does HRT always mean a monthly bleed?

[Gatekeeper]

my last period was the end of Feb and since then I have terrible trouble sleeping and am having hot flushes during the night and day. I tried HRT a year ago for the same thing (whilst still having periods more or less every month) and it worked ok. Came off it for no real reason but things settled down and the flushes etc didn't seem to return until now

Trouble is that i have HORRIBLE periods- very heavy with large clots which are uncomfortable to 'pass' and they last 8 days. Have tried tranexamic acid and something else beginning with 'M' and they gave me awful nausea and cramping

I feel shite though and am considering hRt again but am dreading the return to flooding, awful periods which happened even on hrt

It will mean a monthly bleed unless you have the Mirena coil fitted- has this been offered at all?

If you aren't too old (!) some drs will prescribe the OCP (under 50) which should also control the bleeds.

Ask your GP for a referral to a specialist who is sympathetic to meno issues and discuss!

I was told that mirena + gel/patch was the best thing for period problems. I pooh-poohed this idea when I had the chance as I wasn't having periods and was not keen on it. ( I was even promised 'no more periods' by the GP which is a load of codswallop and dissed by further reading - they should make them lighter and gradually reduce though) However, 5 months later, they started up again with a vengence.

I am doing ok on ordinary hrt tablets - it seems to take very little to knock my cycles on the head.

some women do find their periods stop completely with the Mirena- have a friend whose have.

I think it is something like 60% over 2 mirenas for fertile women.

I expect that all peri-menopausal women will stop having periods eventually in the 5 years, and for the unlucky few who have continuous bleeding, extra oestrogen is supposed to help that.

I'm 53 this year and I cant bear the thought of continued bleeding for years to come. I am heartedly fed up with periods but am also sick of insomnia etc etc

Have tried the mirena coil....eight months of continuous heavy periods brought me to my knees. Have been scanned for fibroids but nothing there

... I hate being a woman at times

Thanks for everyone's posts by the way

rang surgery this morning and was lucky to get a cancellation for this afternoon. Went but was a complete waste of time

GP -male- asked me what i knew about HRT and the pros and cons. I said that I knew there was a small risk of cancers and stroke etc, but he disagreed. "No. no...the risk is actually quite a serious one- NICE does not recommend" blah blah blah

Told me that I should accept flushes , insomnia etc as a natural part of being a woman. Told me it will improve in a few months

Refused to prescribe ...Git!

not impressed

Your GP needs to refresh his information - NICE issued HRT guidelines last Autumn and I don't think your GPs knowledge reflects their stance.
I'm not a HCP, so won't offer any advice, other than to say it's worth a Google and then revisit your surgery - but perhaps ask for a different GP if possible.

That gp us a fuckwit.

Visit www.menopausematters.co.uk, read the forum and get some info. Then go back to docs with your findings and kick his ass until he gives you it.

I'm so very sorry you had your time wasted today op - you really do have to to basically tell the gps what to prescribe

Agree your GP is well out of date. The latest NICE guidelines are very positive about HRT in fact.

If you've not had a period since Feb you could actually try a continuous HRT (I.e one that doesn't have a monthly withdrawal bleed). If you get troublesome bleeding on that then you probably would need to revert to a sequential formulation which would mean a monthly bleed, however after a year on that you could then try continuous again and see how you go.

You will still need to consider contraception though, which is why using Mirena as the progesterone "bit" of HRT is a popular option in terms of killing two birds with one stone.

Also that "natural part of being a woman" is a real cop-out on the part of HCPs who are too nervous to update their knowledge and offer HRT. It's failing female patients.

The guidelines for conti HRT (no bleed) are 12 months with no natural period or over age 54. I'm not sure 4 months since Feb qualifies you for that. Using conti HRT usually gives erratic bleeding for weeks or months- so be warned.
I tried conti after being on sequential for several years and didn't like it at all - constant spotting for 3 weeks and not feeling great with daily progesterone. I reverted to sequi and although bleeds in your 60s are no laughing matter there is some small comfort in that it's safer re breast cancer not to use progestogens daily though micronised progesterone may be less of a risk.

Your GP is completely out of date Gate. I added a link to the International Menopause Society's latest publications earlier today- maybe a couple of posts down- where prescribing guidelines- the opposite to your GP's behaviour- are clear.

DocMcFanjo Hope you might see this!
Are you a 'real' dr or another type of health professional? Not being nosey but wondering if you are a GP could you shed any light on why many GPs are not up to date on NICE meno guidelines? Reading this and other meno forums it's clear that women are being given very poor care by many GPs who sometimes don't have a clue about HRT and even prescribe the wrong types.

You say that you are doing a training course on HRT and meno. Why is something that will affect 50 % of the population (ie women) not mandatory training for GPs? Does the Royal College of GPs not make it part of CPD that GPs have to subscribe to training around new NICE guidelines?

From my professional work I'm aware of the training being done by the British Menopause Society across the UK in the hope of educating GPs and other HCP on HRT and menopause. I also know they are concerned about how little many GPs know and how they are out of date (relying on research etc from 12 years ago.)

I fully understand that GPs are just 'that' ie 'general' drs who have many other demands on their time, but menopause is not a rare disease or condition - it affects every woman. Why are more GPs not learning more about it? (If you know!)

Thank you everyone for talking the time to post. I've driven myself crackers with varying scenarios involving crap GP so have made another appointment in 2 weeks with female middle aged GP whom I hope is more in tune and sympathetic . Utterly awful sleep last night again and my brain feels like tapioca. Will resort to anti histamine to try and get a bit of kip

Write yourself a list of symptoms/what you need to ask etc.

I hope it goes better this time.

Will do: was still awake 2.30 this morning ...dozed off around three and awake again at five. I am shattered

I hate it when the birds start singing and you realise you have been awake all night. I usually crash out then and then am shattered when the alarm goes off. I only get it 2/3 nights in a row, then comatose the next night then back to normal. Sometimes I can be in a funny state of not quite dropping off for hours. Then suddenly I can feel myself drifting over into sleep, get an adrenaline surge of excitement and that is it for quite a while longer.

It is worth googling 'sleep hygiene'. Bizarrely, it is not about how often you wash your sheets .

Cherylene I am up to speed on sleep hygiene but nowt is helping. I even - in desperation last week- took one of dh's anti histamine but I still couldn't bloody sleep

my children recoil at the sight of me on a morning as I am like a swamp monster , hauling myself into the living room...

I don't find anti histamine a help either (I take it all the time for pollen/dust/food allergies. .

I have chamomile/lavender/valerian teas and chamomile oil for the bath.

I have books that I enjoy but aren't too exciting, low level lighting, clean sheets etc.

Luckily, I know it will not happen every night and I do crash out eventually.

HRT does make a difference to me. However, I will still have the odd wakeful night if there is something on my mind.

arghh...have a couple more weeks of this as the GP I want to see (small village practice) is on holiday until next month

arse GP informed me that there is at least 40% chance of me having a stroke or heart attack on HRT. This was after I told him both my parents had had one (in their late eighties and nineties)

I am not a confrontational person but after I listened to him again pontificating on about 'women from my country' not using HRT I could have twatted him one (or twice) . Poor bloody women...

Arse!

If he really said that then he's even more of a fuckwit than I originally thought.

Did you go on that website?

He's a complete plonker. Seriously, I'd consider questioning his ability to practice. He's completely out of touch and who knows how many other women are being denied treatment???

What does he mean 'women in his country'? Is he from outside the UK?

He cannot allow his own prejudices to affect medical decisions.

What does he mean a 40% chance of a stroke? he's an idiot. There is NO increase in stroke with transdermal HRT in women under 60 and barely any after that age.

Have you printed off the NICE information to take with you?

You don't have to stick with a rubbish GP. You might find a menopause clinic (NHS) in your area, (look at the Menopause Matters website for info) or see a gynae privately.

Totally agree with Polly.

Here's just one of the great factsheets from the BMS about HRT and risk (breast cancer in this case).

thebms.org.uk/_wprs/wp-content/uploads/2016/04/WHC-Understanding-Risk-of-Breast-Cancer-160516.pdf

I'm crap at links so hope it works.

GPs as a group have been reaaaaaallllly slow to upskill on HRT and it's actually shameful IMO. What a failing to deny women what could potentially be a really helpful solution to a really miserable problem all because we can't be bothered to overcome our own prejudices based on decade-old and terribly interpreted (even deliberately misleading?) studies.

As an aside, Polly, I've PMd you with my expanded ranty thoughts on your post to me earlier.

Really hope you get sorted OP

Sorry about your arse GP. I think we have one of those at our surgery too - I have to time my visits to coincide with the sensible part-time one or the nurse prescriber.

thanks for everyones posts; they helped a lot

I saw female GP yesterday and am now the proud possessor of 3 months owrth of Elleste Duet. She typed an awful lot as I grumbled on about him. She didn't agree with what he said but obviously couldn't call him an arse as I was

Hope they kick in soon as I feel bloody awful and I smell like boiled tea towels