At my absolute breaking point with periods, how do I make my GP listen?

[InsideOfEmptiness]

Just got my period. As usual, it's ridiculously heavy. That's not the only problem though. I start getting horrible period pains, tender breasts, and unbearably painful nipples at least a week before my period arrives, every single month.

Then I have a week to ten days of excruciating and heavy period. Then it feels like no time at all before the horrible ovulation pains and breast tenderness start.

I've essentially got about a week a month free of some form of menstrual related misery, and it's destroying me.

I've spoken to my (lovely, but old school, GP) about this multiple times. His answer is always the pill. I've tried various pills, they've never helped, and have only made me gain weight / feel seriously depressed / caused hyper-pigmentation etc. He's suggested the injection but given my experiences with the pill, I'm so wary.

Aside from any of that, surely feeling like this for at least three weeks out of every four isn't normal? Should I insist that he refer me to Gynae? I hate even using the word insist, I don't think we should be able to just demand medical referrals. However, something is causing me this much pain.

I had a CT a few years ago (at the instance of a locum GP) for abdominal pain. The letter that was sent back to my GP mentioned free fluid in my pelvis and recommended a Gynae referral. He read this out to me at my follow-up appointment and said, that's ridiculous and totally unnecessary. I took his word for it at the time.

Do I just accept he's right and this is my life until menopause? Or is there anything I can do?

I had very similar symptoms and was diagnosed with endometriosis. They can't see it on a scan, I needed gynae referral and exploratory surgery. You need to insist on a gynae referral I'm afraid. It could also be a number of other things, but you need an expert opinion, you can't carry on like this. Good luck.

Thanks so much, Yebanksandbraes. Really sorry to hear you've had the same problems.

I guess I just need to woman up and have a serious conversation with my GP. Which should be so easy, but I've had a lot on my plate lately and am a bit worn out. I definitely can't go on like this though.

Thank you so much for your reply

Can you start by seeing another GP?

Lots of doctors have an online e-consult facility now. Maybe use that so you can take your time and get down exactly what you want to say.

OP I’d have a look here: www.nhs.uk/conditions/heavy-periods/
The self-assessment tool on this page is really useful and is in a format that you can present to your GP either in person or online.

I’m a GP who does a lot of gynae - it’s difficult to know what is the right treatment for you just by what you’ve said but there are certainly options other than the pill. I would say that you’re likely to wait an age to be seen by gynae at the moment so have a look at the website and see what you think. It’s possible that a Mirena could be life-changing for you and that should be able to be done either at your own GP surgery or at least before you get to outpatients, if you think it might suit you. You don’t need to have a laparoscopy-confirmed diagnosis of endometriosis (and as a pp said this is a possibility with your symptoms) in order for us to treat the symptoms you’re having.

DD had this and the only way to get the GP to take it seriously was to photograph every flooded pad and substantial clot (with a finger tip beside it for scale) before she changed them for the whole period. We then made the unsympathetic GP look at every single one, quoted the NHS guidance on what constitutes a heavy period and said that if they weren't going to give us a gynae referral we wanted a letter from them confirming that we had requested it, the reasons why why had requested it and their confirmation that they had refused the referral and the reasons why not. I promise that this will get you the referral you want.......

Yes make the demand! I have had gynae appointments throughout the pandemic and a failed ablation. Next step for me is hysterectomy. I totally sympathise, I have probably one week a month where I feel like my normal self.

I’ve heard brilliant things about the Mirena coil for heavy / painful periods

It releases a tiny amount of hormone, probably not enough to cause horrible side effects you get from the pill

Can you see a female GP instead?

Ask to see another GP and preferably a female one who may have some idea of what you are going though. A male GP will never understand.

There are tablets like tranexamic acid and mefenamic acid as well as referrals etc.

Good luck.

Change GP if yours won’t help. You are absolutely entitled to a referral. I once got a referral to a consultant after NINE visits to the GP surgery. When I finally saw the consultant, he was like WTAF why didn’t they refer you the first time. He was horrified. Don’t let this GP block you from getting the care you need and deserve.

If your old school MALE GP knew exactly what you were going through he would not be so dismissive!

I had problems with flooding and after just one chat with my then GP - female, with an interest in women's health - I was booked in for a Mirena and it's been life changing.

You do not have to put up with this. Men wouldn't.

Going to make this short - I had 20 years of this and horrendous PMT and saw numerous doctors none of whom would refer me.
Moved house, new doctor and was referred to a specialist. Hysterectomy (full) 5 years ago now and it is wonderful.

You need to see a different doctor.

@Prestissimo

OP I’d have a look here: www.nhs.uk/conditions/heavy-periods/ The self-assessment tool on this page is really useful and is in a format that you can present to your GP either in person or online.

I’m a GP who does a lot of gynae - it’s difficult to know what is the right treatment for you just by what you’ve said but there are certainly options other than the pill. I would say that you’re likely to wait an age to be seen by gynae at the moment so have a look at the website and see what you think. It’s possible that a Mirena could be life-changing for you and that should be able to be done either at your own GP surgery or at least before you get to outpatients, if you think it might suit you. You don’t need to have a laparoscopy-confirmed diagnosis of endometriosis (and as a pp said this is a possibility with your symptoms) in order for us to treat the symptoms you’re having.

Thank you so much for that insight. Seriously, it's really helpful.

Yeah I was thinking a Gynae referral could take quite some time (and I'm okay with that, I know how strained services are at the moment). I've never given birth and GP said Mirena is extremely painful for women who haven't, then told me he'd prescribe some diazepam to take beforehand if I really wanted one. Maybe I'm a big scardey cat but that put me off a bit.

The only way I finally got mine sorted was when I sat and cried and begged to a young, male doctor. Not my finest moment but it got me some treatment after years of problems. The female doctor I saw was the worst of the lot of them.

And also thanks to everyone else who has replied. It's very much appreciated and I will take your advice on board and speak to my GP tomorrow. And will get back to you then with an update.

It might be time to change GP. I genuinely like mine, but then that's not the most important thing, is it? My DH and parents have been at me to change for months now. It's just very difficult in my area to find one willing to take new patients, especially at the moment. Thanks so much, everyone.

I'm also unbearably hormonal several days a month. Right now I am bawling my eyes reading your lovely posts.

I had my first Mirena before I had children OP. I also fit Mirenas and have done many on women (and teenagers) with no children. That’s really not necessarily a barrier. Most fitters use some form of local anaesthetic now (we use a gel in the cervix) and although it’s not the greatest 10 minutes of your life - I’m not going to lie - honestly the benefits can be huge. I’ve had many women over the years so grateful to me for changing their lives with a Mirena - it makes me really cross that they don’t know about it or can’t access it for whatever reason.

It’s not a panacea but honestly it can be great. 80% of women have lighter periods than before a Mirena and for 50% their periods stop altogether. It’s NICE’s first line recommendation for heavy periods for a reason. But as mentioned above there are still other options apart from the pill if you would rather discuss those - you just need to find a GP who is willing and able to discuss them with you.

@Prestissimo

I had my first Mirena before I had children OP. I also fit Mirenas and have done many on women (and teenagers) with no children. That’s really not necessarily a barrier. Most fitters use some form of local anaesthetic now (we use a gel in the cervix) and although it’s not the greatest 10 minutes of your life - I’m not going to lie - honestly the benefits can be huge. I’ve had many women over the years so grateful to me for changing their lives with a Mirena - it makes me really cross that they don’t know about it or can’t access it for whatever reason.

It’s not a panacea but honestly it can be great. 80% of women have lighter periods than before a Mirena and for 50% their periods stop altogether. It’s NICE’s first line recommendation for heavy periods for a reason. But as mentioned above there are still other options apart from the pill if you would rather discuss those - you just need to find a GP who is willing and able to discuss them with you.

Thank you so much for this. My GP kind of made it sound like it'd be awful. A painful 10 mins, I can definitely cope with! I've had a few colposcopies, so presumably I could manage a Mirena insertion? I think it was the idea of needing to be given Diazepam that put me off tbh.

And sorry, @Prestissimo,the question mark at the end of 'presumably I could manage Mirena insertion' was more my tired musing. I definitely wouldn't expect you to answer that question, given that I'm not your patient and you've never clapped eyes on me. Sorry if you thought I was putting you in that position.

My periods were horrendous - so heavy I had to put 2 old towels under me in bed, get up in the night to change (sometimes the sheet too), huuuge clots, lasted a week and couldn't even travel to work (thank goodness for WFH at the moment). I got referred for a scan and have a couple of small fibroids and the doctor told me, no problem, they'll go once you hit menopause! No no no I said, made a fuss and got a Mirena in December. Had one light period since - it's been life changing. I took paracetamol before the fitting and honestly, if you've had a smear it's no worse. I would have suffered any pain at that stage to help me! Before children I had the depo injection and that meant no periods at all, would that be worth thinking about?

Sorry if you thought I was putting you in that position.

It’s no problem - I didn’t!! But yes, I’m sure you could probably manage it. Actually anti-inflammatories, such as Ibuprofen, can be helpful to take before insertion (and I once had excellent results with a patient who’d had a gin and orange before she came in for our second attempt )

I have Endo and adenomyosis. Years of life ruining agony. Multiple surgeries. Chemically induced menopause, opiates..
The works.

I have the Mirena now. Didn't feel it going in - speculum, gel anaesthestic on be cervix and a quick gossip whilst bit kicked in. Popped it in and off I went. Huge improvement immediately. I'm now also taking the mini pill - my gynae calls it the "Mirena and a half". I have no cycle at all now. No ovulation, no breakthrough bleeding, no pain, no hormonal swings... Nothing. It's been 2 years and it's bliss.

Sorry I've only quickly read the thread but my first thought was "endometriosis" alternatively if they don't find any then a mirena cool may help.

Call the GP and ask to speak to a female doctor then request a gynae referral, they really should have done this by now. You need a laparoscopy to see what's going on and if you do have endometriosis it will be visual during the laparoscopy xx

I sympathise OP, I'm a lot older, my periods have been horrendous for the last 10 years and the attitude at my GPs practice is that I'm peri menopausal and that's just how it is

There was one sympathetic locum who gave me tranexamic acid which does work, but other than that it's been shit. I just put up with it now.

They suggested the injection would help. It was fine for 6 weeks then I bled constantly. Not heavy, actually quite light, but literally constant. I wore tampons every day for nearly 6 months. I felt dirty and unclean all the time. When I finally got them to agree to me giving up the injection, they gave me the pill. Same thing.

I didn't have the Mirena as at the time (this is a few years ago now) it was a 6 week wait to have it put in and 12 weeks to have it removed. I couldn't face the thought of 3 months of bleeding. At least as things are I get a week or 2 of respite!

I used to buy tranexamic acid over the counter (the only thing that stops me leaking everywhere or having palm sized clots) but everywhere has stopped selling it and my GP isn't interested.

I'm 50 in 2 years so hoping not much longer! In your shoes I'd definitely change GP.

He sounds like a shot GP and women's health is disproportionately affected because of just this old fashioned attitude.

Push for a referral, be extremely clear and forceful. I had to do it for an eczema referral had to really push, when the derm saw my skin she literally gasped.

Speak to another GP