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[flyingsquirrel]

So, I'm on the last birth control pill I ever care to try.  I thought maybe my body hated progestin, so I asked for Ovcon-35 or something similar.  I ended up on generic Balziva for it (35mcg estradiol, 0.4mg norethindrone).  I asked for it because it's one of the few packs available with the lowest potency progestin, and it also is under 1mg.  I figured, if I'm progestin intolerant, this might be the only one that will work.  None of the "Fe" family worked for me (i.e. Lo Loestrin Fe, etc.), and I started on 10mcg estradiol, then 20, and 30, etc, each with somewhat increasing norethindrone acetate. Nurse makes me wait 2 months on each pack before she'll let me switch.  Last pack was Velivet, which was triphasic with desogestrel, which turned out to be one of the the most potent progestins.  It stole my ability to sleep...at all.  And I already suffered insomnia.  Which led me to beg for Trazodone.  Ah, sleep at last!  But the depression ultimately is still in my life.  Hence, I wanted to try dropping the progestin potency this time and cutting its dose even further.

I ended up refusing to go on the second pack of Velivet, and started on Maca to reboot my ovaries.  It took a couple of weeks, plus a second random period, but suddenly my mood began to improve.  I got a week off from being depressed!  Interestingly enough, my libido came back a bit, which I haven't had in over a year really.  It wasn't that impressive, but it was something.  Early last week I suddenly couldn't sleep much even with Trazodone, but didn't care because I was crazy happy.  Extremely wired, but happy.

I started the current Balziva pack the day after the wired-out happy insomnia started.  The first 3 days the positive mood continued.  By day 4, though, I was slipping again.  Today, I feel terrible.  Very sad, depressed, struggling to fight away the anxious/traumatic thoughts.  I suspect my ovaries booting back online caused a spike in...estradiol?...that enhanced Trazodone's antidepressant properties.  And now that the birth control is taking over, the happy feelings are gone.  One would think 35mcg estradiol would be more than enough to make me happy (especially after the mere 10mcg I started on so many months ago).  But, if I'm intolerant to even such a small amount of progestin, that could explain some things....  Or, an absorption problem with the pill form of estradiol?

I know it can take months to find out if something is working, but feeling worse again stinks.  Anyway, as I resist the temptation to not stop this pill pack early and go back on the Maca, I'd like to prep for the next OBGYN nurse appointment in a little under 2 months.  Yes, it's very pessimistic of me to assume this pill won't work after only 5 days, but I'm used to all these pills failing me at this point.  I'm honestly not confident in any of it anymore.

Anyway, I need information to help me steer the nurse practitioner in the right direction.  When I was last in the office, she was contemplating putting me on just the Mirina coil by itself, or just micronized progesterone by itself, with ZERO estradiol.  (Why, God, why?)  I'm hoping I can talk some sense into her.  I have a feeling that will go very, very badly.  No doubt, the hot flashes will return if she does that, and I who knows if I'll just get even more depressed.

So, some of you in perimenopause have been helped by the Prof John Studd way of doing things? Transdermal patches or creams for estradiol, and low dose micronized progesterone?  The most intolerable symptom I have is the unrelenting 24/7 depression.  It never stops.  It's such a fight to get through each day, and I can only hope I don't have anxious thoughts in my sleep that turn into nightmares.  (And yes, I saw a shrink.  For what good that did.  CBT just made me cry because the beach I was supposed to imagine was empty and lonely.)  I know it's possible to be happy again.  I've tasted it.  I got a week off from feeling crazy.  I want my life back.  I'd trade having the hot flashes return and the heart palpitations and even the muscle weakness in exchange for being happy.  Even being a happy insomniac is so much more tolerable than being depressed and sleeping on Trazodone.

For those of you who have had a consult with Prof Studd or someone who adheres to his school of thought, what is the first thing I should try with the nurse?  Do I still want to stop ovulation?  What's a good starter dose of estradiol and micronized progesterone?  Do I want only the vaginal kind of progesterone?  Or is that being too shy?  How about testosterone (if I can even get her to give it to me)?

Thank you so much for your help/advice.  I wish I were in the UK so I could see Prof Studd for myself.  Alas, I have to endure the US doctors who all seem oblivious to the latest and greatest research.  I appreciate any ideas you have to offer based on your own experiences.

Sorry this post was long.  I'm just putting out my experience so far in case someone has an insight I didn't think of.  Thanks again!

[sheila99]

I started on 2 pumps oestrogel and 12 days of 200mg utro in peri. I use it vaginally. I have since increased to 3 pumps. How old are you and where are you in meno? Do you have other meno symptoms? If depression is the only one it's possible it isn't caused by low oestrogen. Is there a reason for using birth control rather than hrt? I can't understand why the nurse would suggest no oestrogen as this is hormone hrt is replacing, the progesterone is to keep your lining thin.

[flyingsquirrel]

I'm 36.  When this started a year ago, I had severe physical anxiety, severe insomnia to where I felt super wired like I was on a caffeine IV drip 24/7, waking up in a panic after only a couple of hours of sleep.  Then the depression set in on top of it all.  What tipped me off that this was hormonal, was that during menstruation I would have hot flashes, weakness in my legs, and nausea.  The weakness in my legs would get so bad I could hardly walk and do things.  Stairs were suddenly a challenge.  I also started having heart palpitations throughout the month at random times.  Just sitting there watching TV my heart rate would jump up to 90 or above for a few minutes before settling back down.  Never in front of the doctor, of course.   

It took a few months of the above symptoms before I recognized the pattern of hot flashes etc. happening during menstruation.  Went over my thyroid with a backhoe, too, and it's fine.

I'm very early on.  Before I started the birth control earlier this year, I was still regular.  Birth control did eliminate the hot flashes during menstruation, the weakness in my legs, the nausea, and the heart palpitations.  Took care of a lot of the physical anxiety symptoms, too.  Tightness in my throat and chest wasn't as bad.  Though, the heart palpitations and muscle weakness came back on Velivet.  Tells me I didn't like the progestin potency.

It's clearly hormonal.  But getting my brain happy again....  That's the biggest thing for me right now.  And hopefully if that becomes happy, I won't need Trazodone to sleep anymore.

Thanks!

[Alicess]

Hi Flyingsquirrel, Did you ever try a birth control with a more androgenic progestin like levonorgestrel? As I explained in your other tread low testosterone can cause depression. I switched from a low androgenic BCP to levonorgestrel and after 6 weeks my depression went away. But it took 6 weeks and in the first few weeks depression became worse before it got better. Although I still had bad sleep and anxiety in the early hours on some days I was much more able to cope with them. For me switching to HRT and especially Urtrogestan made everything much much worse as it is a very low dose and many women don't do well on Urtrogestan.

[KiltedCupid]

Hi Flyingsquirrel - like Alicess, I'd recommend a completely different type of progestin. Have you tried Drospirenone? It's in Yaz and Yazmin, I think they have different strengths of E & P in each. I used Angeliq as hrt which is low dose tablet hrt and I got on with the progestin, the only time I've managed to feel ok on a progestin. Yaz is prescribed for PMD so it be be worth trying it?

At your age and stage, you'd need really high bio oestrogen which would mean a heavy dose of progestin to balance and I'm not sure the Studd method of 7 days would be enough.

[flyingsquirrel]

Hmm, conflicting recommendations!  One for androgenic and the other not really so much.  I guess once I try those two, though, I'd finally be out of options.  Levonorgestrel sounds a bit more on the progestin-potent side of things, though.  And, the desogestrel I had been on was already very potent and was moderately androgenic.  I did not do well on it.

Wouldn't it be better to just get some testosterone cream rather than relying on progestin to provide the same effect?  What are your experiences with that?  The nurse didn't want to try testosterone yet until she'd balanced me out with estradiol/progestin first, but maybe I can persuade her?

Also, if all else fails, how high does the oestrogen go with the Studd method at my age?  If I have to take progesterone more than 7 days, can I still start with a very small dose and maybe slowly work my way up?  What's the smallest dose I can ask for?

Thanks, ladies!

[Alicess]

Yes, it is conflicting but it just means every women response differently. I think that what both KiltedCupid and I are trying to say is that HRT is not strong enough for you at your age and we both had a bad experience switching from birth control to HRT. Please correct me if I'm wrong, KiltedCupid.

It's not just about the progestogenic activity. Besides androgenic activity progestins can also have glucocorticoid and antimineralcorticoid activity. It also depends on elemenation half- life aka how long a drug stays in your body and on SHBG. It's very difficult to figure it out as you can't tell how your body will respond. It is a matter of trial and error I'm afraid. And you have to stick it out for a while before you can really tell if it's working for you. It's possible you do feel worse before it gets better. Desogestrel has very weak androgenic activity by the way.

I was prescribed testosterone alongside birth control but it didn't do me any good. It could be different for you though.

[KiltedCupid]

Alicess - yes, you're right, although it's been a while since I used bc, I never had any problems. Interesting though that I'm now back using Levo in fem7 and that's what was in my BC.

Flyingsquirrel - I'm entirely in agreement with alicess in this, the progestins all have different properties other than progestigenic and therefore only trial and error will single out the best match. Drospirenone isn't a progestin made from progesterone or testosterone it's made from spironolactone and is therefor suited to women who can't tolerate other types of prog. It's anti androgenic and reduces water retention. I found it really dried me up but others don't.

In terms of the Studd method, you'd probably need around 4-6 pumps of gel and if so, would need a hefty prog to balance that. You'd need to speak to a medic on the 7 day prog and have regular endo scans to make sure everything is ok. In your shoes, I'd stick with BCP, simpler and more effective at your age.

[sheila99]

Few women in the UK are on 4-6 pumps, most are on 2 or 3. 2 would be a good starting dose and increase only if you need it. I'd be reluctant to use utro for 7 days unless you have regular scans, the standard dose here is 200mg for 12 days. It's true some people don't do well on utro but thousands are absolutely fine with it - if it was that bad they wouldn't be able to sell it. I wouldn't consider a reduced dose unless you have problems. I used to get very tired on but have been normal recently, I think because I am producing less prog myself now. I was told 4 pumps would be fine with this dose of utro. Specialist said up to 6, GP unhappy with more than 4. Here they like you to be stable on HRT before adding testosterone if it's required. All a matter or trial and error I'm afraid.

[Alicess]

KiltedCupid, how are you now? Did you sort it out eventually? Was there any reason not to go back to BC back then? I hope you feel better on Fem7.

[flyingsquirrel]

Thanks again, ladies!

All right, looks like I should probably keep trying more birth control.  I do wish there was a way to separate the estradiol from the progestin in it.  By that, I mean that every time I switch birth control packs, the doses of each change.  I'd like to be able to freeze, say, the estradiol at whatever mcg, and then play with just the progestin type/dose.  You know what I mean?  I feel like something should be stabilized rather than both being changed around.  Is there a way to do that?  Can they be prescribed separately and still have the same estradiol potency as in birth control?

Also, I've been considering whether I absorb estradiol orally very well.  I know there's one combined patch for that that has the same potency as birth control.  Do they sell something like that separated out so I can freeze the dose and still play with the progestrin?  I've tried Googling for this, but it's hard to tell whether it's the weak bio estradiol vs the birth control pill sort.

[Alicess]

Ethinylestradiol is available as a pill in dosage of 10 mcg per tablet but unfortunately neither Levonorgestrel nor Drosperinone are available as progestin-only pills. Ortho Evra (or Xulane as a generic version) is a birth control patch containing ethinylestradiol and norelgestromine. I don't know the strength and I'm not familiar with norelgestromine and it's properties. I believe it's been discontinued but not sure.

[flyingsquirrel]

Ethinylestradiol is available as a pill in dosage of 10 mcg per tablet but unfortunately neither Levonorgestrel nor Drosperinone are available as progestin-only pills. Ortho Evra (or Xulane as a generic version) is a birth control patch containing ethinylestradiol and norelgestromine. I don't know the strength and I'm not familiar with norelgestromine and it's properties. I believe it's been discontinued but not sure.

Drat. I was afraid that would be the case for the progestin being separate.  I think Ortho Evra is still around.... I think.  I was looking into it as an option at some point.  It looks like the norelgestromin in it has "weak androgenic activity and no other important hormonal activity", according to Wikipedia.

If I did end up on creams or whatever after trying out all the BCPs on the planet*, how much of the oestrogel cream would I have to use to equate to BCP ethinyl estradiol potency?  Would it still be 4-6 pumps?  Or is it such apples vs. oranges that it's really unknown?

*All right, I won't try every BCP on the planet.  But I'll give Yaz or Yasmin and something with Levonorgestrel a try before I give up.   

[Alicess]

I honestly don't know how to compare synthetic versus bio-identical, I would like to know myself.  It's not only potency but also a different substance and a different kind of delivery. Maybe someone else comes along with an answer. I do believe you will find the right one but if you need a peptalk please do pop in ( if that's the right expression).

Alicess 🌷

[Hurdity]

Ethinylestradiol is available as a pill in dosage of 10 mcg per tablet but unfortunately neither Levonorgestrel nor Drosperinone are available as progestin-only pills. Ortho Evra (or Xulane as a generic version) is a birth control patch containing ethinylestradiol and norelgestromine. I don't know the strength and I'm not familiar with norelgestromine and it's properties. I believe it's been discontinued but not sure.

Just caught sight of this and there is a mini pill containing levonorgestrel - if it is still available - it's called Norgeston https://www.medicines.org.uk/emc/product/1133/smpc. Also FDA in US has recently (June this year) approved a mini pill containing Drospirenone called Slynd available from autumn this year.

Hurdity x