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[Mich10a]

Hi. I am new to this forum but have joined because I desperately need some advice. I am perimenopausal and am on HRT. Initially I was on Femiston 1/10 (after reading this forum & pursuading the doctor that this is more bioidentical progesterone), but I was finding that my mood was very low during the 2 weeks of the progesterone, so we increased to the 2/10. This helped but as time went on I was getting the low moods and depression again.
At this point I met my current partner & when looking into getting a coil fitted as contraception, the gp suggested a Mirena coil could be used as the progesterone side of the HRT & because it's localized to the uterus it should have less  overall effects than the tablets. So I had a Mirena coil fitted and was put on 75micrograms oestradiol patches. BUT I have noticed my mood has gone down to rock bottom, I'm crying all the time, have no energy or will to do anything & have withdrawn into myself. I have been off work for nearly 2 weeks now. I have just pursuaded the doctor to increase the patches to 100mgs, but am worried that I will still be the same. I believe that this is the maximum that the patches can go, so is there anyway that the oestrogen can be topped up with oestrogen cream or pressies? I think I am progesterone intolerant as when I was on the pill the gp put me on the progesterone only mini pill & that was just awful, with similar symptoms that I'm getting now. Have I had/got PMDD? I feel like the gp is not helping me at all & not listening but I can't carry on like this, this is no life!

Thank you for listening. 

[Hurdity]

Hi Mich10a

 

From what you say it does sound like the progestogen is the problem - at least the synthetic types anyway even the one in Femoston which is usually the best tolerated of the pill types. As you are on a fairly high dose of oestrogen anyway and are only peri-menopausal, it could well be the progestogen in the Mirena coil making you feel like this. Contrary to popular belief - this is absorbed systemically - but not as much as when taken orally as in some of the pills containing the same progestogen (which is levonorgestrel). The amount absorbed gradually reduces with time - but is highest in the first months/year. You may find that increasing oestrogen does help despite your lack of tolerance of these progestogens. You have to give it a few weeks on the higher dose. If not then the only other alternative is to have the coil removed and to use the patches with separate micronised progesterone (Utrogestan) which is bio-identical with our own progesterone (ie body-identical). This would be taken cyclically - so you would still get normal bleeds.

As a matter of interest how are you normally ( before HRT) in the second half of your cycle? Do you experience pms and at what point in your cycle? Some women just don't get on with the synthetic progestogens in HRT but are more or less OK with their own prog - give or take a bit of pms just before their period.

Sorry to hear about your GP - depending on how you get on - can you find another GP in the same practice that is more sympathetic or can you ask to be referred to a menopause specialist clinic (sadly these are few and far between especially in some parts of UK)?

Good luck and hang in there - I am sure there will be a regime out there which will help you feel better....

Hurdity x

[Mich10a]

Thank you Hurdity,
To be honest, before I was on the mini-pill I had become quite stable on the combined pill, but the gp took me off it because I had been on it for so long. I do suffer with depression anyway, & am on a fairly high dose of anti-depressants. But now I don't know where to turn, I am literally all over the place and cannot function. I will give it a few weeks on the 100mcgs patch, but am tempted to see someone privately to see if they can help. There is a NHS menopause clinic at the hospital, but I need to be referred by the gp and it can take up to 16 weeks to get an appointment, I cannot wait that long. I did read an article about 200mcgs oestrogen patches but the only ones I can find go up to 100mcgs and I'm sure my GP won't want to go higher than that.
I will keep you posted.

Thanks for the help
Mich x

[Dancinggirl]

I am personally  not convinced that higher doses of oestrogen are the answer. In my experience I felt better on lower doses of oestrogen, especially in the peri stage when I was still producing some oestrogen. Perhaps try reducing the oestrogen dose a bit for a couple of weeks to see if that helps.

You need the Mirena for contraceptive purposes and the side effects should settle in time. If you don't have the Mirena then you should use condoms or try one of the newer BCPs that have bio identical oestrogen.
. Hurdity, could you tell mich10a about these BCPs - I can never remember their names.
As you are on ADs, perhaps these aren't working as well as they used to - perhaps a review of the ADs would be a good idea. DGx

[Mich10a]

Thanks dancing girl. I need the coil for both contraception and HRT (the gp said it would be fine for both). Maybe I need a blood test to check what my levels of oestrogen are as this has never been done since before I started on HRT, that was about 4 years ago. Mich x

[Hurdity]

Hi there - if you were OK with the Pill (CCP) then you can't be completely progesterone intolerant - maybe just to some of them. What a pity the doc said come off it - how old are you and how long had you been on it?

The CCP types that are similar to HRT are QLAIRA and ZOELY  - they contain estradiol so a good transition from the stronger CCPs through peri-menopause - to HRT. They're not usually prescribed over 50 though, but can't see why as the doses of oestrogen are not high. These would give you contraception and control your cycle so you don't get such mood swings.

Oestrogen tests are not necessary except perhaps for those who've had a hysterectomy/surgical meno - as levels change daily and even hourly. Symptoms are a better guide. It may well be the underlying mood swings from your own hormonal cycle that are causing your problems (although the oestrogen you are taking should mean these are not so extreme), if it is not the Mirena.

Hurdity x

[Dancinggirl]

Hurdity - thank you for helping with the info on the new types of BCPs that might be useful for mich10a.
Hope we've given some useful help for you mich10a ? The peri stage can be so tricky.
Do try a slightly lower dose of oestrogen for a couple of weeks to see if this helps before abandoning the Mirena. You may find there has been an initial big hit of progesterone that should settle over the next few weeks - after things settle, you will have 4 years of contraceptive protection and your womb lining is protected at the same time. You will probably have little, if any, bleeding with the Mirena and you can use as little or as much oestrogen as you need - so very little hassle generally.
Keep us posted. DG x

[Mich10a]

Hi to both of you,
Thank you for the info. I am 48 and I am being on the combined pill for 20 years so then the doctor put me on the Mini pill which is when all my problems started. When I came off the pill completely and they testing my hormone levels that's when they said I am perimenopausal and I started the HRT.
 I do feel a bit more human now with the increased patches and have been able to go to work part time. I went to see my GP on Monday and she said it will take a bit of time before you feel the full effects of the increased dose, so I see her again in three weeks time. She did say if we felt the patches weren't working we could try the oestrogen gels so it's just a case of waiting.
I will keep you posted
Mich10a x