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[Hurdity]

Hi there

It's important to understand what happens in a normal menstrual cycle to even be able to begin to guess at what might be the cause of any symptoms.

Oestrogen begins to rise around the time of the bleed and continues to rise until it reaches a peak around the time of ovulation at mid cycle. Thereafter it falls dramatically and then over the next few days begins to rise again to another, lower peak and then falls again in the last week. During the second half of the cycle after ovulation, progesterone also rises and reaches a peak sometime during/late in the second half of the cycle and when it too falls, this signals for the bleed to start and then we're round again.

During peri-menopause the fluctuations become more extreme though I was not aware that the second, lower peak is ever higher than the post-ovulatory peak. Also the absolute level varies from woman to woman.

These dramatic fluctuations just before ( ie during late reproductive stage when ovulation is still more or less regular) and during peri-menopause, in both oestrogen and progesterone are the csuse of most symptoms.

There is a lot of confusion about low progesterone and balance etc. I'm not sure whether the absolute amount of progesterone produced by the corpus luteum after ovulation falls during peri as the ovaries begin to fail, but certinly when there is no ovulation (anovulatory cycles) no extra progesterone is produced. Sometimes extra progesterone is used (and as part of HRT) to regulate the cycles and bleeding - but not to alleviate general symptoms per se.

I'm with CLKD on this one - shaking and tremors etc due to low blood sugar - hormones do have an effect on blood sugar regulation. The first thing I noticed before I was even peri-menopausal (regular periods) was that I would get hypoglycaemic ( low blood sugar) symptoms during the morning in the second half of my cycle and had to adjust breakfasts accordingly - which remains to this day in my late 60's!  I attribute that to the metabolic changes caused by the rapid increase and then decrease in progesterone. Some women (me!) are affected more than others. For me as I said the blood sugar regulaton still remains a problem sometimes even when not taking progesterone as part of HRT.

So Joannefran - make sure you have a good breakfast of slow release carbs and/or protein and cut down on all sugars and refined carbs in your diet - and this will help regulate insulin.

Day 13-14 onwards after ovulation until the next cycle - as far as I understand it your oestrogen will never spike in the same way.

Notwithstanding Gilla999's experience and also being in early menopause (if I understand correctly) I would not get hung up on measuring oestrogen but concentrate on understanding the main principles of hormonal changes and especially continue to keep a diary. If your cycle is still regular then unlikely that you will yet need oestrogen though  (and I might have mentioned on another thread) you can regulate your cycle using one of the birth control pills designed for late reporductive stage and esrly peri?

Just a few thoughts

Hurdity x

[VanillaLover]

I am taking Evorel 50 (and utrogestan). I would like to try 75 but need to wait for specialist appt first (yawn). I am also coming to the end of CBT (free, NHS) which has been really really helpful for the anxiety. I would say that the HRT has calmed things down massively too BUT only after the full three months (and I’m still seeing improvement now).

I should add that I also take antiDs (have done for years since PND) and have tried increased dose but it made little difference to the anxiety.

[VanillaLover]

Should also say that I suffer with the low blood sugar thing too. Be kind to your body and go with it! Give it some decent fuel etc.

I would love to try the newer oral contraceptive pills as I think it would be ideal for me in evening out the cyclical swings but I have migraines so it’s a non starter. Hopefully as I get older and my periods start getting far apart or stop (can’t come soon enough) it will be better in that regard.

[Gilla999]

Just to chime in my two cents: you can absolutely still have a regular cycle and still need HRT    Many meno specialists have told me this, and it was my own experience.

[CrispyChick]

Hi. My (long) story is similar, but also different.

I'm 45 now. Had horrific symptoms on and off for 4 years - I've tried all the pills available, some help a bit, but none made me feel good.

My symptoms are awful day 2-ovulation, then just not great after, but not as awful. I have now started having annovulatory cycles, which give longer cycles with bad symptoms - for me.

I echo what Gilla, says, we are very different in the way we respond to hormones.

I tried hrt for only 2 weeks - the estrogen made me feel horrifically poisoned. That was when I opened my eyes and realised im probably not low estrogen.

There's not much on this forum about the early stages of peri, where prog falls and estrogen can be erratic. I now believe that's where I am.

I've since had a 21 day blood test. This showed a good level of estrogen, for my age (obviously that's just one point in time, but it wasnt on the floor). My progesterone was on the floor however. I recall feeling particularly bad the morning of the test.

So, I'm now supplementing with progesterone. I've had a bad few months so I can't say yet if it'll work... More bloods to follow.

Unfortunately, my experience of the NHS is they dont take bloods, go off symptoms. I have bad symptoms, therefore I must need estrogen. I don't think I do.

That's not to say I won't need estrogen in future, just pointing out that I'm hugely symptomatic with early stage peri where my prog has bottomed out.

I think tests would be best for you. Give you an indication. I'm under a private clinic where they test and treat. It's expensive, but I had no other option. Good luck x

[JoannFran]

Thank you all so much.  This information is invaluable to me.  I've ordered the dutch test on the recommendation of my nutritionist who is also helping me with food and supplements.  I honestly didn't make the connection with the blood sugar thing but it makes total sense now because my eating habits were/are terrible (I'm addressing it now).  I'd never have breakfast and go for hours without eating and then grab something sweet.  Hopefully the dutch test will give me some clue as to whats going on with my cycle. 

I'm thinking of ordering some ovulation tests to see if I am actually have anovulatory months.  I'm not sure if this would this be helpful to know?  I just desperately need to find whats causing this debilitating anxiety the second half of cycle so that I can try to balance it.

My Dr is really good but she thinks that low estrogen is the cause of everything and so tells me to up the dose 

I am considering just trying the utrogestan (without the estrogen) for the 2nd 2 weeks of cycle.  100mg vaginally.  Anyone know if this is safe?  Or anyone tried it?

Thanks again xx

[CLKD]

   Huridty.

[JoannFran]

Yes!!!  Definitely a great big THANK YOU to everyone!  So helpful hearing everyones journeys.  I WILL get to the bottom of my inbalance!

[CrispyChick]

It will be fine to try the utrogestan on its own. But, and it's a big but...oral progesterone is highly metabolised and can give side affects that other forms don't e.g makes you sleepy.

However, if you've been taking it with estrogen, I'm assuming you cope with it OK. So probably worth trying.

I have spent 4 years being told my estrogen was likely low. And the pill did not work enough for me - or gave me more daft side affects. My volatility just seems so high. Other countries seem much more up on the whole low prog - you'll find lots out there. Over here... It's an estrogen focus.

Now, only time will tell if that was wrong. My progesterone journey is on the 'alternatives' section under the compounded bhrt thread. Sorry, I don't know how to tag it. But it's very very early days, so I wouldn't want to sway you on that at present. X