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The ring is fantastic!

I have heard that it doesn't interfear with any other medications because its not absorbed through your liver like oral bc pills.

It has done nothing but good for me.

It's easy to use and just an all around good product.

They hardest part is remembering to take it in/out. The box comes with stickers you can put on you calendar to help with that.

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Heya JooolzRooolz,

Thanks for the quick reply!

This is the kind of feedback I'm looking for, good and bad.

(You're not a drug rep right?  Just kidding.  ;) )

I'm leaning towards the ring for exactly those reasons, med interactions.

How (if at all) has it affected your periods?

--ncc--

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Wish I knew what to tell you on this. I'm attempting to get my doc and gyno to actually speak with one another about this! Also, my situation is complicated by the fact that I'm on the threshold of menopause.

You've probably already looked throught the 57-page Lamictal complete prescribing info. Describes the interaction but, not helpful in a practical way. If you haven't looked at it you can get it here: http://www.lamictal.com or here is the direct link: http://us.gsk.com/products/assets/us_lamictal.pdf

Something you mentioned ncc1701 has brought to mind another Q. You wrote about testing Lamictal blood levels. I've yet to have this done. Is there actually a target range on the results for which they are looking? If so, what is it?

Thanks.

revlow

PS - Wish I could have been more help. Never had an IUD or the ring. Another thing to consider, I suppose, would be a OCP that has a more consistent dose throughout the month. (I'm on Mircette.)

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Heya revlow,

I don't envy you the perimenopausal stuff.

In terms of blood levels, my psych (and what I've read) says there's really no specific therapeutic level and it's not routinely monitored.

In our chat, he said that absolute numbers wouldn't help us, but if the level *changed* a lot between on- and off-OCP, that might help us figure it out.

Seems pretty nebulous.

Also, we're (in Canada) depending on US data for this (Lamictal in BP) because it's been generic in Canada forever.

It's never been approved here for BP, although it's used off-label first- or second-line, based on US data.

Noone here is going to spend all their R&D money paying for approval for BP if it's generic.

The downside of generics.

Thanks revlow.  And I reiterate:  I don't envy you the perimenopausal thing.  I'm *not* looking forward to *that,* except for the no periods thing that you're on the verge of.

--ncc--

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LOL. Thanks for the sympathy! I'm sure it will be good once I'm through it, but at present there sure are times when I miss my regular and uncomplicated "womanhood" of my younger years.

Please keep us posted on what you and your doc find out, okay? I think it's cool that he is actually paying attention to this and willing to work with you on it.

revlow

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No not a drug rep!

I'm just a VERY happy ring user.

The ring is AMAZING!

I rarely get cramps and my period lasts about three days. The flow is SOOOOOOOOO light as well.

I think the only part i notice is a little more pms symptoms.

I get a bit bitchy and scarf the chocolate down. (that rarely happened to me before.)

It's easy to deal with though. Especially when you barely have a period and no cramps!

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Guest luli2545

I'm way past a pretty early menapause. This thread is great...I'm going up on lamictal, at 50mg per day now. I used to be on hormone replacement til they said to not use it a couple years ago. I'd love to go back on hormone replacement because I felt better on it. But now being on lamictal and not wanting to complicate lamictal's effects....dunno...hmmm. And the therapeutic dose for lamictal seems to vary widely. Maybe there's another lamictal over 50 thread...or for women on hormone replacement and lamictal...

I'm liking lamictal pretty much, but it's a little energizing...also on 225 effexor...

Sorry if I'm off topic; liking your comments.Thanks.

Luli

ps. I had very slight "spotting" the first two weeks on low dose lamictal. That worried me, as it's probably been a decade since that has happened. I mean, how complicated IS this drug? I hope it's not too important. How long has this drug been around? (mebbe I'm lazy; actually my brain is a bit scattered since starting it, so I can't follow the drug info as well as I might have before)(that's weird too).

But, no horrible dips into depression, so that is good.

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Heya,

OK, so this is what I can tell you Luli without looking anything up, because I've promised myself I'm not looking things up while on vacation ;)

Lamictal seems to have some sort of effect on our hormones.

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Ah, back to the mysteries of Lamictal and hormones! I wish I knew more. I see my doc on Monday; by then I am hoping he will have talked with my gyn. (I wrote my doc a letter last week asking him to please do so.)

I wasn't aware of the info on post-menopausal women. (Thanks, ncc1701!) I just did a search in the 57-page Lamictal complete prescribing info (link in post #4 above). I couldn't find anything.

I did experience a lot of break-through bleeding the 1st couple months after I started Lamictal. But in my case, I'm perimenopausal and still taking OCP. So, not the same situation.

I know that NARS (also in perimenopause...sorry NARS, tmi?) is going to be meeting with a doc who she believes has a good understanding of all this hormone/Lamictal interaction. I'm looking forward to hearing what she finds out.

luli2545: I'm with ncc1701 -- get yourself checked out just to make sure nothing bad. Please let us know what happens. And if you find out anything re: Lamictal and hormones, please by all means *share*. We are all sisters in this together! ;)

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Guest luli2545

Thanks Ncc, Rev,

Hmmm. ok. I'll call obgyn on the 27th or 28th. It's time anyway for annual stuff. No other weirdness in hormonal/menses history. Hmmmm.

Luli, of course will share, not sure where, maybe start with a new topic...

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The ring is fantastic!

I have heard that it doesn't interfear with any other medications because its not absorbed through your liver like oral bc pills.

It has done nothing but good for me.

It's easy to use and just an all around good product.

They hardest part is remembering to take it in/out. The box comes with stickers you can put on you calendar to help with that.

<{POST_SNAPBACK}>

(Another satisfied NuvaRing user here).  They're website, http://www.nuvaring.com, has a timer that some doctors used to give out, but they ran out I guess because I never got one, for FREE.  It counts down the days and beeps when you need to take it out or put a new one in.  Makes it alot easier to remember.

The link for the NuvaTime is under Patient Support to the right.

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I am very interested in the info about Lamictal and girly hormones.

I don't have anything to add, other than that often get hypomanic before or during my period.  A continuous level of hormones sounds like the best plan all around for mood stability and reducing med interactions, but I think I'd better finish titrating before messing with it.

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Heya,

OK seriously considering the ring.

Worried a bit though about losing the apparent mood-stabilizing effects of my OCP.

But I can always titrate medications, I guess.

Tomorrow (30th) I go get my blood drawn, then off OCP, and redrawn a week later.

Thanks for the interest and support!

--ncc--

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Bit of a threadjack here, but we did mention it in passing above.

My doc order a bunch of tests the other day, including a Lamictal level. I was surprised to find out it was a urine test. Thought it was a blood level they were looking for. The lab tech called to check (the lab in the local hospital in a collecting station for the lab company my insurance uses, so it's sent out). So he called the lab in Q and showed me what they faxed back, that indeed it was a urine sample they wanted for Lamictal.

Anyone know about this? Should I be insisting on a blood test?

Thanks.

<end of threadjack>

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Heya revlow,

(edited to obsessively fix typos)

Not a threadjack BTW, Lamictal is a weird and wild friend.

From what I've gathered, chatting with my lab, there are *no* actual blood *or* urine levels for Lamictal.

My veins *suck,* so I was wondering in fact ;) if maybe this *was* a pee test, but then again I have a phobia about public washrooms so maybe not.

This drug is so variable -- noone seems to know how long it takes to clear our systems, what's a therapeutic level, what's a toxic level, blabla.

All we really seem to know is it's very very safe, mostly, except for SJS, which we can't predict.

The whole reason I'm doing two levels is to compare A to B and, if there's a *fair-sized* difference, to change management based on that.

Psych says this is important b/c otherwise, one level alone is not *useful* (unlike, say, lithium or epival).

So, IMHO, looks like urine or blood levels are just as useful as each other.

I'll see what the lab tech does tomorrow.

Accounting for our dosages, it *would* be fun to see what our respective levels are.

I'll tell you mine if you tell me yours.

Of course, all these other people are watching.

Great, now I can't pee.

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Heya,

So, FWIW, this is the first period I've had in ... I guess three or four months, since shortly after starting my wonder drug of choice.

I took pill 21 on Thursday night and had my blood drawn Friday am, and again tomorrow, then I'll start the next pack and wait for results when I see my psychiatrist on the 17th.

But, I can say this.

How I feel is I think better.

Slept so hard the last few nights.

Laughing more.

Get depressed or angry but feling like I have more say in the matter and can get some control over the thoughts/feelings before they get really nasty.

Still goddamn anxious but handling it by "sucking it up."

Of course, for as long as I've been on OCP I've felt better on that week off.  Physically, emotionally, mentally.

Before I went on, I had horrid mood swings and cramps and everything nasty, except for the week of my period, whenever that happened to be.  That week was not as bad.

But I wonder this time how much of this (relative) stability is (1) placebo effect -- if so, yay placebos!! or (2) huge burst of Lamictal level effect versus (3) the same old hormones being better balanced during my period.

If there's an actual big difference in my levels from last week to this, then dammit I'm switching to the ring, because a correlation is good enough for me.

Just had to write that down, I need something to distract me from the not-good day I've had so far.

--ncc--

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Please keep us posted!

As for me, I'm seeing my GYN next week. I'm not looking forward to it. Nice guy and I'm sure very intelligent, but takes so much time and energy to get him to understand me. Hoping to get some answers, not counting on it.

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Hiya there.  I've been more absent than usual the past few weeks.  I thought maybe it was good not to spend too much time on the computer.  Once I got honest I realized it was depression.  Sigh.

So yesterday I saw the pdoc again.  I like him.  My DHEA test came back fine, but my lamictal levels are at the low end of what the manufacturer suggests (note that I had to be taking all my lamictal at night for at least a week before the blood draw, and had to get the blood draw as close as possible to 12 hours after my last dose).  Given that I've been less than stable this past 6 weeks, he said the first thing to try was going to 400 lamictal, and to divide the dose to make sure my blood levels are even.

He's still concerned about hormone levels, so he gave me a saliva test to take and send off to a lab.  I think he's testing for a bunch of things including cortisol to check out my adrenal function.  If all that comes back OK, and if the lamictal helps, then I'm good; otherwise I may end up taking cortisol or some other non-reproductive hormone.

Speaking of hormones, I'm beginning to think any oral hormones affect lamictal levels.  The manufacturer says that oral birth control increases lamictal clearance and reduces blood serum levels by 40% (and lamictal affects hormones too, but it's not clear how much).  This means that during the week off of BC you get a lamictal bump.  Maybe that bump while you already have PMS makes the PMS seem worse?

And oral estrogen would have the same effect.  It's possible an estrogen patch might be better for estrogen replacement.  I use transdermal progesterone cream, and it doesn't seem to effect lamictal levels the way oral estrogen did (caused terrible depression).  So the ring for BC is probably the way to go, unless you're like me and prefer a cervical cap, which involves no hormones at all.

As for premenopause, I'm also well into it; I only get a period every other month.  Progesterone has been good for me, as it seems I've been very low on it since puberty.  I've got lots of estrogen, and oral estrogen for hot flashes did not work.  BC pills give me horrible side effects.  And since halving my thyroid meds my hot flashes are almost all gone.  So I'm sticking it out for now and hoping the lamictal steadies my menopausal nuttiness.

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Heya NARS,

Nice to see you back!  (Plus you called me cute on another thread, which is not a term often associated with me, so thanks ;) )

I've also done that -- thinking I just need a break, then figuring out much later that I've been depressed.

It's interesting that, even though the PI actually states the decrease in Lamictal levels with OCP, there's no recommendations out there for *what to do about it.*

Which is what makes us all so fascinated/obsessed.

(Besides our natural tendency to be obsessed, that is.)

I agree that we've got to assume oral estrogen is oral estrogen, whether in birth control or hormone therapy.  There's less clear evidence as to whether progesterone and Lamictal have any interaction.

(And now that it's generic all over the damn place we *may* never know.)

Transdermal hormones *should* avoid the clearance issue, and I'm so glad progesterone cream helps you.

I hope you don't end up needing to be on a whole wack of more meds, and that the Lamictal helps the mood swings.  But hey, whatever helps.

I'm seeing my family doc and psych both next week, so based on what psych tells me, FP and I will figure out the birth control thing.

--ncc--

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Ncc, I assume (and we all know how reliable that is) that you'd treat it like you do tegretol/carbamazepine.  Tegretol is documented in the PI sheet as increasing lamictal clearance and so reducing serum lamictal levels.  So the PI sheet has a whole different titration schedule and target dose if you take tegretol (about twice what you usually take).  I've heard others on the board say they're taking significantly more lamictal because they use BC. 

Sigh, being a chick is soooo much fun, no?

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Heya NARS,

No.  Heehee.

Whenever I have to admit to having a period, DH makes a stupid comment:  "You're a woman now."  I just want to kick him.  Well, not anymore, becasue I feel more forgiving when I'm stable, and I definitely felt more stable last week.

Whether placebo effect or not, I *did* feel different in my week off than I do now.  So I'm just so antsy to see the blood levels.

--ncc--

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I take Lamictal and the Pill. My pdoc says that the Pill cuts the amount of actual Lamictal I get in half, so I take 400mg instead of 200mg.

I thought I'd save some money and go off the Pill (no consultation with pdoc or gyn), and cut my Lamictal in half. It played a terrible number on my hormones and resulted in a week off of work.

When dealing with Lamictal and hormones, take note! Don't mess around!

And NCC, why the embarrassment of having a period? I keep my fem products out, no shame, and at 27 no one is singing "you're a woman now" to me. At least without getting smacked.

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Heya Loon,

Don't misunderstand.  I don't give a damn if I have a period or not.  I've quite happily bought double the amount of pads/tampons/whatever just to get bonus points.  It's just that if I tell DH, I *know* he's going to say that, and it bugs me to no end.

Before Lamictal I used to get angry.  Now it's just irritated, which is much more proportionate.

At any rate, seeing the psych tomorrow and I'll see what the bloods look like.

I'm just so very *curious.*

--ncc--

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I'm on Lamictal and Depo-Provera.  Works for me!  A shot in the butt every three months, no periods (side effect not everyone gets), no mess, no cramps, no worry about missing pills and whatnot, 99+% effective.  In the beginning, there's some spotting, but it goes away after awhile.

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Heya,

OK, here's the update.

I saw my psychiatrist yesterday and I copied all the bloodwork.

(I currently take 225mg of Lamictal at bedtime.)

First, it was kind of a testament to how little we know about this drug, because the lab forwarded my blood to the specialized lab at Sick Kids.'  (Hospital for Sick Children in TO.)

The reference range they used was 4-34 mmol/l.

No real indication of where that range comes from, whatever.

(OK, now I'm curious about *that,* IPD again.)

My level on day 21 of active OCP was 9.1.

My level on day 7 of no OCP was 13.3.

So?

What this tells me is that my levels *do indeed* fluctuate with and without OCP on board.  So my feeling better during that week off might have been not *all* placebo effect.

Like, the 225mg acts more like 150mg when I'm taking OCP.

Also, that I probably have a lot of room to increase my dose of Lamictal anyway, since even 13.3 is well towards the bottom of this mysterious reference range.

Seeing my FP on Saturday to chat about birth control.

Thanks to everyone for your interest and suggestions!

I'll get back to you.

(as an aside -- Beth, has your doctor talked with you about the long-term risk of osteoporosis?  In general women don't stay on Depo longer than about 3-5 years.)

--ncc--

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(as an aside -- Beth, has your doctor talked with you about the long-term risk of osteoporosis?  In general women don't stay on Depo longer than about 3-5 years.)

Yeah, I'm taking calcium supplements for that.  I've been on it less than 2 years.  Thanks! ;)

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I saw my gyno for a consult today. I was dreading it, for good reason.

I've come to think of him as the ADD OB/GYN. He's so all over the place, I can't get a straight answer from him. I always leave more confused than enlightened. Plus he's a Mr. Science Geek show-off. By the time he'd launched into the 3rd or 4th type of estrogen receptor (including one or more with an extra molecule off the side, or something), or whatever the hell he was talking about today, my eyes had glazed over.

Of course, I'll ask numerous times for him explain something, but it makes no difference. I want scientific, sure...but jeez, I don't have a friggin' advanced degree in biochem. He doesn't use the scientific info as a way of illustrating something, to make it more understandable (the way my wonderful internist does). He just seems to babble on.

I could scream right now.

I'll write more later about whatever the bottom line was that I could discern (sort of?) from our encounter today. Right now I'm just exhausted from both the encounter with The Amazing Gyno-Wizard, as well as from first digging out my roommate's truck from the snow in order to drive the hour there. Luego.

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Okay...I'm going to try to reconstruct what happened yesterday with the GYN, which isn't easy. Like I said, the guy is so all over the place, talks in science-babble, and I honestly can't follow him or get something even close to a reasonably understandable answer. ;)

First of all, I'm not strictly dealing with the OCP/Lamictal issue. I should probably put this in the Menopause forum, but hey...since we're all women here and the hormones with Lamictal issue is all related, I'm putting it here.

I'm 51, and in perimenopause. My wonderful internist doc (who's treating my BP; remember I live in the boondocks) wanted me to see this GYN again. Doc has been concerned that my estrogen level might be too low, and that trying to treat my depression, et al. with too low a level of estrogen would be the equivalent of trying to fill up a gas tank with a hole in it. Also he's been wondering if my severe hair loss has been due to this, rather than strictly from taking Lamictal. And wondering if I've transitioned from perimenopause into the real thing menopause.

So, I go to the GYN. The one who took two long previous visits to convince that, yes I was having hot flashes. :) (He just kept saying that I couldn't be since I was on OCP.) Once I'd finally convinced him of that, he'd switched me from Ortho Tri-Cyclen to Mircette (with more continually hormones) which had helped considerably, virtually eliminated the hot flashes. Did give me more cramps.

One other thing to keep in mind here: I have fibroids, so any hormones have to be of the kind that are not "activating" to them, ones that act in more "suppressive" manner.

So, I bring all this up with him yesterday, and first off he says "Well, Mircette's too activating for your fibroids anyway." What, MF...why the hell did you prescribe this to me in the first place then? This is not what you had told me before! (Okay, I was in too much shock to say this. Just too damn pissed.)

Then, as I said in my last post, he goes off into his biochem lecture on the 9 (I think he said) different types of estrogen receptors, or estrogen molecules, or whatever the fuck he was babbling about. I kept trying to bring it back to, um, the Real Fucking World and how this applies to real life applications, like me. But it was hopeless.

So, saying that this was really all an experiment (and after babbling about -- I don't know -- maybe half a dozen different options) he says he wants me to switch to continual hormone replacement, using natural bioidentical estrogen and Prometrium. Says I will probably get worse, have more hot flashes (oh, joy!), but that this would eliminate the concerns of my doc re: my estrogen levels. Whatever. Oh, and if things get too bad, well then he'll add some Depo-Provera. (Yeah, this with a woman who is already on the edge of osteoporosis.)

Oh, at one point he rambled about the possibility of using a patch. He asked me if I have sensitive skin (which I do, generally, but I think I could take a patch) and that was the last of it. As I was driving home, I thought...shit, I should have pressed him more on that. At least it would bypass the liver, and that's got to be better for the Lamictal issue, right? So, I called his office, and will probably be playing telephone tag with his nurse from now till I'm post-menopausal.

I HATE doctors! (With the exception of my wonderful internist and ncc.) I'm sick of being some "thing" that gets talked down to, that feels stupid and lacking for asking questions and not getting any reasonable answers. I'm tired of having my inner workings f'ed around with. I understand that medicine is both an art and science, but please at least take the time to 'splain in to me, Lucy. As well as take the time to try to figure out the best for ME, considering all MY special factors.

So enough of the rant. If anyone has some coherent thoughts on this, I'd love to hear them. Again, in a nutshell, my main issues with this are:

1) I'm perimenopausal, at the very least

2) Trying to figure out what will work best with Lamictal

3) Need hormones that are least activating to fibroids

4) Want a mommy, at this point. :ninja: (Okay, that's not part of this picture, but I sure feel I could use one.)

Oh, one more note. At least this time I didn't have to fight to convince him that I've been rapidly losing hair. Guess it was obvious. :P

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Yes, your pdoc is an *bubbles the chimp*.  But from what you say I think I can glean a little bit.

Estrogen receptors: different types of estrogen fit into different receptors.  There are a bunch of types of estrogen.  Ideally your body takes the estradiol it produces and makes it into the different types so you've got all your receptors covered, and so you don't get weird effect in the rest of your body (there are estrogen receptors in the brain, bowels, breasts, fatty tissues, you name it).

I'm not familiar with Mircette but I'll guarantee you that it's some type of synthetic hormone.  Synthetic hormones can be problematic because they favor one receptor over another and act strangely in your body.  They simply don't do the job as precisely as your body can with natural hormones.  So why does everyone take them?  Easy.  They can be patented by the drug companies, because they're synthetic formulas.  This makes them lucrative.

Enter bioidentical hormones (usually progesterone and estradiol).  These are effectively the same as the ones your body produces.  They are incredibly cheap because they were discovered and the drug companies learned to produce them a long, long time ago, so all patents have expired.  Your body can handle them and use them better because they're what it's designed to use.

The NP who takes care of my hormonal stuff is highly trained in bioidentical hormone therapy for us pre-menopausal and menopausal women.  One thing she looks for is whether we need progesterone, since so many women actually are low on progesterone by the time they get to middle age.  Why?  Because as we approach menopause (for as long as 10 years before) we stop ovulating regularly.  And right after ovulation is the only time in your life that you produce any significant amount of progesterone.

Yes, we do usually have fluctuating estrogen levels; apparently it's the fluctuations that make the endorphin system start screaming for estrogen.  This is what causes hot flashes.  Estradiol supplements can help alleviate that by providing the system with enough estrogen to make it think everything's OK.

All of this is in John R. Lee's book "What Your Doctor May Not Tell You About Premenopause."  You can get it on Amazon.  It will help guide you so you can make suggestions to your gyno. 

It's a bummer to be in the boonies.  These days there's a network of doctors and NPs doing all kinds of creative thinks derived from Lee's ideas and focus on hormone balance, including thyroid, DHEA, cortisol, all that kind of stuff.  But by reading the book you may find alternate strategies.  For instance, if you check out your symptoms in the book you can figure out whether you need progesterone.  He doesn't recommend estrogen much, mostly because his theory is that the body shouldn't be given synthetic hormones, and that most women actually produce too much estrogen on average, which causes all kinds of other problems.

I can't offer much other help.  It is true that with oral estradiol or oral progesterone you are likely to have lower lamictal levels, as much as 40% less than without oral hormones.  I was a nutcase when I tried estradiol pills specifically for that reason; if I'd raised my lamictal first I might have tolerated them.  That's why the patch can be better for estradiol, and transdermal cream works so great for progesterone.

By the way, transdermal progesterone actually does something for my hot flashes, PMS, bloating, and breast tenderness.  I've dropped the estradiol and as soon as I also reduced my thyroid medication I stopped having so many hot flashes.  Nowadays I only have about one a night.

If you want to try transdermal progesterone, you can get very good quality creams online.  Don't go for the drugstore or health food store versions until you've researched what brands are best.  Don't be tricked by wild yam; it doesn't contain any progesterone and is one of those old wives tale herbs.  You want high concentration, high quality progesterone cream.  I know of no side effects of the cream, but it initially may cause breast tenderness and bloating.  If that doesn't go away, or if it doesn't work after a few weeks, or if you feel worse on it, just stop using it and it'll be out of your system in a few days.

I hope you get this stuff settled and that this helped a little.

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Thank you. Thank you. Thank you. NARS, you explained it so much better than my *&$@ GYN!

Yes, Mircette is a low-dose OCP, essentially 1/2 the same stuff as Ortho Tri-Cyclen, but it only has 2 placebo days (and 5 days days of an even lower dose than the rest of the month). So it helped enormously with the hot flashes, virtually eliminated them.

Looking back on it, I'm realizing that though indeed the GYN is a jerk, I also was PMSing. Think this might account for some of the intensity of my reaction to the appt. But he still is a pedantic asshole. ;)

He did say the Prometrium is derived from yams. As far as I can tell from rxlist.com, it's in a pill form though. I am hoping to get some word back from his nurse on Monday about the patch. I don't have a lot of hope though; I've found that communicating through her has been pretty pointless in the past. Wish I had pushed all these issues when I saw him. Oh, well.

Again, many thanks NARS. We're all sisters in this mess, aren't we? :)

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This is interesting. I just came across an article Lamictal cuts effectiveness of the pill. Yes, we knew of this possibility from what we read in the PI, but now it seems GSK has been sending out a "Dear Doctor" letter advising that Lamictal can reduce the effectiveness of oral contraceptives.

Read it. It includes this beauty: "A hormonal contraceptive should only be used as the sole method of contraception if there is no other alternative." Lovely. Would be nice if more docs, oh, say...let us fucking KNOW this! (Okay, rant over.)

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Heya revlow,

Cripes, I really *did* pick the wrong three days to stay off the computer.

;)

(Yay, I'm one of two doctors revlow doesn't hate!  Between that and NARS calling me cute before, I'm all warm and fuzzy ...)

Nice to know we're officially getting told Lamictal cuts OCP.

Nobody told *me.*  I had to decipher it out of the monograph, which includes no such direct advice.

Seriously.  Never seen this letter.  In any of the offices I've locumed in.  But it's nice to know GSK is at least covering themselves.

At any rate.

As NARS said, revlow, after we (women) stop ovulating we pretty much stop making progesterone.  Used to be we (doctors) considered this a deficiency and gave everyone estrogen and progesterone, as some kind of wonder cure for menopause.  There was even an aborted trial of estrogen in men at one point.

Commercial creams are a good option.  Unopposed progesterone is unlikely to be the last word, though, because of the osteoporisis issue, so you might be stuck also using transdermal estrogen.

Managing menopause, fibroids, and Lamictal ... while being bipolar and trying to be stable ... fun being a girl.

Let us know how it goes.

For me -- well, now I'm using this ring-thing, and we'll see (1) if it stays in -- I'm SO not convinced :) (2) what effect it has on my periods and (3) on the next cycle -- how it screws with my Lamictal levels.

Ugh.

Right now I'm waiting to see how stable I feel.  Since this is still messing with my ovaries, after all.

There aren't any gyne-psychs.  There's a niche market.

I'm not doing it.

:P

--ncc--

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Well, when I saw my doc this morning, he read from the lenghty consultation notes the OB/GYN had sent him. A few things:

1) The GYN said that he thought the hair loss was caused by my not having enough (or the right kind?) of estrogen. Which, by the way, is NOT what he told me in person -- he'd said exactly the opposite!

2) My doc said that frankly he thought the GYN would have been putting me on bioidentical estrogen, etc. back in the summer when he 1st sent me to him. Why he didn't at that point is sort of a mystery. (Maybe he wanted to keep me on the pill, even though I'd told him I wasn't sexually active so pregnancy wasn't an issue?) So, now we're finally here.

3) The GYN went into great depth about all the receptors, etc. in his notes. When I told my doc what I thought about how the consult went, how frustrating it was with him babbling incessantly, my doc said, "Well, I can understand that. I don't even think I understand half the stuff he's written here." Said he really just wanted to tap into this guy's expertise (in other words that he hadn't really expected I'd have a great doctor/patient relationship with him). Doc went on to say he usually doesn't send women to him, just on the occassions when it's more involved.

Obviously still not thrilled about the situation, but at least I do know my doc understands where I'm coming from on this.

YET ANOTHER UPDATE: Just spoke with the nurse at the GYN's office. She'd asked him about doing the patch; his answer was that he wanted me on such a high dose of estrogen (2 mg. as opposed to the usual 1 mg.) that it was better to give this in pill form. Also, I asked about why I was getting the progesterone in a pill form rather than a cream, and she said the answer was that he wanted to be able to control the amount I'm getting exactly.

Whatever. At this point I guess all I can do is try it and see how it goes, and holler like hell if I'm not doing well. I am so *tired* of this shit.

Nice to know we're officially getting told Lamictal cuts OCP.

Nobody told *me.*

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Heya revlow,

Yeah.

The dosage thing is *true* in its way.

As in, we know more about oral doses than about transedermal doses.

As in, my FP didn't know much about the ring, and I'm her first.

I'm (I should specify this) a bit of a cowboy compared to her.  Which is a *good* thing, b/c if she was *also* a cowboy, I'd be on a *wack* of weird and wild meds.

So yeah, if I wanted to know doses, I'd go oral.

Ugh.

I enjoy being a girl.

I saw that song on a commercial for Sex and the City recently.

Whatever.

At any rate, let us know what transpires (that ol' IPD acting up again).

--ncc--

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If you haven't yet, ya gotta see the original Nancy Kwan version! It'll crack you up! Don't know if it's available to rent (it is available in VHS Tape), and I haven't seen it on TV in ages, but it's well worth it. Flower Drum Song (1961) is a wonderful movie musical.

</end threadjack>

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You know, I've been mulling over this Q of why the GYN didn't put me on HRT last summer. I remember at my last consult with him back then, when he put me on Mircette, he kept saying "You don't want to get pregnant now" or "at this stage" or some such thing. To which I kept saying, "No indeed, that wouldn't be a good idea." But I kept reassuring him that this wasn't an issue, as I wasn't sexually active.

If I ended up losing 2/3 of my hair because for some unfounded & goofy reason this guy wanted me to stay on the pill, I'm going to be pissed. I mean, on one hand, of course it would be a good thing -- better than it being from Lamictal. I'd assume it would mean that with the right hormones, my hair will grow back. But *really*! It would also mean that this profound hair loss and receding hairline could have been avoided! ;)

Anyone have any clues how long it takes for hair loss to start reversing itself, once you get the right hormones? (Guess I should post this in the Menopause forum, too.)

Thanks everyone. You've all been a big help!

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Oy.  Is the hair loss from too little estrogen or from too much testosterone?  Basically it's from an imbalance; hair loss in women, especially male pattern hair loss, can be due to insufficient estrogen, but can also be from too much testosterone.  Has he done any hormone testing?  Blood tests take a snapshot; saliva tests allow you to sample a number of times a day to see patterns.  Either way, elevated testosterone should show up if that's the problem.

You might ask him about Spironolactone.  I forget exactly how it works; I think it does something neat like block testosterone receptors in hair follicles or something cool like that.  It's used to treat polycystic ovarian syndrome, a situation where hormones go wild and hair loss is pretty common.  Anyways, it often helps hair to grow back.  I stopped taking it after a few months because of the initial spotting it caused; basically I wasn't worried about hair loss and decided to reduce the number of pills I was taking. It's said that the spotting goes away with time.

I like the sound of your doc (not the gyn).  Why isn't he doing some of the hormone work himself?  It sounds like the gyn is all over the place.  I dunno...this cold is making my head very very foggy.

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Thanks for the info re: Spironolactone. I'll read up on it.

No, the GYN did not do any testing this time. He did a bunch of testing in the summer, but I remember it did NOT include testosterone. I'd asked, but didn't get anywhere. At least I'm glad that he didn't pull me off all hormones to retest me; I had to go through that in the summer. I was fearing he would do that again.

Yeah, my doc is great. I guess this is just one of the areas in which he feels he needs to have outside input. It's the quality of that input I'm questioning. ;)

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Yesterday when the GYN's nurse told me how much estrogen he'd prescribed and that it was double the usual amount, I blurted out "Oh, goody-goody!" Seriously, I did.

During all the years I was on OrthoTri-Cyclen, when I'd be about to start the 1st day of the active pills after the week off, I'd think "Yippee!" or "Thank God!". I'd even think "Estrogen...my drug of choice." My brain just doesn't function on a low tank. During that week, I'd be dumber than a rock.

I am hoping some of these recent memory problems have been due to that, and that the bump in estrogen will improve the situation. On the other hand, could just be the Lamictal.

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Heya,

Just more of my musings on hormones and Lamictal.

(I really need to get back to work in a big way, this is getting obsessive ;) )

Anyone catch the fun about the Evra patch recently?

They used to tell us is delivered about the same estrogen dose daily as what was in Alesse.

Now, it turns out to be like 60% more than that.

Except in Canada, or I guess anywhere outside the US.

The non-American Evra has less estrogen in it than the American one, which makes even less sense than usual for big pharma.

So, who the hell knows how much estrogen I'm getting into my system from this ring-thing?  The package says 15 mics, which is less than Alesse.  Plus, it's supposed to have local effects on the endometrium.

My medication-related priorities are:

1.  Mood stabilizing.

2.  Mood stabilizing.

3.  Mood stabilizing.

4.  Cycle control.

5.  Mood stabilizing.

6.  Contraception.  B/c there's always condoms, and non-reproductive-type sex.

7.  Mood stabilizing.

So, I think I'm on hormones to fix my periods and to give me a hand up with contraception.  Using extra methods is always good.

I'll find out in a month or two what this ring-thing is doing to the Lamictal.

If it comes down to it, I'm happy to go off hormones altogether in order to accomplish ***mood stabilizing.***

Just ranting.

(Peri/menopause gets more complicated, b/c hormones are *part of* mood stabilization I think.  Revlow, your internist sounds like a good guy, and probably (internists love, love, love lab tests -- not that there's anything wrong with that) wouldn't have a problem running hormone levels on you.  If you can find a hormone solution that doesn't screw up the Lamictal too much, that's what you're looking for.  And yah, Lamictal *could* be making you fuzzy, but so can messy hormones :) )

:P

--ncc--

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Also:

Revlow, I just saw your other posts about the rozeram and about the Lamictal levels you had done.

You noted that you only had one level done, in the week off OCP.

Feel free to bring in my levels from above, if you like, when you ask to have your levels done both on & off OCP.

(Or, if you're switching hormones, after a couple weeks on the new regimen.)

Mine went up by a third in my week off OCP.

I think it's important.

--ncc--

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I recently came across the data in the PI, from the one study they did of this, and thought "Oh, that's just like ncc's results." Here, in part, is what they say:

In this study, trough serum lamotrigine concentrations gradually increased and were approximately 2-fold higher on average at the end of the week of the inactive preparation compared to trough lamotrigine concentrations at the end of active hormone cycle.

Ain't this rollor coaster ride fun, ladies?

I'm hoping that the continual hormones I'm about to start will help. Will need to take more Lamictal to compensate, but at least the Lamictal levels will remain consistant due to continual hormones? At least that's what I'm hoping. The estrogen will be continual, but the progesterone will only be 25 days out of the month. I haven't come across data specifically about progesterone's effect.

And, oh...EEE GADS re: the Evra patch!!! What are these f***ers doing to us? This ain't exactly house paint they're mixing up here. What about some friggin' quality control??? (And I do not want to deparage house paint by inference. Hey, at least they manage to get the colors consistently right! Could you imagine what it would look like if it were, say 60% off!!!)

Bastards. ;)

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The ring is fantastic!

I have heard that it doesn't interfear with any other medications because its not absorbed through your liver like oral bc pills.

It has done nothing but good for me.

It's easy to use and just an all around good product.

They hardest part is remembering to take it in/out. The box comes with stickers you can put on you calendar to help with that.

<{POST_SNAPBACK}>

What exactly is the ring? ;)

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I don't use any BC (I'm sterilized) but from the information that I could find, You will be exposed to about 60% more estrogen if you use ORTHO EVRA than if you use a typical birth control pill containing 35 micrograms of estrogen. 

I found this information from the following URL:  http://www.orthoevra.com/html/pevr/new_lab...CFTC0YKB2IIQNSC?

I hope that helps.

Maddy.

also:

For more information about ORTHO EVRA

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I don't know, I just assumed that since this was the most up-to-date information available you would like to have it.  And since Lamictal does affect your hormones it may or may not have some impact on you.

Information is power.  I was just trying to help.

Maddy.

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I'm uninformed - why should this worry me?

there has been a lot of stuff on the news of late about the patch.  it has a significantly higher risk of causing deep vein thrombosis (clots) thank the ring or the newer birth control pills.  there have even been those "have you been on the patch and want to sue" commercials. 

my gyno no longer uses the patch.  she also does not use what was once my favorite pill (desogen) or it's newer version (mircette) because they also have higher risks of deep vein thrombosis than other pills.

and, in terms of estrogen, in general, you want to take the lowest amount that you can.  above a certain weight, doctors have started using the older pills again, but when you are under a certain weight (i think 160 but i'm really not sure on that) the low estrogen pills are just better, lower risk for side effects, mood swings, etc. (basically, with hormones, you always want to take the lowest effective dose possible... even if you don't smoke and are not at risk for heart attack.  estrogen has other effects on the body)

just in case no one answered the ring question.

the ring is the shit.  you insert it vaginally once a month and it sits there and your body absorbs hormones.  it is VERY low in hormones.  and hard to screw up as you only put it in once a month.  most women never feel it inside them, and if your partner is um, well endowed, and can feel it, you can remove it during sex without loosing protection. 

i hate the commercials for it, but it's my favorite form of hormonal birth control. (with the yasmin pill running a close second)

for more info:

http://www.nuvaring.com/Consumer/index.asp

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Hi, antipeople! Glad to see you made it here. (Remember me from the other board?)

I'm sure more informed folks than I can answer your questions. Several women here are trying forms of birth control like the ring to see if it will effect their Lamictal levels less than the oral pill. I don't know that any of us have hard evidence on this yet -- as far as I know, there haven't been any studies. BUT, it seems to make sense, so I think that's why some women are trying it. I'm sure they'll share what they find out.

At least that's my limited understanding of it. Remember, I'm Ms. Menopause around here...so I'm not as up-to-date on the birth control issues.

Again, glad to see you! ;)

Best,

revlow

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Although I've quit Lamictal, based on what I know, many of its side effects could be related to estrogen deficiencies.  I strongly suspect that Lamictal in some way lowers or inactivates estrogen.  (But I am not a doc, just a motivated consumer.)

Poor memory

dry skin

migraines

acne (too many androgens relative to estrogens)

hair loss (again, an imbalance tilted towards the androgens, such as DHEA and testosterone)

poor sleep

night sweats

It looks like a list of menopausal symptoms!!  If I were on Lamictal, I would boost my estrogen levels as high as I could without getting breast tenderness or swelling, and see if it alleviated my SE.

I use bio-identical estrogen and love it.  No side effects.  I use either the Vivelle patch (pure estradiol) when travelling, or Tri-est cream, which is 80/10/10 estriol/estradiol/estrone. Estriol has been shown to be protective against breast cancer in some studies.

Had my last period in August.

Highly recommend Uzzi Reiss's book "Natural Hormone Therapy."  I've read them all and he's the best, IMO.

I don't use progesterone at all, that stuff makes me feel ill.  So I take a supplement to improve my 2-16 ratio, rendering my estrogen metabolites benign. 

It's late, gotta crash now.  Hope that helps!

Goddess

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This is OT (off-topic, for any newbies here), but I'm kinda curious on a few things. Please feel free to participant or not (or to tell me to start a new thread):

1) How many women here are taking OCP mainly for the more consistent level of hormones/mood stabilization? How many mainly for birth control? How many for both?

2) How many women here have ever used a barrier method as their primary form of birth control?

I'm kind of curious how much the decision to use OCP is based on a desire for mood stabilization vs. birth control. And I wonder about the changes in preferances in birth control. (I've always been fascinated with the history of contraceptives. Okay, I'm weird.)

When I was in my late teens and 20s, most women I knew were looking for better and better forms of barrier methods. The pill was still relatively new, and the side effects were awful for a great many women. Eventually it was realized that the dose was 10 times too high. The modern multi-phasic pill formulations didn't come out until the early '80s.

Then the the Dalkon Shield IUD fiasco happened, which also propelled women towards safer barrier methods. For most of the sexual active period in my life, I used barrier methods; first the diaphram, then switched to the cervical cap when it was approved in the US. (Well, actually even before then; there was an underground of women getting them from England). I loved the cervical cap, and every woman I knew who used them did as well. They're great -- more comfortable than the diaphram (almost forget it's there), stay in place better, you can leave them in longer, and your partner doesn't feel them.

I only went on the pill for medical reasons; 1st for problems with my period, later for mood stabilization. Been on it for the latter since 1998. Alas, haven't really, um... taken advantage of it's birth control properties much since then. I'm really not too *old* for this; more due to circumstances; depression; the SEs of Effexor; and after my last in a long series of BAD realtionships, realizing that I just don't trust my judgement in this department.

Anyway, I'm just curious (suffering as I do from what ncc calls Intelletual Personality Disorder, or IPD): do you think barrier methods have completely fallen out of favor with younger women? And do you think many women are using condoms? (No, I didn't much like them then, but this was during a time when most STDs could be cured with simple antibiotics. I do hope young women are "playing safe" -- lost too many friends to AIDS.)

Okay, enough rambling. Jump in if you like. And I understand if you don't want to -- after all, this is not the purpose of this thread.

</end threadjack>

PS - my apologies for the length of this. ;)

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revlov

does OTC mean orthotricyclin or just the pill?

when i was on lamictal (which i reacted horribly to) i was also on the ring.  i spotted quite a bit.  then i got off lamictal.  and went on provigil.  and my doc didn't mention the whole provigil bc issues and i got pregnant.  needless to say he is no longer my pdoc and he can rotate on a spic in hell.

but yeah, spotted on the ring while on lamictal.  i presume this means that it lowered the amount of estrogen in my body??? no idea.  i should know, but i don't.

i take yasmin b/c the progesterone in it is supposedly non androgenic and i have to supplement my DHEA because my adrenals are screwy (yay cfs) so i don't want any more stuff in there than can turn into testosterone.

i've been on the pill since i was 15... when i went off i got really moody and pimply.  i like the pill.

i don't use barrier methods b/c i'm allergic to latex and have had too many non latex condoms break.  i'm also married.  when i would younger and had yet to develop my latex allergy i used condoms.  gotta play it safe.

i'd consider an IUD, but getting one before you've had a kid involves gyno shopping.

ps, i'm a history grad kid... want me to find out a good book on the history of birth control for you?

----

goddess...

my step-mom swears by bio identical progesterone and says that docs are too focused on estrogen.

it's interesting how varied women's hormonal needs are.

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Lamictal didn't work at all for me when I was on birht control pills. Now it works great. FWIW.

I'm an appointment at the hospital next week to talk about getting a copper IUD inserted.

<{POST_SNAPBACK}>

Has anyone thought of any long term (as in, NOT condoms) birth control solutions besides an IUD or the ring that would not effect the Lamictal levels??  I know that is way picky but I refuse to entertain the idea of an IUD because of the bad times my mother had with one and I do not like the idea of the ring either...just freaks me out.....

;)

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Heya,

I bet hysterectomy is less popular than NFP.

(in a silly mood, sorry)

--ncc--

<{POST_SNAPBACK}>

Actually, (even though I don't use Lamictal but have tried it) I have been sterilized for approx. 9 years.  No pills, no worries.  The procedure was easy and recuoup time is about 3 days for most.

Mine was longer because I thought I was SuperBitch and could go back to work the very next day.

D'oh.

That's a REALLY good way to re-open an incision in your abdomen.  I don't recommend it.

But it was only 2 small incisions and they just slipped 2 silicone rings over my fallopian (sp?) [sorry they upped my topamax] tubes.  And wam bam thank you m'am, I was outta there in about 3 hours.

Maddy the non-breeder.

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I strongly suspect that Lamictal in some way lowers or inactivates estrogen.
That might be one of the reasons Lamictal makes me feel better.  I seem to be estrogen dominant--that is, too much estrogen and too little progesterone throughout my adult life.  Progesterone cream actually makes me feel better, and estrogen in any form really whacks me out.  I actually have less PMS, breast tenderness, etc. now.  In fact, the progesterone even helps my hot flashes (strange but true).  That sure wouldn't work for a lot of women.

Hormonal imbalances (excess estrogen or excess progesterone or out of balance testosterone) are often linked to MI; I know they're linked to BP disorder.  Statistically more BP women have polycystic ovaries than non-BP women.  And we all know how our mood swings get so easily triggered when we have PMS.  It's just something to deal with.

Just remember YMMV; we all have different reproductive systems, and we react differently to different medications.  All we can do is get informed, find good medical support, and do what we can to improve our lot.  Sometimes that means estrogen, sometimes that means progesterone, sometimes it means diet changes or dealing with stress differently.  Try to keep an open mind and remember that what works for your buddy may be exactly the wrong thing for you.

Revlow, I used a cervical cap for 15 years and absolutely loved it; I doubt I'll ever use anything else.  It's sorta like a diaphragm except it fits right over your cervix so you really don't feel it.  You can put it in and leave it for like 12 hours, which was nice when going out with a honey, because you didn't even have to think about it.  You have to be fitted with one, which means you have to find a GYN who knows how.  But mine lasted about 10 years before I replaced it.  I'd still be using it now except that I seem to have become a nun. ;)   Anyhow, I hated the diaphragm and have never known how to deal with condoms because I always wanted to take care of my BC myself, not ever really trusting guys. :)

I forget exactly what the percentages were for its effectiveness, but it was at least the mid-90's.  I've never done well with BC pills, and I came of age when IUDs were quite dangerous and painful and don't really want anything to do with them.

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faith:

Thanks for reminding me! This was also an option, during the time I mentioned, that many women explored. An awful lot of us were looking for healthier alternatives.

Obviously, the Fertility Awareness Method and Natural Family Planning take a high level of committment and awareness.

There didn't used to be as many tools to help in this. Back when I tried it briefly, all we had was the the BBT (Basal body temperature) thermometer, and the Billings method (observation of cervical mucus). Which of course was a far cry from the ol' Rhythm Method; these were a real advance. But for me personally, I soon found that my body was too weird to use these methods reliably.

However, there's now hormone monitoring (using a home ovulation test). Haven't used this myself; would assume this to be a big leap in reliability? And by using a combination of all these methods, the reliability goes up even more. The latter is referred to as the Combined (symptothermal) method.

Here's a link: http://www.webmd.com/hw/infertility_reprod...on/hw214032.asp

However, none of these methods (as well as the majority of contraceptive methods) prevent STDs. Condoms really should be considered when possible as an addition (of course it's not a consideration when there are contrary religious beliefs or allergies to latex).

Unfortunately, usless you are in a truly monogamous relationship and know that for a fact, as well as know the sexual and drug-use history of that person, serious STDs happen. And can have dire consequences.

Okay, I'll get off my "mom" box. ;)

Best to all for happy, healthy sex lives! (Yeah, now I gotta figure out how to get me one of dem!)

revlow

PS -- Hope I haven't bored anyone with this historical "walk down memory lane". Again, not the purpose of this thread -- please do let me know if I should move it.

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Goddess:

MI is short for Mental Illness.

Good link for any newbies (and, well, for those of us with short memories) is this Glossary here at CrazyBoards.

And don't be afraid to ask (I ask all the time). The glossary is good, but from time to time, I'll see something that's not listed there.

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The ring is fantastic!

I have heard that it doesn't interfear with any other medications because its not absorbed through your liver like oral bc pills.

It has done nothing but good for me.

It's easy to use and just an all around good product.

They hardest part is remembering to take it in/out. The box comes with stickers you can put on you calendar to help with that.

<{POST_SNAPBACK}>

Ok, sounds like it could be good...but can you tell me if your partner can possibly "feel" the ring when you have intercourse???

oh shit...and what about the patch...does that lower lamictal levels too??

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Ok, sounds like it could be good...but can you tell me if your partner can possibly "feel" the ring when you have intercourse???

yup.

but you can take it out for er, i think up to 2 hours a day, and not loose bc coverage. 

and whether or not your partner can feel it depends upon your combined anatomy... a lot of men don't feel it.

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Gosh, Goddess, I do have tons of pdf's at home that I accumulated pretty quickly upon being diagnosed with PCOS.  If you just type in "PCOS" and "bipolar" you'll get a bunch of hits.  If you just search under PCOS (or polycystic ovarian syndrome) you'll find lots of medical and patient sites with diagnostic tools and descriptions of what PCOS causes. 

If I can unearth some of the pdfs I'll see if I can figure out which sites I got them from.  Basically, any kind of endocrine system screwup is likely to cause some symptom of a mental illness--depression, anxiety, irritability, distractibility, for instance.  And some of them fly under the radar.  PCOS, for instance, often doesn't get diagnosed because the patient is put on birth control, which suppresses the symptoms until the syndrome gets bad enough.  Even then it's often left untreated.  One of ways it's usually noticed is mildly elevated insulin and hypoglycemia.  Many think PCOS is actually rooted in ineffective insulin, which means excess insulin keeps circulating, upsetting endocrine tissues throughout the body.

Anyhow, that might be a place to start.  Like I said, I'll try to remember to post some links.

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Heya ladies,

At any rate.

Anecdotally -- definitely feel different on the ring than on the pill.

I would venture to guess that the ring is indeed delivering less estrogen to my bloodstream than the pill did.

Which would be a novel circumstance of a hormonal product working as advertised.

--ncc--

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Heya Waterfall,

Yeah, I'm not convinced either.

I'm trying it, but jury's out.

No exogenous hormones for you then?  Are your moods messed up by your own "natural" cycles, or okay?

--ncc--

<{POST_SNAPBACK}>

I get PMS.  At that time I feel like I want to go out and leave myself at home!  But since I've been on the Lamictal and Abilify it's much better.

I really wanted the ring to work out for me.  I've always gone nuts on hormonal bc.  I should have known better!

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Okay, I am going to go a little off-topic but because you all are so good at figuring out the hormonal aspects of how Lamictal affects women, I was wondering if anyone had any input for me. PLEASE!

From what I understand, Lamictal is less effective during PMS week. Not just hormones you add to your body, but just your natural hormones mess you up, too.

Does anyone have any advice on how to combat the ineffectiveness of Lamictal during PMS week? Mine is totally severe, and even though I realize it, that doesn't help. Seriously it's like I am on nothing at all, without the hypomania. Which WAY sucks. Do you think birth control would be helpful? I don't need it. And I HATE the way I feel on BC. Plus I gain weight.

My meds are 200 lamictal, 450 Wellbutrin, 20 Lexapro. I mean, you would think that the Wellbutrin and Lexapro would take care of the depression, self-loathing, super-sensitivity, irriation, etc. BUT NO!

Any suggestions would be helpful! Thank you!

Sam

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Heya Sam,

Welcome to the girls-on-lamictal thread.

Also known as the intellectual-personality-disorder thread.

You'd have to go a lot farther than that to get off-topic on *this* thread.  I'm just so glad we're all talking about this.

Finally.  B/c I think we've all been *living* it for a while.

In fact, I wonder about women on Lamictal for seizures, b/c that's been going on longer.  Really - does this all mean they have less antiseizure efficacy on PMS week or on the week off OCP?

For sure, in the PMS week, we have more estrogen and less progesterone (relatively) floating around.

From what I can tell, our *own* hormones seem to mess up Lamictal somehow.

And/or, there's a *separate* PMS effect that just kind of overpowers the Lamictal.

You're right, I would have thought your antidepressants would alleviate the crapping-out of Lamictal druing PMS.

Huh.  OK, well you've tried OCP and it's no good for you. 

I can't say for sure that any *other* hormonal treatments will be any better, although might be worth a try, b/c they can get rid of PMS, and at least even-out your hormones, depending how you use them.

Let me think about it, and let's see if the other women have any experience??

--ncc--

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Sam:

Just throwing this out, cause honestly I don't know my ass from my elbow re: this stuff. But a couple thoughts:

1) When you were on BC before, what kind was it? Was it one that was low-dose? If not, you might consider trying a low-dose BC and see if that is better for you, whether you get fewer and less severe side effects. And some of these (Mircette is the only one I know from personal experience) deliver a more consistant dose of hormones throughout the month. In the case of Mircette, there are only 2 placebo days, compared to 7 placebo days with Ortho Tri-Cylen.

2) If you haven't already, talk with your doc about this. (I know, duh! Why am I even saying this?! 'Cause I'm a compulsive freak. ;) )

3) Get yourself to a good GYN to deal with this? (Yeah, like I have a clue how to find one. Don't bother going back through my posts; suffice it to say, I've gone through gyno hell recently.)

4) Since the BC part isn't an issue for you, as ncc mentioned, possibly continual hormone treatment might work better for you? (I'm just now starting this myself, but in my case I'm menopausal -- so needed this for other reasons.) Some other non-menopausal women here have experience with this. NARS? Any others? Any feedback?

So, a bunch of no-brainer comments from my corner. All I've got at the moment. Like ncc, I'll give it some more thought.

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Thanks, y'all! I'm a member of the Lamictal Chick Club!!! Who hoo!!

Let me clarify. Back in the day when I was supposedly trying NOT to have the three kids I have (heh) I took BC, just for birth control. I felt awful. I had no sex drive, I gained weight...it was just crappy all around.

So, let's pretend that there is this normal person named Sarah. Sarah had really bad PMS but she has no other medical or mental worries. So the week before her period, her estrogen levels soar and some of her progesterone takes a hike. If Sarah was BP and took Lamictal, is there any difference in her PMS chemical makeup?

The real issue here is if Lamictal makes your birth control less effective, right? Because it jacks with your hormones. But BC would be good for me because it would...keep my hormones more stable? Would Lamictal not just mess that up, too? I just don't get it all. I just know that I am SO tired of feeling completely unmedicated for 7-10 days. I just don't see how having no sex drive and gaining weight is going to help my mood any that week. I mean, I already take Lexapro which takes a huge enough toll on my sex drive anyway.  At least with the Lexapro, sex sounds fun. On BC I was all, "GET THE HELL AWAY FROM ME UNLESS YOU WANT ME TO GO LORENA BOBBIT ON YOUR ASS!!"

And I imagine the same thing would be true of the Lithium my pdoc wants me to add to everything else. What is it Jerod says about Lithium on crazymeds? It turns you into a fat old bald guy. Sigh.

My GYN. She is really nice. She told me to talk to my pdoc. Who told me to talk to my doc. Who doesn't know anything about BP. NO ONE KNOWS CRAP!!! I just don't understand how this is all such a mystery.

Back before my BP freak out, they gave me Sarafim, or Prozac in drag, and it seemed to help some. But 20mg of Lexapro is nothing to sneeze at as far as an SSRI goes.

Okay, I am rambling. I hope one day I can be in Good Housekeeping or Cosmo saying, "No doctor could help me with my severe PMDD symptoms which caused me to want to harm myself or others until I met Dr. Knows-His-Rear-From-A-Hole-In-the-Ground!!!!" Who fed me mind-altering berry juice and now I am his love slave!!!!

OKAY THEN!!! Thanks for letting me vent!

Sam 

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Gosh, you've manage to sum it all up in a nutshell! That's the friggin' balancing act we seem to be struggling with here.

My GYN. She is really nice. She told me to talk to my pdoc. Who told me to talk to my doc. Who doesn't know anything about BP. NO ONE KNOWS CRAP!!! I just don't understand how this is all such a mystery.
Yup. I relate. You're preaching to the choir, sister!

I found that going in with print-outs from the official prescribing info has helped a bit. Here's the link to view/download this 57-page document: [url="http://us.gsk.com/products/assets/us_lamictal.pdf"]Complete Prescribing Information for LAMICTAL

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WOW!!!! Thanks, Rev! I have a pdoc appt today so I am going to take that to him! I don't really get the hormone relation to birth control and my PMDD. Maybe it will make sense to him. Maybe I can do a quick search on the internet before I go! FOR SURE a good thing, though!!!!

I'll let you know!

Sam

Newest member of the Lamictal Chicks Club.

That rolls of the tongue nicely, I think!!!

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