From all the research Gaby published here, as well as Dani, who is no longer active on the forum, but contributed to great info, and I also kept researching with the help of Grok, I came to the conclusion that:
- Oral estrogen has always caused me problems, even when I was young, but now I know why. Estrogen is better taken bioidentical and transdermal.
- Progesterone is better taken orally, because it will eventually cause problems when taken transdermally, as per Gaby's post:
Avianne28 is causing me digestive problems (nausea, feeling bloated, intolerance to carbs, food sitting in the stomach too long), so I had to switch to taking it after dinner to diminish those problems, until I finish the pack and see my doctor this Friday to change my prescription. The only positive effect I witnessed: I sleep better. Thank god...
I found out why it does that:
- Oral estrogens (like ethinyl estradiol in Aviane) often irritate the stomach lining, slows digestion, and triggers nausea or that "full but need to eat" feeling. It relaxes the lower esophageal sphincter and delays gastric emptying → carbs that already ferment or sit heavy now feel unbearable.
- Wheat, rice, and many oat-milk coffee drinks are high in fructans or excess fructose → ferment in the gut → gas, burping, bloating. Hormones make the gut more sensitive.
Why taking oral estrogen in the evening works better:
- Gives your stomach a full meal (protein + fat) right before or with the pill → the estrogen is absorbed more slowly and irritates the stomach lining much less.
- Gastric emptying is naturally faster in the evening for many people, so the pill + food doesn’t “sit” as long.
- Peak estrogen blood levels happen while you’re asleep → you skip the daytime nausea/bloating window completely.
- Real-world data: 60–80 % of women who switch from morning to bedtime dosing report that nausea and bloating disappear or become minimal within 3–7 days.
Mood changes, depression, weight gain, breast tenderness, loss of libido, headaches, Spotting or breakthrough bleeding
I want to start hormone supplementation because I'm at the early stage of perimenopause, and I don't want to wait until the symptoms are out of control before stabilising myself. As per Gaby's last post, it might be better to start earlier than later.
Also, I need to reduce my blood loss since my periods are too strong and I'm borderline anemic. For that, contraceptive progesterone doses work better than micronised hormonal therapy doses.
Oral Progesterone choices
- Contraceptive Progesterone (Norethindrone 0.35 mg - Synthetic): Oral micronized progesterone can sometimes cause mild drowsiness or bloating, but it's far less nauseating than the synthetic progestins (like levonorgestrel in Aviane) combined with oral estrogen. Slightly higher chance of mild nausea or mood changes than Drospirenone.
- Contraceptive Progesterone (Drospirenone 4 mg - Synthetic): Best-tolerated modern mini-pill. Very low nausea rate, often lighter or no periods, and is especially good if you also have acne or PMS. Women who are “super-sensitive to synthetic hormones” usually tolerate the best and report the fewest digestive/mood side effects.
- Hormonal Therapy (Prometrium, Utrogestan, 100–200 mg - Bio-identical). Not contraceptive. Best for menopause.
Bio-identical estrogen patch options
- Estradot (0.025–0.1 mg/day; changed twice weekly) – Most prescribed in Canada; Novo Nordisk.
- Climara (0.025–0.1 mg/day; once weekly) – Bayer;
- Vivelle-Dot (0.025–0.1 mg/day; twice weekly) – Pfizer.
Novo Nordisk is a Danish multinational pharmaceutical company founded in 1923 and headquartered in Bagsværd, Denmark. It's one of the world's largest producers of diabetes care products and has grown into a global leader in treatments for serious chronic diseases.
It operates differently from those giants—it's not a sprawling conglomerate with deep ties to agrochemicals (like Bayer's pesticides/Monsanto merger) or a history of major opioid scandals and aggressive patent tactics (like Pfizer's). Its foundation-owned model prioritizes patient access and ethical R&D, with transparent commitments to affordability (e.g., capping insulin prices in the U.S.). That said, no pharma company is perfect—Novo Nordisk has faced criticism for supply shortages of Ozempic/Wegovy and high drug prices in some markets—but it's generally viewed as more "mission-driven" and less profit-obsessed than U.S.-based Big Pharma
Regarding contraception, not that I need it yet, but it's good to keep in mind that it's complicated for many reasons:
Tracking cycle
Women who are fertile and sexually active in perimenopause might find this challenging and not reliable. I had a few surprise, unwanted pregnancies in my life by using the tracking cycle method, even though I had a very regular cycle. I'm now very irregular and want to fix that.
Condoms
Just want to point out that it works great for many people, but there are some minorities for whom it does not work, such as men with erectile dysfunction or with smaller organs. Some men lose their erection when putting on a condom, and some can't reach an orgasm. And there is always the "it slipped/stayed inside" scenario. Then, add those who prefer "skin to skin" and/or being able to be spontaneous.
Copper IUD: hurts like hell
Hormone IUD: never tried, never researched, so I don't know, but I once tried "NuvaRing" (a vaginal ring) when I was young and almost vomited from nausea 3 nights in a row. I cursed and threw it in the garbage.
Hopefully, women will eventually have more support and resources to help them through this transition. From talking to people around me, I realize that most of them are completely lost and have no idea what to do or who to trust. They just endure...
