What to expect at first GP appointment for peri?

[RadioDorothy]

At least I think it's peri. I'm 45, and I'm in year 3 of my second mirena coil, so I haven't had periods for 8 years (owing to the coil, I mean).

For the last couple of years I've suffered with mild bladder leakage and feeling overheated very easily - I get a red face and chest most evenings, which lasts an hour or so.

In the last 6-12 months I've also noticed;
Low mood, mood swings
Intense irritability
Being tearful
Brain fog - poor memory, can't grasp new tasks and feel overwhelmed, can't cope with change.

I've managed to get an appointment with the menopause doctor next week - do I just tell her what I've outlined above? What will they do? Does having the coil make any difference, how can they test hormone levels when I still have a functioning mirena?

I'm worried that they'll just shrug and say, it might be, might not. Carry on.

I could have written this! I’d be interested to know too. Are we likely to get fobbed off? Been having symptoms on and off for about 2 years. Luckily 1 at a time! But mood and anxiety are bad for me at the moment.

I'm interested to know how you know you have their peri/menopause when you have the Mirena.

Following.

Menopause hadn't actually occurred to me until I casually mentioned to the practice nurse that I wondered how I'd know, as I don't have periods anyway. She asked me a few questions, we suddenly linked things together, and she said I should make an appointment!

I wonder if they'll do a solo blood test and declare it negative...

I went to the GP initially about 2 years ago. My only symptom really was haywire periods so I had lots of investigations to check there was nothing else causing them. There wasn’t, but because I was young and the blood test for menopause is very difficult to get a clear result with, they just sort of lost interest and wouldn’t do anything else. I saw a haematologist about something else and when she reviewed my blood results said it was clearly perimenopause as although the hormone levels were within range, they should have been much higher for someone my age. So she wrote to the gp and told them to put me on hrt and I finally started on it about 8 months or so ago. So it was after about 18 months of being dismissed by the GP. 🙄

YOU need to decide that you want before you see your dr. Don't be passive- decide if you want HRT, make a list of symptoms and ask for it.
They prob won't do a blood test partly because NICE has said not to for women or 45. If the symptoms respond to HRT, that's the answer.
If you don't want HRT there is not much your dr can offer other than reassurance, or drugs for heavy periods in women who have these near meno.

Hope your GP is sympathetic and helpful OP.

No need for a blood test at 45; if you have symptoms of the menopause it is likely to be the menopause.
The benefit of a blood test for you would be to see whether you still need contraception.
If you are suitable for hrt ( no contraindications) a mirena is very handy to provide the progesterone component , have a chat to your Dr

Thanks all, sorry I haven't responded. Appt is not until Thurs. I need to plan my approach I think...I suppose I would like to not have the mood swings, hot face and brain fog if at all possible.

I don't quite understand how the mirena affects the onset of peri. In theory, shouldn't it be effective as HRT - so why am I getting symptoms?

peri symptoms are caused by falling oestrogen levels. The Mirena is a synthetic progestogen so it won;t help peri.

Oh I see - thanks Polly!

I expected to be fobbed off, but my GP knows the NICE guidelines and basically said quality of life is the test, and in the absence of risk factors, was happy to prescribe Oestrogen patch (I also have Mirena), without blood tests.

Now pursuing treatment for zero libido, which hasn't been helped by HRT- possibly testosterone. Again, no fobbing off (this time, a male GP)

Really Getaway, that's interesting - an oestrogen patch? How long have you had your mirena?

I've decided that I most want my concentration and my ability to work back - and maybe be less irritable! No trouble with libido so far, but we've never been particularly active anyway...

I've had a Mirena for over 14 years. You can take Oestrogen as a pill or a patch - like a clear plaster that you stick on your arse twice a week .It comes in different dosages so you can switch it up or down as necessary.

I'd say it's improved my sleep, mood, energy and also stopped palpitations I was having.

Well, the GP was very pleasant and didn't fob me off exactly - she has requested an FSH blood test together with a full blood count.

I commented that they would probably come back in the normal ranges and I'd be no further forward, but she said she looks at much more than simply the bloods in isolation.

The blood form says "mirena + menopausal symptoms".

I'm unconvinced and think it will all be a colossal waste of time. Bet my next appointment will be talk of anti depressants (even though she said the NICE guidelines say to look at HRT in women of a certain age instead), talking therapies and bloody bladder training.

Well at least that's all a start!

If she knows NICE says no ADs why so you think she is going to suggest them to you?

What are you doing about bladder leakage? Has she suggested an appt with a women's physio? You need your pelvic floor strength assessing and then at least 6 months of kegel exercises. DO NOT ignore this issue- it's common and in many cases easily fixed. In the meantime do the exercises anyway, 10, 3 x a day. Hold for up to 10 secs each squeeze. You might also find that vaginal estrogen will help build up your tissues.

Bladder training is more for women with urge incontinence, not stress incontinence.

The Mirena
Some women find it great, especially when used along with estrogen (pills or patches or gel) as part of HRT. But some of the progestogen in it does get into the blood stream (despite it being promoted as localised to the uterus) . In some women when estrogen levels fall, during peri, the Mirena can add to the feelings of low mood etc because of the progestogen in your system. Obviously this varies- some women feel fine.

If she prescribes HRT all you would need would be some form of estrogen because the Mirena would be providing the progestogen part.

You may have to push for what you want- don't just accept no further treatment! I'd query the leakage with her and ask to see a physio, or if you can afford it, most private hospitals will allow you to book an appt with a physio yourself without a referral.There are also women's physios working independently all over the country who treat women for leakage. Google is your friend here :)

Hi Polly. I only say they'll start on about ADs because I've taken the same ones for 17 years, and she already commented that perhaps they are no longer working as they should.

She didn't suggest physio for bladder leakage, no - just gave me some info sheets and a sample pot, and a diary sheet. I'd already been to the GP about it, no sign of infection, and I've just had a scan of bladder and kidneys, all of which were normal (I just have a large capacity bladder). I have little sensation there, leak without knowing and rarely get a good satisfying pee, iykwim. But I will start doing the kegel exercises.

I have medical insurance, so would be happy to ask for a private referral if it becomes worth pursuing.

She was very knowledgeable and specialises in women's health, so I'm hopeful that she'll be constructive! I wonder if the full blood count in conjunction with the FSH test will tell a better story?

FSH only rises once you are well into peri or post meno- it's used to show menopause. It's not reliable anyway.

If you are leaking you need a referral to a women's physio.

Your GP ought not to increase your ADs when you are also having peri symptoms- you can use HRT as well as ADs. She ought to follow the NICE guidelines on this. Remind her :)

Radio I think you should push for a referral for your bladder. I've read your post again and it doesn't sound like normal stress incontinence- more like loss of sensation which can be called 'overflow bladder' where your bladder holds a lot but you don't have the urge to go, then it overflows. You need to see a urogynaecologist.

Thanks Polly - I do feel that they aren't really looking closely at the bladder thing. My mother has no muscle tone in her bladder and started self catheterising at the age of 70. I've described my problem to her and she said her symptoms were the same at the start, apart from leakage - she never leaked even though she'd had 2 children and even had a prolapse repair.

I can ask them to refer me and I'll check that my insurers will pay...they should do. I think I need some kind of flow testing?

Thanks for your advice I appreciate it

I think it sounds as if you have the opposite of overactive bladder- a bladder that doesn't like contracting! It's not a well know condition but I have read about it. Maybe something like bladder training would work for you- maybe google and see what that throws up as treatment? But do push for a referral. And yes your insurance should pay.

I had gallbladder problems last year, and when I contacted the insurer they wanted 12 months notes before they'd approve the claim - the GP took so long getting the notes together, that I'd seen the consultant and had a date for surgery on the NHS by the time they were ready! Crazy. It's because I haven't had the policy quite 2 years I think, there'll be a moratorium.

I've just looked up overflow bladder - OMG that's exactly how I described it to the doctor! Weak flow, can't seem to empty, difficulty starting, little sensation or urge, dribbling (eww) of urine during the day and night. I do occasionally feel like I'm bursting to go, but when I get there it never seems to fully release.

I used to have chronic infections years ago - it was constant. Smelly wee, pain in the bladder, kidney symptoms, low grade fever, etc etc. But I had a 3 month course of nitrofurantoin in about 2008 which seemed to fix it, I've only had a handful of infections since then.

I hate being THAT patient that goes in to their GP armed with all the crap they've read on the internet on some imagined condition, but perhaps I'll have to be that patient this time!

Wonder what causes it in women.