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Menopause

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Order of symptoms?

32 replies

Fingerbobs · 22/07/2017 07:17

Hi all, I'm (just) 45, no period since stopping progesterone implant contraception in February. I had blood tests in May and June with FSH of 57 then 69 and LH of 37 then 46, so despite my GP's initial scepticism I am indeed peri.
I am having some insomnia and night sweats, and what I now realise is brain fog; what I'm wondering is whether hot flushes are in the post - part of my GP's scepticism was that I hadn't had any. So - did any of you have night flushes that then became day ones?
I really hated periods so question two is do they come back with HRT and if so are they the same, less or worse than before? (And here I mean pre-peri rather than those who get relief from awful flooding). I feel childish wanting to avoid them but ATM symptoms are pretty manageable. However if flushes start in daytime I think that would tip it for me.
Thanks in advance for any advice/knowledge/experience.

OP posts:
PollyPerky · 22/07/2017 07:35

Everyone is different. There really is no 'this is what happens in this order' with meno :)

Your dr's being a bit thick really because some women have loads of the 'usual ' symptoms but might be missing one that is common- like flushes, OR sweats, or whatever.

I started with flushes- once an hour all day long- and insomnia but not much more than feeling a bit sweaty in bed.

As for periods, yes, unless you have been period-free for at least a year, the type of HRT used is sequential, meaning it gives you a cycle with a monthly withdrawal bleed. It's not a real period because you aren't ovulating. It's a withdrawal bleed to prevent the uterus lining building up and possibly in time becoming dangerously thickened.

If you are 12 months post meno then you can use a type of HRT which stops the lining growing and you won't have a bleed. The downside of this is that the HRT is 2 hormones daily and it's the 2nd hormone (progestogen) that is likely to give side effects in some women.

There is no knowing how your bleeds would be on HRT. It depends a bit on how your uterus responds to the extra estrogen. Some women bleed more, others less. I get a fairly heavy bleed which is a real nuisance but I've decided for various reasons to stick with the type.

I think you need to see how you go. There is one type of HRT Tridestra which gives a bleed only once every 3 months. This is good for women in peri who have irregular periods.

At 45 you certainly need to seriously think about HRT because you are 6 years earlier than the average meno and it's a risk for heart disease and osteoporosis. In your shoes I'd use it anyway at least to 52 just for protection.

Fingerbobs · 22/07/2017 13:35

Thanks Polly. Interesting that my GP says HRT is only licensed to treat symptoms, not to protect bone or heart (or indeed brain) health. I wonder when or if that will become normal? Obviously if I want it I just say yes, I'm having symptoms, but if the real reason is that I need something I'm lacking - as if for e.g. I needed iodine or insulin - surely that should be ok.

OP posts:
PollyPerky · 22/07/2017 13:59

It's recommended by NICE for women having premature or early menopause- that is under the age of 40 and 45 respectively.

Here from Chair of the BMS
menopausematters.co.uk/pm-management.php

For women over 45, then yes, symptom control is the main reason for HRT. It would be harder for a GP to prescribe HRT to prevent diseases purely on that basis.

If your periods have well and truly stopped now, you are on the cusp of early menopause and your estrogen levels will have been low for some years now. Your GP should be sensible and say that no periods, some symptoms AND being younger than average for meno (52) is a good enough reason for HRT.
It's not crack FGS!

GP seem on the whole to be terrified of HRT yet happy to dish out ADs, ABs and all manner of drugs that can be addictive or dangerous. Madness.

TBH if you've not had any flushes yet, they are most likely to come along.

PollyPerky · 22/07/2017 14:02

Info on what early meno is- you will see it says before 45 here.

menopausematters.co.uk/pm-definition.php
Print off and show GP if she is unwilling.

This site is written by Dr H Currie - consultant gynae and until very recently chair of the British Meno Society.

Waterlow · 22/07/2017 14:22

There is another period-reducing HRT alternative, which is oestrogen via patches or gels, plus Mirena coil. Particularly suitable in Peru, as it provides birth control at the same time.

Symptoms vary. There's a range of symptoms and of severities. I didn't have sweats at all for the first 8-9y or so of my early peri. I just blushed all over and felt unbearably hot. (Tho the sweats are catching up with me this year!)

Waterlow · 22/07/2017 14:23

Peri-meno, not Peru.

BicBac · 22/07/2017 14:26

"GP seem on the whole to be terrified of HRT yet happy to dish out ADs, ABs and all manner of drugs that can be addictive or dangerous. Madness."

I remember one lecturer in my health related course warning us all not to take HRT to manage menopause symptoms. There were some extensive studies that suggested some pretty drastic side effects but I don't remember what the side effects were? Does anyone know?

Waterlow · 22/07/2017 15:29

Side effects of HRT:

Even emotional tenor - tick
Ability to hold a coherent conversation

  • tick Sleeps through the night - tick Urinary continence - tick Lack of palpitations - tick

As a consequence of these side-effects I am able to look after myself (thus saving the NHS substantial costs for current and future treatments), parent effectively (thus saving the NHS and CAMHS substantial costs for current and future therapy), and hold down a responsible job (thus saving the government substantial costs, oh, and paying tax).

Yup, seriously serious side-effects.

BTW it costs a heck of a lot more to treat a broken hip, and a broken wrist, and crumbling vertebrae, than to prescribe HRT for a few decades.

PollyPerky · 22/07/2017 18:29

And if you see a consultant privately, you even pay for your own HRT! (As I do.) Costs me about £12 a month.

Fingerbobs · 23/07/2017 09:30

Thanks everyone for the info. My GP is by no means against HRT, it's me, and not because I'm against it in principle. Quite the opposite - I spent several unhappy years in my late teens attempting to get my mother (onset at 37) to take it, and saw the immediate improvement in her life when she did, not to mention those who still lived with her.
The issue is that my symptoms (so far) are pretty manageable, and crucially emotionally I'm far more even-keeled than I have been since I started puberty. So quite frankly I have no desire to go back there, but if that risks my bone and brain health I think I might have to. And it makes me angry that this is all there is - either go back to a monthly cycle I have suffered from and don't want for years and years, or risk osteo and dementia. I just want to be both done with it and healthy, but that's not on the table. Sigh.

OP posts:
Waterlow · 23/07/2017 09:57

Fingerbobs you do not have to have the cycle - investigate Mirena.

Fingerbobs · 23/07/2017 11:31

Thanks Waterloo, will do.

OP posts:
Okite · 23/07/2017 11:37

I've just started hrt (2 months in), I'm 43 and have had increasingly erratic, then missing periods over the last 18 months or so. No other clear symptoms apart from crazy periods. I suffer from extreme fatigue but have other conditions which can cause that too. No hot flushes.
I am getting a tiny withdrawal bleed, but it's more like spotting over a period of a week or so. It's a right pain, the big advantage of menopause is no periods! But I will stick with it for the first year, then switch to the other type of hrt hopefully. I'm taking it for the protective effects against osteoporosis.

PollyPerky · 23/07/2017 14:48

Finger it's about finding what suits you best.
With the Mirena, you may have spotting or some bleeding for a few months while it settles down.
You may be one of the unlucky ones who have side effects- it seems to be a 'marmite' type of thing.

PollyPerky · 23/07/2017 15:29

sorry- was interrupted.

Mirena might work well for you.

I was offered it many years ago along with oestrogen gel. For me, I didn't want to risk it as I didn't want a progestogen in my system all the time in case I had side effects. I do 'long cycle HRT which is a bleed roughly every 8 weeks. It's not ideal by any means but it's the best of all the options at the moment (for me) as I don't want to use conti HRT .

BicBac · 23/07/2017 18:52

Waterlow It's great to see a list of positive health outcomes associated with HRT. However could anyone please remind me what the negative effects of HRT are? I know that one of the leading and independent experts in the field warned our class of HRT, I'm too busy to look for articles but I believe there is / was some sort of scandal in terms of quite serious side effects. Anyone? Thanks

Mrsmartell08 · 23/07/2017 19:00

I'm Peri and have been since I was 40. I'm now 44 and have been on sequi hrt for 6 months
I'm back at the Dr next month as I'm on the lowest dose patch (evorel sequi) and I'm going to ask for a higher dose
No period so far this month....

PollyPerky · 23/07/2017 19:33

BicBac what do you mean exactly bu your 'class'?
Not being funny, but if you are a HCP or studying medicine, you should have access to impartial and detailed information.
The pros and cons of HRT are well documented.

Have a read of the site Menopause Matters- use the drop down menu on Treatments/ HRT/ risks & benefits
-And read the NICE menopause guidelines
-International Menopause Society info
-British Menopause Society info.

Dignity7 · 23/07/2017 23:54

Avoid menopause matters. The admin just supports a group of members who bully anyone who is not evangelical about HRT. Anyone who disagrees is deleted. So funny reading post when people just cut & paste from guidelines

PollyPerky · 24/07/2017 08:46

That's a really odd thing to say Dignity. Are you a member ( or ex member ?) of MM? I don't think it's ethical to make those sorts of comments (which appear to show bias.)

MMatters is far more than a forum. The site is run by a consultant gynae former chair of the BMS. There is a wealth of info there irrespective of the forum.

user1498911589 · 24/07/2017 08:52

Place marking as I am starting to consider HRT having always said I wouldn't.
Persuading my GP might be difficult though.

Dignity7 · 24/07/2017 08:54

Ethical. It is the same as you recommending it/I'm not. Exactly the same.

PollyPerky · 24/07/2017 09:10

Dignity I am more than happy to discuss the pros and cons of HRT with you in an informed way. I've used it for almost 10 years under a consultant who is regarded as one of the top drs in the UK , who is also in favour of other ways of dealing with meno, not just HRT. During those years I have been able to ask many many questions about risks and benefits and consider myself well informed.

If you want to say why you don't like the idea of HRT and what worries you about it, please do, and I may reply with stats and research to either agree or disagree with you.

You may choose to not use HRT and that is fine. It's your choice.

PollyPerky · 24/07/2017 09:11

My comment about 'ethical' was nothing to do with HRT it was about your comments about another forum and using your posts here to slag it off.

Dignity7 · 24/07/2017 09:13

I have discussed HRT with a medical professional.