How bad must menopause be to be prescribed HRT?

[JustMeAnon]

Im 50 and whilst my periods are still regular-ish (though changing in other ways) I have been suffering from low mood and exhaustion for a couple of years now. I have had all the usual things checked out (eg thyroid, iron, vit d) and already take anti-depressants since I have a history of low mood anyway. I changed to a different a-d a while back which helped a little. In these 2 years my PMT has been getting worse and worse and can last for half the month. It isn't every month, some are okay, but more often it is pretty much intolerable. My symptoms include memory issues, clumsiness, low mood to the point of paranoia - I convinced myself my DH was sexually abusing my children one month, and was so sure that he was having an affair another month that I downloaded spyware for the PC....totally cringe when I think of it now - I get a weird all over body restless legs type sensation, I am tearful, strung out, and to be honest feel desperate and quite frightened by how intense it all is. However, I don't get hot flushes or any other particular physical symptoms so when I present to the GP I suspect I'm being dismissed as a depressive. I was recommended evening primrose which has never helped with my PMT before so can't see it helping now. I intend to go back to the GP, but wanted to know what my chances of getting HRT are given that my periods are still quite regular and my symptoms mainly emotional? Also, a recent blood test showed nothing menopause wise.

I just went and asked if I could try it, for my joints. I was already using vagifem for dryness, prescribed by consultant after vaginal surgery, and which I had started using after lots of 'infections' that weren't.

It was the doctor who had always done the 'ladies stuff' who was now retired and working as a locum. She never asked about my periods...... which had been absent at the time of the infections, but had returned and were frequent at that point.

You need to make sure you are eating good food regularly - low GI, plenty fruit and veg and plenty omega3s, proteins etc, drink plenty and that you are exercising regularly as this helps whether you take hrt or not.

HRT has made things more predictable, but it has not helped with feeling tense and with adrenaline surges for me. I am trying more exercise and relaxation stuff now.

Sometimes, ADs are prescribed for hot flushes - if you are prescribed one of those, it may be why you have no hot flushes?

Interesting about ADs and hot flushes whatevva. Have googled and you're right, sertraline can help apparently.

I have been doing as much self help as possible. I gave up alcohol a few months ago, I eat well. I'm loosing weight, am active (tho could do more!) and have low/normal blood pressure and heart rate so think Im reasonably healthy. Partly thats why Im so down about it at the mo, I've been so careful the last few months and yet this last bout of PMT was the worst yet. Not fair!!

www.menopausematters.co.uk/at_menopause.php

Have a look at the information on this site. It is pretty sensible and a good start for reading up on things.

It's always tricky getting HRT prescribed if your periods are regular and blood tests are normal. When you say quite regular what do you mean? What blood tests were carried out and what were the readings? In any case docs are advised not go on blood tests for women of your age but to look at symptoms and cycle instead. Some women experience symptoms well before the classic missed period, and increased pms is typical. Also symptoms arising from the fluctuations in hormone levels which begin to occur at this time. From what I've read some women do find HRT helpful at this point - a low dose one would mean that your oestrogen levels would not dip as low as they normally do just before a period although you may still experience pms from rapid rise and fall in progesterone.

There is another article on the menopause matters website about the peri-menopause which might be helpful - not sure you've got to that point yet though!
www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

There is info about diagnosis of menopause here:
www.menopausematters.co.uk/diagnose.php

There are other sites eg patient.co.uk and NHS sites that also cover all of this.

Femoston 1/10 is a good one to start with - tablet HRT. I would suggest you ask for this. As Whatevva says - the fact you are taking ADs may be masking your hot flushes. Many docs seem to use the presence of these as a yardstick for prescribing HRT - but it is worth a try and you could say you would rather try a low dose HRT than increase your dose of ADs - which I imagine could be the docs standard response,

Thanks for the detailed reply Bellaciao.By regular-ish I mean that they used to be 28 days on the dot, now they are 26-35 ish. Last month I skipped one entirely for the first time. Then had really awful PMT in the run up to my subsequent period. It has left me feeling frightened of what will happen next month

I just did a menopause questionnaire on-line and a score of over 20 was considered to require treatment and I got 38!

I had a go at the questionnaire and got 28 without the flushes/sweats and wonky periods.

The vaginal irritation/cystitis/joint pain/severe woolliness of the brain/constipation seemed to do for it quite nicely.

The doctor I saw when I first started vagifem and said 'why am I getting all this but no hot flushes' said it doesn't follow; anything goes in menopause. Hopefully there are a few of those out there.

Why does menopause need medical 'treatment'?
I recommend you read Germaine Greer, 'Women, Aging and the Menopause' .

Lisbeth, and I recommend that you try feeling like me for a few days. Not everyone can have a lovely 'natural' menopause with just a bit of evening primrose from the health shop. The way I have been feeling, if I was offered a hysterectomy tomorrow I would accept. You are patronising in the extreme.

Oops, probably being snappy and menopausal there, I'll just go off and read some feminist theory and then I'll be just fine

No no I agree that we do need something and that might be a radical diet change or vitamins or a weekend in Venice or whatever, but dont put too much trust in male medical experts who might try and convince you to have a hysterectomy. they do NOT have your best interests at heart.
I really dont mean to sound 'patronising' but these things are important. I am also going thro the menopause.

I used to think it was fine too, and I was winging it, and if I just carried on with my dancing, healthy eating and kept smiling and a positive outlook, it would be fine. That particular house of cards came crashing down 3 years ago.

Just me, read up on HRT- the risks and benefits. Make some notes. Go to your GP and say " I would like to try HRT because ..... and I'm aware the risks are ....what do you think?"

As long as you have a good realistic appraisal of the situation and do not have any contraindications I don't know a gP that wouldn't issue it for you in you circumstances.

Also OP, re-reading, why would you need a hysterectomy?
If a man having mid life problems asked his doctor to remove his cock and balls, what would the answer be?

or a weekend in Venice

I tried Nice. It pissed it down the entire time - never seen rain like it! My period came on very early and I bought sanitary towels and ibuprofen in French and spent the weekend looking for toilets that did not charge 1E a go. I can recommend the museum of modern art . Tokyo is really good for free toilets but you will need a towel handkerchief for the ones without a drier.

I think it should be your call based on how much your symptoms are affecting your daily life and how able you are to work round them. In my case the combination of hot flushes, night sweats, insomnia, brain fog, apathy and grumpiness meant I felt shit and was doing a crap job of being a parent and of my job. HRT has been brilliant for me.

I was lucky in that although I'm perimenopausal my GP was prepared to prescribe on symptoms alone (his attitude was that during peri hormone levels fluctuate so much blood tests weren't likely to be accurate).

My understanding is that for maximum benefits HRT should (should as on for women who feel they personally need it, not a blanket all women) be started prior to the cessation of periods. There are small risks attached - round about the extra 1 in 1000 level for eg breast cancer (to put this in proportion this is at least an order of magnitude lessIin terms of increased risk than common lifestyle factors like smoking or obesity). NICE guidelines I believe currently reflect this (and also say ADs should not be used to treat menopause - different if you're on them for other reasons of course).

As to the "menopause is a natural part of life" horse shit - so's a substantial percentage of women dying in childbirth. Personally I am a big fan of modern medicine, provided HCPs talk to their patients as intelligent adults and it's coupled to informed consent.

Have a look at Professor John Studds website - only practices privately now but talks a lot of sense.

If I had the money and when the time comes I will be going here!

There are some good Annie Evans videos on you tube.

Apologies for snippiness Lisbeth - not in a good place today! The hysterectomy comment was just trying to illustrate how desperate I feel. I have no desire to go that path. I would only see a female consultant or GP incidentally, I can't see the point of seeing a man whose interest in the subject can only be purely intellectual.

Thanks for all further comments, they make me feel slightly less bonkers. whatevva Dr Evans does a private clinic near here so I may go that route if I have to. I will have a look at youtube.

Though a weekend in Venice would be lovely in the meantime

Not intended as a slight to the kingfisher - he does indeed talk sense, but I'd just prefer a woman.

No problem at all JustMeAnon, like I say I am going through it too - realise I may have sounded patronising but had no intention of that, so apologies. I am so glad you are going to ask for a woman doctor.
There was some interesting stuff in the book about giving up bad habits like smoking and drinking, things like that. Allthough yes I would draw the line at gathering herbs on the mountainside.
Hope you feel better soon.
x

and book that weekend away if you can!

There's plenty of info on mainstream sites about health, diet and lifestyle changes which should be made by any woman approaching mid-life, hormonal depletion, menopause - whatever you want to call it eg here on the Menopause Matters website www.menopausematters.co.uk/diet.php

Also LisbethSalandersLaptop - you might like to have a look at this paper published a year ago (in the journal of the International Menopause Soceity) about the prevention of diseases after menopause which recommends many of these changes and which includes the use of oestrogen replacement as one strategy amongst many we need to take to help prevent a whole spectrum of conditions and diseases:
www.imsociety.org/downloads/world_menopause_day_2014/white_paper/wmd_white_paper_english.pdf

(As an aside can some tell me how to do a link with eg just the title and not the whole link please ie so that you change the words to wharever you want as upthread menopause Questionnaire?)

Also nothing wrong with having a male gynae - but of course depends on his bedside manner. A male gynae is very unlikely to try to persuade you to have a hysterectomy - it is quite difficult nowadays - it's usually the other way round ie women trying to beg for one at this stage! I would be delighted if Nick Panay for example was my gynae., and why wouldn't they have your best interests at heart? Doesn't credit them with much empathy does it?

Due to advances in life-expectancy ( which is still increasing) we may now spend more than a third of our lives in a hypo-oestrogenic state with all that entails (see paper above) and retirement/pension age stretches well into this period of time. Not everyone has the luxury of curling up on a sofa as fatigue/night sweats strike, nor go to Venice on a whim!

The annoying thing Bella is that I feel that I have implemented the sensible life changes - I have lost a stone, I gave up alcohol a few months ago, I eat the oily fish/avocado/nuts type stuff, I am fairly active (despite the extreme tiredness.) It doesn't seem fair to still be hit so hard by PMS.

The male thing is just a preference - I know really that there are men perfectly capable of being empathetic, or indeed women who aren't.

But thanks, I will read some of those links, I am familiar with the menopause matters site already and find it useful.

And do a link without all the http etc stuff, paste the link inside the then add the word you actually want it to say, then close the

I went through menopause without 'medical assistance'. It wasn't that bad (for me). My periods were irregular for about two years and then stopped. Yes, there were 'power surges' but none that were so horrendous that I couldn't manage them. Same with 'night sweats'. My moods were 'off' but nothing so bad that it disrupted my relationships or made me feel horrible. Maybe I was just lucky. But three of my friends have also been through it without needing HRT.

Each of us is different.

JustMeAnon - if you've started skipping periods you are definitely peri-menopausal and as I said upthread you can't diagnose menopause from blood tests alone.

You should definitely be a candidate for HRT in this case and a low dose one might just be what you need. The constant level of oestrogen should prevent your mood dipping quite so low before a period although you will still get the progesterone fluctuations and some pms due to that. Something like Femoston 1/10 might do the trick as I said before?

I think you should press for this because as I also said you may not be getting hot flushes due to taking the AD depending on which one it is so the doc might just want to increase this re mood etc - so you will need to press for oestrogen/HRT and emphasise the skipped period!