Hi,

My doctor has suggested I go on some type of HRT due to perimenopausal symptoms and I am really struggling with what to do. I hope some of you can offer some suggestions. I am 44 and have irregular periods but do still have them every three to four months. My lab work showed high FSH and low estrogen and I am not sure what other things are out of whack.

Every time I have taken birth control pills in the past they have made me feel just lousy…tired, depressed, etc. I hesitate to go that route because I am afraid I will feel worse. And I wonder if synthetic HRT would just do the same thing. I am also hypothyroid (On Levoxyl and Cytomel for treatment) which may have something to do with it. I did try a compounded bioidentical progesterone cream last year. I felt really good on it for a short time but then became really depressed. I almost think just suffering through this is better than playing around with trying all these hormones which... could more than likely make me feel worse.

I am already feeling so tired, lethargic and depressed I don't want to do something to make it worse! I do tale Welbutrin and Zoloft for depression but I feel like this is something more than "depression". I really do think it is hormone related. Can certin hormones cause depression or make it worse?

Does anyone have any suggestions as to what I might try?

Thanks

k

Anti depressants made me much worse. I am taking klonopin for anxiety (tiny odse 0.5 mg) and xanax for breakthrough symptoms (not often). I think what we often feel is depression cause by anxiety. I now take a low dose BCP called Aviane and am doing GREAT! I also use a Viville Dot 0.0375 mg estrogen patch (bioidentical) during the placebo days to avoid the estrogen crash migraine and mood swings. This combo is working wonders for me. It took several different trys with different combos, but i have finally found one my body can tolerate and has rid me of most symptoms

M

I went through most of my peri journey on nothing. I didn't always feel well, but I was utterly unaware than my symptoms were from peri. I had the super heavy periods (expected), I had irregular periods (expected), I got hot flashes (expected)......but then there was the UNEXPECTED....dizzies, anxiety, panic attacks.....and even these I lived with, the dizzies scared me to death, but all blood work, EKGs, etc all came back great. I just carried on living, quietly freaking out about the dizzies.

Then my periods stopped....and all He11 broke loose!! The anxiety ramped up to a level I could NOT function, the panic attacks set in, the dizzies became constant.....I was a mess, agoraphobic, couldn't see people as it caused huge waves of anxiety...not even my own family!!! I spent weeks in my bedroom....got my partner to buy me a laptop that I could have in bed with me....and started to research!! On Sept 17, 2007 I found Power Surge!! What a massive relief that was. Everything, every single thing I suffered from was relatively COMMON!! I was not dying!

I haven't taken BCPs for many years, as they used to make me really sick, and get fat. So I didn't even consider that as an option for myself.

I got myself on Ativan to deal with the anxiety and panic, which helped but didn't fix it. I then added the anti depressant Paxil...that also helped a lot, but didn't fix it. So in December I started bio identical estrogel and prometrium. I felt an improvement within an HOUR of applying the estrogel, and I believe I was so depleted of estrogen that I felt an immediately surge of energy when it hit my system.

From all the reading I have done over the months of my hormonally induced incarceration (in my bedroom!! ) I have drawn some conclusions regarding hormones. And I am possibly wrong, and if so hope the ladies will be KIND to me when they correct me!!!

1. Progesterone is believed to be the first hormone to "go", however if your progesterone level gets too high in relationship to your estrogen you will become depressed, bloated, tired and generally blah.

2. If your estrogen level is up high enough, then the progesterone can act as a very calming, soothing, relaxing hormone....but it must be offset by sufficient estrogen.

3. Another thing I have learned is some bodies LOVE and need hormones, while other bodies HATE them. You have to figure out when your body is a lover or a hater. Mine is definitely a lover. For instance, during pregnancy I felt great, never was sick. Others are sick as dogs for part or even all of pregnancy...those bodies do not like hormones!!

Lets see how much disagreement comes along.....I am scared here! There are lots of women WAY better educated on hormones that I am.

Good luck!! I hope you find your answer sooner rather than later!!

Hugs
Floater

Oh yes Kimball certain hormones or lack there of can cause all kinds of symptoms - Floater is right on - what works for one does not work for all. SO, you may have to try different combinations.

My lab work is similar to your although I am 49 years old. After much consideration and experimentaion with different remedy cocktails - presently I am on just 20 mgs of lexapro and .5 mg a day of klonipin. I must tell you though, that if you are so disposed, I did have a successful trial with 2 mg of biest sublingual (maybe P for you was not enough and you need some E) along awith 75 mg progesterone (bhrt also sublingual) per day each taken 12 hours apart.

Most recently I have stopped the bhrt although I could tell it added an "extra layer of normal" to how I was feeling because I have a legitiamate or illegitamate issue with the safety (particularly BC risk) of any added estrogen. Many ladies will agree and disagree with this too!. If I found that I was falling apart then I would go right back on the bhrt - one has to be able to have some quality of life. In truth I did feel better with the combination pych meds and bhrt.

Also - perfection maybe obtainable for periods of time - please don't be disappointed this is a 3 steps forward and 1 step back process for many and there is hope offered by those who pass through to the other happy side.

much love and keep posting

Pooks

Floater's right: some women do well, some don't. And finding the right combo can take time. It takes 2 to 3 months to get the full monty. But for all the theory and all the knowledge one can gleen on hormones, at the end of the day, its down to personal experience.

Floats, I liked your note about feeling better in the first hour. I was given the patch, the smallest one made. Came home, stuck it on and within an hour I felt this weird tingling in my neck and back. It took a moment to realize it was the muscles relaxing. They'd been tense full time for months. It only lasted a couple of days, my period started, two weeks later a second one started. I convinced my doctor's locum that I needed a higher dose of estrogen, and she added prometrium. I took the prometrium at bedtime, and the only way I can describe it is to say it felt like rich warm soothing cream being pour on my soul.

Eventually my gyno up the level to o.625mg and I'm pretty good there. Added testosterone, and boom. Good as I think it will get.

Thank you all so much for your responses. I am a bit overwhelmed by all of this so I appreciate info and suggestions from everyone!

MDSBLY, you use the estrogen only on the days you take the placebo pill? Just want to make sure I understand all of this correctly. The pill has both estrogen and progesterone then you have only estrogen from the patch for 7 days? Do you have a period?

Floater, Thank you for you post. Like you said, I think I have had many of these symptoms for over a year now. I just didn’t recognize them for what they were. From what you said it seems like I may need a little estrogen to balance out the progesterone…since after a while the progesterone made me very sluggish, moody and depressed???

Pooks, thanks for the info. What you wrote makes me think I do need a little progesterone too.

Dutch, I hate to hear that this is such a trial and error thing. I have been struggling to get the right balance with my thyroid meds for three years. Now that I finally have that balanced out along comes this!!! I really just wanted to feel better quick! So you use an estrogen patch plus prometruim (is that only progesterone?)?

Is anyone out there willing to make a specific suggestion as to what I start with? I know no one is a doctor but I need some suggestions of where to start.

I already have compounded progesterone cream 40mg per cc. I was supposed to use one cc at bedtime days 1-14 of my cycle. Well, I never got a period so I don’t know when days 1-14 are…plus it made me very depressed after a few weeks. Maybe I need to use less and/or use estrogen too?

I do have an appointment with my doctor next week to discuss all of this. I just want to go in armed with as much info as possible. Sometimes I think the doctors take a “one size fits all approach” and I want to be ready with some back up info incase he tries to do that.

Thanks again everyone!

Okay, I will go out on a limb. When I approached my doctor, I went armed with information, and I told the doctor what I wanted to try. I was not going to even consider synthetic hormone replacement, and interestingly enough she was all read to write me a prescription for premarin!!!

You first have to decide if you want periods each month, or only every 3 months as you are doing now?

I had not had a period for 9 months when I started my BHRT and didn't want to go back to having periods, so I chose the continuous therapy, taking a week off the progesterone every 3 months to see if a lining needed to be shed or not.

I started with 1 measured dose of estrogel (.75mg of estradiol) and 100 mg of prometrium every night.

After about 5 or 6 weeks I had to increase the estrogel to 1.5 measured doses (1.12 mg estradiol) and continued on the 100 mg of prometrium. The nice thing about the estrogel is you can increase or decrease your dosage yourself, according to how you are feeling...until you get it just right!

When I stopped the prometrium, for the week....I felt horrible! There is no doubt that it is a necessary hormone for me to function. I had an immediate return of hot flashes, felt edgy and anxious, didn't sleep as well. Needless to say, continuous therapy is what I will continue to do.

I have not added testosterone to my regime yet, but I most likely will in order to get a return of libido, but I am putting that one off for a bit. I admit to being a little scared of it, I don't want to grow a beard and have my voice change....which can happen if you take too much T!!

If your estrogen levels measured low, then you need some estrogen. The Vilet books say your levels should be 80 - 100 just to feel half decent. Menopausal levels are generally under 35!! No wonder we feel so lousy. Let us know what you decide to try!

Thanks for going out on a limb...I was hoping someone would.

I hate to sound so ignorant but is going off of the progesterone what gives you a period? I just know it happens (or used to happen) every 28 days…I don’t know much about the biology/chemistry… or what ever it is…behind it. Is that why you stop your progesterone every three months, to see if you have a period/shed the uterine lining? And what if you don’t shed the lining? Does that mean it could be building up?

Now about prometrium and estrogel. .. Promertium is considered a bioidentical hormone, right? But you can get it at any pharmacy and it does not have to be compounded? Do you know how that compares to the progesterone cream I tried? I read a little about the estrogel and saw it is made from soy. Do you know if all bioidentical estrogen is made from soy? I have read that people with hypothyroidism (which I have) should avoid soy. I wonder how all that would figure into the equation?

You asked me a couple of questions...As far as having a period each month...I'd rather not but it really does not matter to me. I'll do whatever I need to do to feel better. And you mentioned my needing to decide about synthetic or bioidentical. Again, I'd rather not do synthetic (based on my experience with BCP's) but I'll do what I need to do to feel better.

Based on what I have told you would you stick with the progesterone cream I already have (former gyno prescribed it... and he is no longer practicing...I had to switch to a new one during all of this). and add a little estrogen or do something different? I realize you are not a doctor... but I am just curious what someone more knowledgeable about hormones would do in my situation.

Also...my prog. crean says to use day 1-14 of cycle. Again, I hate to sound ignorant but why is that? So I continue to get a period? Is there anything wrong with using it continuously?

Thanks again for all of your advice and for answering my barrage of questions!!!

k

You need both estrogen and progesterone in order to have a period. A natural cycle goes like so......

You start your period.
Within a few days estrogen levels start to rise.
estrogen level starts to drop off and
progesterone starts to rise.
then progesterone drops off
and both hormones bottom out
and Your period starts.

From what you have described you still have a little estrogen, but not enough. I would probably stop the progesterone cream for now. And start a new regiment.

Progesterone drops off in order to start a period...but estrogen has to have been present first. If you stop prometrium and there is no period or spotting, chances are you are NOT building up a lining. However, because you still have some of your own hormones you might have a regular period.

I have not heard that estrogel is an issue with hypothyroidism, I suspect the soy has been altered so much from its original form that it isn't going to be a problem...but you can do some googling on it.

Progesterone used transdermally does not provide bone loss protection, I understand.

Hi Kimball,
You had asked if Prometrium is bioidentical--it is-- and yes, you can get it from a regular pharmacy. It comes in 100 and 200 mg doses; 100 mg is generally prescribed for continuous therapy and 200 mg for cyclical. You also asked what it means if you don't have a period after stopping the progesterone. I think, like Floater says, it usually means you didn't build up enough of a lining (not enough estrogen) to start a period. However, if you don't take a high enough dose of progesterone, your lining could build up too much. Your progesterone was prescribed for 14 days of your cycle because an ovulating woman only produces progesterone during the second half of her cycle. If you are still having periods, you should probably take it starting on day 12 of your cycle. I take my Prometrium cyclically--it just seems more natural (I feel better too.) I use the Climara patch (bioidentical estrogen) supplemented with a little compounded estradiol cream and Prometrium for 12 days of the month. I start bleeding about 3 days after I stop the Prometrium. The only problem with the patch is that it doesn't stay on very well and I have to put a Tegaderm bandage over it. It also runs out after five days, although it's supposed to last for a week.

I also agree with Floater that the soy in the Estrogel is probably altered enough that it wouldn't affect your thyroid. That would be something to ask your doctor about though. Oral bioidential estrogen is also available, but I've read that transdermal, rather than oral, forms of estrogen are safer, so you might want to keep that in mind when you talk to your doctor.

Two things to keep in mind: let your doctor know that you really want bioidentical hormones and be patient--you may have to change dosages or delivery methods a few times before you get it right. It also can take a few weeks to a month or so to feel better, although many women feel better right away. Good luck!

Hi there,

I have not taken any hormones except natural plant estrogen and black cohosh that are found in Estroven, a supplement. for menopause I am 55. Started having a few hot flashes and skipped and erratic periods about 4 years ago. About 18 months ago, suddenly had a panic attack, more hot flashes, and anxiety, plus the heavy periods. Three months later, I went on low-dose BCP (Microgestin) for 6 months. I think it helped the hormones level off. I took BCP years ago and never had a problem with them, and didn't have a problem this time. The periods got lighter and lighter, and the last one I had on BCP was even lighter. After that last BCP period, I haven't really had a period since. I had couple phantom periods, where I ovulated but the period never started.

I still take the Estroven, extra magneisum, calcium, and Vitamin E. I feel great. I also walk as much as possible. Exercise helps with the anxiety and overall wellbeing. I do, however, have Xanax in my purse for just in case. I think it helps me just to know it's there if I need it.

I haven't had a real hot flash in over a year, but I get what I call "warm moments" during the day. I wake up hot at night, not really sweating much, but enough to toss the covers. One nice thing is that since I haven't had periods, I think my "meno tummy" has decreased a good bit. I went shopping last weekend and was able to buy pants a size smaller. Yea! that and eating the good veggies and fruits, exercising, and sleeping better has contributed to the overall wellbeing. And I love not having periods. I have more energy. It's liberating. I wouldn't take hormones now anyway, because I wouldn't want anything to cause periods to return.

Of course, I could suddenly have a horrible period or the return of awful anxiety like others on this forum have experienced. I try to keep positive about all that and hope I'm done!

Good luck with your decision. It's so different for every woman.

WriterMom

Thank you again to all of you who gave me your input.

I just came from the doctor today and he wants me to try Estratest HS and 20 mgs of progesterone cream daily. He was very persuasive that this was right the place for me to start. It all sounded good to me when I was in his office. Now that I have searched and read info on the message boards about Estratest I am not so sure any more. I read several "success stories" but many more negatives.

Does anyone have any opinion on Estratest...Or better yet has anyone tried it?

Hi Kimball,

I'm in the same boat with you. I'm 47 with very irregular cycles one every 3-4 months. My blood levels have been at the postmenopausal range for about a year, but I didn't take the Prempro I was given. Now a year later and after suffering daily muscle aches, joint pain, mood swings and no sex drive I'm off to for my annual exam tomorrow. I also checked a lot of boards on the Estratest and saw what you saw. I'm interested in whatever responses come through on the Estratest. I'm not sure what to take but I know I want the bios. It is all so confusing. I read all the books too and I'm still not sure which ones to take. I definitely want to take a low dose of the testosterone b/c my husband is going to leave me soon if I don't get that back. I thought Estratest was the best, but then I saw some negative posts and the Doctor on this site says that synthetics are counterfeit b/c they are not the same molecular structure as the bios that they create from plants.

I lost an ovary 3 years ago and started with these symptoms and I've put off taking hormones and went the vitamin/mineral/herb route, but I've had enough and am willing to try a low dose of something just to see if it works. I lost 40lbs and I read many women gain weight on hormones and that was also a big drawback for wanting to take the hormones so if I gain any weight at the onset, I'm quitting. My husband said wouldn't it be better to be a little plumper if your pains go away and your sex drive comes back???? But I'm not agreeing with that. It took me a year to lose 40lbs that I was clinging to for 5 years and I'm not about to take it back.

If you start the hormones let me know how you are doing. IM me anytime and I'll let you know the same.

Hey Corkey,

Thanks for the reply. If nothing else it helps to know there is someone in the same boat as me.

I did decide to try the Estratest. If I gain even one pound though I am going off of it!!! My husband would rather me be fat and interested in sex than skinny and no sex drive...but I already struggle with my weight (I'm hypothyroid on top of it) and I am not willing to gain more. I work out 3-4 days a week and still struggle so I am not eager to take something that causes weight gain. I've read a few positive things about Estratest on a hypothyroid message board. From what I understand if you have the correct balance of estrogen, progesterone and testosterone you won’t gain weight...in fact I read about a few women who actually lost weight. Wouldn’t that be a nice side effect!!!

My doctor said that not only would the testosterone help with libido but it would also help with my fatigue...which has been awful lately. I really need to feel better because my lack of energy is affecting everything!

I still think I would prefer something other than synthetic hormones. But I am willing to try the Estratest since my doc was so sure it would help me. But if it does not help or if I have any adverse effects I will go back to him for another option.

All of this is so confusing and everyone has a different opinion. Some people say stay away from synthetic hormones, some say they are ok. My doctor believes there are advantages to both… so for now I am going to trust his opinion and try the Estrotest. I'll let you know how it goes!

Good luck with your appointment tomorrow. PLEASE let me know what you decide to do. Our situations do sound very similar and I am very interested to know what your doctor suggests.

Thanks,

Kim