Why are GPs so clueless with Peri?

[Joto369]

I'm 48. My symptoms include hideous anxiety, mood swings, foggy head, midcycle migraines, chin hair and itchy nipples, drier bits and if Johnny Depp crawled into bed with me I'd tell him to sod off. Underneath all this crap (and that's a shortened list) I feel like me. I just want to shake my whole self and then I may feel ok. There is a pattern with it all BUT my periods are still regular so they won't do a thing. Has anyone got any advice or maybe a magic wand?

[PollyPerky]

I suppose it depends what you want your GP to offer.
They don't have the time or expertise to offer much, especially when it comes to an holistic approach to meno (or health per se.)
It also depends on what you feel is the way forward.
If you want to improve things 'naturally' then there is a lot you can do with diet, exercise, relaxation (yoga etc) to try to make symptoms a bit better.
If you want to try HRT then you need to be more assertive with your GP and ask for it, listing your symptoms as typical of peri. The ought not to refuse 'just' because your periods are regular. But at the same time, peri can be helped a lot with lifestyle changes. You ought to ask for vaginal estrogen though if your bits are dry and sore because they won't get better any other way! :)

[Joto369]

Thanks Polly. The options offered were anti depressants or an HRT pill (?). I am using KY bits wise as with everything this symptom fluctuates. I tried vagifem a year or so back and but my mood worsened (I know it's not supposed to be systemic but I've read this as a side effect on another menopause forum). I'm going to try acupuncture/acupressure tomorrow and I've downloaded headspace along with spotify so starting to use that too. I suppose it's the up and down ok-not ok feelings that are so wearing. I'm up now having fallen asleep at 730am to get rid of a migraine I've had all day along with the accompanying nausea and I'm weepy and anxious. This along with the usual sore breasts and feeling like my period is on the way though it's not due for 11 days! !! I've a Gp call back scheduled for Wednesday so will have another chat.

[gleegeek]

OMG! You have pretty well described me to a 'T'. Went to the gp and was told at nearly 46 I'm too young for the perimenopause! Have you had any racing heart type symptoms too or horrific nausea??? I feel like I'm going mad... I left the surgery with a prescription for proactive but feel too scared to start down that route. I'm not at all depressed and the anxiety doesn't seem to relate to real worries, it's just there.
Aaagh I hate being a woman at times! I almost feel like i did when I was pregnant (I'm definitely not!) So feel it could be hormones but periods are still fairly regular but different in length and style.

[gleegeek]

Sorry see you mentioned nausea with the migraines!

[Joto369]

Hi gleegeek! I get ectopic beats where they kind of skip and then a lump in my throat thing which is odd. Sometimes it races too. I'm glad I'm not alone - I feel like I'm going mad too which clearly we're not! And yes re the anxiety and depression! I'm looking forward to things - hols concerts etc but sometimes feel like Im in a real fog. It's bloody exasperating! ! Oh. And insomnia. Aching joints. Dry eyes. Etc etc! I assume you meant prozac not proactive??!! 😂😂😉😉

[Joto369]

Forgot periods are shorter and really heavy or usual length and light. With a heavy day just when I think it's done 😡

[PollyPerky]

Joto- I'm confused !
Are you saying your GP offered you HRT in pill form? If so, why didn't you accept it?

To be honest, there are no other treatments available from a GP and ADs are not supposed to be offered for peri menopause (unless women have had /got cancer or other serious illnesses where HRT isn't suitable. Glee These are NICE menopause guidelines.) Please read the meno guidelines so you are up to date with what your GP ought to offer and not offer. The guidelines are easily found through Google or the Home page of [[www.menopausematters.co.uk

Vagifem and Ovestin are not absorbed systemically. If they are, then it's only in such a minute quantity during the first few weeks when the vaginal mucosa is still thin. Once it's built up again there is no absorption. Also, oestrogen is a mood lifter- it's not going to make you feel worse.

[Joto369]

Thanks for the guidelines Polly very informative. I understood the GP meant the pill but I may be completely wrong so I'll check on Wednesday when I speak to her. Vagifem was prescribed for bladder issues and occasional dryness (I didnt have full blown VA) and I switched to gynest cream which has less oestrogen in and that was fine. I only used it for a few weeks as the symptoms went used sulk amd then nothing. Now it's just during sex that I feel drier but it's not impossible! On a day to day basis it's fine! I understand oestrogen is a mood lifter but what about oestrogen dominance which causes it's own issues? Isn't that why it takes time to get HRT levels right for each person?? I'm just curious. I've had period/pms problems including polycystic ovaries for 30 years - feel hostage to my hormones! !! 😂😂

[Joto369]

Used sulk 😂😂😂 sorry I meant sylk! !!!!!

[PollyPerky]

If you find you need some more help 'down there' ! you might want to try Ovestin cream which is a weaker estrogen than the one in Vagifem. It's the same as in Gynest which Gynest is 10 x weaker than Oveston- or rather, you have to use 10x as much- the applicator is huge!

Your Gp may have meant Qliara (sp) which is a birth control pill with levels of hormones sometimes used for younger women in peri, but at 48 you don't really fall into that group (sorry!) It's more for women late 30s/ early 40s.

There is no such thing as oestrogen dominance. This is/ was a myth invented by people in the US (Dr J Lee) who made progesterone cream (which is useless as the body can't convert it into a form of progesterone that works.)

It doesn't always follow that it takes time to get oestrogen levels right. Sometimes it does, but it's usually more a case of starting low dose and gradually increasing if the symptoms are not being controlled. More often, it's the progestogens that are a potential issue: there are around 4 types (taken for half a month) and some women find some types gives PMS type symptoms. There are usually only 2 doses of oestrogen- 1mg and 2mg. Gel can be used in anything from 0.75mgs daily-3mgs daily (you adjust it yourself.)

During peri when we tend not to ovulate every month, the cycle is not completed. No progesterone is produced without ovulation. This is 'vaguely what is meant by 'oestrogen dominance' but it's completely misleading. The only symptoms of 'ED' might be heavy periods when the lining builds up due to no periods for a few months, then comes away as a heavy period.

[Joto369]

Oh lordy it's very complicated!!!! Could the fact I don't ovulate every month as in the polycyclic ovaries mean I havent been producing progesterone? I went years without a period about 10 years ago but oddly had pms every month just no bleed? Thank you for your extremely informative words. And there was me thinking I was still a younger woman in peri 😂😂😉😉

[FurbysMakeSexNoises]

Replens is another great lubricant women mention. I echo the response above regarding oestrogen cream- mood changes are coincidental. You can have Qlaira perimenopausally though if no other risk factors.

Or you could consider a Mirena coil for Period control and patch/gel oestrogen so you can minutely control how much you need.

Menopause Matters is a great website and will tell you what works and what doesn't in terms of self management and alternative therapies.

[Joto369]

Love the name! I assume by risk factors you mean cancer etc like the pill if yes I've none. It is a fantastic site yes. I've not thought about coil mainly as I don't need contraceptives (sterilised) so it literally would be symptom control and the main of that is mood. Spoke to my mum this morning and her periods stayed regular and then just stopped so by my GP standards she wouldn't have been offered HRT either!!

[PollyPerky]

It's not that complicated- honestly!
HRT replicates a normal fertile cycle. So over 28 days you'd normally have 28 days of oestrogen and 14 days of progestogens ( if it was pill form.)
Almost all oestrogen now is body-identical(meaning it's molecular structure like your own) but there is only one sort of progesterone that is natural. The rest are synthetic and that's why some trial and error might be needed.

But be aware that it's usually only women with problems who post on forums- many women are getting on really well with their HRT and don't need advice.

Yes, if you have PCOS then you may have had only a few periods a year but it's not worth worrying over that. You don't need progesterone . It's only use in the cycle is to make the womb lining grow thick for implantation. It doesn't affect your mood (except adversely) in any way.

[PollyPerky]

Spoke to my mum this morning and her periods stayed regular and then just stopped so by my GP standards she wouldn't have been offered HRT either!!

Why? Many women (including me) only started using HRT when our periods stopped. Mine stopped at 53- I had no peri symptoms except a short fuse- and periods got slightly irregular for a year. I started HRT after that for hot flushes, bladder issues, insomnia etc , and have been using it for several years now.

HRT isn't just for peri- many of the horrible symptoms only begin when periods stop for good.

[Joto369]

Sorry I meant in the peri stage which she suffered badly in!

[FurbysMakeSexNoises]

Thanks I love my name too! As you can see the peri and menopause is pretty complex so might be worth returning to talk to another GP who feels more comfortable with it as a topic- requires lots of keeping up to date. There is no one size fits all and some of it is just trial and error.

I fit loads of Mirenas for women wanting them for cycle control and as a component of HRT rather than for contraception.

[PollyPerky]

Your GP is clueless if they think that irregular periods are he be all and end all of peri and a reason for HRT.

Some women don't have irregular periods till almost at the end of peri. Any change in periods such as lighter, shorter, heavier etc all 'count' as peri.

[PollyPerky]

Furby are you are GP?

I agree with all your points but I don't think it's complex for GPs to keep up with the guidelines. NICE guidelines came out Nov 2015. There was a HUGE amount of publicity in the media on it - from This Morning to women's mags, features in broadsheets- and the British Menopause Society runs courses all year round across the UK as well as their annual 3-day conference in London. There is really no excuse for a GP not to update themselves; as part of my work I read the NICE guidelines and, as a non-medical person, if I can follow them so can a GP.

One of the biggest issues is that women aren't reading the guidelines so they are accepting poor treatment by GPs who are behind the times.

[FurbysMakeSexNoises]

Yes I am and I agree with you really but didn't want to diss her GP too much.

[FurbysMakeSexNoises]

Are you a GP with special interest in menopause? Had considered doing the extra qualifications but the money and time put me off and don't do enough to make it worth my while unless I was going to do private clinics.

[Joto369]

The criteria was changes in periods and hot flushes! I get some night sweating but not the drenched in sweat kind. As I'm sat here now I have period pain cramping my breasts are heavy and swollen and as for my mood - fluctuating between anxiety and tears and then perfectly ok thanks! But my period isn't due for 9 days. I feel if I could sort the mood then the rest would follow! !!!

[thekingfisher]

Joto, would you consider seeing someone privately? I went to my GP with similar symptoms - i'm younger however, but had had a hysterectomy(retaining my ovaries) As i had no periods to track the GP did blood tests which came back 'normal' (Ha!)
So she tried to suggest that that was that. I was clear that I couldn't continue feeling as I did - she then tried to offer me AD's - i clearly stated that i wasn't depressed and finally she did agree to refer me to a consultant who specialised in menopause issues.
It was a really frustrating process as she ignored the NICE guidelines, tried to offer me AD's and only when I said that I needed more assistance than being reassured I wasn't about to die ( according to the blood tests) did she reluctantly refer me. This is the GP who is supposed to be the specialist in the surgery in women health. Anyhow saw the consultant and within 10 minutes of talking through my symptoms etc she had said in her mind I was clearly menopausal and prescribed Evorel 75 ( a patch) .
I'm only at the end of the first week and I can't say i ve noticed huge changes - however my sleep has improved immeasurably and I fancied a shag .... so some upside!

I was just so disappointed in the GP, it wasn't like the consultant needed any persuading or convincing....

[thekingfisher]

Joto - i also didn't have hot flushes but described it a bit more as trouble regulating my temperature - feeling un reasonably hot and then hot at night sweaty - not dripping and certainly no instant flushes and dripping that the GP seemed to think I should be having..

[Joto369]

Fancied a shag .. Kingfisher thank you!!!!! You made me laugh 😂😂 I would walk to the end of the earth and back to stop feeling like this!!! I know I will be offered AD's again as I had some relationship issues and a car accident at the end of last year which are stressors yes. BUT I had started to feel better - not brilliant but better. Eating better sleeping better. I have no issue with going to work, planning things, going to gym etc which doesn't sit with depression. My first dip was aftercare period and it felt exactly like this one which is 9 days before. I considered paying privately too and I think I can self refer to one in Leeds.