is much less pronounced on the Zoely.

Do you think that 26 days in is still early days and it could all sort itself out? So desperate for this to work so I can try and actually treat my lyme without my head flaring up every few days :-(

So I don't know if its a different dose of (oral) estrogen or the progesterone causing the problem really.....Does progesterone tend to cause muscle pain? I thought it was a relaxant if anything?
thanks as always