Peri menopause? Thyroid? B12?

[MrsFitzherbertsGoat]

I've been back and forth to the GP over the last 3 ish years. Periods used to be every 28 days lasting 3-4 days of proper bleeding, now irregular from 20-26 days, last at least 7 days but much lighter / brown (so although longer, they aren't heavier). Also tend to stop / start.

Am 37. All female maternal relatives had menopause in their mid 30s.
Feel constantly tired and have recently started to get dizzy migraines.

Doctor has just offered the pill to regulate periods, no comment / willingness to explore anything else. Apparently it's just a nuisance and just one of those things that women get....

Any thoughts? I'm happy to pay privately for any extra tests. Blood we're apparently all normal, but I'm not convinced, considering symptoms:

TSH 2.4 (same level 2 years ago. Could it be hypo?)
LH 8.9 (seems high in relation to FSH - not done during ovulation surge)
FSH 4.3
B12 248 (this seems low to me)
Ferritin 31 (is this low?)
Folate 17.4
Haemoglobin. 143

What might it be? What tests should I be asking for?

[MrsMulder]

Have you had your thyroid peroxidase antibodies checked? Apparently if they are high it indicates hypothyroid even if your levels are borderline. My GP was reluctant to start me on thyroxine even tho my tsh was 9! She did so because of the positive antibody test. My levels had previously been normal but since being on thyroxine I noticed symptoms I had had for years going away such as cold peripheries, fatigue etc.

[MrsFitzherbertsGoat]

No, GP won't do any more thyroid tests as TSH is 'normal'. From reading posts on here, it might not be. Am looking at home finger-prick tests for antibodies and the other thyroid things, just wasn't sure if it was worth it with a level of 2.4 - I was convinced it was peri, so not sure where that leaves me!

I can't believe your GP was reluctant to treat at 9!! Interesting about the symptoms you'd has for years going. I think part of the problem with things like this is that it is a collection of vague symptoms and younstartvto feel like a hypochondriac if you keep going back to the GP.

[PollyPerky]

Premature menopause is hereditary (not always but tends to be) so you should focus on that.

One FSH test is no good- it can vary from week to week.

You need 2 tests, 2 months apart, on days 2-5 of each cycle for an accurate reading.

Don't let them dismiss this because if you do have prem menopause then it will need treating with HRT sooner rather than later.

read the Daisy network //www.daisynetwork.org.uk for advice

[MrsFitzherbertsGoat]

Thank you Polly. I was hoping you'd answer - I've read lots of your other posts! I did wonder if I should have posted in the menopause section.

The test was day 17, I think. I did query this (on the basis of what I've read on here) but was dismissed with an eye-roll. Doctor won't test again in the foreseeable future.

Should I get a private home test for FSH on day 2-5? Would I need to get LH and oestradiol too, or is the FSH sufficient? I can get FSH alone for £35. Trying to keep costs down as I was going to order thyroid too to cover all bases.

If it's normal - how often should I be re-tested (considering 3 generation family history)? What concerns me is osteoporosis.

[Pleasemrstweedie]

TSH is too high and needs watching. Both B12 and ferritin are way too low and need supplementing.

https://www.amazon.co.uk/Jarrow-Methylcobalamin-5000mcg-Vegetarian-Lozenges/dp/B0013OQGO6/ref=sr112aait?ie=UTF8&qid=1472126755&sr=8-2&keywords=jarrows+methyl+b12

https://www.amazon.co.uk/Solgar-Gentle-Iron%C2%AE-20mg-Vegetable-Capsules/dp/B008Q58OL8/ref=sr113aait?ie=UTF8&qid=1472126812&sr=8-3&keywords=gentle+iron+solgar

Your GP is just noting that everything is within the reference ranges, but that B12 needs to be around 1,000 and your ferritin around 100 to be optimal.

Good advice from a PP regretting thyroid antibodies tested. If you do, and they come back positive, come back here for more advice. You would need to get both types of antibodies tested, Tg and TPO.

[MrsFitzherbertsGoat]

Have found a thyroid test for £59 which tests FSH, FT4, T4, FT3 plus Tg and TPO. Is that sufficient? Also seems to be RT3, but much more expensive and needs a proper blood test.

Is it worth adding vitamin D? It seems to come with some thyroid tests. Or I could just supplement, as I'll be ordering the B12 and iron anyway!

[MrsFitzherbertsGoat]

oh, and thank you you mrsmulder and pleasemrstweedie ! I feel like I've got further on here than in 3 years trudging back and forth to the doctors.

[Coffeepot72]

Given your low B12 result, I wonder if you may need B12 injections, rather than supplements to boost your levels? I was diagnosed with a B12 deficiency last year, I was very tired and dizzy/faint, and kept getting pins and needles. Even though my B12 result was 241, theoretically just at the bottom of the normal range, my doctor gave me a course of 6 injections over 2 weeks, to rectify things quickly. Some people have a condition called pernicious anaemia, which means they don't absorb B12 from their diet, those people need injections for life, but if your B12 deficiency isn't due to that, then once you're boosted back up with injections, you'll be ok with supplements.

[PollyPerky]

This is the relevant page from Daisy

Diagnosis/ tests

Peri meno (whether at average or normal age) is to be considered if your cycles vary by more than 7 days each month and you have other peri symptoms.

If you start to miss cycles altogether or the flow is very light, then you should insist for further tests - sounds as if you are almost there now. I'd push for a referral to a gynae who knows about prem meno, and who is sympathetic, on the grounds of your family history.

If there is a family history of osteoporosis then you should have a DEXA scan now, or at least by the age of 40 if your periods have stopped by then. The usual practise is to repeat DEXA scans every 2-3 years.

[MrsFitzherbertsGoat]

B12 is apparently within normal range...!!! Interestingly, when I queried some specific numbers with the GP, he asked how I knew what the numbers were, then said reception shouldn't have given me a print and he was reading the results based on experience. Or, as it would seem, blind adherence to arbitrary reference ranges in spite of symptoms and where the numbers are at the bottom of those ranges.

He also said 'you are definitely not peri menopausal'. I think I will push for a gynaecologist referral Polly In the mean time, have ordered home FSH to do on day 3. My GM and GGM both had osteoporosis. Would the DEXA scan be arranged by GP or at a gynae appointment? Really fed up with the repeated fobbing off by the GP.

[Coffeepot72]

I would argue about the B12, OP. My GP commented that whilst my results were in the very bottom of the normal range, it was clearly far too low for me - and given your results are similar to mine, I would assume the same advice applies to you. And if I needed B12 injections, I'm guessing you do too.

[MrsFitzherbertsGoat]

I'm thinking about changing GP, coffepot.

[PollyPerky]

well, your GP was 'right' to pass that comment on the basis of those results BUT he didn't do the tests at the right time or repeat them. I'm amazed at how GPs don't know these basics when even a quick google would tell them and the general public. I mean , what are they teaching them at med school?

Your Gp could refer you for a DEXA scan or a gynae could. You can also self-refer if you can find a private provider. There'd be no problem finding a place in central London for example to do it (self refer) but harder in other areas. I had my first DEXA scan by self referral - purely out of interest (no risk factors) and got a nasty shock.

[MrsFitzherbertsGoat]

The London Imaging Centre do a DEXA for £65. I'm nowhere near London but will be there in a few months for work so could fit it in then. Edinburgh prices are in the hundreds! I've already spent £110 ordering thyroid and hormone tests today!

Thank you all: will undoubtedly post again with results of thyroid and correctly timed FSH.

[PollyPerky]

£65 doesn't sound right. London fees are around £200. You need to make sure it's a full DEXA scan and not just a heel scan which is useless.

[PollyPerky]

I'd be wary of the £65 one. This is what it says on their site:

DXA for the detection of osteoporosis – £65
DXA + Instant Vertebral Assessment (IVA) for the assessment of vertebral (spine) fractures – £99

I don't know what the £65 scan offers, but if it doesn't include an assessment of your spine and hips, then it's not a full scan . I suspect that for £65 you would get a wrist or heel scan which is useless. At best it would show up advanced osteoporosis but the sites that ought to be measured are spine and hips/ You need a lumbar spine scan and a pelvic /hip scan. Anyway- push for one on the NHS first.

[MrsFitzherbertsGoat]

I will push for the NHS one. It might also be covered by my health insurance, shall have to query that one. The policy excludes initial consultations etc but does include some diagnostic things.

[devilinmyshoes]

How on earth is TSH of 2.4 too high?!

[PollyPerky]

OP I'd not panic about the DEXA scan. Osteoporosis takes years to develop. If your periods had stopped at 35 and you'd had no HRT for 10 years that could / would be serious and a scan essential. If you'd had 5 years with no oestrogen, ditto. But your periods are more or less regular now, so unlikely your bones have suffered yet.

[Pleasemrstweedie]

In a healthy, unmedicated person, you'd expect TSH to be around 1.

[devilinmyshoes]

Didn't see OP was on thyroid meds but I've had my TSH and T4 checked twice a year for about 17 years (because on meds that cause hypothyroidism) and TSH was always around 2 or 2.5, right in the middle of the range, when my thyroid was healthy. I know ranges vary but not that much!

[ArgyMargy]

I'd be looking to change GP purely on the basis of the comment about "you shouldn't have a copy of your results". Ridiculous, patronising, shitty attitude.