How do I know when I am in menopause if I am on HRT?

[diamonte68]

I have been peri menopausal (?) for about 5 years (I am 48), I put up with the hot flushes, aching joints, severe mood swings and night sweats for as long as I could as there is a family history of breast cancer and I wanted to try to persevere without it. Anyway I finally caved as my symptoms were having a detrimental impact on my life (I actually quit a very well paid and amazing job because I just couldn't cope with life).

My periods had become very irregular - initially they were coming very frequently sometimes only 2 - 3 days between etc but since the end of 2014 they went the opposite. I had a period at end of Nov 14 then nothing until end March 15 then nothing until end of June 15. I finally went to GP to request HRT in Jan of this year (7 months without period) and he has put me on Elleste duet 1mg. It is the type of HRT that means you have a bleed at the end of the 28 day pack although it does say that a percentage of women wont have a bleed. I am just at the end of my second pack and did not have a bleed so it is now 8 months since my last period. From what I have seen on the internet etc the bleed that you get while on this form of HRT is not a real period it is the tablets forcing your body to replicate a period (I know thats a rubbish description!).

I have read that once you are post menopause you should be on HRT that doesn't produce a bleed - continuous type. My question is how will I / my doctor know when I am post menopause if I start getting bleeds from taking the type of HRT I am currently on?

The short answer is- you won't know unless you stop HRT and see what happens. At 48 you are quite young to think about conti HRT (no bleed) and the 'rule' is 12 months with no natural period (not a withdrawal bleed from HRT) or over age 54.

Not having a bleed does not mean you are post menopause. The withdrawal bleed is the same as women on the Pill get- it's not a real period.

You don't have to go onto the type of no-bleed HRT you mention. It's optional. You can carry on with a sequential type forever if you want. I am! I don't want to take progestogens daily (which is what you need to do for a no-bleed regime) for safety reasons and side effects, so I am still using a type that gives a bleed after 7 years on it, post menopause.

Thanks for the reply PollyPerky.. it was what I was expecting. I guess my issue is that I completely totally and utterly hate having periods and there was only one upside to menopause that I could see and that was the lack of periods but it seems that I am now doomed to have them for the forseeable future. Even if they are not real ones it is still a pain to have to cope with periods in the job that I do (similar job as to the one I left but different industry). I spend stupid amounts of time travelling on public transport and hate having to use public toilets (almost a phobia of mine) but of course when periods are here I have no option so have enjoyed the last 8 months!

I just wish my menopause symptoms weren't so horrendous so I could just get through it without HRT but it really wasn't an option so I just need to learn to suck it up and get on with life I guess.

There is another option....

Has your dr suggested using the Mirena coil for the progestogen part of HRT plus transdermal oestrogen- either a patch or gel? This is considered the 'gold standard' by many consultants because the progestogen in the Mirena works directly on the uterus lining, so no periods.

Also, in the latest NICE report on the menopause, there was the advice to move away from pills which have a higher (though still very small) risk of blood clots and to use transdermal HRT.

From NICE

'Explain to women that taking oral (but not transdermal) oestrogen is associated with a small increase in the risk of stroke. Also explain that the baseline population risk of stroke in women aged under 60 years is very low (see table 2).'

My GP has not been that helpful to be honest. He just listened to my symptoms whilst looking at his computer screen then gave me a script for the elleste duet. I have a follow up appointment next week with another GP at the practice maybe he will be a bit more helpful.

Thank you for the info on the coil that sounds like something that would suit me much better but if my GP wont put me on that regime then at least the elleste has sorted my side effects nicely and my only issue is having to face a few days every 4 weeks of inconvenience.

I think you ought to go to the appt with the line 'I'd like to try the Mirena and a separate oestrogen please, as I have heard this is the preferred option by consultants. unless there are any medical reasons why I can't have it, that is my preference.'

Patient-doctor is a partnership and your preference should be taken into account.

I was in the opposite situation where my consultant suggested the Mirena + oestrogen but I have sensitivity to progesterone and didn't want anything that was hard to change.