PMDD, perimenopause and HRT

[u/Rare-Connection-7084]

Started hrt 3-4 days ago and am having a horrible time. I have a lot going on but now I'm majorly depressed with very intrusive SI. Does it get better?

45 yo. PMDD is helped with 5htp supplements. Haven't had a period for a few months. Started estrodiol gel + 200mg progesterone a few days ago (trying to help with generalised joint pain hEDS)... Had a little breakdown with my manager yesterday following a workplace injury meeting. And haven't been able to snap out of it. Went to bed at 7pm last night and cried for a few hours thinking about the hopelessness and wanting to not be here any more (but also the guilt and selfishness of that way out, I'm sure you're all familiar with it). Anyway, still feeling rubbish today. Lots of SI thoughts. Google says to expect a period of adjustment and normal to have "blues". My doctor didn't warn me about

this.

Please tell me it gets better.

[u/DefiantThroat]

There is a unique protocol for those in peri who have PMDD. I was on it for just over 2 years. Worked miracles.

[u/Rare-Connection-7084 → u/DefiantThroat]

The thing is, despite clearly being in perimenopause, I haven't felt bad. I haven't bled in over 2 months (before that it was 3 x in 6 weeks). So this is saying to take progesterone quarterly... I'll discuss with my GP tomorrow

[u/DefiantThroat → u/Rare-Connection-7084]

There’s a study that shows when your cycle is naturally spacing apart beyond 60 days you’re likely to have your final menstrual period in the next 15 months. So perhaps the end is nigh?

[u/LingonberryIll6513]

Progesterone didn’t work for me at all. Had quite the opposite effect and turns out I’m intolerant to any sort of progestin, progesterone, or progestogen.

My PMDD also got exponentially worse in perimenopause. Surgery has alleviated all of it though :)

[u/undeniablysarah → u/LingonberryIll6513]

What surgery did you get?

[u/LingonberryIll6513 → u/undeniablysarah]

Oophorectomy with total hysterectomy. So I don’t have to take any form of progestigens. :)

[u/nisfb]

For progesterone to work optimally, your ferritin and vitamin D levels should be in a good range. Please make sure to check these values, as low ferritin can significantly impact how well you tolerate progesterone.

[u/Rare-Connection-7084 → u/nisfb]

They're fine.

[u/Jazzspur]

200 mg progesterone makes me feel PMDD-y during follicular. I have to take a lower dose during the first half of my cycle.

I also find that the amount of progesterone I can take without negative effects depends on how much estrogen Im taking

[u/Rare-Connection-7084 → u/Jazzspur]

I also have no idea where I am in my cycle. Day 64??

[u/Rare-Connection-7084 → u/Jazzspur]

Going to drop to 100 tonight. Asked a friend who is o&g trainee, she said don't stop altogether, too much yoyo.

[u/This-Refrigerator-24]

Are you taking progesterone before bed? That is key for me since it makes me sleepy. Estrogen I was very sensitive to. My doctor started me on the lowest dose of the patch and it made me really angry. So now I take half a pill which is a very low dose. Also my doctor started me on the lowest dose of progesterone at 100 mg because she acknowledged my sensitivity to hormones. I now take 300mg because I had bad insomnia and did good on it. Hormones are different for everyone so it takes a little testing out how it works with your body and your symptoms and adjusting it accordingly. I suggest talking to your doctor about easing you into it more gently. Do you feel really tired along with the depression? More tired than before hrt? If so, its most likely is the progesterone. It does take a little time to adjust to it. It wouldn't hurt to take 100mg instead of 2 if that's an option but like I mentioned before talk to your doctor. Im so sorry you're having a rough time and I promise it'll get better. Ive felt both awful on hormones and wonderful but I am so glad I'm on the right dose now. Life is a lot better on hrt for me. I hope you feel better soon!

[u/KarlMarxButVegan]

I started HRT last year at 42. My doctor more or less begged me to try Slynd to suppress ovulation (and thus the estrogen spikes and drops). I had a very bad time on Yaz in my mid twenties so I was hesitant, but finally tried it. I didn't make it through the first pack. I was so emotional and upset. I felt hormonal, is the only way to put it. I started to feel much better after stopping it and adding micronized progesterone. All of that is to say: there was definitely a rough adjustment time period for me, but I don't know if it was all thanks to Slynd or what.

[u/wilksonator]

Have a look on wiki and search previous posts on r/perimenopause and r/menopause they have some really good info on wiki on what to expect and also support and information.

PMDD symptoms are really likely to change and evolve with when in peri and definitely when starting HRT. I’d consider talking to dr about meds targeted to PMDD to help with symptoms in the interim eg low dose SSRI during luteal…at least while adjusting to HRT.