GP has offered a blood test. What next?

[arousingcheer]

I'm almost 50 and in the last year or so have had an increasing variety of what (thanks to this board) I now understand to be perimenopause symptoms (nausea/appetite changes, headaches, very heavy periods, fatigue, memory problems/poor word recall/brain fog, zero libido etc). I also have hypothyroidism that was not very well controlled so I've previously attributed symptoms to that instead; there's a lot of overlap.

My GP couldn't get onboard with the other issues (aside from periods) being perimenopause. She said I'm probably getting headaches from iron depletion (consequence of the crazy heavy periods) and offered to do a hormone blood test (though I see that is contraindicated in the NICE guidelines) as well as an iron panel.

(I've been iron deficient for years and supplementing so no idea why that would suddenly result in daily headaches. They do sometimes come up with some odd theories.)

I am wondering what to expect from the blood results (should I even be tested if the NICE guidelines say no?), what the GP is likely to offer, how I can advocate for myself and where to go next. How can I tell a knowledgeable GP from one who isn't? I hear you get better results going private but not sure where to start.

There is breast cancer in my family (only one immediate relative so I was refused genetic testing) so I need to ensure any treatment takes account of that.

Any reading recommendations welcome.

Sadly, it appears 99% of GPs know FA about menopause. Maybe they missed the half day lecture at med school. Sorry but you only need read the meno forums to see the bleak picture.

The advice of NICE is to treat symptoms and not faff about with blood tests. Hormones can change by the hour/day in peri so they only tell you what's going on then.

They are very inaccurate. I had a wide ranging blood test by my consultant (1st appt) incl hormones, though not just for hormones as I wasn't seeing him about meno, and the result was I was post meno. Clearly untrue as I had periods for another 18 months. He laughed and said another good example to tell his students.

You either need to see a better GP- it's unbelievable she doesn't recognise peri symptoms - or see a private GP who is meno trained (Louise Newsom, Midlands) or a consultant. Your local private hospitals can be a source to look up gynaes and their specialisms.
Books- Your Change Your Choice, Michael Dooley (consultant gynae.)

ps the breast cancer of your relative is irrelevant. In the book I've mentioned, it says 2 first-degree relatives (mum or sister) with BC early in life (before 45-ish.) Anyone else is irrelevant as only 5% of BC is hereditary anyway.

Are you still getting periods?
It's important to have bloods done within a certain time frame in your cycle (or so I was told) Sorry I can't remember exactly when.

Crazy heavy periods will result in iron deficiency anaemia, or non iron deficiency anaemia (low ferritin), or both which will mean that your thyroxine is ineffective and so on in a vicious circle. Do you have any idea where your iron levels (haemoglobin and ferritin) are now, and/or your thyroid levels? It would be as well to ensure that everything is optimal in that department before tackling the other issue.

PollyPerky thank you, that has clarified why hormone testing is not recommended. So should I refuse testing and/or insist on treatment (hrt I guess)? Just would like to know more about what to say before next appt. If I'd known more I would have been able to steer the last appt in a more productive direction.

I was told (by an oncologist) it's up to 15% of bc that is inherited and there is early bc on one side of the family but you're correct about the guidelines for genetic testing. My genetic questionnaire placed me at slightly elevated risk.

CherieBabySpliffUp yes, very heavy periods, getting closer together (maybe every three weeks, I must make more of an effort to track more closely). If it get the blood test done I will ask if I need to do it at any particular time of the month (though not convinced they'll give me accurate info).

timeistight I am on liothyronine as well (for now ) so that issue may be mitigated (I don't have to worry about conversion to the same degree). I'm always iron deficient, sometimes very low (19 once, in a range of 60-170) and am taking two gentle iron caps a day but not sure if that will be enough.

Thyroid test is scheduled at the same time as iron and hormone test so I should have some idea when I get the results. Last (private) tests showed raised tsh as well as good t3 (fairly high in range but there was a bit of wiggle room so am taking a small increase in both t3 and t4). If the GP's results are the same they may refer me to an endo (they will not know what to do) and I really don't fancy going down that road again.

PS. Thanks PollyPerky for the book recommendation.

I might be able to use private insurance for private treatment. Can see anyone in London or Dorset (maybe points in between) so would be grateful for recommendations if anyone can help. Would like to avoid spending many thousands of pounds on it if possible but will do what I have to do.

I suffered with depression for many years, then that lifted and I had a brilliant five or so years before hypothyroidism became a big deal (I really struggled for dx and effective treatment), so I don't really want to lose more quality time in my life to treatable health issues. It's so hard to know who is on your side.

This was a good tread, similar line.
www.mumsnet.com/Talk/_chat/3023523-Menopause-what-do-you-have-to-do

Out2pasture thanks for that, though it does mainly seem to be people commenting that they're fine, having at worst mildly unpleasant symptoms and don't want hrt! I am having a variety of fairly unpleasant/painful symptoms and would love it if I could trust my GP to know what I can safely do about it.

You can use private insurance for symptoms that need investigating but you can't use it for menopause per se. Friend of mine saw a gynae using insurance for heavy periods but once it was established in her notes it was meno, the insurance wouldn't pay long term for appts.

I will PM you with details of Drs.

PS. I've just had a look at the NICE guidelines and as I had suspected it is very flush-focused: 'perimenopause based on vasomotor symptoms and irregular periods'.

While my periods are getting closer and are monster-heavy now (I spend two days just trying to keep myself and my clothes clean, have stopped using tampons as I will be changing the first one of the day almost before I can get downstairs for a cup of tea etc) they're not especially 'irregular'.

I don't really have much flush activity going on. When I exercise I am red and very sweaty for longer than is normal for me (even if I've only been walking it may look like I've been running iyswim), but no night sweats or feeling hot all the time.

So basically I wonder if because I'm not having flushes GP just thinks this isn't part of the perimenopause - ?

It will be because of your cycle that your doctor will be saying it;s not yet peri-menopause. This term is often applied very loosely to the changes women experiences any time from nearing the end of their reproductive life (before ovarian function starts to decline dramatically) to around the time periods cease. However as you have found, medically the term applies to the time when periods do become irregular and and vary by at least a week between cycles - which is when the typical symptoms of flushes and sweats tend to appear in most women ( if they are going to). The criteria were set up through various workshops looking at loads of data and termed the "STRAW" criteria or something similar. There was a paper produced as a result entitled "Stages of Reproductive Ageing" (hence STRAW).

The stage you are at is known as the late reproductive stage and is particularly characterised by periods getting closer together and some hormones beginning to go awry resulting in some symptoms notably more extreme pms. The problem can be treating women in this stage. Some women start to get flushes at this point ( due to plunging oestrogen levels after ovulation). Your thyroid condition can't be helping because of the interplay between thyroid function and oestrogen which is somewhat complex and I don't really understand (too involved biochemistry and endocrinology!).

Some women who start HRT at this point actually feel worse whereas for others it works a treat. Some gynaes tend to want to control the cycle at this point ( eliminating pms and mood swings) through the CCP - and there are gentler types which are more like HRT - but once you are over 50 this is not licensed. This also involves largeish doses of synthetic progestogens which might not suit everyone.

If you are thinking of treatment at this point and especially as you have heavy bleeding, have you thought of a Mirena coil? You could then add in oestrogen when (if!) you do start flushing. The disadvantage (in terms of menopause awareness) is that eventually it may stop your periods so you won't know quite where you are with your cycle - although the symptoms will tell you!

I agree I would definitely ensure your thyroid hormone levels are tested regularly from this point onwards as it may well be that your medication needs adjusting. Have you noticed any difference from increasing the T3 and T4 ( I know very little about this!)?

LuluandtheNightshade oh gosh, how much time do you have? T3 changed my life. I had symptoms that persisted even on a good dose of levo (150mcg) that kept my tsh below 1 and t3/t4 in the upper quarter of range. I remained bloated (limbs were hard to bend, face round and puffy etc), constipated and exhausted and my hair remained thin.

On a bit of t3 (I started out on 5mcg and increased to 10), my gut returned to normal and after about a week, the bloating went literally overnight. In the morning I looked like a different person, clothes fit differently etc. My energy is better on t3, my eyebrows have come back and my hair is thick again (though I still get a fair bit of hair fall).

I started having symptoms again and decided to try reducing my levo and increasing t3 and that seems to have helped. There is this 'reverse t3' issue that may or may not be a legitimate thing, but I do feel like changing the proportions of meds has done me some good so perhaps there is something to it.

I am particularly upset about the new issues because I feel like I've finally got on top of the thyroid stuff and here comes a new bunch of problems. I do have regular private monitoring because the doctor doesn't seem to have much idea how to deal with the t3 aspect of my treatment. T3 was recommended by my endocrinologist and although the gp agrees (for now) to prescribe it, they aren't that keen on it and I worry they will take it from me. I really don't fancy having to see the endo again either.

Thanks so much for such a comprehensive explanation of where I am hormonally and what is to come. I am reluctant to have a coil as hormonal birth control really affected my moods and I'd hate to have something in me that I have little control over. I had an iud (admittedly a long time ago) and it was a real pain to have it removed when it didn't suit me.

My gp prescribed transexamic acid but I haven't had a period yet to try it out.

I don't notice terrible pms so much as my periods themselves being out of control (heavy and unpredictable) and getting some shooting vaginal pain (like cramps, but in my vagina) during. But I'm otherwise very lucky with periods.

Thanks again, I appreciate your help. I despair when I think of being subject to so much medical intervention (I have had some bad experiences with my surgery and the gp I've got on with is now leaving) but I can't avoid it forever.

Askingforafriendlyneighbour yes, gp has scheduled an examination as well as a blood test. Should I ask for a referral or is that only needed if something looks wrong?

I'm reluctant to get a coil as the last time I had one it didn't suit (heavy periods, pain) so I had to have it taken out and the whole thing was a faff.

I am under the impression gp is testing for iron, thyroid and sex hormone related things, though it was a phone appt so I have nothing written in front of me and can't rule out a misunderstanding. I'm going to ring up and ask re hormone test. It is possible that it is just for other stuff (iron, thyroid etc).

I am taking two 'gentle iron' a day w 1000 units of vit c away from dairy and thyroid meds. The ordinary iron tabs can make me feel nauseated and these don't but not sure if I'm taking enough. Tests will show I guess.

I tend to be anaemic at the best of times (results were 19 once, when my periods were light) so I expect this to be an issue. Wouldn't it be great if this is the only problem and causing all my symptoms?

Thanks for the info, I appreciate it.