Am I being a hypochondriac, drain to NHS?

[Iamthinking]

I am one month past my 45th birthday. I have very irregular periods, they started going kooky when I was 41/2, but I didn't pay much attention.

Apart from night sweats that I got for about 4 months at around 41/42, I haven't had them since. Which is odd.
I have no other symptoms that I have noticed other than some things that could easily be nothing related to hormones at all. No night sweats, no flushes, no aches and pains.

I have now skipped 3 periods, so I thought it was time I should go to Dr as I am worried about osteoporosis and heart problems and getting some protection from them.
I was told that they treat only the symptoms, so no to HRT, and I am over 45 (one month) so it is not early menopause. He would not prescribe me HRT until after 12 months of no periods.

I feel like if I had just got my arse in gear and made the appointment a couple of months ago, I would have heard a different story. But also, I really DON'T want to be a drain on the system and should maybe count myself lucky that I don't need it yet.
In the appointment I was really pissed off, but have just come on here and read the NICE guidelines and my position seems to be really opaque and I am wondering if he was actually right.

I just worry about heart protection quite a lot as my father had a heart attack early, and his mother before him.

Or am I being a hypochondriac?

[PollyPerky]

If you can, change your GP- anyone else at your practice?
Your GP knows nowt, to be blunt!
What on earth is the matter with these GPs???
The whole point of HRT is that it's there for peri meno (and post meno too) when women have symptoms. So saying you can't have it until you are post menopause is just rubbish. There are thousands of women having periods who use HRT.

You won't be given HRT as prevention for heart disease and osteoporosis unless you have evidence that you have a family history of osteo, or you have a bone density scan that shows you are at risk. but you will be given it for peri meno symptoms. Missing periods in your early 40s is s sign that your oestrogen levels would have been lower for some time. The average age of meno is 51-52 so you are earlyish. Keep a diary of your cycles. They may settle down again for a good length of time.

My suggestion is:
see another GP
If they are still talking rubbish, see if there is a NHS menopause clinic in your area
if there isn't and GP is useless, consider a private appt with a gynae/ meno specialist. The NHS is not the only means of getting medical care.

You need to discuss your worries about osteoporosis with someone who will listen. You could also ask for a DEXA bone scan to get a base line for your bones now.

The good news :) is that if you have missed 3 periods then you are likely to have all the other meno symptoms soon -ish!

[Iamthinking]

Polly, thanks so much for your reply.
Yes, I could get the symptoms soon, or I drift into menopause one of the lucky 20% without. Nice on one level, but I would be worried on another level.

I did book another appointment with the main older doctor at the practice, the one I saw today was young so not long out of medical school. I am going to see him on Wednesday - I am just trying to garner more information before I go in then to ensure I say all the relevant things, and know the facts. If the Dr can answer my questions in a credible way then I would feel like I had properly been listened to. I am not sure I do at the moment.

However, the Dr I saw today said that all the docs would say the same as hims - it was the standard policy that lack of periods/irregular periods don't count as a symptom, so I don't merit consideration for HRT.

I have just found a menopause clinic in the Borough though!! I didn't know such things existed. I can try for a referral there maybe. Thanks for that idea. I think if someone who I trust can speak to me and tell me that I shouldn't have HRT yet, then that would put my mind at rest a lot.

[Sprink]

OP, if you have a family history of heart disease then HRT might not be suitable for you.

The 80s and 90s advice has been challenged so it's worth asking your doctor specifically about the newer research.

www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550

[confusionis]

Get a second opinion. Your GP may have very valid reasons for saying no to HRT, it doesnt make her a rubbish GP. and as for NICE guidelines, they are just that, guidelines. Your family history warrants a closer look and its possible your GP has already taken that into account, or not. Just put your own mind at rest, by getting a second opinion.

In my experience people who worry about being a drain on the NHS, never are. Its the entitled ones, who are rude and obnoxious and demand things because they read it someplace random. Who attack peoples professionalism, etc etc.

[Abraiid1]

The NICE guidelines for prescribing HRT say:

Guideline recommendations include:

In otherwise healthy women aged over 45 years with menopausal symptoms, diagnose the following without laboratory tests: perimenopause based on vasomotor symptoms (hot flushes and night sweats) and irregular periods; menopause in women who have not had a period for at least 12 months and are not using hormonal contraception; menopause based on symptoms in women without a uterus

So women with irregular periods at 45+ are included in the group who can be treated in this way.

[Iamthinking]

You see, that NICE guideline suggests to me you have to have both the irregular periods and the vasomotor symptoms. So today's Dr was right according to these guidelines. But if I had gone along this time last year I would have been in the under 45 category with period irregularity. I just didn't get round to it.

[Hassled]

I was put on HRT at 46 while still having periods - on the basis that I was a hormonal mess (either furious or sobbing), was very irregular and for a long time was actually having 2 periods a month, was sweaty and generally miserable. It's done me the world of good and I feel like myself again, after a horrible couple of years. Please try another GP.

[PollyPerky]

Sprink the research on HRT and heart disease shows that there is a significant reduction in it amongst women who use HRT within 10 years of the menopause. This is acknowledged by the BMS and the IMS.

This link from the BMJ shows you the info www.bmj.com/press-releases/2012/10/10/hrt-taken-10-years-significantly-reduces-risk-heart-failure-and-heart-atta
The Mayo Clinic is not the BMJ or NICE.

So someone with a family history of heart disease (which in fact is pretty much everyone as cardio disease is the No 1 cause of death in women) should be aware they are reducing their risk by using HRT.

My gran had a heart attack at 60 (she was very overweight and inactive and it was decades ago- born 1896) my mum had a TIA at 80, so my view is that I'm reducing my risk by using HRT.

Also, my consultant who is one of the foremost drs on menopause in the UK never even asked about family history when he prescribed HRT for me.

confusion1 Guidelines in the medical world mean 'Do what we suggest'. what else can they mean? NICE looks at dozens of studies and has a panel of consultants who are far better qualified to advise than GPs. To suggest as you have that a dr can read the NICE guidelines then just say 'I'm not doing any of this' is wrong.

[Sprink]

The Mayo Clinic is not the BMJ or NICE.

Um, okay. I'm not sure I see your point.

Should the OP only consult sources that you believe, or is she allowed to research on her own?

All I suggested was that she ask questions.

Also, my consultant who is one of the foremost drs on menopause in the UK never even asked about family history when he prescribed HRT for me.

Again, okay. But this is anecdotal and proves nothing.

[PollyPerky]

Sprink Of course the OP is allowed to do her own research; posting the link from the BMJ was supposed to be helping her do that!

I'm not giving an opinion. I linked to a report published in the BMJ (British Medical Journal) which was a summary of a peer reviewed trial. So that is a link to a scientific journal, nothing to do with my 'view'.

As far as I know, the Mayo Clinic is a US based health business- it has an online site which is the equivalent of a 'magazine' publishing health articles. It's also a means by which people in the US can access drs who advertise on the site.

The link from the Mayo clinic refers to opinions about HRT in the 1980s and 1990s, then says 'new research' has shown risks with heart disease. The 'new research' they are talking about is the WHI study (2003) done in the US and has now been discredited. In other words, the info on the Mayo site is out of date. Also, HRT used in the US tends to be of a different type to the UK.They use CEE ( oestrogen from mares) and synthetic progestogens. In the UK these are not used so much as they are considered to be riskier.

[Lizzzar]

The Mayo Clinic is nonprofit. It is not a business of any sort. Although they do publish health information for free on the internet, no one has to read it if they don't want to. They may publish based on other research, but they also frequently do their own research.