Hi everyone--

I hope some of you can give me some insight/suggestions here. I'm 45, will be at the 1-yr-since-last-period mark in about 6 weeks. My whole body is screaming for estrogen (frequent migraines, hot flashes, depression, anxiety, fatigue, dryness, loss of libido, etc., etc.) but nothing I try seems to work for very long. Over the last 18 months I've tried the Climara patch, oral Estrace, Estrogel, compounded estradiol and Bi-est, BCPs (horrible! progestins kill me!) and even implanted estradiol pellets. Each time I start a new method I get a "boost" (usually lasting several weeks) in which I feel WONDERFUL (i.e., normal) but then the effects gradually fade and I'm back to square one.

This can't have anything to do with progesterone because I use it vaginally (Prochieve) only every 2-3 months and the fading of the estrogen benefits doesn't coincide. I've used oral Prometrium but it's way too sedating/depressing for me. I've tried using small amounts of testosterone cream (amounting to about 1 mg. a day) but all it seems to do is give me acne.

This has me feeling discouraged, to say the least. In all of the books I've read (Vliet, Redmond, Reiss, etc.) the patients find their appropriate dose of bioidentical hormones and live happily ever after. Why not me? Am I the only one this has happened to? Do I just have to get used to it and forget about quality of life?

Sorry about the whining, I just had to vent and didn't know where else to turn.

Help!

Mimses

Perhaps because you still haven't had your "last" period--you are still making some of your own estrogen sometimes--and perhaps NOT making it sometimes. This would make it hard for any steady dose of a hormone replacement to really remain steady--since you may be adding your own hormones to the mix every once in a while--and other times--not adding your own. I've read that it is much easier to find the right dosage for a post menopausal woman than a peri-menopausal one for this very reason. This would also be why you can't seem to find a pattern--because you only know about one side of the mix--there's no telling what your body is doing on it's own. I've also read that estrogen levels can drop more than once post menopaual, causing a need to readjust the dosage of the replacement hormones.

If that's the case, happy days may still be ahead for you since you seem to be closing in on the magic "year" without a period.

Does your doctor give any explanation? You really sound like someone who is "in flux" to me. I hope it settles down soon and you find some relief.

Miss Tibbs

This is an interesting topic and I have had similar reactions in a way. I believe it has to do with our "set levels that is our levels that are "preset" in our bodies for the amount of hormones we need. Once you overshoot this, the ngeative feedback loop of the pituitary sets in motion　and "readjusts" your levels to that "perset" level what ever that may be. In fact it may be at something where you don't feel particulary well. This is just my theory having gone through lots of stuffy with thryoid and many trials of many different herbals, and hormones and even accupuncture all of which affect this loop. I am at a loss, if this is the case, how to reset this "preset", but it mght be worth discussing it anyway with a doctor or a specialist like pituitary specialist or "good" endocrinologist (which are hard to find)....just my unscientific guess...not sure it helps! I am in the same boat! 　　Joan

Miss Tibbs and Joan--

Thanks to you both for your replies. I've often wished I could have some kind of magic window which tells me my hormone levels on a daily basis so I could correlate them with how I feel. On my most recent blood work all of my levels were "fine", even my estradiol, and this on a day when I felt especially cruddy. My doctor is at a loss, naturally; all of his other patients do great after one or two tries at balancing their hormones (or so he says!)

I, too, have wondered whether those times I felt especially well were times when I was "cheating Nature". It's a depressing thought that my own body could be so insistent that I feel half-well at best. It could even be happening at the cell level--the receptors deciding they've had enough of the good stuff and tuning out, so to speak. (Can receptors do that?)

Then again, I do have hope that once I get further into menopause things will calm down and even out. At least I won't have any of my own fluctuations to deal with.

If anyone knows of a good (and patient!) endocrinologist, I'd love to see him/her!

Thanks to everyone for listening--

Mimses

Mimses, I have even played with this idea...take for a while, discontinue when it stops working...wait a few weeks and then "trick" the feedback loop again....this on and off kind of therapy may not be good...but I wonder...for me I don't mind feeling good for a few weeks, and then bad for a couple and then good...better than nothing...pretty sure no doc would go for this!...I bet I have the "cellular level" problem.

One other thought that crossed my mind..I wonder if after you get "used" to is so to speak, at that point you just need to tweak it a bit and up the estrogen a bit? Joan

Hi Mimses,

There are many of us on BHRT and most of us don't feel like "happliy ever after", I thought the same thing when I first started using BHRT, oh goody now life is going to go back to the good ol days! Ha

What I have found is that the peaks and valleys are still there, only perhaps not so severely. It keeps my hot flashes at bay, helps me with a bit more energy and I am not so irritated all the time. I also find that prometrium makes me feel "loopy" and sluggish. I'm not sure what to do about the progesterone situation.

I think our bodies are not static, they are constantly changing (the hormone levels), that is why we may feel so great one day and feel like crap the next, it's my only explanation. At times I can have a great week, good energy and then the next thing I know is that I don't want to climb out of bed, I feel tired and depressed, wondering where that awful feeling comes from. Also, I get lots of horrible anxiety, that seems to just grip me, and then it passes. This has to be attributed to hormones!

When I first started my hormones, it was like "rocket fuel", I felt euphoric for the first couple of weeks, I thought I had found the fountain of youth, of course that feeling passed quickly, I just wish someone could bottle that.....

Juliann

Also, have you been increasing your dosage? My reading of hormone replacement suggests that generally women need to increase their estrogen dose every three months or so, and after 3 or 4 increases you will find your comfortable level. I started my estrogel at 1 pump per day and now I am up to 1.5 pumps. I started having hot flashes again, so I figured I needed to up it a little bit and that has done the trick. I fully expect I will have to raise it at least one more time.

I know my mother also had to play around with dosages before she got it right, but once it was right, she has been on the same dosage for years!!

I have been using the estrogel since September 2007. I have had to keep increasing it, and yet my blood level remains pretty low. I am up to about 4 doses a day so that is 1.5 mg times 4 equals 6mg. When I test blood first thing in morning estrogen is 25, When I test blood 3 hours after second dose of day which would be the peak my blood is 103 so even with what are massive estogen doses my blood level is rather moderate. However, I have just missed my first period, so not totally in menopause. The BHRT has fixed lots of things though and my quality of life is bettter even if I feel like I need to carry estrogel with me all the time and wonder if it is dangerous to take this much estrogen. I mean I know it is helping some on a cellular level, and I guess it is not making overgrowth in uterus if I am not having period. It has helped my personality, dry skin, dry eyes, I sleep through the night, less heating pad feeling on back, no prickly feeling on face which I really really hated, no racing heart, no anxiety. So, this is better than nothing. I am quite sure that I am not overdosing as my ri ngs fit fine and my bosom feels fine.

I too had a surge in wellbeing, feeling great when I first tried a small dose of estradiol in a patch (Vivelle dot 0.025) which lasted a few weeks. Then the improvement in my symptoms subsided and my doc increased it to 0.0375; same thing happened - improvement for a few weeks and then ... not so much. She increased it once again to 0.050 (which she says is still a relatively small dose) and again I had improvement. This time the feelings of wellbeing leveled off somewhat but symptoms didn't recur at their original level. I'm in peri, still having monthly periods so I imagine there is quite a bit of hormonal fluctuation going on and my native estrogen levels are dropping, so more dose adjustments may be needed in the future.

It is my understanding that it is not necessarily the LOW estradiol that makes us feel bad, but rather the FLUCTUATION and DIPPING of the estradiol. So when you feel poorly, it probably because you are in an estradiol recession. For example, I feel the WORST around 14 days after I start my period. Why? Because the level of estrogen shoots up for ovulation, and then DIPS or plummets right after that. This is what causes the migraines, which in turn causes dizziness, headaches, anxiety, etc. So it's not that the estradiol isn't working for you - it is that your estradiol is still fluctuating all over the place. Mine is too, especially since I am still having my period.

Thanks to everyone for your input -- I've tried upping my dosage on my own several times, always with similar results (an initial stage of feeling much better followed by a return of symptoms even on the higher dosage). I think this may be part of my problem, this "chasing the levels". If only I hadn't had those periods of feeling really well, I wouldn't feel so bothered when the symptoms inevitably return! (sigh)

I had an ultrasound recently to check my endometrial thickness; the ultrasonographer said it was 1.3 mm, which she called a bit thickened but which according to my reading is fine. She also said I still have some small follicles in my ovaries. So . . . could these be the culprits causing fluctuations, still (in spite of nearly one year since last period)? For what it's worth, my cycles did end very abruptly at age 44, just a couple of shorter-than-usual ones and then nothing.

Anyone have any thoughts on this? Sharing my frustration here and reading about others' similar experiences is very helpful!

Mimses

Hi,
I, too, felt wonderful for about 2 cycles after the initial tweeking of my E (.5 sublingual) & P (100 mg sublingual). My doc wants me to take E daily and P for 3 weeks only (1 week off during my period). I'm 49 years old and have monthly periods (28 day cycle) like clockwork prior to taking hormones and now it's a few days off - 1 month it was over a week late and this month it's a week early (day 21)! I'm so confused. I'm guessing my period is early this cycle because I was 5 days late in taking the P? or is it that I needed more E? I tend to think I needed more E because the depression (one of my greatest challenges in peri) did not/has not subsided like before. However, when I took P on days 13-27 my period was over a week late, hence, my doc insisting I take it for 3 weeks instead. Does anyone want to take a guess at this?

I so wanted to feel better by starting hormones and do overall (I think), but it still feels like a seesaw every month. Thank you for listening & allowing me to vent.

I am also finding everyones input very informative!


Mimses, if I am reading correctly, your peri came to a very quick and abrupt end??? I suppose we either run out of eggs or run low on hormones, so that it can't fire off an egg??? Either way, for most of us ( as everyone else has stated), we are in "hormone fluctuation". For some, this could take years to "settle" down. I guess if you have a long peri or a short peri, either way, the body must adjust to the change and that is what seems to be a process for us all.

I started feeling perimenopause at the age of 45. I had an ovary removed, and within 3 months of that surgery, I was feeling extreme bouts of fatigue. That was my very first symptom. My cycles were still normal, but my PMS and my periods were awful. I had tons of cramping and clotty. Then my next symptom became feeling like I was having PMS all month long! I was like an angry bee. Then eventually the hot flashes and insomnia. Not to mention the itchy skin, digestion problems etc....

Last year at the age of 49, I started my first skipping of periods. Then they returned, regularly for 6 months straight, now I have skipped 2 months in a row. My periods (when I do get them), are different now, they are not so heavey and last shorter in duration.

When I have a couple days in a row where I am feeling bad and running low on energy ( I can read my body), I tweak my E dosage up a tad. Usually by the next day, I will feel a renewed sense of energy. I use estrogel, and I use 2 pumps per day, which is 1.5mg (topical gel). I also use a small amount of testosterone, but have to be careful, it can make you break out!

Juliann

Hello All--

I guess I did have a very abrupt end to peri -- although in retrospect, I'd been having frequent migraines for about 8 years before that, so I must have been in it longer than I thought. (This seems like a common experience! We don't figure out what's happening till it's halfway over!)

I was reading last night that migraines and hot flashes and many of the other miseries we know so well are like classic symptoms of withdrawal and that they often improve 2 years or so after the last bleed, when fluctuations become much smaller (or nonexistent). I guess I needed to read this AGAIN. So maybe there's light at the end of the tunnel after all -- I just can't see it because I don't have my contact lenses in! (Oh yeah, that's right, I took them out because eyes were so dry they felt full of sand.)

I certainly wish I had some elder ladies in my family to ask about all this (my mother passed away several years ago). Why are we the generation that seems to need to figure out EVERYTHING for ourselves? Hooray for this website!

Mimses

I don't know if this will help, but at least give you something to think about...about the stopped periods...even though the ovaries are "throiugh" does not mean the pituitary is throuw yet. My friend's obgyn said the pituitary it the LAST one to get the message...I think she may be right! Joan

I don't know if this will help, but at least give you something to think about...about the stopped periods...even though the ovaries are "throiugh" does not mean the pituitary is throuw yet. My friend's obgyn said the pituitary it the LAST one to get the message...I think she may be right! Joan