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[dangermouse]

I've not had that yet but yes I'm pretty sure it's normal for them to get closer together before you start skipping the odd one and then I guess the gaps become longer until they completely stop.

[Charys]

Thanks dangermouse...again  Anyway the whole 'skipped period' thing is cancelled now, arrived on day 40. Honestly don't know if I feel happy or sad....I was desperately low yesterday and didn't know what to do with myself. Within hours my mood has lifted....so guess I'm more glad its arrived.

[AG]

Hi,
Since last summer I have had longer gaps between periods (mostly 6-8 week gaps), then one shortly after the last one in Dec 2017, and then nothing... in March I started feeling pretty rough like with water retention and probably wild hormone fluctuations, then blood pressure went "off the rails", and things did not get any better. Then, at the end of April, after nearly 4 months, another period with lots of hormone fluctuations. I am now hoping that I am in late peri but there is no way to tell. Never had gaps between periods like that before (and neither such crazy hormone imbalances). Sleep was very patchy and often 3-4 hours only, and felt exhausted in the morning already. Now, things have calmed down again and I feel about 75% "normal" but not every day.  Good luck and all the best.

Anna

[Charys]

HI Anna,

I truly sympathise. It seems I'm a little behind you, if things follow a pattern, which is seems often that they don't! The lack of sleep is horrendous at just the time you need extra rest to be able to cope with the fluctuations. I have to say that last night I resorted (at 2 am) to a small piece of sleeping tablet, and got another two hours. The last week has been as you describe though, terrible sleep issues. The hormone fluctuation outcome this time was the worst I've had, I honestly didn't feel PMT-ish (I've always had bad PMT) but really depressed, and pacing with anxiety. I didn't know what to do with myself yesterday and spent most of it crying.

Its the not knowing isn't thats so hard - each month you just have no clue what is going to be thrown at you, what will happen and what will change or not change. I think I would have been better yesterday had I have known that today a period would come, but everything felt unsurmountable and never-ending yesterday.

Anyway, feel free to have a chat with me if you ever want to - not that I know anything much - but happy to share notes and sympathise. 

[dangermouse]

Ah yes the 40 day'ish cycle was happening to me last few months. I think it's because they're anovulatory and so no progesterone is produced and so oestrogen just continues to surge.

I'm back on my progesterone cream now so my cycles are 28 days but still can feel the surging to some degree until the period.

You may find this article of interest (aside from the over dramatic title!) http://estrogenerrors.com/blog/great-perimenopause-cover
It's based on the CEMCOR research into perimenopause.

[Charys]

That IS a very interesting article, the 'oestrogen myth' is something I would have believed until recently! You know....until I joined this forum I honestly felt so alone, despairing and confused. I've had hormone problems in my life before...very bad post natal issues (hospitalised and advised against another pregnancy), and was taken off tamoxifen within weeks due to how to changed me mentally. I can't have HRT, well I 'can' but due to the breast cancer its not obviously a great idea; so being here and reading the stories of unpredictability and change in the perimeno women (and from those who went before me) is comforting, at a time I feel is such immense upheaval. Thanks Dangermouse 

[Hurdity]

You may find this article of interest (aside from the over dramatic title!) http://estrogenerrors.com/blog/great-perimenopause-cover
It's based on the CEMCOR research into perimenopause.

Thanks for posting dangermouse - I think I've seen this one before. Some of the stuff being said in there though, is frankly wrong ( I read it earlier) - some research is quoted but other points are just one woman's opinion. This paragraph for example is full of errors and misconceptions!

"It is now proven that 300 mg of oral micronized progesterone at bedtime decreases sleep disruption, improves refreshing rapid eye movement sleep and doesn't cause a foggy mind the next morning (15). There is also reason to believe that progesterone, like medroxyprogesterone (16) will help hot flushes and night sweats. It is important, however, to realize that no drug has been proven effective for perimenopausal vasomotor symptoms in randomized controlled trials. Oral contraceptives were not effective (17) and no study has shown that estrogen works. "

For most women 300 mg oral progesterone would be anathema and would cause at least a foggy head and more - progesterone has a known sedative effect which is more pronounced in larger doses!

Yes it is known that HIGH doses of some progestogens like MPA can control hot flushes but this is when given in high pharmaceutical doses ie when used as a drug.

As for the assertion in the article that no drug has been proven effective for vasomotor symptoms and no study has shown that oestrogen works - this is utter bunk!

It is really important in all of this for us to try to read source material and from some of the learned medical or menopause societies - there is an awful lot of other stuff out there - often written by people who have something to sell. Always difficult to know what to accept and what not to accept.

I'm not saying that oestrogen doesn't reach high peaks during early peri - I think this is generally accepted - but this isn't a reason to stuff progesterone down your throat as the article implies women should be doing! Yes progesterone does play important metabolic functions but as far as I understand it is only needed in large doses to prepare for and maintain a pregnancy. At other times it is still produced but at a low level. In any case there are question marks over breast cancer risks through long term intake of progesterone or other progestogens. In anovulatory cycles it is pretty much essential anyway to protect the endometrium.

As for the later paragraphs saying we all recover from menopause and it's natural for them (oestrogen and prog) to be low - this is so out of date - there is so much research and general consensus now of the health consequences of oestrogen deficiency. This isn't the place to list them all but really - please MM readers do not take this article as the reliable source for info about the role of oestrogen and progesterone and menopause!

[Hurdity]

Indeed, I understand the too much or too little thing.

Can I ask....is it within the realms of peri to have months and months of shorter and heavier cycles, and then rapidly and suddenly have a missed cycle? I honestly feel so confused and anxious about this, as never had it happen.

What happens isn't a missed cycle or skipped one as such - as you will have read in the STRAW article the general trend is for periods to start getting shorter and then eventually start to get irregular and specifically longer - and once they start to vary by 7 days between cycles this is termed the start of peri-menopause - so it sounds like this is where you are going at the moment!

It is also the extreme fluctuations that tend to cause the problems in early peri-menopause - which lead to the mood swings - I think I posted the link to the article on "Perils of the Perimenopause" which explains what's happening to your body.

Can't remember if I've already said but if the mood swings and the fluctuations are bothering you to the extreme then you can take something to regulate your cycle ie one of the CCP types - sorry if I've repeated myself - can't see back to my earlier reply.

As for that article - some of the stuff being said in there is frankly wrong ( I read it earlier) - some research is quoted but other points are just one woman's opinion. The article is full of errors and misconceptions!

It is really important in all of this to try to read source material and from some of the learned medical or menopause societies - there is an awful lot of stuff out there - often written by people who have something to sell.

Sorry Charys - I've just read your latest post after answering the various previous posts - I hadn't appreciated in all of our discussions that you have had breast cancer - I have lost track. If you cannot take oestrogen because of this and your oncologist has vetoed this, then there are medications that do control hot flushes, if these are bothersome. There is a paper with reference to breast cancer - I did post this recently for someone and if it was you - sorry again for repeating myself - I can't remember who I've posted what to - anyway if so - here it is again:
http://journals.sagepub.com/doi/full/10.1177/2053369117711646?hootPostID=6690d93930a10b86869c48433ab506e7

This is a summary of the relevant section:

"Since paroxetine is the SSRI with the best evidence for efficacy19,23 effective at 10 mg daily, it is the SSRI of choice for patients not taking tamoxifen and the more usual 20 mg dose chosen if an antidepressant effect is also required.

Venlafaxine is the preferred treatment for breast cancer survivors taking tamoxifen, and at 75 mg, there is significant reduction in hot flushes with concomitant improvement in fatigue, mental health and sleep disturbance.2"


I hope this helps and you manage to find a solution that works for you - and do keep posting - as you say this is a time of great upheaval. All the best

[dangermouse]

I guess a lot of what we read is opinion and, yes, who knows what is relatable to ourselves until you try it.

That dose of Utrogestan does seem high but I don't know if it feels different taken on it's own (without estradiol), I really should be a guinea pig and try it if the doc will prescribe.

I think the main bits that were interesting were that most women do recover from perimenopause, which ties in with most women I know who say they really suffered in their 40s but feel great in their 50s (none I know of took HRT), my sister said the same for her friendship group. I'm sure it's still fine to take HRT to smooth the path but feeling good after menopause would probably happen whether you took it or not as it's easy to assume its because of what you're taking, when it would have all calmed down anyway. Saying that, some may have a strong imbalance to start with that will always need correcting.

The other part is the balancing role that oestrogen and progesterone have, I liked the analogy of the wings of a plane! Although progesterone is notedly important for pregnancy, it needs to always rebalance oestrogen so is also essential for bones, heart, skin etc. to keep oestrogen from causing growths and providing the yang to the yin (as in oestrogen grows bones and progesterone strengthens them).

I agree that (synthetic) progestins shouldn't be used though as they can increase cancer risk, unless you don't have a choice and quality of life is better.

Another interesting bit I read today in Dr Katharina Dalton's PMT book is that if you suffered from PMT in your 20s, that you'll have an easier menopause as it means you have higher than average oestrogen (but may suffer more in peri). Conversely if you had an easier time when younger that you are likely to have a rough meno from too low oestrogen.

[Charys]

Thanks everyone for your recent replies. I take on board that not all information is accurate on the WWW (infact a lot of it is dubious), but I guess the key to it is that you have to read a variety of sources....some things will relate....some won't. I'm not hugely interested personally anyway in the meds that can be taken, as my oncologist has said they won't be given to me, so I ignored that part anyway, but I thought there were some nice analogies and I felt it was positive about the future - which is kind of what I'm needing right now.

Hurdity, don't worry about forgetting the BC thing, yes was diagnosed at 47. Second year mammo was clear though a few weeks ago.    As it happens I don't get hot flushes at all, apart from the day before a period is due, and guess what - I've been on venlafaxine for years !  Flushes were also the only side effect that I didn't get on tamoxifen....So, there we go, an example of how it does work, as you correctly stated.

Yes, its the mood swings that are bothering me most, they are crippling me at times....what is the CCP type ? You are so darned knowledgeable lady.

I promise I have read every link you've posted Hurdity ....and I understand that getting to the source material is a good idea. 

[Charys]

Hurdity.....can I ask you something else? (or anyone, who knows the answers ...Dangermouse? lol)

What makes periods stop-start? I know it happens, I know its a normal part of this stage....but wondering what the specific hormonal reason is. Thinking back now, years ago, I started getting days where there would be nothing and then it would start again. Now, its even more stop-start than before.....tap on, an hour later...tap off.

I'm just interested really, as am trying to build my knowledge of reasons for things to help me feel less anxious.

[Hurdity]

Hi there

So glad to hear your recent mammo was clear

CCP is the combined contraceptive pill ( I shouldn't have used abbreviations - I post quickly though as pretty busy!)  but I wrote that before I read about your breast cancer but left it in in case it helped others - sorry it's irrelevant to you.

I just happened to have read a lot and also older than many on here as mid 60's, have been on HRT for 11 years and have made sure I know what I'm taking and why. I came on this forum originally years ago to ask questions and like Dancinggirl said recently to another member - just want to give something back and help out if I can - I mean it would be a waste of all that info floating around my head!!!

But yes - there is opinion, personal experience, and scientific evidence - what is said on this forum is a mix of all of these!!

This link about peri-menopause should explain in simple terms the hormonal background to periods during peri-menopause.....and the hormonal upheaval. Lots of hormones floating about, complicated feedback loops, ovaries beginning to pack up - insufficient viable eggs being produced etc...

https://www.menopausematters.co.uk/magazine/pdf/Article%20-%20Perils%20of%20the%20Perimenopause.pdf

Hopefully the Venlafaxine helps with the mood swings a bit?  I presume that after your cancer treatment you are taking extra care with lifestyle (exercise, alcohol etc), diet and weight to minimise any chances of cancer of any sort recurring? I hope you don't mind my saying - as I am sure you will already be doing all you can!

Sorry I can't be of more help...but hoping you feel a lot better very soon.....

Hurdity x

[Charys]

I presume that after your cancer treatment you are taking extra care with lifestyle (exercise, alcohol etc), diet and weight to minimise any chances of cancer of any sort recurring? I hope you don't mind my saying - as I am sure you will already be doing all you can!

You know Hurdity; Before being diagnosed I was perfect BMI, teetotal for 20 years, don't smoke, am a pescetarian (only eats fish as a meat source) who eats vasts amounts of vegetables, pluses, nuts and healthy home cooked foods. Ok, so my exercise isn't rigorous, but I am very active and do a lot of hill dog-walking, gardening and physical activity in my working roles. Never taken any hormone medications including the pill, gave birth, no genetic link either. There is nothing in my background that would have screamed 'risk factor', it was purely unlucky and if it reccurs it will also be unlucky. I spent a long time, as many women do, feeling guilt about having caused it and analysing their past, so I make a deliberate effort to be honest to not worry too much about life factors and try to live it with as much vigour as I can currently muster lol My oncologist said to just go out and live and not concern yourself about obsessing over diet and so on, so I do that; eat plenty of cake, chocolate and do lots of what I enjoy.

I've read the article a few times now Hurdity, I understand all the loops and feedback, this failing and that failing and dropping, eggs and ovaries and so on ....but it doesn't describe the actual point by point hormonal reason for stop start periods. I know what in general is happening to me and the reasons for the irregularity. 

Maybe I'm expecting to understand something that I can't, in detail of knowing what is rising, falling and so on differently to usual in this particular period only. I mean - in this case is it - non-egg production, High FSH, Low progesterone or high oestrogen...you get what I mean....the specific relationship between all the variables that produces this outcome, this month. Ignore me, LOL, I know what I mean. I analyse each period, as each one is different to try and figure out the physiological causes that particular month. By applying some logic, to what feels entirely randomly changing I thought it might help. Maybe I just have to accept that I won't know or understand, as I'm never going to understand the complexities of all the reproductive hormones. 

Thanks for all your help, I appreciate it.

[Charys]

Ah yes the 40 day'ish cycle was happening to me last few months. I think it's because they're anovulatory and so no progesterone is produced and so oestrogen just continues to surge.

Yes, that would make sense I guess. So, dangermouse....I'm going to get you using your peri/hormone problem solving now  If oestrogen is surging and not enough progesterone as anovulatory, then it takes longer for the progesterone to build up to overtake the oestrogen and trigger menstruation? Is that kind of it? However, both oestrogen and progesterone might be low, with oestrogen being lower than it used to be a few years ago - but still more dominant than progesterone. In that set of circumstances, it could account for lower amount of bleeding to usual (which is what is happening) right, as less oestrogen to build lining ? The stop/start could be the progesterone dipping and rising? Oh I don't know....) There are other things here too aren't there, LH and FSH and testosterone, other variables.

Orrrrrr it could be that the whole cycle was slow to get start, as both Oes and Pro were diminished at the start ?

[dangermouse]

I think the bleeding patterns you suggest make sense as oestrogen builds the lining and progesterone stops the growth, nourishes it and then releases it (at menstuation or birth). With less progesterone the lining will thicken and cause heavy and more frequent bleeding or spotting, or, when anovulatory,  oestrogen will continue to surge and cause longer cycles.

I'd always assumed peri madness was due to dwindling egg supplies making the ovaries push out more oestrogen in a last ditch attempt to fertilise an egg, followed by no eggs left so oestrogen comes down and periods stop.

However... I've since read many different hypotheses from various endocrinologists that suggest it follows consistent anovulatory cycles and that the eggs are still there but the ability to fertilise them in the absence of enough progesterone causes them to shut up shop.

Who knows who is right. The NHS choose the former explanation but they may be guided by the drugs research.

I do wonder about these private fertility companies that freeze eggs, is it all legit and based on strong evidence?

We know the FSH shows high on post menopausal bloods but this could be triggered by any cause of annovulation.

They also don't know what causes hot flushes. Both oestrogen and progesterone can stop them. However, I suspect it's more linked to the thyroid and hyperthalmus and it's very common a week after an anaesthetic.

Hormones are complex with each one having a knock on effect to another. Rather than adding hormones or suppressing with high doses I would think that dealing with the root cause of the imbalance through diet (e.g. raw carrot is good for hypothyroidism) would be the ideal. Where to start though?!!