Perimenopause & HRT

[Frostycake]

Which tablets/patches/gel do you use if you are mid-forties and peri-menopausal?

Just trying to get an idea of what works and what doesn't.

I want to avoid being palmed off with the poor quality default option by my doctor.

Can you tell me your stories? At the moment, I have brain fog, poor sleep and heat (all the time). Restless legs and anxiety occasionally.

There is no difference between what to use whether you are peri or post menopause. It all works!

The only difference is that after 2 years or age 54 without a period you can take no-bleed HRT which means you won't have a withdrawal bleed.

You should avoid any HRT with the prefix PRE- such as Premarin. These are made from CEE ( conjugated equine estrogens) and have more potential risks and side effects.

They are the oldest and cheapest.

Take a look at the info on www.menopausematters.co.uk under HRT types and all the ingredients are listed for each product.

Patches and gels are safer as they bypass the liver and have a much lower risk of blood clots. with gel you can adjust your own dose to see how much you need - 'average' dose is 1.5mgs ( which is 2 pumps) but you can got down to 1 or up to 4.

Progestogens can be synthetic or natural - the only natural one is Utrogestan. The dose is 200mgs from days 15-28 of a cycle.
Not many GPs know about it so it's worth asking.

Wow. Thanks Pinkfrocks

Are you a medic or is this the voice of (bitter) experience/trial & error?

Ive heard a rumour that 'tailored' HRT is behind Christie Brinkley's phenomenal youthfulness. If so, I want some!

I've been lucky enough to have private medical care for years and seen a top gynae with meno expertise for a long time- so I'm sharing what they have advised me- and treated me with.

I went on no bleed HRT and had 32 days non stop bleeding
Went back to Elleste duet...the conti was not for me.
Have been on HRT about 5 years.

I was on Elleste duet and didn't really get on with it.

Eventually had mirena coil combined with 100mg patches which seem to do the job.

May I just jump on in here?
I'm 47 and I'm feeling utterly terrible.

I feel absolutely angst ridden, totally unable to cope with my life. I sleep very little and am generally sad most of the time. In the little pockets of clarity, I say to myself 'remember this feeling, remember this feeling'.
Within minutes I can be back to feeling dreadful.
Just yesterday I made an appointment to see the doctor because I just cannot go on feeling like this. My anxiety is at its worst when I wake up daily anytime after 3am and start to panic about how I'm going to cope that day.
Any advice would be very, very gratefully received.

saythatagain I let the perimenopause/menopause drag on for over 3 years before I went to a doctor. The sleeplessness, anxiety and weight gain honestly made me want to put my head in the microwave. It took me two goes to find a sympathetic doctor, and I more or less insisted that I was given HRT. I had tried a number of natural alternatives beforehand, none of which made a jot of difference to me. You lose your mind, you really do. I remember sitting there in the doctor's office, crying (if you knew me 10 years ago you would not believe that possible) and begging for help.

Don't let it get to that stage. Some women sail through it. Some women manage with natural remedies. Others don't. I used to be fit, super healthy, positive, and with an easy laugh. In menopause I have gained 20lbs, lost my energy, my sense of humour and my temper. I slept fitfully and DH wondered what the hell had happened. Now, after 6 months of HRT, I am sleeping normally, my energy is coming back (yesterday I did a 3 hour hike up a mountain) and I laugh again. Sadly, my weight is still there but I also have a small problem with my thyroid (again, it appears that this is not uncommon amongst menopausal women) and this may be a contributor to the weight issue.

Make sure your doctor listens to you and is ready with real solutions to this. Women shouldn't have to have their lives fall apart and then beg for medical attention.

Mumsnet should do a campaign for more funding for menopause treatment. It pisses me off how so many women suffer.

Chinup
I could cry reading your post. I have honestly thought I'm going mad, im actually going mad.

I started a new job 18 months ago and I'm barley coping with it. The anxiety I get is crippling me. It's just a job, nothing high powered, there are no bad bosses, nasty colleagues, just me agonising minute by minute as to how I'm going to cope.

It's impeding on my home life too, where my character is altered to a snipey harridan, almost wanting there to be an issue with something....like, 'there, I told you so'.
As is the norm, I woke at 3:45 and immediately my stomach is in knots, wondering how I'm going to get through work on Monday. I seem to be fixating on work and there's no reason to, which is why I think I'm going mad.
I'm waffling on because this is the first time I've off loaded as to how I'm really feeling.
May I ask what your recommendations are regarding medication?
That question is to everyone.......

Chinup I agree with all you say except the last 2 sentences.

It's not a matter of funding- it really isn't. It's a case of educating GPs. The British Menopause Society is trying to get GPs up to date and they run workshops and courses. (See their website the 'for professionals' part.)

However, it's up to GPs to sign up for these.
GP training on meno is something like 2 hrs at medical school when it's not likely to be a top priority in their learning. Unless they have an interest in it, they spend years knowing only the bare minimum- which usually means reaching for a prescription pad- unless they are the ones who don't 'believe' (FFS) in HRT- and prescribing any old run-of-the-mill HRT- often tablets and not necessarily the right dose.

If women want the best meno treatment and can't afford to access a specialist ( and TBH it's not a fortune for an appt and you might only need to see them once or twice a year thereafter) then they have to educated themselves- and educate their GP. There is a lot of info online including the Menopause Matters website, the BMS website, and Google Scholar if you want to read research papers.

Menopause is NEVER going to be top of the list especially now there is a diabetes epidemic and lifestyle diseases are draining NHS funds.

The products (HRT) are there, on the NHS, but you need to know what to ask to try and not be deterred if the first type you try isn't the right one.

End of rant. (not aimed at you chinup just the poor treatment some women get.)

With apologies to Frostycake for hijacking her thread (perhaps she will feel a little comforted by the thought of others struggling too), I feel for you saythatagain I really do.

My situation was complicated by the fact that I live overseas, and was previously in the Netherlands, where my doctor refused to prescribe HRT for more than 3 months. I tried to argue for a long term prescription (there are no cancer, high blood pressure medical histories in my family). He wouldn't budge - he said it was medical guidelines in NL. I might have remarked snappily "well 3 months of HRT isn't going to bloody help, is it?". I might have said that quite loudly as well. And then cried.

Due to brain fog, depression, and lack of energy, it didn't occur to me to google "menopause uk" and read up on it. Or even look at the menopause thread on Mumsnet. Sad, eh? In my new country, I saw a GP privately, and was eventually prescribed Activelle. Before getting that, I was given mild non-addictive sleeping tablets and a mild sedative for 4 weeks, the name of which will come to me - no it won't, begins with an 's'. Still takes time for the memory and brain cells to come back - sorry.

When you see the doctor, ask about HRT options and get what you can. I couldn't tell you what's in Activelle - I would have taken serum from snake's pee if someone had told me it would help, that's how desperate I was. Activelle seems to be OK - the ideal is to have bio-identical HRT and nothing beginning with 'prem' as that's made from pregnant mare's urine. Seriously.

If there is a delay in getting a prescription, ask for mild sleeping pills and a mild sedative. Tell your doctor about your anxiety, and sleeplessness and how it's affecting your every day life. Tell him/her they will be writing you a sick note if they don't give you something to get back on track. Don't leave without getting something. In the meantime, look at the menopause threads - some are seriously technical (some bloody smart mumsnetters out there!) and others just have tips on websites, and what not to eat or drink. That tends to include coffee and alcohol. I limit it to one coffee per day and a couple of smallish glasses of wine in the evening.

You're not alone. There's millions of us worrying, snapping, crying and gaining weight together.

pinkfrocks no offence taken!! I don't know how much awareness there is in the UK as I don't live there any more. I haven't been very lucky overseas, and I can only assume that it's similar in the UK.

With regard to your comment on costs of seeing a GP privately, I did have a look at the Marion Gluck Clinic costs page. Gulp. That's going to be a lot of money for a lot of MNers. When you consider that women are at least 50% of the bloody population - why is this knowledge and treatment more readily available on the NHS?? It makes me angry. So flipping angry, that something that can make some of us so unwell so that we lose the person we once were and make people around us miserable, that menopause is so unimportant to the GP community. Just as a start, how difficult would it be to send out an educational email to their age-appropriate female patient database? We don't live in the stone age any more!!!

(goes off to make a cup of coffee and tries to calm down)

sorry that should be why isn't this knowledge and treatment more readily available on the NHS??

Thank you for this thread, it's very informative. I'm 49 and haven't really had any symptoms yet, other than erratic periods, but I'm just waitng for the other stuff to start. I'm glad to read this info so i'm forewarned when the time comes!

Yes, apologies Frostycake
Thank you for your advice and kind words. Just talking about it is giving me some mild relief, albeit temporarily.
Another thing I'd thought about; I was going manic with my moods. High one second and very, very low the next, but remaining low. I haven't put on weight, in fact I've lost weight, but that's down to my job, which is being on my feet 8 hours a day, Monday to Thursday and not stopping.
I have the runs very often now (I hope I'm not offending anyone by being to graphic?), but I've put that down to the anxiety.
I'm not certain which doctor I will be seeing next Friday, but will follow your advice and be quite firm in requiring something. Of course, before that, I will cry, wail and blubber, whilst apologising profusely for my behaviour and embarrassment!
How misinformed am I? I hadn't even thought about being peri menopausal until I saw this thread title. Thank you MN!

chinup

WRT the Gluck clinic that is a different kettle of fish altogether. I don't want to slag off other drs, but there are well qualified gynaes ( she's actually a GP not a consultant) whose fees are far less- maybe £150-ish per appt, twice a year. Personally, I'd rather pay for good health care than clothes, holidays etc if I had to choose. But I agree that the NHS ought to be more on the ball.

The treatment she prescribes has been criticised by other professionals (I can link to articles and comments if you like)) because it's based on the idea that you need masses of expensive blood tests to see how much HRT you need and then it is made for you in a private lab. Blood tests are not reliable- in peri your levels can change by the day or the hour! It's possible to get a tailored dose by using gel, for example, which is mainstream and NHS. But women need to know what to ask their GPs for because, going round in circles, most GPs are not well informed on HRT.

The changes ( no pun intended) will only come about if women inform themselves and ask drs for what they want- it IS all available on the NHS ( ie the actual products.)

chinup if you are reading..

just had a look at Activelle- not heard of it before and assume it's the same as others but is a different name due to you being overseas?

It's not listed Here

You must be post menopause ( see info on the link) if you are taking continuous combined HRT? (That's oestrogen and a progestogen daily.)
You don't have to use that type- some of us prefer to take less progesterone ( which can cause mood swings and perhaps weight gain) by sticking to cycles- which means progestogens ( or bio identical progesterone) on only a few days of the month or even every 2 months.

Worth thinking about maybe.

saythatagain mood swings - oh, yes. All to be mentioned to the GP. Mine weren't particularly up, mostly low and lower.

Take a pack of tissues with you. And know that I blubbed too. In a country that doesn't blub. They do stoic.

pinkfrocks I have PM'd you. Thanks for the link and the advice. Now that my brain is in better working order, I'm going to look at alternatives that might suit me a little better.

Thanks for this thread everyone. I am nearly 46 and peri I think. Very random periods of varying lengths and strengths, the most ridiculously sore boobs more often than not, poor sleeping and rattiness / mood swings that I am pretty ashamed of.

All made more complicated by a thyroid condition and the fact that my mum died at 48 of breast cancer, my dad 63 of prostate cancer, so not sure HRT is an option for me.

pinkfrocks could I just ask if you mean that you only take progestogens and nothing else? Do you take it in gel form? Thanks for all the info.

Wow. Nice to know Im not alone but and for those suffering.

Mumsnet should do a campaign for more funding for menopause treatment. It pisses me off how so many women suffer.

This is a great idea. Mumsnet HQ? Are you listening?

Ive had a look at the other Mumsnet Meno boards as well as the menopause matters site but its all just so confusing. Ill go and see my (new) GP first and then go from there.

hush
could I just ask if you mean that you only take progestogens and nothing else? Do you take it in gel form? Thanks for all the info

I'm a bit confused by this- I didn't say that because you can't take progestogens on their own.

Ah sorry pinkfrocks. Think I misunderstood - so presumably a combination of eostrogen and progesterone must be used. Not just one or the other.

Sorry about that, a bit new to all this :-)

yes, that's right.

Thank you.

Well, I've come back from a relatively ok day, which I think, is because I've 'let it all out' here on MN!
I'd just like to ask about your recommendations with regards medication.
I'm not sure where I stand with regards oestrogen and progesterone levels or whether I require something like fluoxetine?
What I do know is that I require something and I'll try anything that'll help to control my mood swings and current inability to deal with 'life'.
After coming on here and telling all, I've realised I don't need to suffer.
Once again, thank you.

Awake from 1am, knots in my stomach, weeping and thumping heart. A feeling of total despondency and weakness.