feeling confused

[alextedd]

Hi all, I'm a bit confused and not sure what to do next... perhaps others have been in the same situation.

About 4-5 months ago I made an appointment to see my GP because I was feeling tired, low energy, low libido, couldn't focus and - more importantly - at that point I missed about 3 periods (not in a row, basically this year I had every 2nd period). I'm 39, not overweight (BMI 22), no hair issues, but I do have oily skin and blackheads. My GP did a blood test and she sent me for an ultrasound thinking it might be PCOS. After the ultrasound results came back she said she was 'almost positive' that it was PCOS - at that point I decided to go see a specialist.

Last week I saw an endocrinologist who is also a PCOS specialist. He says it's not PCOS, it's rather low ovarian reserve because I'm high FSH, high LH, undetectable oestradiol. I'm also 'high response' AMH though (22.5 pmol/L), which suggests "good potential for fertility" - in my mind that's strange, as it contradicts the FSH/LH/oestradiol results. Also, AMH is not high enough to be indicative of PCOS either...

He suggested hormone-replacement therapy - Femostone 2/10 for three months, estrogen-only. I'm really scared to start HRT though, because of the side effects (breast cancer etc). But, I'm also scared about not having periods for a long time, that also can lead to uterus cancer. So I'm not really sure what to do now... should I go for another opinion? Try the treatment? Try something natural (like maca powder)?

Thanks for any ideas...

PS. I'm single with one child and no plans for more kids for now, although it would have been nice to have a 2nd one...

I can see how hard it is to be given different opinions...

I think you might be a bit confused on some of this...

Not having periods does not affect your risk of uterine cancer.(If it did then all women post menopause would be at risk.)

Taking HRT at your age does not confer any risk re. breast cancer- this ought to have been explained to you- why do these damn drs not do their job???!!!

The risk is tiny anyway and only kicks in slightly ( and new evidence shows that there may be no risk anyway if certain types of HRT are used) after around 10 years for women who have taken it in their 50s.

So many women still don't know that the studies done almost 14 years back which showed a link with breast cancer have now been shown to be unreliable and flawed.

However you ARE at risk of osteoporosis in your 50s if you have low oestrogen levels now, and the same for heart disease.

My advice would be to see a gynaecologist who can help you with premature menopause because you ought to take progestogens if your periods become fewer than every 2-3 months.

Thanks, will try that too, although the endocrinologist I saw is a reproductive medicine endocrinologist. I'm scared of cancer because I did have lumps in my breasts (benign, did a biospy, then went away after breastfeeding) and also nodules on my thyroid (they were removed through surgery). So I'm just scared of ANYTHING that could increase breast cancer risks or other cancers for that matter.

Hello one doctor thought I had pcos and like you it turned out to be low ovarian reserve. I was ttc so devestating. My pcos symptoms did include lifelong acne etc.
I would look at the symptoms you want to prevent - if you don't have hot flashes etc yet maca can help with energy levels as can adapting diet and yoga. As others have said osteoporosis is a risk so if get a calcium supplement (ideally with vit d3 in to) .

Thank you! I'm already doing yoga. Looking into the calcium supplements...

You do need to look into this carefully.
I had osteopenia- almost osteoporosis - at 48, despite being nowhere near menopause ( menopause at 53-54). I had always taken calcium as I am dairy intolerant. Calcium alone ( even with Vit D) may not be enough if you have a premature or early menopause.

Endocrinologist sounds fine to me.

Femoston has 2/10 progestogen in it:

Estradiol 2mg
Dydrogesterone 10mg for 14 days/28

The breast cancer risk is low. You can reduce your risk more by staying well within the guidelines for alcohol, eating healthily and excercising, and keeping BMI normal.

The breast cancer risk for someone who is having prem ovarian failure is zero- all you are doing is replacing what ought to be there until the age of 51 ( average age of menopause).

The risks only start for women who have taken it for many years and even then the risks are very very small- drinking 2 glasses of wine a day and being a stone overweight are actually higher risk factors of breast cancer for post menopausal women.