Visiting GP tomorrow - trying to arm myself with information...

[Tsmummy08]

Hello all, I've been browsing threads for the last week or so and need a bit more direction before I visit my GP tomorrow.

Background: I'm 44 in a few months, my periods are still happening but cycle lengths are getting less regular - sometimes longer, sometimes shorter and heavier/longer generally. My main issues are mental/emotional: irritability/rage/feeling overwhelmed and unable to control my emotions which seems to be extending well into my period week, rather than subsiding with bleeding. I think symptoms lasted til around day 10 this month. I'm also becoming very foggy brained and feel like I've lost a fair degree of cognitive function over the last few years (not helpful as I'm part way through a PhD and desperate to finish soon)!

In the space of a week I caught the wrong train, locked myself out of the house twice, put the coffee maker on without coffee and missed a rare massage appointment, which cost me £50 as they charged my card - I didn't even realise until waking up in a panic the following day! I also had a complete meltdown at my DD for no real reason and it's affecting my relationship with DH.

I've also noticed a worsening of insomnia (had since my teens) and have been less cold this winter!

I went to my GP last week and among other things mentioned my changing periods and she said "well yes, your hormones are probably changing". Following the week from hell, I've decided to go back and ask for a FSH test with a view to using some form HRT.

I've been looking at the Menopause Matters website, have read a couple of books - is there anything specific I should ask her about? I'm going to see my thesis supervisor in a couple of weeks time (about the time when my period is due) and I'm concerned I'm going to be a useless wreck....

Other background: I'm a prime candidate for osteoporosis but already follow most of the "diet/lifestyle" advice for perimenopause - with the possible exception of alcohol, which I have a couple of times a week

I guess you have to go in saying you think you are having an early menopause (though in theory that means no periods and 'early' would be by 45 or under.)

FSH tests should be done twice over 2 months-and between days 2-5 of each cycle. Even so they aren't 100% accurate as your hormones may be up and down.

what do you mean by 'prime candidate for osteoporosis'? If you have risk factors you need to discuss those with the dr.

Family history of OP and personal history of amenorrhea, low BMI...

I'm not sure what I can do other than HRT to address my mood swings/emotional symptoms... I know that menopause is just another phase of life but I'm loathe to feel like I'm losing my marbles...

Struggling with menopausal symptoms, had endometrial ablation a year ago so no bleeding since, but irritable, bloating, weight gain, headaches etc definitely worse over last few months. Any natural ideas to ease symptoms, also at 50 and no bleeding for a year dare I think safe from getting pregnant? Tsmummy08 good luck for tomorrow.

Pat maybe start your own thread as it's going to get lost in this one about something else.

Ts Just ask for HRT!
You are having symptoms at a young age.
You could also push for a DEXA scan or pay for it privately to see how your bones are now.

I'm fairly sure I'm in perimenopause (wildly erratic cycle after being regular my whole life) but have had the fsh tests done twice (at random points in the cycle - they never said it should be at a particular time 😣) and those were fine so they've pretty much written me off and are not interested in any further investigations. I'm under 45 so would really like to know so I can have hrt if needed.

I would also ask for a general screen of other things that may cause your symptoms just to rule them out aswell such as thyroid function test, full blood count, random glucose, vitamin D, vitamin B12, prolactin levels and oestrogen. Obviously your aware of your osteoporosis risk through your family history and the link to your periods (or lack of). It might be worth asking for a bone density scan, usually very quick of your hip and thigh, to establish whether you have any signs of changes there already and if it is worth supplementing your calcium and vit d3 in the long term, and especially dependant on the results of any hormone testing.

I sincerely sympathise though, the brain fog is the worst, especially when your used to being a highly functioning human being that now routinely puts the keys in the fridge!!!

Thanks for the replies - I'll report back on how it goes today... I'll ask about other tests too :)

Hi, I'm new here....came across this thread whilst googling menopause systems. I too have a GP appointment tomorrow as I think I have symptons.

Im a usually very happy, independent and confident person but for some inexplicable reason have been reduced to a raging, tearful, anxious blob!
Im 50, my periods have been erratic over the last few months and It suddenly occurred to me that the menopause could be to blame...and Im kind of hoping so....at least that would explain a lot.

So, I'll be very interested, Tsmummy08, to hear how you get on tomorrow and I hope my GP will help - I feel like Ive completely lost "me" at the minute, I feel dreadful, I had to leave work yesterday morning because I just couldn't think straight and was struggling to hold myself together. As luck would have it, I have a few days leave now and not back at work until next Tuesday.
Am usually very sociable but currently just want to crawl away into a cave! sorry....have finished complaining now!

Yes, let us know how you get on
I need to make an appt for next week
It's making my life unbearable. I'm not enjoying anything, so irritable and feel like period symptoms last all month. There's no let up

OK so I was offered: combined contraceptive pill or two weeks per month SSRIs (i.e. 2 weeks between ovulation and menses). There was also a suggestion that CBT/counselling may help.....

Her rationale was that HRT doesn't address the emotional/mental effects of perimenopause, my osteoporosis risk won't be improved with HRT because I'm still having periods but should continue what I already do (exercise, vit D, good calcium intake). She also said that HRT comes with risks, but didn't make the same statement about OCP which has higher levels of hormones.

Neither of those options sounds great - I was only on the Pill for a couple of years in my late teens/early twenties and when I tried it again at its lowest dose in my late 20s, made me fat and depressed. SSRIs also have side-effects....

She also said FSH would only be checked when I was definitely menopausal (i.e. no periods). She sympathised (same age as me etc) and said I should take time out for myself (which I do) but that was that.

I forgot to mention thyroid tests etc, what a surprise lol! Not sure what to do next.

I think you need to either find another GP OR go back and discuss the NICE guidelines. Your GP is incorrect on many fronts:

-FSH levels are checked in women under 45 but not over 45.
-SSRIs are not to be prescribed unless there is evidence of prior depression or current depression that is not hormone driven.
-HRT risk do not apply to women under 52 ( average age of menopause ) because it's replacement of what ought to be there.

• Osteoporosis is a higher risk in women who have irregular cycles (ie only a few a year) or whose oestrogen levels fall before the average age for menopause. HRT will help build bone regardless of whether you are still having cycles or not.

This is from NICE.. It will come out as broken lines due to copying/ pasting but you can see all the points I've made above in their guidelines.

1.2 Diagnosis of perimenopause and menopause

1.2.1 Diagnose the following without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms:

perimenopause based on vasomotor symptoms and irregular periods

menopause in women who have not had a period for at least 12 months and are not using hormonal contraception

menopause based on symptoms in women without a uterus.

1.2.2 Take into account that it can be difficult to diagnose menopause in women who are taking hormonal treatments, for example for the treatment of heavy periods.

1.2.3 Do not use the following laboratory and imaging tests to diagnose perimenopause or menopause in women aged over 45 years:

anti-Müllerian hormone

inhibin A

inhibin B

oestradiol

antral follicle count

ovarian volume.

1.2.4 Do not use a serum follicle-stimulating hormone (FSH) test to diagnose menopause in women using combined oestrogen and progestogen contraception or high-dose progestogen.

1.2.5 Consider using a FSH test to diagnose menopause only:

in women aged 40 to 45 years with menopausal symptoms, including a change in their menstrual cycle

in women aged under 40 years in whom menopause is suspected (see also section 1.6).

1.3 Information and advice

1.3.1 Give information to menopausal women and their family members or carers (as appropriate) that includes:

an explanation of the stages of menopause

common symptoms (see recommendation 1.3.2) and diagnosis

lifestyle changes and interventions that could help general health and wellbeing

benefits and risks of treatments for menopausal symptoms

long-term health implications of menopause.

1.3.2 Explain to women that as well as a change in their menstrual cycle they may experience a variety of symptoms associated with menopause, including:

vasomotor symptoms (for example, hot flushes and sweats)

musculoskeletal symptoms (for example, joint and muscle pain)

effects on mood (for example, low mood)

urogenital symptoms (for example, vaginal dryness)

sexual difficulties (for example, low sexual desire).

1.3.3 Give information to menopausal women and their family members or carers (as appropriate) about the following types of treatment for menopausal symptoms:

hormonal, for example hormone replacement therapy (HRT)

non-hormonal, for example clonidine

non-pharmaceutical, for example cognitive behavioural therapy (CBT).

1.3.4 Give information on menopause in different ways to help encourage women to discuss their symptoms and needs.

1.3.5 Give information about contraception to women who are in the perimenopausal and postmenopausal phase. See guidance from the Faculty of Sexual & Reproductive Healthcare on contraception for women aged over 40 years.

1.3.6 Offer women who are likely to go through menopause as a result of medical or surgical treatment (including women with cancer, at high risk of hormone-sensitive cancer or having gynaecological surgery) support and:

information about menopause and fertility before they have their treatment

referral to a healthcare professional with expertise in menopause.

1.4 Managing short-term menopausal symptoms

The recommendations in this section are not intended for women with premature ovarian insufficiency (see recommendations 1.6.6 to 1.6.8 for management of premature ovarian insufficiency).

1.4.1 Adapt a woman's treatment as needed, based on her changing symptoms.

Vasomotor symptoms

1.4.2 Offer women HRT for vasomotor symptoms after discussing with them the short-term (up to 5 years) and longer-term benefits and risks. Offer a choice of preparations as follows:

oestrogen and progestogen to women with a uterus

oestrogen alone to women without a uterus.

1.4.3 Do not routinely offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine as first-line treatment for vasomotor symptoms alone.

1.4.4 Explain to women that there is some evidence that isoflavones or black cohosh may relieve vasomotor symptoms. However, explain that:

multiple preparations are available and their safety is uncertain

different preparations may vary

interactions with other medicines have been reported.

Psychological symptoms

1.4.5 Consider HRT to alleviate low mood that arises as a result of the menopause.

1.4.6 Consider CBT to alleviate low mood or anxiety that arise as a result of the menopause.

1.4.7 Ensure that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression (see the NICE guideline on depression in adults).

I had an early menopause age 42 following a mirena coil - I had very similar symptoms to you op but my periods stopped completely.

I didn't find gp's helpful at all but did discover that using natural progesterone cream that I bought myself via a well known website really did the trick for me. I used it for a number of years where it controlled my symptoms well and I came off it at the age of 54 without any concerns at all.

The Mirena coil doesn't cause menopause but it can stop periods by making the lining thinner.

The cream cannot be converted into progesterone by our bodies in the form it's in. All the symptoms that come with meno are caused by loss of oestrogen not progesterone.
The supplementing of progesterone came from the US by a Dr J Lee. The science behind it is flawed. Women who feel it works are really not benefiting but finding their own hormones settle down - so think it's working.

You should consider having a bone density scan if you had an early meno and had no top up with oestrogen.

Its a shame, I would have expected your GP to run basic tests anyway without you having to ask, especially with your age and symptoms. If you can face it see another GP and write a list before you go so you dont forget anything x

Thanks Polly I had read the NICE guidelines before going in but I didn't call her out on what I thought she'd got wrong (specifically the SSRI and FSH bits)... I need to stand up for myself more.

I'd print them off and work through them, point by point.

She's out of date and misinformed.

I'm having similar. My cycle is getting shorter too. I am 46. My mother had hers at 52 so I may have a way to go. I've inherited her late puberty anyway.

I didn't realise there were options so it might be worth a gp visit for me. I might personally have taken the antidepressants as.I get so very low and anxious during that time so it is interesting to hear it's incorrect advice

Tsmummy08 I can completely understand the foggy feelings you mention as I had them last summer and thought I was getting panic attacks! Turned out to be low B12 and I take tablets from H&B every day now and its definitely sharpened my brain up a bit.

I have just missed a period so looks like I could be starting perimenopause too (48 next month). Maybe I could be one of the lucky ones who just stops having periods and doesn't have other symptoms (she says dreamily and not believing it in the slightest!)