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[AstraKryon]

Just some background: I went off Prozac at the end of January (weaned myself off it VERY slowly, according to dr's advice), after having been on it for seven years.  My life has changed vastly and I felt I could go off it.  It also affected my sex drive majorly and I am so glad to have my libido back.

I had no withdrawal effects.

However,  suddenly, about five weeks ago, I was hit by dark moods and severe hot flushes.  I was in Finland at the time and could do nothing about it.  When I came back to South Africa,  I went to my GP immediately and he said what I suspected - MENOPAUSE!!   I am 50 years old.  He also said that Prozac kept back many of the symptoms of menopause.  My periods had already stopped when I was 42 and my then gynae forced me to go on oral HRT, which made me so depressed that I wanted to end my life.  So I stopped using it and went to another gynae.

I apologise if my story sounds confusing.  I didn't even consider menopausal symptoms when I was 42, and after that (silly me!) up till now.  I have not had a hysterectomy.

I started using HRT patches.  Estalis 40/150 (estradiol + norethisterone acetate).  Two weeks ago.  I have so many questions:
1. When will it start working for my mood?  I do feel better, but some days I feel totally down again.  I wake up with fear in the mornings, not knowing what the day will be like.
2. If it is not working for my mood, should I try a "stronger" version? I see there is an Estalis Sequi 50/250.  How will I know that I am on the right patch?
3. I lost 30 kg when I started on what we call a "Banting" diet here - just Low Carb, High Fat.  I started it in 2014 (after having gained weight due to taking about five different anti-depressants that finally sorted out my mood) and brought my weight down to 63kg.  Last year (2017),  I started gaining weight again, very very slowly, without my life style having changed.  I now weigh 72kg and am very unhappy about that.  Could that be menopausal weight gain?  And will the patches sort that out?
4. I am also on lamotrogine, for unipolar (depression).  Does that interact with the Estalis?
5. I also take thyroid medication.  Will the Estalis interact with that?  I had a thyroid test done a few months ago, and my thyroid levels were normal (being on the medication).  I can't have another one done this year, my medical aid (like medical insurance in the USA) won't allow that.
6. Do I need testosterone? I have only read about that.
7. I also take Concerta (methylphenidate) as an anti-depressant (prescribed by my psychiatrist).  Will the Estalis interact with that?  Concerta has changed my life and made it possible for me to stop most of my other medications.  It is not commonly used as an anti-depressant - I am aware of that.  And I know that too high a dosage will make me anxious and make my menopausal anxiety worse.  So I am regulating it very carefully.
8. When I was on the contraceptive pill before, in my life, it worsened my vulvodynia terribly.  So playing around with my hormones is a scary thing for me.  I have not had serious and chronic vulvodynia pain the last few years.  Could the Estalis bring this back?  Only people who have had vulvodynia know about the terrible terrible pain it causes.  It is as if you are being stabbed in your private parts (sorry to be vague - I am not sure which words this forum allows) all day and night long.  The pain takes over your life.

I am just so totally confused. As you can see from my mail!  My priorities are my mood and my weight.  Will the HRT sort that out?  I can't go back on Prozac.

Thanks so much for reading my long mail and thanks in advance if you can answer some of my questions.  Should I wait a little longer to see the effect of the patches?  Perhaps I am too hasty and working myself up into a premature frenzy.  I want to enjoy my life that has just started properly a year ago (after starting on Concerta).

[aspie65]

It is hard starting new HRT.  I recently had to change HRT type and it took a good couple of months for me to feel it's full effect.  Try to be patient but don't suffer unnecessarily. 

[AstraKryon]

Thanks for that, aspie65.

I posted before I had finished writing my post.

I am going to try and see my gynae ASAP, but I don't know whether she will know the answers to all my questions.  People who have had experience with my issues may have better answers.

[CLKD]

Maybe put 'vulvodynia' in the search box on here and see if threads pop up?

Browse round.  Make notes.  Is your depression/anxiety controlled?

If you read 'the burning club' thread as well as 'My Bladder etc.' you will get an idea as to how a drop of oestrogen may affect the body which becomes dry, inside and out  including the vagina.  Vaginal Atrophy can mimic repeated urine infection-type symptoms !

[Hurdity]

Hi AstraKryon



In UK the standard patch dose for post-menopause is 50 mcg so if this one is not controlling you symptoms you might eventually need a higher dose. However two weeks is a short time so do give it a few more weeks when you will then be clearer as to whether it is doing it for you or whether any negative side effects outweigh the positives.

Only the pharmacist or your doc will be able to tell you about the various interactions between the other meds and your HRT although if you can find the "Summary of Product Characteristics" or similar for that product (the HRT) on the web there is a section on common drug interactions. It may well be that these two ADs you are taking also help with the sweats and flushes - the most obvious menopausal symptoms - and a useful guide as to whether the dose is right. If you are not experiencing flushes and sweats but still experiencing low mood then an increased dose might help.

However I presume you are taking continuous combined HRT (it's not one we have here in UK) - in which case you are taking the progestogen norethisterone - all the time, and this can cause negative side effects eg low mood, headaches, etc in some women. Also some women find that it causes bloating when taken all the time. If you increased your oestrogen dose then the progestogen dose is also increased (to 250) so perhaps not necessarily a good thing. The only other alternative is to go back to a cycle ( ie have an artificial period every 4-5 weeks) so you would only take progestogens for part of the month - but your body would then have to acclimatise to the ups and downs of the prog just as in the normal menstrual cycle. Not sure what unipolar is but could that be affected by hormonal surges and falls?

As for your weight - in terms of your future health that is the most important thing  that you need to be controlling  (apart from the depression if this is very serious). If you are already hypothyroid, and your diet is normal (ie you are not overeating or drinking lots of alcohol or sugary drinks and eating the right foods) then unintentional weight gain could result from your meds being out of whack. Problem is, maybe in SA - as in UK - they go on lab ranges rather than symptoms. If you are also feeling cold and fatigued then this is a sign your thyroid meds are wrong and perhaps a small increase would be beneficial? Something to discuss with your GP at your next visit.

HRT alone cannot deal with weight gain nor loss. Medication may play a small part but it ls what you eat and the amount of exercise you do that is most important. Why not keep a diary of what and when you eat and drink, as well as your mood, and what exercise you do each day and see if there is a pattern or if there are foods/drinks you can change or cut back on - or calories you can save easily without going hungry?

Hope this helps

Hurdity x