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.

Hi Lapcat my GP was interested and had relevant experience though not a full grasp of the recent guidelines, still happy to discuss/listen. GP's jobs are wide and varied and complex for many reasons, as a patient who is keen to understand my own health I am fine working with this reality and have had some really great care in recent years on a couple of things.

If the patient asks the right questions of the right people great, but if they pop in the local health food shop, ask their mum/a friend or depend on a quick google and cauldron.com [...looking at you DH] who is not aware of current guidance they can easily take an inferior path.

The thing is though, menopause is something that WILL affect 50% of the population without any doubt, so although I appreciate GPs are bombarded with new guidelines for various conditions, 50 % of their patients will not have that condition.

The NICE report is the first major study into menopausal treatment for decades. It's turned around all the myths and outdated research from 12 years ago which the vast majority of GPs are still adhering to, if you read the experiences that so many women are having.

There have been some very important issues raised by the BMS and the International Menopause Society into the long term health of women age 50+ (who will live for another 35 years on average) and the role that HRT ought to play in that health.

I'm afraid the current state of affairs seems to be that many GPs trivialise the menopause as something women just a) put up with or b) get over in a couple of years so they don't bother to learn about the long term effects of oestrogen-deficiency on the body.

Not having a pot shot at you personally, but most GPs are not up to speed and if something affected 50% of men (sometimes for the rest of their lives) there would be a heck of a lot more being done!

'50% of men' - sorry, that ought to be 'ALL men, and 50% of all patients.'

My GP has had an about turn after going to a conference and seeing the consultants, and listening to the talks and hearing the evidence. She does blood tests and prescribes hrt to all her patients who need it. Two years ago when I had my first hot flash she recommended sage tablets from Vogel, and naps.... She's a bit embarrassed about that, but as a scientist, she embraces the new research, so, respect is due.

She'll recommend hrt for as long as I want it. Indeed, she's told me she'll take it till she's 70 at least, and then have a think about further use, depending on how the research has gone.

I think attitudes to hrt years ago were "as little a dose for as short as possible".
I have to say I find that attitude very patriacrhal and patronising- like we were going to get "addicted" to feeling better or even feeling human, and needed to be controlled and put back in our box when the Doctor decides we've had enough.

So glad I've got an open minded, scientific GP. I do think GP training is essential.
Seems a shame that some women are missing out because their GPs are closed minded, unscientific, patronising and ignorant.

Thinking about it more widely still I realise that MIL's menopause affected not just her but her and her three children, FIL and indeed other relationships she had ...DH words 'hell' and he was a young teen at the time. It is often mentioned within the family and is another reason I want to be treated. She is love personified now 30 years later though :) So it could be argued that for each woman struggling with it there are others at risk of experiencing some negative side effects of menopausal symptoms, then there is the upset caused by later consequent physical health problems.

Perhaps similar could be said about pmt and also period pain (i suffered untold pain alone with a tens machine i got from Boots, never investigated or treated, assumed discomfort to be expected). Again others affected by this, the odd day off work, friends let down, emotional unpredictability sometimes (!) Feeling that I should soldier on and DH should turn a blind eye till i was ok again. Thinking 'the less intervention the better'. Hmmm. Glad I am better informed about the menopause that I was about all that.

I'm delighted to have found this thread. Thank you all for the information posted.

I've been having problems with my periods - I have a Mirena and only get spotting though even that's stopped - massive night sweats, mood swings, non existent libido, unexplained weight gain, mood swings. I suspected that it was linked to menopause but I'm only 42. My GP agreed thank god, and sent me for a raft of blood tests, I am just waiting on the results now. I know she checked my hormone levels but do you need any specific test to check for POI does anyone know?

I'm back at the surgery on Thursday and will see what tests say and will be having a discussion about HRT based on what I've read here. Like the pp, I've always had horrible periods and was on oral contraception for years to manage them, then the Mirena when they stopped working. I suspect these contraceptives have camouflaged my hormonal issues until this point.

Hi Fluckle.
I suppose the important ones for meno diagnosis are:
Testosterone: 0.3 - 1.7 is normal range (nmol/L)

Oestradiol: menopausal range less than 505 (pmol/L)
Luteninising hormone (LH): menopausal readings are 8 - 59 (U/L)
Follicle Stimulating Hormone (FSH): menopausal readings are.. 26-135 (U/L)

Normal hormone reference ranges change for oestradiol, FSH, and LH within the monthly cycle So it's important to know where you are in your cycle, IE whether you're
Follicular
Mid cycle or
Luteal

But the meno readings are as above.

Hth

Wow, thanks so much for all that detail Dorje - I'm taking a note of those numbers with me to the doctor. I was definitely in my luteal phase as conveniently my period did choose to turn up for once, 5 days after the blood test.

So Thursday will be an interesting day!

Interesting thread. I was wondering whether anyone had any advice: I went through surgical menopause due to treatment for ovarian cancer 2 years ago at the age of 35. I think they told me I couldn't have HRT due to the type of cancer (but to be honest there has been so much to deal with I could have that wrong; i just know its never been offered despite suffering DREADFULLY with menopause symptoms).

I am now through the menopause AFAIK but still have no libido and crucially have vaginal dryness which makes sex painful - aside from everything else that the cancer has caused, I wish I could cure this aspect so that I could have a sex life again (my poor DH!). Anyone know of anything I could try that might help?

I'd suggest seeing your doctor. I think there are oestrogen gels that can help; but hopefully someone more knowledgeable will reply. Thinking of exploring that route myself; I got theough the worst of the flushes with sage tabs but now other issues seem to be kicking in and I don't think they'll cut it!

There's going to be a webchat on Thursday.

Hmm actually, as the pp in the last comment points out, it's a journo not a menopause expert.

No worries Fluckle, I have my own read outs here in front of me so that's why I could tell you! I had a blood test two weeks ago, and am now on bio identical hrt (oestrogel and utrogestan) and feel great.

"Normal fertile cycle" readings for bloods taken in Luteal phase are
FSH 2 - 8
LH 1 - 11
Oestradiol is 82 - 1251

Menopausal readings are
FSH 26 - 135
LH 8 - 59
O

Hello again.
So into the world of HRT I go with Evorel 25 initially (can double up if I decide I need to). Provera for the second half of the 'cycle', may swap that for a mirena coil later).

Fingers crossed that I get the benefits you have Dorje

I might be getting over excited but I have just had two whole hours without a hot flush, it is the first two hours like that in .... 101 days. Patch has been on almost 24 hours.

Doctor did not go well.

Apparently my FSH is 2.3, and they didn't test for LH and O because she said they were irrelevant to menopause. So despite my raft of menopausal symptoms the GP completely discounted any menopause related issues.

However when I asked what else would be causing these symptoms then, she had no answers. I asked if it was with repeating the bloods at another part of my cycle, she said it wasn't.

Instead she honed in on my taking ADs and decided I needed to increase my dose or change my tablets. I refused both, because the symptoms I have are distinctly linked to ovulation/period starting, and apart from prior to my period starting my mood has been positive and stable for months. But I had a shit night's sleep for the fourth night in a row thanks to night sweats, I'm exhausted, I've got PMT now and the frustration at this situation meant I got a bit teary. So of course she saw this as virtually conclusive that I needed to change me ADs. But I don't want to have all that faffing about, extra mood swings, the weeks of side effects again. I just want to know why I've got these hormonal problems and what I can do to fix them

Oh Fluckle this sounds very frustrating. I don't have much experience to offer but just wondered could you take a little diary covering a few days focussing on the number and impact on your life of the night sweats (to a different GP perhaps).
For me the night sweats wake me 4-6 times a night and cost me an hour or twos sleep and the impact of that is that by 8pm I am good for nothing and somewhat short tempered.

That is very disappointing fluckle.

Don't give up. If you are having an early menopause then you need the right treatment.

Please read the NICE guidelines which recommend tests for women under 45. It says which ones. print off, take and discuss with this GP or another one.
If she refuses to believe you and your symptoms, ask to be referred to a specialist. If she refuses then you will have to insist and say she isn't treating you correctly, according to NICE, so you want a dr who will.

Your other options are an NHS menopause clinic in your area if there is one, a private appt with a specialist or change to another GP in your practice or another practice.

It's really not good enough.

That's a brilliant idea WaterWorld, thank you. The GP has asked me to go for some other blood tests, just to rule out a few other things, and I'm still waiting for my ultrasound appointment to check my Mirena and make sure there are no physical issues. Then I'll go back to another GP (a non locum this time so I can get some consistency in approach) and see what they say. I'm determined to get to the bottom of this one way or another.

Thank you for your advice too PollyPerky. For some reason I didn't see your post earlier, but I shall do what you suggest with the guidelines. I'm going in armed with even more info next time!

Well 48 hours in and I feel a bit better, I slept a fair bit better last night (not perfect woke three times to night sweats) and though the daytime flushes have not miraculously vanished there are fewer of them over all.

I am wondering if the oestrogen builds to a level over time with the patches or if it is a fairly even level once the patch is in place? Reason being I have the option of doubling up the patches if I think I need to, but did not check how long to wait before deciding it is needed .

Great thread, thanks for the info.

Quick question, I'm wondering if one is still having periods regularly, can HRT such as Oestrogel and Utrogesten still be prescribed?
I'm reading in a lot of places that they're the best. But I'm very much still peri- as I still have the regular periods and I think ovulate some months too. But blood tests and symptoms are positive for meno... Night sweats, surges of adrenaline, palpitations, joint pains, and more

All HRT can be used during peri except combined HRT-( 2 hormones daily.)
If you are very much having periods then you may well get your own periods as well as the HRT cyclic bleed- bit hit and miss till it all settles down.

Well 6 days in and I am definitely better off than I was this time last week. The flushes are much reduced in the day time (though I wake up overheated they are then rare through the morning and afternoon, worse in the evening) and compared to last week somewhat improved overnight, maybe halved, so I have had more sleep. I am still using the Evorel 25 and waiting it out a bit longer before deciding if I need to go up to 50.

That's excellent news WaterWorld, you must be so relieved