Insomnia

[desi]

google -- Yoga Nidra --- to find out more

Thanks for this. I'll look around BKK to see if anyone is offering it. For your yoga tips above, I usually go to sleep at night with my iPod piping out an mp3 called Speed Sleep. It takes me through from the toes to my head three times. And it does work, usually.

[desi]

Hi Shery,

No hysterectomy, I just started going through menopause early (my 20's). Excuse my befuddled replies, I'm struggling here to be coherent... what I meant by a natural hrt is the herbal kind. Not only was it expensive, but it created thinning of the wall type problems which made it difficult to travel in the dry air of a plane. And I guess what I should be on is Progynova for three months (or the one you suggested is better?), and then a progestin to force a bleed?

[Sheryl]

Oh, I see. The various herbal remedies are not hormones at all (and didn't work for me, either...!)

The thing about hormones is that, at least until recently, the preparations most commonly presecribed and certainly most heavily promoted for hormone replacement were not identicial to (and in some cases were very different from) the estrogen and progesterone normally produced in the human body. Premarin is made from estrgens extracted from horse urine. Whereas Progyna (estradial) is the same chemical formulation as the estrogen the human ovary churns out. Some people think this makes an important difference, some argue not, although women are voting with their feet towards the "bioidentical"forms. Personally my feeling is that, regardless ofwhether or not there is hard evidence that it doesn't work as well, it sinmply does not make sense to use a preparation different form what you want to replace in the body when it is possible to administer the same thing. (As to why it was ever done -- patents and profits).

Premarin is however at least mammalian estrogen. Progestins, on the other hand, are a totally artifical construct developed as a way to get a patent-able preparation that would mimic progesterone's effect on the lining of the uterus. They differ significantly from progesterone in their molecular structure and have very unpleasant side effects; more recently there has been evidence to suggest that the inc rease in breast cancer found in long term HRT may be due to the synthetic progestins, since the same effect weas not seen in women taking estrogen only. This together with long-standing consumer lobbying has finally led drug companies to start producing progesterone formulations; they even found ways to patent them by developing specific delivery systems (micronized forms etc).

Most definitely, since you still have your uterus, you should be taking progesterone. Not to do so doubles your risk of uterine cancer; i hope you have been getting regular paps and ultrasounds, if not would be a good idea to have both done at least once now, letting the doc know that you have been on unopposed estrogen. Some doctors would also advise an endometrial biopsy, others would be content with a vaginal ultrasound.

And for sure, start taking progesterone if you are going to remain on estriogen,. For the reasons mentioned previously, I would stress progesterone not a synthetic progestin. Beware that many doctors -- including virtually all thai doctors -- do not clearly understand the difference. Utrogestan is the only natural progesterone preparation currently available in Thailand, can be hard to find but it is available and OTC.

In terms of dosage regimen there are 2 approaches: continuous and intermittent. The once every three months you referred to is a variant of the cyclical approach. Given your insomnia problem I would suggest continuous and at bedtime. With continuous use (the progyna and utrogestan together daily) you may not have a period whereas with intermittent use you usually will. The continuous use prevents the build up of endometrial lining to begin with.

For cyclical use the dose is 200 mg whereas for continuous it is 100mg.

Adding progesterone is absolutely essentuial if you are on estrogen to decrease risk of uterine cancer. But it may also have the added benefit of heloping you sleep.

Have you had a full work up for the cause of your premature menopause?

[desi]

Hi Sheryl,

The doctors finally admitted that it was heredity. They would have saved me almost ten years of frustration if they'd just looked at my charts with my family history right there in black and white. I had many tests over the years (at one time they took so many blood tests they decided to leave me hooked up) so they got their money out of it.

The reason I choose the every three months route was due to the dramatic mood swings when I was on both at the same time. By limiting it to three months, my life was not a monthly hel_l, only an on and off again possibility of it. If the combination you mention will lesson the craziness while letting me get some sleep, then I'm all for it.

Thank you for taking all this time to explain it me. I do have doctors in the UK but they just keep giving me the same meds and out the door I go.

[Sheryl]

If your UK docs have been letting you take unopposed estrogen I don't think too much of them...?? AT a minimum, should be closely monitored e.g. annual endometrial biopsies.

In my experience, estrogen is what relieves the vasomotor symptoms and also the muscle aches but it is the progesterone that best relieves "the crazies". Estrogen without progesterone would very likely make the crazies all the crazier.

Suggest you try continuous treatment with the lowest does of estrogen that works plus 100mg utrogestan at bedtime. If this doesn't suit then you can switch over to cyclical.

BTW the lowest dose of estrogen that works is often a lot less than they prescribe, so you may want to experiment with only a half or 3/4 tab and see how it goes. Or better yet try a patch (brand name in Thailand Climera) or gel (brand name Oestrogel, readily available in Thailand), the things about taking estrogen orally is that (1) it then has to pass through your liver which is not what physiologically occurs and (2) as with any oral medication you get a surge in levels and then a drop off, this yo-yo effect can cause a lot of symptoms. The gel is especially useful in terms of being able to titrate to the exact best dosage which may vary a little from day to day. In the normal pre-menopausal state estrogen levels flunctauate. Most women struggluing with this problem readily learn to tell when they need more or less of the gel. (Do not, however, exceed the recommended dosage...but feel free to use less than it as it suits you, most women find they do not need that much to keep symoptoms under control)

If you find that a lower dose of the gel controls the other symptoms fine but that there is still some thinning "down there", adding a topical application (Vagifem) is preferrable to increasing the systemic dose, bioth in terms of mood/sleep issues and also the health risks associated with estrogen use.

Good luck

[desi]

Thanks Sheryl. I'm pretty much a lightweight so can tell when I've had too much of a good thing! I'll try and track down those meds, or have them sent out if I can.

[Tolley]

Calcium tablets can be quite effective for insomnia.

There are also lots of herbal products on the market that are quite beneficial.

I would steer clear of any pharmaceutical sleeping tablets as they all have bad long term effects.

[desi]

Tolley, I agree about the sleeping pills. I only go that route when I'm really really desperate as they make the next day a wipe.

Calcium tablets sound interesting. I'm supposed to be on them anyway so taking them at night makes sense. I've tried a range of herbals but they only work if I'm having a slight problem. When it's all out insomnia, hades rules the day.

I'm now out of it (mostly) and I now have a whole new arsenal, so thanks all!

[Lozza]

Tolley, I agree about the sleeping pills. I only go that route when I'm really really desperate as they make the next day a wipe.

Calcium tablets sound interesting. I'm supposed to be on them anyway so taking them at night makes sense. I've tried a range of herbals but they only work if I'm having a slight problem. When it's all out insomnia, hades rules the day.

I'm now out of it (mostly) and I now have a whole new arsenal, so thanks all!

Hi Desi

I have also suffered as you, I could stay awake for 72 hours. Unfortunately there is no cure. I found the HRT 'LIVIAL' worked, this can be purchased over the counter at any pharmacy although it is not cheap about 1,000.00 baht. Speak to a Pharmacist most are very good and will help you out, they started me on Anti-histamines and advised 2 Tablets as opposed to the normal dose (1), that being a sleeper and not Hayfever or Allergy dose. It did the job.

[SiamSuzi]

Poppies....that will make her sleep! Cackle cackle cackle! Or count flying monkies!

[desi]

Someone was having fun last night ;-)

[SiamSuzi]

LOL! Desi I have terrible insomnia too and that was a result of one of my many late nights.

Anyways, yeah I love that yoga relaxation technique. I usually do it with some deep breathing and visualizations too.

I also like to do guided meditations. I put my earplugs in and I'm out within 20 minutes. They relax you so much. I have two good ones on mp3 that I can send you privately if you like.

Also if you have Eckharte Tolle's "The Power of Now" on mp3 that works too. Even if you care nothing fo the content, his voice always puts me right out.

[desi]

I was laughing so hard when you mentioned flying monkeys as I have a dislike for those little chaps and instead of sleeping, I'd be chasing them all over!

The mp3s on the iPod usually do the trick for me too. Until the big one hits...

Yes please on your good ones... how about a trade? Sometimes I have to switch them out so it's always handy to have a stash.

Off to google The Power of Now...