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[laszla]

Now 5 months into femoston 2/10. 51, perimenopausal. Most significant symptoms that prompted me to take hrt: dreadful hormonal anxiety (also coincided with bereavement), thick brain fog, flooding and endless periods, awful dry skin and hair, no hot flushes (in fact always cold).
I've already posted that 3-4 months in I was disappointed as had hoped it might have done more for me.
But now I am seeing a specific pattern emerging which is that a few days into the progesterone half of the pack I am getting bad pms symptoms, worse than pre-hrt: painful breasts for several days (longer than pre-hrt), very ratty, anxious, bad thoughts, immune system also seems to crash.
Now I had these pms things before but I kept it all under control by taking agnus castus (v effective) but I was under the impression that you shouldnt take agnus castus when on hrt.

I am further confused by the fact that lots of people mention being progesterone intolerant which was my first thought but since agnus castus raises progesterone levels (or so I thought), why did I do well on it for pms if I am progesterone intolerant - or is it more complex than that?
Have phone appointment with gp on tuesday to discuss options and I have no clue what to do and I need to make proactive suggestions with this doctor.
I have read of some people taking less progesterone, either by splitting pills in half or taking every other day but then I would lose out on the estrogen for those days.
So should I just ask for the oestrogen gel protocol and a progesterone-only course for a week or so so that I can control the dose of it? Or simply take some agnus castus and continue with femoston?
Or ask to be referred to menopause specialist (am in London)?
I don't know if the improved 2 weeks I get with the oestrogen is worth the 2 weeks on the white pills.
Sorry for the confused questions, I am panicking at the thought of starting the progsterone pills tomorrow and being so unsure what to do/say to gp...

thanks for your patience.

[Hurdity]

Hi laszla

Sorry to hear about your problems. Can you tell us what your cycle was doing leading up to starting HRT? Were you cycles beginnining to lengthen each time ie longer than the 28 days ( if that was your usual cycle)?

It may well be that if not and you were not experiencing hot flushes then this HRT is not yet right for you. If you have had very heavy periods then perhaps a Mirnea coil might be better and then you can add oestrogen to help with low oestrogen symptoms if/when these occur. The oither alternative is a gentler kind of CCP (QLAIRA) that is similar to HRT but contains higher doses of progestogens than HRT and so will control your cycle and the bleeding and hopefully minimise mood swings too.

Hurdity x

[laszla]

thanks so much Hurdity. Pre-hrt cycle was fairly regular, approx 27 days, constant brain fog, zero energy bad pms without agnus castus (mood wise mainly ) and manageable with agnus, heavy, long periods. the bleeding with hrtis better but the premenstrual bad thoughts/rattiness are bad and now not held in check with the agnus castus because I stopped taking it.
Only discernible difference with hrt is slightly better first 10 days of the packet, everything else seems very similar after 5 months and dry skin/hair seem worse.
Mirena coil scares me and mood is my priority but I will look into qlaira which I've never heard of but confused by its higher progesterone as I thought my reacting badly to second half of femoston course suggested I might be progesterone intolerant - further confused by the fact that I reacted well to the supposedly progesterone-increasing agnus castus.

[Dancinggirl]

laszla - Hurdity has given you very sound advice. 
The peri meno phase is very tricky and alternative remedies like Agnus Castus can seem to work for a time because your hormones are fluctuating during the peri stage and this gives the impression that these remedies are working. HRT an be helpful in peri but when it comes to mood HRT doesn't always help that much.

It will be a range of strategies that will probably help you and it will include a good look at your lifestyle choices e.g. diet, exercise and relaxation techniques.  AS Hurdity has suggested, to stabilise your hormones at this stage, then Qlaira might be appropriate but to reduce the bleeding the Mirena might well be your best option.  If flushes emerge and to help with mood then adding in a low dose of transdermal oestrogen as gel or patch would also be advisable. IT seems to be the fluctuations that are your main issue and the Mirena would give that low dose of progesterone more locally to the uterus (less is absorbed systemically) that might give you the balance you need - just a small amount of additional oestrogen would also be advisable to balance things as well and you could then add in more oestrogen as you get deeper into the menopause. Oestrogel is great for adjusting dosage to requirements (though some GPs are reluctant to prescribe this for some reason) and it is applied to inner thighs each day.  Look under TREATMENTS at the top of this page to get the full info on all this.
A referral to a meno clinic or gynaecologist might be appropriate if your GP isn't clued up or helpful.

Here is the article that explains the peri stage so well; this may help you understand better what is going on and aid your decisions about how you wish to treat them going forward: 
https://www.menopausematters.co.uk/magazine/pdf/Article%20-%20Perils%20of%20the%20Perimenopause.pdf

DG x

[laszla]

Thanks DG - I am and always have been massively into exercise, hypnosis/meditation (all on a near daily basis) and mostly vegan with some fish diet so I don't think there's much more I can do on that front.

I saw my gp who has given me the prescription for estrogel and utrogestan to see if I will do better on this than on femoston - certainly many seem to advocate transdermal estrogen over tablets and micronised prog over dydrogesterone so I think I need to try this regime.
I explained to my gp that some people take the utrogestan for just 7 days though the prescription is 200 mg daily for 14 days. She has suggested I start on 200 mg 14 days and go down to 7 days if I still do badly on the prog days.
I'm not sure how to transition from the femoston to this formula but perhaps it would be best if I made that a separate post.
Thanks for your help everyone.

[Dancinggirl]

Great that your GP has prescribed the gel and Utrogestan combo.
It's probably best to finish a cycle of the Femoston unless you have only just started a fresh packet, before starting the new regime.
If you want to minimise the side effects of the Utrogestan then you could try it for 12-14 days and use just one 100mg capsule vaginally on those days. Using Utrogestan vaginally delivers the progesterone more directly to where it is needed, less is absorbed systemically and the lower dose is usually sufficient - taking it orally means the higher dose is needed because so much is lost due to it going through the liver.
The Utrogestan capsules are prescribed for vaginal use in many other countries but for some strange reason the NICE guidelines haven't accepted this unless it's for IVF treatment!!!!
So why not try 16 days if 2pumps of gel per day and then add in 12 days of one Utrogestan capsule vaginally?
Let us know how you get in. DG x

[laszla]

Thanks for the utrogestan tip DG, that makes sense  and I know it's used like that in my country of origin.
I think the idea that it wouldnt be floating about my system is calming in itself.
I appreciate your help and will update on the transitioning part of my query on my other thread in case it's useful to anyone else with similar dilemma L x