My (limited) attempt at Bio- Identical hormone replacement treatment

4 years in and so far, HRT free. I’ve only recently (2018) started to document the symptoms of the Perimenopause that I experience alongside my Triathlon training programme. I am doing this to help me better understand my body and its capabilities throughout this phase and hopefully enable me to train smarter. The reason I’m so late ‘journaling’ is that I simply didn’t know I was Peri-menopausal, I just thought I had a ‘virus’ until I had a chat to the doctor. Heads up ladies, feeling peculiar and just not yourself it could be the start of the Peri-menopause!

Diary date March 2018 – waking every night with hot sweats:  (no specific details just the * asterisk (my code for each day I experience a hot sweat.) Training is suffering after the 3rd week: Note in the diary as a (:/) frown face) meaning that ‘I’m grumpy and tired’. I’m clearly struggling with FTP sessions, noted with a! exclamation and there are plenty of notes about body ’niggles’ more like aches/ pains and tightness throughout the training diary. 24th April 2019 another note (probably because I’m taking this Menopause seriously, I’m writing about it and want to document it more carefully) Started night sweats again and getting more headaches/ migraines. Bad ovulation pains, and feel very ‘PMTish’ (that means, premenstrual tension, I’m grumpy, struggling emotionally have tender breasts, migraines and tummy drag/ pains). 28th April ** “Sweats start to become more intense at night and during the day, I get noticeably hotter and more sweaty. Now, my body sweats profusely, not just my face and hands. I note that I have deployed a cloth and a fan in the bedroom to help cool me more quickly and rid me of the sweat, I also take a cloth to work. I do not count the episodes just the days it occurs and the intensity (* = it happens a few times and I get some sleep, ** = awake most hours not much sleep, very hot and grumpy!)

With each night sweat I wake for about 10 seconds before I have a ‘melt down’ which lasts for about 1 -2 minutes. In total this ‘phase’ lasted every day and night for 8 weeks (56 days nonstop)

During this phase I train hard and continuously:

3 x bike sessions using TrainerRoad’s (https://www.trainerroad.com/) medium sprint plan where 2 are between 70-80% of threshold power, the other one at or above threshold (80-115%). All sessions last between 1 hr and 1.30 hours.

4 x swims; (1x speed session, 1x threshold or Critical Swim Seed (CSS) and 1 x Strength with paddles and one short swim with technique and a focus),

2/3x runs; (depending on my Achilles which will be; 1 x steady run about 40 mins, 1 x interval session which varies: e.g 5 x 2 mins tempo maybe on a slope/ 1 min easy (never beyond as it seems to aggravate my Achilles) and maybe a short brick run of 10-20 mins. All runs usually on a treadmill at home so I can stop if and ice my Achillies quickly.

2 strength and conditioning sessions.  As set by my physio

Throughout this block (race phase) of training and ‘symptom phase’, I see a lot of ! Exclamation marks. I ‘bailed’ out of 3 bike sets (noted with a L sad face or an expletive!) and was unable to complete a 20 min FTP Test (Functional Threshold Power Test *) which showed no progress despite the training and good based gained previously.  *https://www.britishcycling.org.uk/zuvvi/media/bc_files/sportivetrainingplans/THRESHOLD_TEST.pdf

I use a Tacx Neo 2 turbo trainer in ERG mode and when synched with an online training programme you ride at the target power according your formatted FTP result. When you’re ‘cooked’ you simply can’t turn the pedals.

I also note that I get a bad cold around 3 weeks into the hot sweat phase. This could be due to cooling down at night maybe I catch a chill? Or perhaps it’s feeling vulnerable and run down due to lack of sleep whilst still training hard? It’s a well-known fact that your ‘natural germ defences are low after a hard training session’ so you are ‘more vulnerable to catching viruses’. (A. Blow Training Peaks 2017) I could also be ‘over-training’ when I should be listening to my body and taking more rest at this stage? Or perhaps it’s just bad luck (time of year etc.) Or maybe a combination of all?

During this ‘bad spell’ I decided to try a bio-identical remedy. I search on line and I find www.wellsprings-health.com  they advocate a natural progesterone cream called Serenity, https://www.wellsprings-health.com/pages/serenity-natural-progesterone-cream/ and I’m interested. I send them an email explain what I’m doing ‘writing about the menopause as a sports woman, and could they let me trial one?’  Kindly they sponsor me with one free 30ml pot of ‘Serenity’ cream to review.  The very next day it arrives May 15th (WOW!). They were very supportive and interested in the outcome. OK…  I hear you all shouting, ‘What? Without having a conversation or a medical check-up? You want to take a substance bought on line?”  I know, it felt a bit ‘reckless’ but It was easier to get hold of than a doctor’s appointment (July 1st!). The website looked good, there was a lot of positive reviews for customers with some good information about their products. The cream looked and felt safe but most importantly, the ingredients were not on the banned substance list http://www.wada-ama.org/en/content/what-is-prohibited. I trialled it for 22 days during May-June. The cream lasted for 23 days until the pot was empty and unfortunately it made no difference, I had the usual ‘hot flushes, insomnia, night sweats and brain fog throughout this time.  In all fairness, I guess you need to try these things for a few months for them to take effect, and the web site suggested this and also was clear that * Every woman is unique. Your results may vary. * (Wellsprings 2019)

In my time of need I decided to go back to their product range and trial the 20-1 cream because:

“A small proportion of menopausal women may find they are unable to completely eliminate hot flushes, night sweats or vaginal dryness using natural progesterone cream alone. Any or all of these symptoms persisting can be signs of oestrogen deficiency. In most cases, when progesterone levels are right, the body has the raw materials to produce oestrogen, however in a small number of cases the body does not produce the oestrogen and it is for just such cases that Wellsprings have formulated 20-1 Cream. *” https://www.wellsprings-health.com/pages/20-1-natural-progesterone-and-oestrogen-cream/

On day 48 of my constant ‘symptom phase’ I began the 20-1 product. It came in as a 100ml pump bottle and it was easy to get the correct dose with just one press.  The application routine was the same as before. I note that on day 57 (10 days in taking the 20-1 cream) my symptoms stop. Coincidence? They become sporadic, I have a series of one every other night, then a few days rest bite, then another series of 3 sweaty nights in a row then 3 days off.

Then a new symptom phase begins for a solid 5 weeks of hot flushes, but there are no other notes about how hard or otherwise my training efforts felt or what my mood was like. I did note the start of a new body ache, shoulder pain and I was unable to celebrate my 50th ‘publicly’,  I just couldn’t face sweating during it and I had this intense anxiety where I just didn’t feel like socialising let alone choose something to wear! On the 26th June the symptoms stop again and I begin to feel more normal. I continue using the 20-1 cream. I get PMT on the 11th July, spot on the 13th and then have a period from 16th July until the 19th (93 days since my last one). I continue to apply the 20-1 cream until 24th July and then stop completely because I can’t take it on the plane with me to Russia (there was no room in my kit bag and I didn’t want to risk it being confiscated). This is not recommended by wellsprings you’re supposed to “finish the full jar of your cream to allow time for your hormone levels to stabilise and symptoms to be properly treated.” https://www.wellsprings-health.com/pages/20-1-natural-progesterone-and-oestrogen-cream/ 2019). My diary has no reports of any Peri-Menopausal symptoms and from memory, I felt fine. Training was going well partly because I’d employed a Triathlon coach, Mark Pearce http://www.intelligent-triathlon-training.com/ to take the pressure off me planning my own training (a challenge when you have brain fog and you’re indecisive) and to give me some morale support. He also has the responsibility of ensuring I’m not over training and I haven’t looked back since.

During this time I’m on a reduced training load tapering for the European Championships in Russia. I have a fairly relaxed and enjoyable experience of this trip. The race was typical; a terrible swim (to be expected I’m not a strong swimmer), a decent bike and solid run, no dizziness or panic attacks just the usual race fatigue and to my amazement I manage a Podium spot!

I resume hot flushes again from the 8th August until the 25th August when it stops again, I note how please I am because I’m on holiday in France, it’s very hot and my quality of sleep has been poor. I’m relaxed and able to catch up on a bit of sleep during the day when I manage a power nap. My mood is generally good, I feel a bit ‘stoked’ (energised) but that’s probably because I tend to get an adrenaline rush if I’m not having enough sleep and I’m focused. There are some hard sessions involved but I manage them and then I’m on another ‘taper’ for the World Championship Sprint Triathlon in Lausanne. I’m relaxed (on holiday so minimal house work, plenty of rest, nice bike rides and no stress) I manage to train in the morning and late evening so I can enjoy holiday time thereafter. In Lausanne again I have another good race, no sickness or dizziness and managed the heat and finished in 21st spot. I chat to a few of the usual Age Groupers and was thrilled and blown away by GBRs Emma Fisher’s win she raced like an Olympian and beat a few of them to boot!  (Emma Fisher (50-54) produced a stunning run performance to beat the Sydney 2000 Olympic Gold** (Brigitte McMahon) and Silver (Michellie Jones) medallists, in what was a stunning high quality field. That makes her Triathlon (Sprint) and Duathlon (Standard) World Champion this year. (** the same Brigitte McMahon busted for taking EPO in 2005 https://www.tri247.com/triathlon-news/age-group/lausanne-gb-medals-world-sprint-champs 2019).  Her 5k run split of 19.05mins was astonishing but her swim improvements to date have made the difference, credit to her training. It’s these results that really spur me on as an Age Grouper if you put in the right training, with the right guidance, everyone can improve especially on your limiters, (those areas you have least experience with).  I was surprised that Jacqui Phillips didn’t make the podium she finished 9th, we were all shocked and wondered if her 70.3 training was taking its toll? Her reflections after the race were very interesting and made reference to the menopause:

Jacqui Phillips is feeling fed up.

1 September ·

Sprint World Champs 2019.

This has taken me a long time to write and I apologise for being a little self-indulgent but it is how I have processed what happened yesterday. This was the worst I have ever raced for GB and I was left wondering what the hell happened.

I had a lonely swim after getting kicked in the face at the first bouy which meant I was off the back of the 2nd pack on the road. I had a tough bike by myself but felt great, loved the hills and descents and caught them as we went into T2. The problem was the run. I had nothing at all, just cruised round and pretty much gave up. I had no fight. Not me at all. 🤷‍♂️ 🤷‍♂️🤷‍♂️

I could have been 5/6th. I came 9th.

Looking back on yesterday I realise now I was pretty flat even before I started. Nothing was wrong but I wasn’t nervous or excited or raring to go - I was just calm. As the race unfolded I didn’t get angry or dig deep I slowly let it all unravel and I didn’t do anything about it.

I accepted my fate. Just shows how much mental state can affect performance.

A lot is not said about menopause and I rarely talk about it but this is what happens to me sometimes these days. I am not ill. I’m just not me. It’s not all the time but I don’t know when it’s going to happen and when it hits, its hits fast. This time the timing couldn’t have been worse.

I don’t know if other women are affected this way. I am lucky not to get a lot of the more severe symptoms But thats the trouble with menopause, it’s so individual. Hormones. Who needs them eh?

85Sarah J Pitts and 84 others   102 comments  (https://www.facebook.com/jacqui.phillips.1612

It’s still a bit of a taboo to discuss the menopause with your ‘race mates’ but it’s great that Jacqui shared her story, she has a lot of followers and people really look up to her because of her success so thanks for this Jacqui x

September 5th I feel a bit ‘PMTish’ and start my period on the 13th. Thereafter, I feel normal and have no symptoms. I get another period on the 7th October (31 day cycle). I start experiencing tennis elbow again and my knees start to hurt, on the up side, my shoulder pain has gone! As soon as my period starts 7th October, I begin a new phase of Hot flushes, insomnia and brain fog.

I’m 4 weeks into this October phase and it’s getting me down. I wake every 1- 2 hours with night sweats and get at least 5 or more hot sweats throughout the day as well. I’m tired and feeling very irritable. I’m back at work and into a base phase of training. I’ve decided to swim in the mornings at 6.30am and do my second session in the evening to try and last out until 11pm in the hope of unbroken sleep but so far it hasn’t worked and I look and feel shattered.  My concentration skills are shocking, I’m more indecisive than ever. I can’t remember what I’m doing, when I’m doing it, or why, unless Siri tells me! My hubby’s really noticed it this time because he’s been ill with the flu and I’m not being my usual caring self. I apologise for my harshness but I can’t seem to change my behaviour, I’m just knackered, depressed, hot and overwhelmed.

I’ve have had a series of migraines and headaches on and off for the last two weeks. I feel sick far too often and have a ridiculous irritating scratch on my lower back (I associate this with the menopause too because it’s sporadic, comes and goes and has only been itchy here for about 2 years!!).  Socially I’m usually quite outgoing but more recently I prefer my own company, I get panicked at the thought of being with others I feel boring and pointless and I forever flush and sweat. Can’t imagine having children, a dog and fulltime job on top of all these symptoms how on earth do some women cope?  And, why on earth suffer if you don’t have to?

My symptoms are easily explained on the following brilliant website which everyone should look at:

https://www.menopausematters.co.uk/symptoms.php

Knowing this is really helpful, I’m not going mad, I’m not ill, my body is just ageing. I’m sure my mother would have like to have known all this unfortunately this information wasn’t available in her time but it is in ours and be ignorant at your peril!

I’ve struggled to write this blog this time, it’s a stolen part of another blog which has been on-going for what seems like an age. I’m just struggling to get my thoughts in order and write it and I’m procrastinating that it’s pointless and worthless, even so, it’s cathartic and I’m hoping it just may strike a chord with someone else even if it’s one person!

The point of this blog was to share my experience of using a ‘natural’ remedy to help ease symptoms of the menopause.  I’ve not really conducted a thorough or fair investigation here but I’ve dipped my toe in.  I have only tried one Progesterone cream for 22 days which had no impact on my symptoms and the 20-1 Progesterone and Oestrogen cream for 47 days where I did notice some improvements. However, my experiences are not conclusive.

My history so far with the menopause is very much off and on in terms of experiencing symptoms. This kind of fluctuation is clearly highlighted in the chart below which shows how our Oestrogen (Estradoil) levels fluctuate considerably throughout the Perimenopause and Menopause, the length of this phase is individual like all the other hormone phases but it does eventually even out naturally.

Dr. Kate Placzek, 2017 (Notice how the Estradiol rises and falls significantly during the Peri-menopause phase)

For me taking something for the Perimenopause/ Menopause is a bit of an issue. I feel guilty for having deliberately taken 20-1 during my major race phase because it may have made the difference and given me an edge to cope better? I had a great result at the Europeans (even though the field was very small and missing the usual competition). However, I can’t know this for sure if the 20-1 got me through that symptom phase or whether my own natural hormone rhythms kicked in? I would need to trial 20-1 for a much longer period to make a clear and more considered conclusion for the benefits of the natural bioidentical treatment. Maybe you have tried this and for a much longer period of time? If you have please let me know and share your experiences with the same or a different product and tell us why you went for the bio-identical treatment.

Why should I feel guilty about taking something to help me get through the menopause more easily? I don’t want to admit to failure. Failure at not being able to cope with the discomfort of the symptoms this perimenopause is giving me. It’s too easy for me to get help and give in. I’m happy to grow old, I’m just struggling to manage all these symptoms the Peri-menopause is giving me alongside family, work and training commitments.  I have so much respect for my Gran and Mum they did not have the information or choices I have today, neither did they have the financial security. I feel like a bit of a cheat and it’s this thought that’s holding me back. I should be able to cope, keep myself clean, eat better and deal with life’s natural phases graciously. But right now, I’m knackered, I feel sick, I’ve a constant headache and an irritating itch, I’m flushing and sweating more than 20 times within a 24hr period. I’m not thinking clearly, I can’t spell or remember words or names which is causing issues at work, I’m losing my confidence and I’m depressed.  My skin is dry, hair falling out and my knees are hurting. I’m just not myself and I don’t like myself and if I don’t like myself, then no one else is going to like me! So here I am staring at a 3 month course of HRT prescribed by the doctor 4 months ago and thinking very seriously about taking them.

Next time I will share the Experiences of Kate Bantick and Ultra cyclist whose achievements at Age group level are astonishing.

Please let me and others know how you’re coping through the Peri-Menopause/ Menopause as a triathlete/ athlete whatever field. I’d love to hear experience and so would others.

“A problem shared is a problem halved” ….

As always until next time,

The Peri-Menopausal Triathlete x

TPMTriathlete@gmail.com.

References

Blow. A   2017 Training peaks https://www.trainingpeaks.com/blog/how-to-avoid-getting-sick-while-in-training/ British Cycling 2019 https://www.britishcycling.org.uk/zuvvi/media/bc_files/sportivetrainingplans/THRESHOLD_TEST.pdf Menopause Matters   www.menopausematters.co.uk founded by Dr. Heather Currie 2019 Dr Placzek. K 2017   Mood and Menopause – Going Through "The Change" found in https://www.zrtlab.com/blog/archive/mood-menopause-perimenopause 2019

Levison. J 2019 Tri247 “GB Age-Group medals: ITU Sprint Distance Triathlon World Champs – Lausanne” https://www.tri247.com/triathlon-news/age-group/lausanne-gb-medals-world-sprint-champs 2019

Phillips. J 2019 https://www.facebook.com/jacqui.phillips.1612 Useful reading about bio-identical Hormone therapy https://www.menopausematters.co.uk/article-bioidentical-hormones.php

WellSprings   https://www.wellsprings-health.com/pages/20-1-natural-progesterone-and-oestrogen-cream/ 2019).