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[GypsyRoseLee]

When I saw Dr Annie a month ago, it had been 26 days since my last withdrawal bleed (when I stopped Femoston 2/10 just a few days into the combi tabs).

So, she told me to start 100mg of Utro, within the next 2 days, and only take it for 7 days.

But before I could start the Utro I started my own, natural period anyway. I contacted Dr Annie and she told me to not bother with taking any Utro then, and wait until next month.

Well, I intended to start the Utro today, 27 days since the start of my last period, and an easy date to remember in future.

But, again, my own natural period started yesterday, on day 26. Started just with brown spotting, but today there's red flow and I'm having a few cramps.

Contacted Dr Annie's secretary to ask if I still need to bother with taking Utro this month, as I'm already having a period. Apparently Dr Annie says I should still start the Utro, and take it for 7 days.

Fair enough, she is the expert, and I will do what she says. But what will happen if I start Utro tonight? I know my own period will finish probably by Sunday. But I'll carry on taking Utro until next Friday. Once I stop it, will I have an artificial withdrawal bleed a few days after stopping?

It would make more sense to me, to not take Utro tonight, but actually wait until, roughly, April 19th/20th. Then take it for 7 days, at the end of which my own natural period will no doubt start anyway, regardless of whether I have taken Utro or not.

I am really reacting to the sudden drop in my hormones, due to my period starting yesterday e.g. slept badly last night, feeling tearful, low and very chilly today (having to wear thick jumper and dressing gown, despite heating being on). So, don't really want to have to go through this all again in 7 days time when I stop taking Utro.

Any advice would be welcome.

[GypsyRoseLee]

Oh, and can one of you wise ladies remind me if it is low oestrogen or low progesterone that can cause me feeling very chilly all day today + nausea (have felt very hungry but sick all day too)

With my own natural period starting yesterday, I don't know if it's my own low oestrogen or own low progesterone that is causing my symptoms.

[Taz2]

Hi GRL - I can't help on what causes the nausea and chilly feelings I'm afraid but would just like to say that as Annie Evans is considered expert enough in all of this for you to have consulted her then try to just go with what she says. I wouldn't question why she has told you to take the utro even though you are having your natural period at the minute. She has obviously got experience in all of this so try it for a few months and then, if it's still not working, you can go back to her and tell her that. It takes a good few months to settle onto any regime. Isn't it hoped that the HRT will override your natural cycle in the end so? I don't understand all of it I must admit 

Have you been diagnosed with PMDD? I just wondered as from one of your other posts I see that you are considering full hysterectomy to combat your symptoms. Has anyone recommended that you first have your ovaries shut down to see how you would cope without them if they are removed? I should have posted on your other thread about this really but am in a rush!

Taz x 

[Hurdity]

The thing about taking progesterone is that all the while you are taking it it is preventing the womb lining from thickening due to the oestrogen, as well as changing the structure of the lining that has already built up - which is why Dr Annie Evans says you should take it I presume? My understanding of it would be that it would be doing its job even though you might have shed some lining, especially as you are taking a very high dose of oestrogen.

I presume because you've had a bleed at an unexpected time then the oestrogen has not yet prevented ovulation, and I understood these very high doses of oestrogen are designed to do that? If that happens perhaps you won't feel the effects of the fluctuations in quite the same way?

Re your other question - it's impossible to answer - but surely you won't have low oestrogen because you are taking a continuous high dose? It will still fluctuate a little but the idea is to minimise this with the gel I thought?

If you have ovulated then your own progesterone will rise and fall and the usual pms from progesterone withdrawal is likely to occur as in the normal cycle. I know that progesterone and oestrogen have different effects on blood sugar which casues sugar/carb cravings during the second part of the cycle - but I'm not exactly sure how this works, but all this sounds normal for peri. I definitely experienced hunger, cravings, low blood sugar etc quite extremely during the last week of my cycle as I neared peri-menopause. Nausea is usually a temporary effect of high oestrogen (like in early pregnancy) altough I read on here recently that some women felt nauseous on low oestrogen - so you see it's impossible to say!

Sorry I can't help further but hopefully you will be able to ride through these minor symptoms as long as it does the job mood-wise that you are hoping for after a couple of months.

Take care Hurdity xx

[GypsyRoseLee]

Very interesting, thank you Hurdity.

Actually my period which started on Thursday was bang on time, exactly 26 days since my previous natural period (I hadn't taken any synthetic progesterone since start of Feb).

So obviously I still must have enough of my own progesterone to cause a natural period?

I used 3 x sachets of sandrena for the first 2 weeks after seeing Dr Annie but felt quite 'headachey' so dropped down to just 2 x sachets (which she said I could do if I was having headaches).

So, I'm assuming just 2 x sachets wasn't enough to supress my own cycle obviously? Hence me having my own natural period and bang on time too.

I am going back up to 3 x sachets today, but splitting the dose (on her advice) so 2 sachets in the morning, then I sachet at night.

Hopefully this should help the headaches, but also should be enough to supress my cycle this month too?

Just worried that I might now have too much oestrogen, but who knows?

[dangermouse]

I always got bad nausea from about Day 2 and am peri so think it's the oestrogen surges. Adding oestrogen can help though as it can add to the negative feedback loop so less natural oestrogen is then perceived to be needed. My chills were really bad on about Day 6/7 when oestrogen is really climbing so again makes sense.

I think it's very hard to stop ovulation when you are having peri oestrogen surges as its so high. I'm still ovulating on the pill, which I've learnt is quite common in peri and generally for some, again due to the oestrogen surges. The progesterone part of the pill is the more important part for contraceptive protection.

If you can try to log your natural cycle that's going on behind your HRT on a period app it can help you to know what to expect each week. Then you can plan around the dodgy days and, most importantly, not suddenly feel disheartened when you swing from feeling great to awful. I'm hoping in time the peri surges will calm down as mine felt like they peaked for a few months so there's a good chance that will go in the other direction soon! I hope...

[BrightLight]

So obviously I still must have enough of my own progesterone to cause a natural period?

Just worried that I might now have too much oestrogen, but who knows?

Hi GRL its important to take the progesterone along with the estrogen to balance things out.

 I don't think you can assume you have 'enough' progesterone because you can have very low levels in perimenopause and still have a cycle, the ratio of low progesterone and relatively higher estrogen is actually responsible for many symptoms. So I think if you are replacing hormones you need to do it in the ratio prescribed.

[Hurdity]

As BrightLight says - if you do not take progesterone and are taking a lot of extra oestrogen and which is not suppressing your cycle, then the additional oestrogen can cause thickening of the womb lining and then subsequent heavy, possibly erratic bleeding. You do not have a true menstrual cycle unless you ovulate and if you ovulate you usually produce sufficient progesterone for your particular natural cycle (but not necessarily for added oestrogen). However you can have a lesser cycle with some rise in oestrogen due to some folliclaes starting to develop (as I understand) without the high spikes that occur at ovulation - ie anovulatory cycles. Not quite sure how this works in reality though! These should not be associated with the extremes of mood etc that the normal cycles are though because there are no extreme highs and lows. Eventually though further into peri - oestrogen levels drop overall which contribute to low mood. It's all very complex and I don't really understand it all!

I think you are supposed to be taking a high dose of oestrogen to suppress your cycle. Until it does so I imagine it could feel like too much at the time of ovulation ( I'm not sure what this feels like!)?

Hurdity x

[Briony]

Oh, and can one of you wise ladies remind me if it is low oestrogen or low progesterone that can cause me feeling very chilly all day today + nausea (have felt very hungry but sick all day too)

With my own natural period starting yesterday, I don't know if it's my own low oestrogen or own low progesterone that is causing my symptoms.

I know low estrogen can for sure. http://menopause-aid.blogspot.co.uk/2011/03/cold-flashes-chills-during-menopause.html
It has always been one of my worst symptoms (never had a flush).

The fact you are so affected by your natural period starting surely suggests that the gel isnt suppressing/controlling your system? This is exactly the problem I had with 100mcg patches. It just wasnt enough. You do need an awful lot to control your system through estrogen alone, hence the reason Studd's original research suggested 200mcg.

Have you considered trying the Mirena?

[BrightLight]

I've experienced those chills and nausea but I honestly believe mine was due to higher estrogen levels. That doesn't mean my levels might not have been low generally but in ratio to everything else estrogen was high.

Unfortunately I really do think the symptoms of high/low hormones can often overlap, though hot flashes and dryness do seem to be the tell tale ones for absolute low estrogen

[Briony]

I agree BL. I am convinced that it's the sudden fluctuations that affect me most, regardless of the direction or actual levels. I too get nausea with the chills, and often a sudden fatigue that will then disappear a while later.