When to take HRT

[beachywaves]

Forgive me if this sounds a really stupid question. At what stage do you start to consider HRT i.e. after your periods have stopped or when you start perimenopausal symptoms? I've read quite a few threads and it doesn't seem clear. I am nearly 50 - loads of symptoms, but its the mood changes in particular that bother me the most as they are getting way beyond a joke. I have seen a female GP who specialised in womens health who told me nothing could be done and to find another way of dealing with it - great! I do take vit B complex and complete EFA which has helped enormously and have just started on the St Johns Wort for the winter, but am wondering if I need something more hardcore? I hope this makes sense.

First- change your GP. Seriously, she needs a good slap. That's pretty poor treatment.

You can start HRT as soon as you have menopausal symptoms. This can be during peri or after your periods have stopped. In practise this means anywhere from 45- 56 ish. HRT started within 10 years of the menopause ( last and final period) has a better safety profile than if it's started later.

The research shows that there is no alternative treatment which works as well as HRT. Some of the things you take will help, but they may stop working or not offer you enough of what's needed once your hormones deplete further.

Thanks pink frocks for that. Yes that GP is spectacularly useless and my current GP has referred me to a gyne for a scan for fibroids due to heavy periods. I absolutely do not want the Mirena as I cannot risk an increase in the hormonal/mood problems (I do realise that it works brilliantly for most women). I feel I would have more control with HRT as I could stop it if it did make me feel worse iyswim. I will go back to GP as I haven't discussed it with him.

Mirena can work brilliantly for some women as the progesterone is in the uterus, where it is needed and less of it circulating round your body, where it causes symptoms. You can then use patches for the oestrogen part of your hrt, which is more stable than pills each day.

You then have less progesterone in your system than you would using pills. However, as you say, it is taking the plunge, and not being able to get it out if you don't like it.

Are your periods still regular beachy?

The problem with starting HRT in very early peri is that your own cycle may still be strong - so you could still get mood swings, and because you would be on cyclical HRT - this could cause bleeds to be even heavier.

It is a difficult time but personally until you start missing periods, in your position I would look to try to sort out the heavy bleeding at this point if the only symptoms you have are mood swings.

Yes my periods are still regular. I shall wait and see what the scan shows (hopefully a ginormous fibroid and I can have a hysterectomy!). I have a list of symptoms a mile long, but its the mood swings/depression/anxiety that have the biggest impact on my life. I am looking into making some dietary changes very soon.

It was the mood swings that were the killer for me too - and what prompted me to go to the GP. Periods were wildly irregular and very heavy. HRT has been a life-saver - I've been on it since I was 46. I feel myself again. Please find a new GP - good luck :)

Have just come back from the consultant gyne who as I anticipated pushed the Mirena coil on to me. I explained my concerns and she completely and utterly dismissed my worries and said she was part of the research group when the Mirena was being introduced and there are no side effects! In fairness, she offered to put one in there and then and to give me an appointment for 6 weeks time and she would remove it if I had a problem with it and she would also leave the strings a bit longer so I could remove it if necessary. I declined.

I asked about HRT and she said no HRT was not given if you still had periods.

My scan showed a large fibroid of about 6cm on the outside of the uterus so ablation wouldn't be suitable. She was very against a hysterectomy.

All of this started with discovering I was very anaemic and hence the scan. I asked if the anaemia could be sorted while still having the heavy bleeding and she assures me yes it can. I am due another blood test is 4 weeks to see what my levels are. Have been taking ferrous sulphate for about 7 weeks. Is there anything else I should be doing?

That's weird of your gynae, Beachy. Reading around various websites it seems that starting HRT during the perimenopause is a fairly standard treatment protocol. My male GP was quite happy to prescribe HRT (I'm 49, had a 3 month gap with no periods last Christmas, hot flush hell, periods came back - no flushes, periods have now disappeared again) on the basis that my symptoms were classic perimenopause and interfering with my life (can't function on sleep disturbed every hour). Now it may be that he's behind the times on prescribing and what the best drugs are (see my thread on "how long before the symptoms go?") but at least he's listening to me.

Is there anything else I should be doing?
Yes shoot your consultant.

Honestly that is complete tosh!

There are 2 types of HRT- sequential and continuous.

Sequential follows your own cycle or gives you one to override an irregular cycle. This means you have a 4-week cycle ( some consultants are happy to do 12 weekly which is what I had for several years)
THIS kind of HRT is for women who still have periods.

The other type is continuous- this means both hormones are taking daily keeping the uterine lining thin so there is no bleed every 4th weeks. This is given to women aged over 54 ( whose cycles have well and truly stopped) or if you have been period free for a full year.

I despair really. I have the most wonderful consultant ever and that's why I know what I do, because he explains everything and is at the top of his field.

I am speechless that a gynae doesn't know this- or maybe she just disapproves of HRT.

Find another one,

Thankyou both of you for responding and especially Pink (was hoping you would respond as you seem so knowledgeable). I am going to have to go back to my GP and see if I can see someone else.

I called in to my local Health Food shop and had a chat and she lent me a book Natural Progesterone which I will read. I also have Patrick Holfords Balancing Hormones Naturally. I do feel I can cope with the heavy periods as the Tranexamic Acid is effective. However, the more pressing concern at the moment is the anaemia and the mood changes/depression (which I know can also be a symptom of the anaemia).

I am going to give the "natural route" a proper go, as I know from past efforts it can really make a difference to my mood. It might not be enough, but it is a route a feel happy about. Are GPs ok about referring to another consultant?

You can request a 2d opinion and it's a 'right' as far as I know. You can also see any gynae anywhere privately if you can afford the consultation and they can refer you back toyour GP for future prescriptions.

I would suggest you do not bother with the progesterone balancing or whatever.

Symptoms are caused by a lack of oestrogen.

'Natural' progesterone that you buy OTC in creams or whatever cannot be converted into the kind the body can use anyway.
I use natural progesterone as part of my HRT regime but it's prescribed and available from a pharmacy only- it's the real McCoy!

All the scientific evidence shows that 'natural' measures do not work. You may get some relief by changing your diet, doing exercise, having acupuncture, doing yoga, and so on. You won't find any of these make any difference to vaginal symptoms, bladder problems, and the more serious long term consequences of being without oestrogen.

I take on board what you are saying Pink. From my personal experience, I have found natural measures to be effective. Whilst they may not provide a cure, if it provides relief, then that will do for now. I am not anti HRT, far from it - I just don't seem to be able to get very good information from the medical profession in my area.

If it's mood swings and not flushes, sweats, aches and pains, lots of weeing etc, then diet and especially exercise may well help you.

good luck !