Desperate at wits end

[mrsmobbs]

Hi I am 54 and have been having hot flushes for 4 years now. I cannot have hrt as I had a thrombosis. I have tried everything on market from black cohosh to menopace etc. I was put on citalopram which worked for my sister forca while, but not for me and coming off after just 2 months was hell. Have tried to live with this for so long, eventually went to menopause clinic and was basically told to stop wringing and accept my ovaries were dying. I was told that you English people take more antidepressants than any other country when I said I had tried citalopram. So basically have been trying to just get on with it. I know the heat at the minute is not helping but I have not had more than 4 to 5 hours sleep for years now, and my ds keeps commenting on how sweaty and red I look all the time, it runs down my face and makes my hair all wet which is really feminine. Any advise greatly appreciated

How appalling that a menopause clinic told you that - was it a specialist clinic or a doctor/nurse at your own practice?

Regarding the thrombosis - I don't think HRT is definitely out of the question completely, but you should be referred to a specialist menopause clinic and discuss this with any specilialist you may be under for your thrombosis - if you still are.
If you look at the menopause matters website under health conditions
www.menopausematters.co.uk/atoz.php#GlossT

this is what it says about thrombosis and HRT:

"Since HRT is associated with a small increased risk of venous thrombosis, care must be taken when considering HRT use in women with a past or family history of thrombosis. Depending on the indication for HRT and on the cause of the thrombosis, risks and benefits should be assessed. If HRT is to be used, preference would usually be given to the transdermal route (patch or gel) [ref 22]. Specialist advice should be requested. Vaginal estrogen may be used for treatment of vaginal and bladder symptoms."

Here are the latest recommendations from the Brisith menopause Society and Women's health Concern paper published in May this year

min.sagepub.com/content/19/2/59.full

Venous thromboembolism (VTE) and HRT

"Oral HRT increases the risk of VTE two- to four-fold, with the highest risk in the first year of use.

VTE risk is further increased in those with a personal or family history of VTE, advanced age, obesity and other risk factors such as surgery or hospitalisation.

The VTE risk is associated with oral rather than transdermal estrogen administration and there is increasing evidence that risk is greater in combination with certain progestogens such as norpregnane derivatives and medroxyprogesterone acetate.

Individuals requiring HRT should be risk assessed and counselled regarding their VTE risk.

Routine thrombophilia testing prior to commencement on HRT is not required but testing might be considered if there is a family history of thrombosis due to a known genetic defect.

In ?high-risk? individuals who require HRT, transdermal preparations should be used and if a progestogen is required, suitable options might include micronized progesterone or dydrogesterone.

Hospitalised users of HRT require review of their therapy and should receive thromboprophylaxis as appropriate."

Hope this helps and you are able to discuss this further and maybe have a trial - because really - only oestrogen can help you.

It goes without saying you need to do everything possible to keep yourtself healthy re making sure you are not very overweight, take exercise, eat a healthy diet, do not smoke and limit alcohol....

This is some great advice and really looking after yourself is key. I am not sure about whether they are safe given your DVT history but flash fighters are great herbal menopause tablets, you may have to get them online from H&B. Good luck and I hope this awful menopause thing passes soon.

Rosh- the evidence on supplements as being effective it not great- in fact there is no research which shows it is any better than a placebo. The OP says she has tried everything on the market already.

OP- transdermal oestrogen is not associated with blood clots. There is though some query as Bella says over whether you could have it post- thrombosis.

My drs take on this is that it depends on where the clot was, how long ago you had it, what your prognosis was, and the causes. ie post operative, in legs, lungs etc.
it's not a one-size fits all yes or no for someone in your situation.
There are some very good drs in London who also work in the NHS- such as Nick Panay- who are meno experts and who could help you if you could get to see them.

If you find that you cannot take HRT at all, then some people find that TCM- traditional chinese medicine- which includes acupuncture and herbs helps, as can yoga and exercise.

Not an EBP suggestion but I know a few people who find it very helpful. Saying supplements don't help but try TCM ffs!!

Sorry I don't know what EBP is.

I'm sorry you seem sceptical about TCM-it does have some validation especially for menopause and skin conditions. I speak from personal experience of the latter.

This trial on acupuncture and hot flushes was in the British Medical Journal and is research carried out in Norway.

BMJ

If you don't want to wade through the entire paper, the conclusion is the main part to show the benefits.

There are some flaws in that study. I acknowledge some people were helped by 10 consultations that helped them relax or feel energised.

As far as I can make out from a brief look at this, the main flaw is that it is not a placebo controlled study ie there is no way of knowing whether the results obtained from the admittedly very detailed and in depth study, were due to the placebo effect - there was no placebo. Self-help as a control group does not count. I don't know how you would use a placebo in relation to acupuncture but maybe a placebo pill could have been used to compare? That woudl have been more powerful if the acupuncture group showed a significant difference to the placebo group and boith in relation to the control group. That is not to say scientific studies into this are not worth doing, nor belittling the power of the mind - but that in my view the conclusion that acupuncture can contribute to a reduction in hot flushes may be due to placebo - and if so maybe there is an alternative/easier placebo which would be equally effective?

PS Apologies Mrs M going off on a tangent here!

Pills with 10 sessions being listened to about your symptoms by someone with counselling skills perhaps?

Hi thanks for replies. Yes it was a specialist menopause clinic and it was both my gp and this lady who said I cannot have hrt, but I will try again as I really have tried all herbal things on market, including some I got in America as well as the anti depressant citalopram which can work on some instances. I have always been hot rather than cold so perhaps it is just me

All I would add is that my gynae consultant who is very conventional in many respects, does believe that acupuncture has a place in menopause and says there is good documentation. I don't have it all to hand but I know he has studied it.

The 'placebo' effect of acupuncture can be to still use needles, but use them in random points - not specifically to treat the condition. Not sure if this study did that- need to read in depth.

Having said that. TCM is not just acupuncture- that's just part of it- the other side is herbal ltreatment. It's been used for over 2000 years so I can't believe it would still be used in hospitals in China if it simply didn't work.

I've just been checking what my dr has to say on TCM in his book on meno- the says there is 'compelling evidence that acupuncture helps with.....[various meno symptoms] including heavy bleeding'
Whilst I concur that some symptoms are possibly responding to a placebo effect, I don't think we can 'think ourselves' into having different bleeding patterns.

I don't think you should mix acupuncture and the consultations / relaxation that go with it up with eating shark's fin. These are two completely different things.

Roshbegosh

Maybe we should agree to disagree over this? I don't know what your own experience of this is, and whether you have tried it without success or what...

I began my initial post to MrsMobbs mentioning TCM, as a possible treatment she might like to try. TCM incorporates both acupuncture and herbs. My consultant gynae is in favour of it, so to my mind it's worth letting mrsm, know, as she is desperate.

I'm happy to have an informed debate on this but it's a bit pointless making what appear to be snide comments, don't you think?

Ok missbopeep . Don't think I was snide but anyway yes, we both have our views and are trying to help. Good luck to the OP whatever she decides, we all know the menopause is a bugger.