perimenopause and FSH

[vintagefiend]

Hello, ok it's a long one!
bit of a niche question: is it possible to have a normal FSH (result from one blood test), but still be in perimenopause?
I know I'm in perimenopause based on symptoms- for example my PMS is becoming unmanageable...extreme anxiety etc and this is not something I experienced in my twenties or thirties...I am 42.
In addition, I have extreme fatigue, acne, headaches and horrible mood swings throughout the month...definitely new (within last couple of years) symptoms, not experienced previously. Periods becoming erratic in timing, length and heaviness.
However, I saw gp about 1yr ago with this problem, had fsh blood test and it was fine- so tried mirena coil which was awful (tho i know it works for some)!
Symptoms have inevitably worsened over the last year so I returned to gp today and begged for HRT!
To be fair he was great, really listened but felt that, from medico-legal point of view I ought to have FSH checked to see if I am in perimenopause- so i've had my blood test today...await result.
i'm concerned that- given hormonal fluctuations, my fsh might be ok today and i did put this to the gp and he agreed, it could be misleading. He was v honest with me- he's not particularly up to date with hrt/perimenopause and was happy for me to tell him about oestrogel/utrogestan!! he's not a defensive gp.
however, i'm worried that if my fsh is normal- he may be reluctant to prescribe hrt... tho he did acknowledge my "compelling" argument based on symptoms!
Obviously, i'm quite young- but my mother and aunt were early and mid forties for their actual menopauses- i told this to gp and he said that was important.
So i guess i'm asking, would he be going way out on a limb in prescribing me hrt if there's a lack of lab evidence? am i too young- or can a patient's symptoms be enough for diagnosis? how does the amount of oestrogen in oestrogel compare with contraceptive pill (combined) which i have been offered fairly recently, so if they're happy for me to have oestrogen in oral contraceptive pill, could i argue for oestrogel?
i return to gp on friday- to get result- and hopefully commence hrt. he's definitely happy for me to research and advise him- so if there is evidence that women in early forties with symptoms of perimenopause can legitimately be treated with HRT, I need it!
thanks so much for any help.

[pinkfrocks]

There is a link in this thread for the latest NICE guidelines that came out on 1 June- it's maybe about 10 threads down.

The advice is there about FSH tests- you will have to go into the doc and find it.

What is says is that for women aged over 45 FSH levels are not required. For women under 45 they have a place as you may be having a premature menopause.

BUT tests are not reliable. Your Dr should do 2 tests in one month: one on day 3 and another after day 14 if you have an average 28 day cycle. he ought to know this.

On the otherhand, if you use HRT and respond well, that's the answer- proof of the pudding.

[vintagefiend]

thank you very much, pinkfrocks- i'll have a look now!

[vintagefiend]

Hi Pinkfrocks, if you're around?! or anyone with hrt experience!
I have read the guidelines and they don't seem to cover the issue of HRT for symptomatic relief (of under 45s) in the absence of corroborating blood test, so, I wonder if it's at the discretion of the doctor.
I have phoned a prominent harley street gynae's clinic, to find out costs and whether he performs blood tests routinely. Seemingly, he does perform bloods but he also prescribes HRT immediately based on symptoms and prior to blood test results. If the results show eg liver failure then he might reconsider prescription....what I don't know is whether he's that interested in FSH levels.
But certainly, he prescribes HRT based on symptoms...though of course I don't know if he has a caveat for under 45s
I'm just trying to work out what he does without shelling out the best part of a grand!!
Cheers for any help- I see my gp again on friday and i really want to leave clutching an hrt prescription!

[Mimigolightly]

Hi - I'm 41 and I was lucky in that my doctor prescribed HRT purely on the basis of my symptoms. I had numerous blood tests for FSH, LH and the results were all over the shop - completely inconclusive. I've been on Evorel Sequi patches for 5 weeks now and symptoms such as anxiety, hot flushes, night sweats, hair loss, etc have almost disappeared. I'm still a bit emotional at times but I guess that's path of the course when taking hormones.

Take a copy of the NICE proposed guidelines when you see your GP again on Friday just for his information.

Good Luck

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will this pass info on to my gp- obviously it's anecdotal but i do think he's not resistant to the idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will pass this info on to my gp- obviously it's anecdotal but i do think he's not resistant to the whole idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will pass this info on to my gp- obviously it's anecdotal but i do think he's not resistant to the whole idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will pass this info on to my gp- obviously it's anecdotal but i do think he's not resistant to the whole idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will pass this info on to my gp- obviously it's anecdotal but i do think he's not resistant to the whole idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will pass this info on to my gp- obviously it's anecdotal but i do think he's not resistant to the whole idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will pass this info on to my gp- obviously it's anecdotal but i do think he's not resistant to the whole idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will pass this info on to my gp- obviously it's anecdotal but i do think he's not resistant to the whole idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

Thank you, Mimi- it's extremely helpful- and reassuring- to know that GPs will prescribe based on symptoms alone- and to someone under 45. I will pass this info on to my gp- obviously it's anecdotal but i do think he's not resistant to the whole idea!
and i'll take a copy of the guidelines
thanks again!

[vintagefiend]

oh whoops! sorry for multiple post!!!

[pinkfrocks]

Hi Vintage- am around now.
What do you want to know? Your GP is able to prescribe on symptoms alone- they can do what they want within reason- but the NICE guidelines were - I assume- more about not wasting money and resources by putting women over through blood tests and the suggestion was that GPs ought to prescribe more on symptoms than blood tests which are not reliable anyway.

I think your quote for your Harley St consultant sounds excessive - though without a breakdown of the fees it's hard to know. Most 1st appts are around £250, blood tests can be anything from £25-ish for something simple to £600 for something complicated.

PM me if you want more info.

[pinkfrocks]

women over 45 that should say!

[vintagefiend]

Hi Pinkfrocks- thank you again..hope i'm not hassling you too much!
To be honest what you say- about GPs being able to prescribe on symptoms alone is all I need to know and, boy! does it gladden my heart! I was worried that i was putting my gp in an awkward position but if symptom-based diagnosis is encouraged then i don't feel that i am especially if blood tests are notoriously unreliable.
the quote was for prof john studd who's obviously been mentioned on here- something like £600 for initial consultation plus £100 for blood tests and then around £100 to a pharmacist for a private prescription so: yikes!!
very kind to offer more info- i will see how my appt goes and hopefully i won't need to badger you again- but if it doesn't go well i may be messaging you for consultant recommendations!
cheers

[vintagefiend]

or it might have been £650 for consultation and £50 for bloods- something like that.

[mandmsmummy]

vintagefield are you me? I actually checked I hadn't written this thread!
Keep us posted xx

[vintagefiend]

ha! i will do , mandmsmummy- think a lot of women feel like us x

[Kontiky]

Hi

I started experiencing very similar symptoms to you not long after I turned 40. My PMS started getting more and more severe coupled with feeling very depressed the week before my period was due. It got so bad I had to organise my social life around my PMS.

Then just after I turned 42 I suddenly started experiencing extreme anxiety and agitation for no reason. I had insomnia for the first time in my life. I became irrationally afraid of being left alone and hated it getting dark outside. I stopped wanting to cuddle my children and hated looking at myself in the mirror.

I thought I was going mad or having a breakdown.

Saw a GP who thought it could be hormonal as I would still have several normal days per month but he referred me to a consultant to double check.

The consultant immediately diagnosed with hormonal anxiety/depression caused by early ovarian failure. He diagnosed me even before getting the results of my blood tests. He told me they would still probably show 'normal' levels of FSH (which they did). He said he treated dozens of women just like me every year. Some as young as 30

He started me on HRT 2 months ago and I think it's starting to really work

[vintagefiend]

thank you so much, kontiky- that really is great for me to read.
it certainly resonates, the managing your life around pms...and then anxiety at other times of the month until making arrangements is nigh-on impossible! fab to hear that hrt working for you.
it's annoying to think that my normal fsh prevented any hrt when i saw the gp a year ago- i've had such a pants time and i know everyone on here can relate!
could i ask a couple of questions: was it a consultant gynaecologist that you saw? daft question but just so i know!
also could u tell me what he prescribed?- not that i'll necessarily demand it but i'm just getting an idea of whats available.
thanks again.

[Kontiky]

Hi

I think as I neared 40 my PMS actually morphed into PMDD which is much more serious and destructive. But it crept up quite slowly so I didn't really notice until one day I realised I was actively avoiding doing anything for at least 14 days per month because I knew I wouldn't enjoy it due to feeling very low and detached and depressed. Some months I would only get around 7 good days, usually around ovulation. The rest of the month I would feel very flat, irritable and uptight.

Unfortunately most GPs know very little about peri menopause and its symptoms. I have several friends who were fobbed off by their GPs who seemed to think that you could only be peri menopausal if you were over 50 and having 20 hot flushes a day. Useless.

I saw a consultant gynaecologist at a specialist menopause clinic at a large teaching hospital. He prescribed me Estradot 50mg patches with separate 200mg of Utrogestan to take on days 15-26 of my cycle.

[vintagefiend]

thank you kontiky for the meds info also for the honesty about your symptoms...i have some horrible thoughts sometimes and it helps to know that this is not unusual

[Lauren83]

Sorry not read full thread but I got it no probs, my endocrinologist wrote to my gp (I had my FSH checked) suggesting I was put on it and they did, I was 29