Is my understanding correct - can anyone advise please

[WaterWorld]

Hi

I am 44 and suffering hot flushes up to 20 times a day for 4 months and no period since mid Jan. I have serious night sweats costing me maybe 1-2 hours of sleep waking up to 6 times in a night, overheated then chilled as soon as it passes for the same four months. Exhausting.

I have had similar symptoms last year and the year before for 2-6 weeks then it passed and my cycle resumed though not very regular.

I had not used contraception for the last 5 plus years with one miscarriage and no other pregnancies so realise this is beyond a long shot now.

Am I correct in thinking that if I have no contra-indications such as breast cancer risk that overall I would be an ideal candidate for HRT and that it would be pity to miss out on the potential benefits of this and pursue herbal remedies for the flushing?

I have seen two doctors, first in Feb and then the second this week. The first one wanted me to have blood tests three months apart so had first set in March which were inconclusive - and I can't bear to wait till mid June for the repeat as I am struggling.

Second suggested sage while waiting for the second blood test and also a varicose vein op to be out of the way then reconsider mid June.

I am not keen on trying herbal remedies as I feel that in thirty years time I might regret the lost years of hormones if my bones are suffering etc. But given the doctor suggested Sage aso m I missing something here?

Other symptoms are there such as reduced libido (possible more exhaustion related) and advancing prolapse (maybe not related don't know). Shorter fuse (again possible exhaustion related rather than strictly hormonal). Sorry for long post. Any guidance appreciated.

Are you me? Everything you have said is me apart from the age I am 45. I haven't had a period since beginning of Jan and the hot sweats and waking in the night are beginning to take there toll on me. I went to the Drs last week and after a chat about symptoms and family history chat have been given hrt to try. Haven't started it yet as we go on holiday end of May and the hrt I have been given gives you a monthly bleed at the end of each pack roughly so I am going to start this weekend as this means I won't finish first pack until I come back. I didn't need any blood tests I just confirmed that I had done a pregnancy test to rule it out which I had. Go back to the gp ask to see one that specialises in gynae problems. That's what I did. Good luck.

The facts are very simple and I suggest having a really good read of everything you can lay your hands on about HRT and risks.

Basically there is NO risk at all for women under the age of the average menopause if they use HRT - average age is 52- because all you are doing is putting back the hormones you ought to have in your early 40s. Without these you are at a higher risk (in 10 years time) of osteoporosis and heart disease. This is clearly set out in the NICE menopause report. (easily googled!)

In fact, your GPs ought to be trying to persuade you to use HRT to protect your health! This again is the advice from NICE.

You are having an early menopause and this needs treatment.

ALL the symptoms you've listed here are signs of low oestrogen/ hormones.

Sounds as if your drs are being overly cautious. The NICE report says tests women under 45 but over 45 just treat symptoms. You've got so many symptoms that are screaming 'peri meno!!' that your GP ought to listen and treat you.

If you don't get any joy from them - and you might need to be assertive and say what you want- find another GP or a gynae who can help you.

This thread has scared me as I'm 43 and have had sweats for 3 years and only one period in that time too yet the doctor days I can't have hrt as I'm under 45 and this would massively increase my risk of breast cancer. She took bloods and said I'm almost over the menopause. Has anyone else been told this?

You know what I'd do- I'd tell your GP very politely that she and anyone else at your practice who believes such tosh ought to get themselves booked on the British Menopause Society's conference in London a week today so they get some education about women's health, and HRT! The days are for GPs to get them up to speed and my God, they do need it from the rubbish some women are being told. This is nothing short of disgraceful really. Women's lives are being potentially endangered by GPs who do not have the foggiest about HRT and premature /early menopause.

What you have been told is utter rubbish.

I suggest you print off the NICE report , highlight the section about premature and early meno and the treatment, and take to your GP to discuss. Or find another dr who knows what they are doing.

If it helps, this is the part from the NICE guidelines. You probably do have POI as you have only had 1 period since age 40 - 3 years ago.

Managing premature ovarian insufficiency

1.6.6 Offer sex steroid replacement with a choice of HRT or a combined hormonal contraceptive to women with premature ovarian insufficiency, unless contraindicated (for example, in women with hormone-sensitive cancer).

1.6.7 Explain to women with premature ovarian insufficiency:
the importance of starting hormonal treatment either with HRT or a combined hormonal contraceptive and continuing treatment until at least the age of natural menopause (unless contraindicated)

that the baseline population risk of diseases such as breast cancer and cardiovascular disease increases with age and is very low in women aged under 40

that HRT may have a beneficial effect on blood pressure when compared with a combined oral contraceptive

that both HRT and combined oral contraceptives offer bone protection

that HRT is not a contraceptive.

1.6.8 Give women with premature ovarian insufficiency and contraindications to hormonal treatments advice, including on bone and cardiovascular health, and symptom management.

1.6.9 Consider referring women with premature ovarian insufficiency to healthcare professionals who have the relevant experience to help them manage all aspects of physical and psychosocial health related to their condition.

Thank you so much everyone. I was feeling desperate especially about the sleep but a bit more optimistic now.

I have read everything I can find from nice and rcog and nhs(their page seems to have been written before the current nice guidelines so is perhaps out of date ).

I am going to book with the second GP again asap she is on a training rotation and has some obs and gyne experience. She was very interested and conscientious but perhaps following examples of her current rotation GP sponsor (or what ever they call them - supervisor maybe - with the herbal things).

I would like to have a 'transderma'l solution to try. Have tried to research brands but the names are swimming in front of my eyes!

ebay you might like to take this along to your GP. From the Royal College of Gynaecologists website and a statement from the British Menopause Society. the question asked is about heart disease risk in women with early menopause but the answer also includes a statement on breast cancer risk. There is masses online if you google early menopause/ HRT- so have a dig around.

A 2007 consensus statement on premature menopause from the British Menopause Society Council states that “No evidence shows that estrogen replacement increases the risk of breast cancer to a level greater than that found in normally menstruating women”

www.rcog.org.uk/en/guidelines-research-services/guidelines/hrt-in-premature-menopause---query-bank/

The link is from 2007 and since then the use of HRT for early menopause has gained more favour, not less.

This is a link all about prem meno from the BMS. Note that it says that 45 is now considered early (and some specialists actually take it to 47.)

www.thebms.org.uk/factdetail.php?id=1

Fact Sheets: Article

Title: Premature Menopause

Women with a premature menopause are usually advised to have hormone replacement therapy until the average age of the natural menopause (52). This advice is unchanged by the Women's Health Initiative and Million Women studies which were both undertaken in women aged 50 and over. There is no evidence that hormone replacement therapy (HRT) increases risk of breast cancer, cardiovascular disease or dementia over and above that found in menstruating women with a normally timed menopause.

Background

Premature menopause should be defined ideally as menopause that occurs at an age less than two standard deviations below the mean estimated for the reference population. The age of 40 years is frequently used as an arbitrary limit, but many gynaecologists take

I'm fairly open-minded about the possibility of going on some sort of hrt at some point, but sage tablets changed my life and made the sweats so rare as to be barely a problem. Best ones I've found are by Vosgel.

My periods didn't fully stop until I was 49, however.

You've been very lucky if something like that has helped. The point is though that hot flushes although awful are not life threatening in the same way as low oestrogen is for women with an early menopause. Sage won't help bone density or heart disease risk or genital/vaginal atrophy etc.

ebay I was told the same (although I was older than you at the time).

I wish I'd pursued some sort of treatment as I felt dreadful for a while (exhausted, flushes, anxious) but at last I seem to be feeling a bit better.

I had to go through 3 GPs till eventually I was offered HRT - bloody ridiculous as I started with symptoms at 36. Had to wait till 42 before I found a GP who knew what they were talkign about.

I'd armed myself with all the information but fortunately they just said 'why haven't you tried HRT?', like I hadn't been asking for it for years!

Also take Agnus Castus for PMT like symptoms, which helps, Menopace, because why not really, and bought some sage to make sage tea. But the HRT i'm taking for my bones.

Don't doubt I am peri, so It sounds like at (just still) 44 then I would make the cut for 'early' symptoms and therefore HRT would be more beneficial to me than Sage as on balance it offers the extra health benefits.
Either way hats of to anyone who went through all this without any meds or supplements because it is not nice at all.
A real pity people come across Gps who are not up to date on current recommendations.

Thank you so much Polly for all the info, will go back to doctors next week.

Polly I can see you have been helping on many of the threads about this sort of issue and I am much better informed. Are you a HCP? Thank you for your clear translation of the guidelines.

I just feel concerned for women who are putting their health at risk by being given mis information.

I was at the same stage as you OP and the other ladies who were all experiencing symptoms of low oestrogen, before our time.

I'm on a transdermal bio identical oestrogen gel which was prescribed by my GP and a capsule of progesterone to take in the second half of the month along with the transdermal gel.

I honestly do t know myself. It's like I'm alive again. I sleep, I'm got my SOH back(!) and I've got energy. The aches are gone.

I used to take sage, meno pace and all that, but seriously hrt has changed my life for the better. I even like my work, kids and husband again.

My GP didn't know very much about the oestrogel or utrogestan, even though she's on hrt herself. She takes a combined oestrogen and progesterone pill every day and has no bleeding. This might suit you OP as your periods have almost stopped. If you're post meno, then just oestrogen is good afaik.
Mine periods patchy and irregular, light and then a heavy one, so I'm on a sequential regimen. oestrogen for half the month, then oestrogen and progesterone for the rest. That way I get a light bleed.

My GP changed her mind about hrt as she attended a conference on menopause and saw the evidence, and she's happy to prescribe it now, whereas before she saw the facts, she was recommending sage tablets and naps. Bless.

I did a "are you going through the perimenopause" survey on the menopause matters website to take with me as my memory used to be terrible and I kept forgetting things.... not so anymore.

Hth

Thanks Polly

This is quite a nice diagram, easy to follow

www.menopausematters.co.uk/tree.php

Thanks Dorje, now I'm really keen to go back to GP next week :)

What a hugely useful and informative thread. Thank you all.

I've been peri since 39, am now 47. Have been on HRT for 6 years which has helped symptoms enormously, but my new GP has warned that he wants to start taking me off it as I've been on it for so long.

I'm going to take this information next time I see him.

It's quite appalling the lack of up to date knowledge GPs seem to have around this area, it reinforces the feeling of 'irrelevance' that pervades around post meno women.

Good luck WaterWorld, HRT has been great for me, I hope it has a similar benefit to you.

As doctors apt is not until Wednesday I headed off to the health store the other day for some sage tablets for a few days [feeling desperately short of sleep due to the night sweats].

Visit went something like this. 'Please can I have some sage tables to help with my hot flushes till I can get hrt prescribed next week' 'Yes' or how about this one with red clover as well as a couple of other things ...'then you might find you don't need the hrt'.

Well as I am only 44 and I am taking a long term view I am still looking forward to getting the hrt prescribed asap.... not sure if the sage is helping or not meanwhile due to the sudden heatwave .

On a separate note the sage alone was £12.50 for one month supply Guess I would have shopped around if I had not got to the desperate stage!

Well, I suppose it's to be expected that a shop selling herbs will peddle those instead of HRT! The Royal College of Gynaecologists has a report online on alternatives to HRT. It's very useful reading because it covers most of the herbs etc that people think work and reviews lots of research which shows that with maybe a couple of exceptions, none of it does. Worth googling. You might find my previous link in this section if you do a search.

Thanks Polly Yes I have read it and am clear on the subject.

I don't know much about the way that NICE guidelines are circulated but get the impression that the new guidance leads to a great big need for education in not only gp practices but in all sorts of public and private organisations and communities - like you and others are doing here. e.g. the actual NHS pages don't seem to have been updated since the guidelines were published. Women go to lots of places and people for advice and .... fortunately for me I came here [pats self on back].

Here's to Wednesdays gp appointment!

Yes you're right!
The new NICE guidelines had quite a lot of publicity in November but not everyone was aware of them. I've also read that some GPs are being a bit sniffy and saying they are 'guidelines' not 'rules' but TBH that's semantics, I think!

The most important part is at the start of the guidelines where it says all treatment should be individualised and a partnership- not drs imposing their own views on a patient.

Next week the BMS has a 2-day annual conference and the says are meant for the benefit of GPs and other HCPs to update them on the NICE report. It's hoped that this will give further publicity to the new guidelines on HRT. The BMS also runs workshops throughout the year for GPs and HCPs but obviously they have to choose to attend!

It's a slow process- the BMS is aware of this- but forums like this and women who are proactive and do their own research then tell their GPs what they'd like etc , all helps.

I'm a GP and am sorry you're not finding a GP who's sympathetic and up to date. HRT is certainly a good option for lots of women in your position. You may require contraception also which complicates things a little but most GPs should be able to sort you out.

I think part of the problem is that GPs are bombarded with guidelines from every direction for every condition and they change every few years. It's actually quite hard to keep up with every development for the few hundred most common conditions we treat on top of the day job seeing patients so you are going to find some that are a bit behind.