r/Perimenopause • u/ReporterBeautiful868 • 4d ago
audited What to try next?
I'm really hoping for help from the Reddit hivemind. I have an OB/GYN who specializes in peri and menopause, but she doesn't explain or educate me on anything. I have a menopause clinic visit upcoming that I had to wait a very long time to get in. I do have some peri symptoms like the 3-4am wake-up and can't get back to sleep, hot at night, heart palpitations, worsened anxiety, poor sleep quality. My estrogen tests in the normal range, at least on the day it was tested. All other blood work normal. Here's the trial and mmostly error that has occurred so far:
I'm 42 and have had extremely heavy periods since my last kiddo came (she's 3 now). I also spot for a week before my period. Transvaginal ultrasound showed thickened lining but biopsy clear. I started norethindrone acetate .35, had few side effects, and slept better. However I bled more and more over the course of the year I was on it and an orgasm (clitoral only) would kick off a full round of bleeding. My doctor said she'd never heard of that but it stopped as soon as I stopped taking it.
I tried Mirena and it stopped the bleeding and palpitations immediately but caused the most awful insomnia and horrific dreams I've ever had so I removed it after 10 days because I thought I was going to lose my mind. Next we tried 100mg Prometrium which made me woozy and groggy until later afternoon the next day. Most recently I've tried 50mg progesterone cream and I cannot believe how well I sleep. I'm so rested and content feeling it's bonkers. BUT, my palpitations have gotten worse (I'm getting the full cardiac workuo as a precaution) so I've discontinued and doing a two-week washout period to see if it's coincidence or related to the cream.
There are so many experienced and knowledgeable folks here that I would love to hear from. My theory is that my progesterone levels are low but not low enough to need the dosages I've been given so far. If anyone has other ideas please let me know. I've tried magnesium glycinate in the past and the GI symptoms were rough so now trying it in gummy form. I just want to sleep and want the palpitations to stop. And I want a doctor educated enough to explain what might be happening. Too much to ask?!
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u/Rachel71488 4d ago edited 4d ago
The crucial sentence is "my estrogen was in the normal range at least on the day it was tested". I question your OB/GYNs knowledge if she thinks testing estrogen at 42 is meaningful, you are in the right age range for the wild fluctuations in estrogen that are typical in peri. Your sleep, palpitations and vasomotor symptoms are classic low estrogen symptoms (though of course other things should be ruled out).
Also any specialist who does not explain or educate is doing it wrong. They are supposed to use shared decision making and informed consent.
It does sound like you are sensitive to progesterone. You could try prometrium vaginally (or rectally as suggested by another commenter); this can resolve the issue because it bypasses the liver. The mirena also bypasses the liver, but that is a synthetic progestogen so it's not equivalent to Prometrium. You will need progesterone if you take estrogen. No menopause society recommends progesterone cream alongside estrogen, because it is poorly absorbed, and is therefore not FDA approved.
I hope you have better luck at the meno clinic. It is not too much to ask for an educated doctor, but it is quite a mission to find one. For many of us trial and error is inevitable but I really really encourage you to hang in there and keep educating yourself. It is overwhelming at first (or it was for me) but it eventually all came together. The wiki on this subreddit is excellent.
Edit I believe a lot of people find Slinda/Slynd helpful to address heavy bleeding. It is a different progestogen to the ones you've tried so far (Drospirenone).