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[GypsyRoseLee]

Hi CLKD, thanks for asking after me. Yesterday was quite a good day. Woke up feeling jittery and anxious, but as soon as I was up I felt something 'lift' inside, and went on to enjoy the day.

But today I woke up anxious, and it hasn't really lifted all day.

I'm wondering if my AD is somehow being over ridden too? My period is due in the next couple of days, so that might be why?

[GypsyRoseLee]

Thanks DM, you're always so positive and supportive.

Yes, that very slightly dreamy/sleepy sensation that I associate with Sertraline has definitely gone. I don't think it can be a coincidence that it 'went' on Day 12 of my cycle - especially when looking back in my diary, I have had a similar dip on Day 11/12 for the last 4 months. But, the dips only lasted a few days, whereas this month it hasn't really lifted and my period is now due in the next couple of days.

I'm wondering if it's because I have been on unopposed oestrogen for the last 3 months, and haven't taken any Utrogestan?  But I must have my own progesterone still working, because I've had a period every month, still.

I didn't realise that hormone surges in peri can be stronger than at any other time? Does this mean that I could be having really strong surges of my own progesterone?

I WISH there was a test which could show how much longer my peri is going to last. I know being menopausal isn't always a walk in the park, but at least these huge surges will stop, won't they?

[dangermouse]

Ive only read about oestrogen surges going higher than any time in a woman's life but I suspect either hormone can surge and crash as one can have an effect on the other. What it does always say for sure is that it does all calm down in the end.

Hormone supplementation is very complicated as the progesterone I am taking initially causes a rebalance that the brain isn't used to, so the oestrogen receptors, which had become desensitised by the high oestrogen, reawaken and so you feel worse initially, so I have to lower the dose when this happens. The same can happen with supplemental oestrogen if the opposite is the case but this only lasts a cycle or two apparently so probably doesn't apply to you.

This explains why my friend (who is in 30s and also feels awful post period onwards) felt great on Studd's regime for the first 6 weeks or so but then felt dreadful and higher amounts made her worse and worse. I suspect she needed  prog too instead of oestrogen.

Yes if only there was a really reliable blood test or a way to measure over the course of a cycle.

[GypsyRoseLee]

Hi DM

Can I ask how you know that the Sertraline 'sleepiness' disappearing means it's being over ridden? I'm just really shocked that my own hormones could actually over ride an AD!

It's interesting what you say about becoming de sensitised. I wonder if that is happening to me?

How is your friend doing now?

[Hurdity]

I didn't realise that hormone surges in peri can be stronger than at any other time? Does this mean that I could be having really strong surges of my own progesterone?

As dangermouse says it is the oestrogen which tends to surge and fall dramatically during peri-menopause. I am not quite sure why because the  pre-ovulatory peak is produced by the one dominant follice so the higher levels ( I have read about) must mean that that particular follice produces more oestrogen - not sure about this. I do know that leading up to peri-menopause more follicles begin to be stimulated, each of which are producing oestrogen - but not sure how much these contribute to the peak 

I have tried to find out about the amount of progesterone produced by the corpus luteum and whether it increases as we near to menopause but have been unable to ( don't have the time to spend hours at it!). However I would imagine that progesterone levels are probably more consistent than oestrogen - as this is produced by the one empty egg sac whereas oestrogen is produced from developing follices and the dominant one?

Hope that doesn't sound confusing and just thinking aloud really?

Hurdity x

[dangermouse]

I don't mean that your hormones are overriding the Sertraline but that it's to do with desensitisation overriding it.

When you first have a drug you feel the full effects but the brain is very clever at retaining homeostasis (balance) so it down regulates the receptors to try to stop the effects, as it thinks it's a bad thing as it's irregular, and suddenly it becomes much weaker. This also happens with pain killers, heart meds, etc.

If you then stop a drug you can get withdrawal effects where the receptors go back to full effect and whilst the drug is still active for a few days you feel much worse.

I have not taken Sertraline but many of my clients (and my mum) have and they report the drowsy feeling on the mornings either if they have too much or if they no longer need it because the anxiety cause has ceased or another drug has rebalanced you. If the opposite is happening and you feel less drowsy it's either more anxiety in your life and/or the desensitisation.

It's a common problem with some anti anxiety drugs and you can either have more of it to see if you can beat the desensitisation or have breaks so that you keep reacting like when you first took it.

My friend is not great as not on anything at the moment but she isn't having suicidal urges like she was with the high Oestrogel.

[CLKD]

If I get more than 3 mornings when my brain feels low I up my dosage of AD for 3-5 days.  Nowt to do with hormones, but depression has ups and downs too 

[GypsyRoseLee]

Thanks DM. It's a horrible thought that I might becoming de sensitised to Sertraline, and it was really helping me. But, having said that my symptoms still resurfaced every month, since I've been taking it, so not 100% effective.

My mood has been so up and down this last week. But even on the 'better' days, I haven't felt nearly as good or stable as I have been used to feeling on Sertraline.

I increased Sertraline from 100mg to 125mg 9 days ago, but it hasn't brought back that very slightly sleepiness/contentment that I've been used to. Not sure if my mood yo-yo-ing so much this last week is due to increasing?

Feeling very flat and down today, but period is due tomorrow so I'm really hoping my mood will lift.

[GypsyRoseLee]

An interesting post, as always Hurdity.

I genuinely do not know what my hormones are doing. This last month I felt great the week before my period was due, and continued to feel great during my period and for the 2 weeks after. So nearly 3 weeks of lovely normality.

Then it all crashed on Day 12 (yet again). My own oestrogen wouldn't have been high in the week before my period, and it would have been very low during my period, so why did I feel so good?

I am so confused.

[flufferama]

GRL I'm sorry to see you're not doing so well.

All I know is that for me, it's not the levels of hormones that cause certain mood related symptoms, it's the fact that they're fluctuating wildly. I always had some form of PMT when my normal cycle did its thing. When the postnatal and peri stage hit, those fluctuations really affected me.

It was confirmed to me by the second gynae I saw recently that some women are simply really badly affected mentally by fluctuations. Guess we're both in that gang.

It explains why I felt desperate when my oestrogen was low, AND when it was high!

I had a rough time on SSRIs (both sertraline and escitalopram) and unfortunately neither worked when that severe PMT hit. For me, I needed a mood stabiliser which did work for those awful black moods, anxiety and insomnia.

[GypsyRoseLee]

Hi Flufferam

I have felt better since starting Sertraline, but the awful anxiety and low mood has resurfaced every month. I am like you, in that I can't seem to stand any fluctuations in hormone levels.

Did you ever try Zoladex injections to totally shut down your ovaries?

Can I ask which mood stabiliser you take, and what dose?

[flufferama]

No I haven't tried shutting down my ovaries because the drugs work!


After tinkering with Evorel patches and lots of blood tests I came to the conclusion that hormones alone can't fix what's going on with me at the moment.
I suffered (badly, really badly!) for three months before I gave up the ghost, had a mini breakdown and asked my doc for Olanzapine. I'm taking 2.5mgs, a tiny dose, at bedtime. At first it knocks the hell out of you but that sedation wears off after a couple of weeks.
Now I just sleep properly and the crushing anxiety is gone. I'm back at work, looking forward to Christmas and am booking a holiday! Two months ago I was having continuous adrenaline rushes, not sleeping, unable to leave the house and thinking I would never get better.

I'm still using the Evorel 50 just for the week or so leading up to my period. I saw a second gynae recently and after reading my long medical notes and my history, agreed that for now I need the two pronged approach of meds and oestrogen premenstrually. She is keen for me to repeat bloods within the year, at the moment my FSH/LH is fine and dandy but if I develop any physical symptoms she wants to know ASAP.
I had an internal scan and all looks good physically.

Olanzapine is an expensive drug, and from what I've heard it's not prescribed much in the UK because it costs the NHS too much.

That's a real pity because SSRIs and SNRIs do not suit lots of people and in some cases don't work at all.

It's often prescribed for bipolar and a schizophrenia which scared me when I read that but I'm neither bipolar nor schizophrenic! I guess I'm an "off label" case.

In short, much as I tried hormones alone, it wasn't fixing me and I wasn't functioning. I'd had a battery of blood tests, four visits to my GP, and three appointments with two private gynaes.
Down the line I hope that when these fluctuations stop I'll be fine on HRT but at this weird point in peri I need the drugs!

[Tempest]

I can categorically confirm as a lady with no ovaries or uterus that it IS fluctuations that make you bonkers!!! If my estrogen fluctuates due to poor absorption in general (which I think is very likely happening on transdermals for me) or drops due to the method 'pooping out' (these blessed patches only last 2 days on me, and the Estrogel only 12 - 14 hours) then I feel HORRIFIC. And I do mean horrific!

When I was on NOTHING for a year, my mood was stable. A bit depressed, but not the absolute crazy I have experienced on both the estrogel and the patches. Prior to my surgery, I was in peri and felt exactly the same. Totally a hostage to the wild swings! The feelings I'm getting now due to fluctuations in HRT are exactly the same, so I think this may help to clarify what you're experiencing.