To try HRT before the menopause has started

For my gp the gate way to hrt is “sexual dysfunction”
when i said I’d probably want more of it if my husband did more washing up etc he agreed to give me HRT, before I said that (despite loads of peri symptoms) he was telling me I wasn’t ready for it.

Get a second opinion!!

HRT is for perimenopause not just menopause.

I experienced symptoms from 40 and spent three years thinking I had chronic fatigue syndrome. Hot flushes were not one of my symptoms. As still under 45, I went private to get HRT but now I’m 48 I’m back under NHS care.

I was nearly 50, but I exaggerated the symptoms! Got prescribed HRT no problem. It has a number of benefits, apart from making us feel better. Some experts believe that the risks are over stated and that women can remain on it indefinitely!

Get your bloods done first for vitamin / iron deficiency and thyroid check. I have very belatedly started HRT and after just one week, the difference has surprised me.

I started HRT at 46 - fobbed off by GP so got prescription through Boots online service.

@Cloud44 often for younger women a combined pill can be really beneficial. By inhibiting ovulation and giving you a “steady state” of oestrogen it can be helpful for fluctuating hormone levels.

The newer pills which contain estradiol rather than ethylestradiol eg Zoely, Qlaira, can be beneficial for younger perimenopausal women as the estradiol is more similar to HRT oestrogen. They also have contraception.

Thank you @Sidge , I don’t want to really come off the combined pill but I feel I may be starting to experience some peri symptoms but it may be best to stay on it and see if it reduces symptoms? It’s a minefield!

No you can’t.

And yes it sometimes can.

You do all realise that the GPs aren’t being deliberately obstructive?

It’s the specialists, eg consultants who determine the referral criteria. If you don’t meet the criteria a GP can’t refer you. In many areas (including the one I work in) secondary care services are under such pressure gynae waits for routine outpatients can be over a year.

Yes the GPs should be open to prescribing HRT. Yes waits shouldn’t be so long. But it is what it is. The NHS is in crisis and menopause isn’t seen as a priority.

This is probably a silly question but can you take HRT when on the combined pill? And does the pill mask some peri symptoms?

Interesting thread, thanks op.

I went to the GP 18 months ago with a list of perimenopause symptoms. I was 42 and she said I could not be prescribed hrt as I still have regular periods.

I ended up quitting my job and now do a much more junior part time job as it's all I can cope with. I'm a mess.

Having read this I might try to see a different GP.

No- see a gynaecologist who actually knows their stuff, they will help you.

They are worth their weight in gold. Don’t waste your time with a GP who is not usually trained in this field unless they are specialised in women reproductive system. I actually know couple of GPs who have done that but it is not the norm.

It might be perimenopause, it might be other things. I’d want to do some bloods first for eg anaemia, thyroids, haematinics, vitamin D.

Then assuming all normal trial some oestrogen gel. I am very pro HRT for most women but do feel that for some it’s inappropriate and others need to manage their expectations. Lifestyle is absolutely crucial too. Smoking, drinking, poor diet, lack of exercise, stress, relationships, all contribute to many of the symptoms that women assume are due to the menopause.

I started at 41 and thought I would have to go privately but my GP prescribed oestrogen and progesterone. Eventually went to Newson clinic to get testosterone too. Had gone to a talk by her when she said sooner the better. Had no obvious menopause signs like hot flushes or no periods but was very anxious and couldn't sleep. HRT fixed that for me. Good luck

I'm reading this thread closely. Thanks for starting OP. I've been toying with the idea of speaking with my GP about possible peri and HRT.

I'm 42 and have been having flushes for about a year, intermittently. Always been a person who feels the cold but now not as bothered by it. Occasional night sweats.

Had my current Mirena 4 years so no idea about periods at the moment as it completely stopped mine.

Struggling with work, concentration, motivation. Can't be bothered with people in general. Sleep has been way worse than normal in the last couple of years.

My issue though is that I have a long history of depression, with some anxiety. Been on ADs for years but MH still up and down. History of being signed off work because of my MH at times.

I just KNOW if I speak to my doctor he's going to try fob me off by saying it's probably my MH and not peri. This is the only reason why I'm avoiding discussing it.

Anyone else had similar?

I think the reality is that it needs to be balanced with overall health expectations. Years ago women were written off in their 50s as past it, too old, gave up work earlier etc….. Our expectations of life and healthcare have changed. We want to live ‘well’, and hrt helps with this. Doctors are quite happy to prescribe medication to prolong life when someone is at the end of life and struggling. Yet it’s a complete lottery when it comes to healthy women in mid life. Hrt has been shown to have many benefits, of course it won’t suit everyone, some will have side effects, and yes it can be abused. But in general it’s a positive thing for female health, with many protective benefits.

It can be beneficial to start sooner rather than later but at the moment the recommendation is that progesterone is considered safe for the first five years of use but there after it may increase breast cancer risk. Also many women seek estrogen and struggle with progesterone but in fact many women have very high levels of estrogen in perimenopause and their symptoms may actually worsen with supplemental estrogen. Unfortunately the symptoms of high estrogen can be quite similar to low estrogen and so that is why some women end up with very high doses and no relief from their symptoms.

The upshot is that women's healthcare is still very much subpar.

Interesting. I’ve heard that you can preserve bone density and protect against Alzheimer’s if you start replacing oestrogen earlier, and I thought the cancer risks were much lower nowadays than in earlier years.

I think that was the hype a few years ago but now there is increasing push back from certain quarters of the medical world. Some Drs still don't trust it, others think there is too much needless medicalisation going on and that women are going straight to HRT as soon as they 40. There is concern its now seen as a kind of anti-aging treatment by some, the dosing is too high, the people are expecting to be on it too long from too young an age.

I don't really agree with that but its certainly being spoken about by Dr's, pharmacists and the NHS in general. Some GP's are already refusing to to shared care going by what a private menopause Doc has said if they feel the dose is too high meaning you need to pay privately or accept a lower dose. There was an article in the bmj I think where GP's were saying they were facing quite aggressive demands from women for HRT and having complaints put in against them if they refused.

I'm not saying these doctors where correct or that I agree but there is still a lot of dispute over HRT in the NHS and its clear many doctors think its use is out of hand.