Thanks for the info. My doctor doesn't seem to think it's important, plus I don't think they even have those tests available in our system here in Qc...
I went to see him and asked for the 3rd time to have my hormones mapped (for perimenopause and for hair loss). He refused, stating that those results are irrelevant because they fluctuate too much. Plus, only blood tests are available; saliva tests are private ($). I asked to be referred to a dermatologist and an endocrinologist, and his answer was: endocrinologists are reserved for people with real problems (I would bet they are monopolized by all those Trans people... I'll spare you my rant about this topic). I can't see a dermatologist either; he's the one going to tell the dermato about my problem, and the dermato will tell him what to do.
He sent me off with a prescription for regular blood test, FSC, Iron, Ferritine, TSH, B12, Creatinine (and I had to convince him to add vit D because he forgot it) + a prescription for synthetic hormonal pills Aviane28 (oral contraceptive: levonorgestrel 0.1 mg + ethinyl estradiol 20 mcg). Always a pleasure seeing him
I went to see a private clinic that does the complete mapping. The doctor's answer: there is a waiting list, plus with the new law against doctors that the government has just passed, so they can't do those tests anymore...
Me = what?!?
I am not pissed about the health system here... I am livid!
I've read this whole thread and took notes. I've downloaded the book mentioned, but haven't had time to read it yet.
I bought a cream (NOW Foods cream: 1 pump provides 20 mg of bio-identical USP progesterone from wild yam), but haven't used it yet. I reluctantly started taking the Aviane28 pills 9 days ago (on day 1 of my cycle), and today I'm still spotting dark blood, when my period usually lasts 4 days... Is this normal?
It's also been 3 days I'm having muscle aches (mostly in the evening/at night) which are so bad they keep me awake if I don't take metocarbamol (muscle relaxant).
I did some research using Grok regarding hormonal supplementation, and I'd like forum members' insight regarding this.
Grok says:
Yam Cream
20 mg absorbed through the skin gives you 4–10 mg actual systemic progesterone (skin absorption is only ~10–30 %)
Start applying twice daily (~40 mg nominal, so ~8–15 mg absorbed) from day 14, until period starts, then stop.
- Doctors usually prescribe 100–200 mg micronized progesterone (oral) or 30–60 mg topical for cycle regulation or heavy bleeding.
Aviane 28 (levonorgestrel 0.1 mg + ethinyl estradiol 20 mcg)
is a low-dose combined oral contraceptive pill — exactly the kind many gynaecologists prescribe off-label in perimenopause to regain control of irregular, heavy, or unpredictable bleeding when women are still having periods (even if erratic). For a 45-year-old in early perimenopause like you, Aviane is actually one of the most effective and evidence-based options to:
Advantages
- Make cycles completely regular again (bleeding only during the 7 placebo days, or you can skip those and have no periods at all)
- Dramatically lighten or stop heavy/flooding periods
- Reduce or eliminate PMS, breast tenderness, migraines with aura that get worse in perimenopause
- Give excellent contraception if you still need it
- Protect the uterine lining from unopposed estrogen (which lowers future risk of endometrial hyperplasia/cancer)
Side effects
- Spotting or breakthrough bleeding is normal on day 9 when starting Aviane (or any combination pill). The first 2–3 weeks (sometimes even the whole first pack or two) are the peak time for breakthrough bleeding/spotting while your uterus adjusts to the new hormone levels. The color changing from bright/clear red → darker red/brown is actually a good sign: it usually means the bleeding is slowing down and the blood is older (oxidized). Many people notice it starts bright red, stays for several days, then turns darker or brownish before it finally stops.
- Regarding muscle aches in your back and the back of your head: Back pain is reported as a common side effect (affecting 1-10% of users), and pain in the extremities or muscle spasms have been noted in post-marketing reports.
- Headaches are also very common (up to 33% of users), which could feel like aches in the back of the head.
- Slight nausea (feeling like you should eat but also full) is a common side effect, affecting up to 11% of users
Potency comparison
The 0.1 mg levonorgestrel in Aviane is roughly equivalent in biological effect to 200–400 mg of natural micronized progesterone.
Ethinyl estradiol is 50–100× stronger, microgram-for-microgram, than your body’s own estradiol.
Dr. John R. Lee was a passionate advocate for natural progesterone cream in the 1990s–2000s, but many of his strongest claims (especially that all synthetic estrogens are “toxic” and that natural progesterone alone solves virtually every perimenopausal bleeding problem) have not held up in larger, better-controlled studies over the past 20–25 years.
Issue
P= Progesterone-only approach (what Dr. Lee recommended)
LD= Low-dose combined pill (e.g., Aviane 20 mcg EE) or modern estrogen + progesterone
Can it regulate / shorten long cycles?
P= Rarely in true perimenopause. Most women still go 40–90+ days without a period.
LD= Yes – almost 100 % success rate
Can it prevent heavy/flooding periods?
P= Sometimes lightens them a bit; often fails when estrogen is very high and unopposed
LD= Yes – usually dramatically (80–90 % of women get light or no bleeding)
Risk of endometrial hyperplasia/cancer (from unopposed estrogen)
P= Still present if you have long anovulatory cycles (very common in perimenopause)
LD= Virtually eliminated because the progestin opposes estrogen every single day
Hot flashes, night sweats, sleep, mood
P= Moderate help in some women
LD= Often much better because the steady low-dose estrogen smooths everything out
What you can reasonably ask your doctor for (all are evidence-based options in 2025)
- Cyclic micronised progesterone 200 mg oral (days 14–25 or days 16–27) – this is the closest to Dr. Lee’s philosophy with real dosing. It helps many women, but still leaves cycles irregular in most.
- Continuous micronised progesterone 100 mg daily + a very low-dose estrogen patch or gel (e.g., 0.014 mg patch or 0.25–0.5 mg gel) – fully bio-identical, regulates cycles beautifully, extremely low clot risk.
- Keep the low-dose combined pill (Aviane or similar) if you are a non-smoker with normal blood pressure – it’s still one of the simplest, cheapest, most effective ways to regain control.
