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[flyingsquirrel]

So, I'm about to enter (or have already entered, depending on who you ask) perimenopause.  My OBGYN nurse practitioner is thinking of taking me off birth control because I've had two migraine auras, which raises the risk of stroke.  That means patches.  Yup.

Unfortunately, none of the birth control packs I've tried has helped with the insomnia, the mental anxiety, or the depression.  So, I suppose I'm not totally against coming off of them. But, I also have this sinking feeling that I'm one of those oddball women whose happy normal is to have naturally high estradiol levels.  The nurse won't go any higher on my birth control.  She stopped at 30mcg, and recently lowered me to 25mcg.  She will not go to 50mcg.  And the nurse practitioner at the sleep disorder center agreed with her--it's just too high.

My question is, if I come off birth control and my ovaries start producing their own estradiol again, will topping off with a patch result in more total estradiol than if I took birth control and had the birth control shut down my ovary production?  I worry that I'm essentially lowering my estradiol when my body seems to want MORE.  But am I actually giving higher by topping off?

Also, is there chart out there that compares the estradiol levels in birth control to patches to bioidentical pills?  I understand that they aren't apples to apples, right?  It's more apples to oranges?  What's the ratio to know what I'm actually getting per day compared to birth control?

[Alicess]

The estradiol in birth control, ethinylestradiol, is much more potent then estradiol in patches or gel. They are definitely not apples to apples by comparison. Birth control pills surpress our own hormones while bio identical hormones add to our own hormone levels.
I changed from BCP's to bio identical hormones and that didn't went well. I think it also depends on how long you've been on them.
It could be that the progesterone ( or progestin) part of the pill is too high. Did you try one with less progesterone compared to estrogen? Like Femodeen?

[flyingsquirrel]

The estradiol in birth control, ethinylestradiol, is much more potent then estradiol in patches or gel. They are definitely not apples to apples by comparison. Birth control pills surpress our own hormones while bio identical hormones add to our own hormone levels.
I changed from BCP's to bio identical hormones and that didn't went well. I think it also depends on how long you've been on them.
It could be that the progesterone ( or progestin) part of the pill is too high. Did you try one with less progesterone compared to estrogen? Like Femodeen?

Yeah, I had a bad feeling switching to patches would make things worse.  Ugh.

Looks like Femodeen is sold in Europe, not in the US, but I'm sure I can find a close cousin.  So far, I started on the Lo Loestrin Fe and worked through the entire "Fe" family--Hailey Fe, Blisovi Fe, etc.  I think they all have 1 to 1.5 mg of norethindrone acetate for progestin. Then I got switched to the current desogestrel triphasic pack. I'll have to ask about getting (a) a way less potent progestin and (b) way less of it all together.  I'm thinking 25mcg might be best for estradiol rather than the 30mcg I was on for the last "Fe" pack, simply because my physical anxiety symptoms had come back on that one (tightness in throat and chest).

I'm starting to feel hopeless about this, though.  It's like my body hates progestin?  Or it wants so much estradiol that nobody would ever prescribe it.  What to do?

This begs another question:  If a magic birth control pack isn't sold with the ratio of progestin to estradiol that my body wants, is there a way to "customize" my birth control?  For example, to take a separate prescribed estradiol pill with a separate progestin pill?  I was even thinking of trying bioidentical progesterone (like Prometrium).  That might be an interesting experiment.

Is such an experiment even possible?  I feel like I have no control over the variables in these packs.  You get whatever the manufacturer tossed together in soup.  I'd like to just fix one variable (such as the estradiol) and change only the progestin for a while.  Or vice versa.  But no, these packs don't always let you play like that.

[Alicess]

It's trial and error, same with bio identical hormones. And you have to give it at least three months.Triphasic pills could cause more fluctuations and don't surpress your cycle as much. When you increase estrogen SHBG will go up to so you will have less (free) testosterone..Low testosterone can also cause depression, anxiety and low libido SHBG can also tie up bio identical estrogen ( estradiol)and your own oestrogen.Synthetic oestrogen (ethynylestradiol) doesn't bind to SHBG. Hence that's why it is more potent I think. BCP's raise SHBG significantly. So when you stop BCP's your SHBG will remain high at first, sometimes four to sevenfold You should discuss this with your OBGYN.

If you are not prone to acne or hirutisme you could try Levonorgestrel, a more androgenic progestin. Norethisterone can have some estrogenic activity
but not in all women. It seems to me that Norethisterone doesn't suit you.

I totally agree, there should be more options regarding synthetic hormones. For some women bioidentical hormones just don't work or even make it worse. Because SHBG is high or because they have the same chemical structure as our own hormones or because they're just not strong enough. There are ethinylestradiol only pills available but not much choice in progestins. And as EE is more potent you'll have to monitor your womblining to know if the progestin is sufficient.