Peri Meno at 40? HRT?

[VikingBlonde]

Went to GP yesterday to get a blood test to try and discern whether I could be Peri. I have been getting actual rage instead of 'standard' PMT for about the last 6 months, I track periods and have done for years just cos - i got into the habit of doing so when trying to conceive as had PCO back then.

I now see a pattern of terrible debilitating hormone fluctuations which used to be way milder. I now seem to get PMT from the minute I ovulate which builds over the two or so next weeks into rage, depression, anxiety, sleeplessness, massive irrationality, night sweats, forgetfulness snapping at children and thinking very dark thoughts. I got carved up on a roundabout the other day (on peak rage day) and if I had been wearing sturdier shoes than my viv westwoods ballet flats - I would have Vinnie Jones'ed the man who carved me up! (this is really, not like me)

GP said I was too young for PM and likely to get beaten up for road rage but I snapped at him then too. HE did admit he doesn't really specialise in womens' health though. Anyway GP recently did thyroid tests for my 40 health check and that showed up to be fine. So I am not entirely sure what they were testing for - hormone levels I guess.

My mum has been on HRT for years and she is the calmest woman I know. The contraceptive pill always made me feel dreadful, as did the Mirena which is supposed to be low dose. Something has to change tho, I am losing half my life to this currently, does anyone have any advice re HRT? I am already taking Agnus castus, black cohosh, magnesium and b vitamin supplements. they help a bit. Best thing is being alone, which doesn't happen often!!

Does anyone know what the next step is from a blood test? Or have any advice as to HRT vs 'the pill'? Many thanks in advance.

I think, because you are under 45, your GP should do a hormone panel. Because you are 40, which would be early for perimenopause, your GP followed protocol by starting out doing a thyroid panel. That's quite a reasonable start. But since those came back normal, it would be good if your GP did a full work-up of your bloods, plus a hormone panel.
Are your periods still regular, heavier, lighter?

I am not sure which test they did and guess will have to go back to discuss that when the results are in. Yep, periods are now different, way heavier, a few mad spot days randomly a good week or 10 days before it's due and really heavy/clotty/floody.

My mum had a hysterectomy at 35 after having sooo many gynae issues - and we have no idea when GM or GA had meno as would never have discussed that sort of matter. very stiff upper lipped upper class ladies. I'd just like to not feel so angry anymore really... it's exhausting!

Not sure, perimenopause typically comes with changes to the cycle, ie they become more variable. The late reproductive stage comes earlier and I know some women can find changes in mood. Many women find they have changes in their early 40s though menopause could be another decade away.

You could have a look at the NICE guidelines - they say the following

*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).*

Best to wait and see what your FSH levels say, and take it from there

sorry, missed the bits about heavier periods, are they still regular timing wise? Had any big gaps between them? All that stuff would be handy to tell the GP.

Actually blood tests aren’t reliable in peri.
If you have severe meno symptoms, your thyroid is ok and your quality of life is poor, go for hrt.
Don’t wait your body to suffer more, your are too young to handle all these hormonal meno changes.
I’m 43 and on hrt, it gave my life back!

Cheers, Paris & Emerald! Yeah I think having looked at the patterns that are forming I am missing some hormones somewhere... let's see what the Dr's say next...

blood test said "normal no action" errr - now I am stumped. Surely something must be amiss for my QoL to be this low down (obvs now on day 6 of cycle I am positive, cheerful, full of the joys of spring (ish). Give me ten days and the hell cycle will start again... argh

Maybe ask for another test in 6 - 8 weeks? How often do you have periods? Has cycle decreased in length? I suppose your doctor would be looking for other symptoms before thinking peri. I do know a couple of people who developed really bad PMS in their 40s, think one used Chinese medicine.

www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/#.WusGDtTwYdU

Worth looking at?

Paris that is so like what I experience! Thanks for the link. I'll need to back to GP and find the most savvy one on endocrine gubbins. Gor blimey. Thank you x

that is such a ridiculous statement from the GP that 40 is too young for peri menopause.
I was through menopause at 42. Ask the receptionist if any of the partners specialise in womens health.
Have a look at the Daisy Network

Hope it helps Viking blonde. So much not understood about the affect of hormones on our bodies. Good luck.

I understand where you are coming from. I have terrible mood fluctuations from just before ovulation for a couple of weeks, it's really bad and I've been to my gp several times. He didn't mention early menopause though. I've seen a gynaecologist and have had 6 months of treatment to put me in early menopause to see if it is my hormones / oestrogen related. I can't take combined pill which can be another option to try before my current one.
Have a look at a charity called NAPS which is the association for premenstrual syndrome. I hope you find some answers, I think the impacts of it can be underestimated- it has massive impacts on family life and relationships.

You could be me OP (I'm almost 40), I feel like I've been getting worse for the past 2 years, feels like bad PMT but not sure if it's related to perimenopause as my periods are still very regular. The rage!

I saw a gynaecologist and asked to try HRT which I'm now on, but I'm not seeing as much improvement as I hoped (apparently I'm on too low a dose of oestrogen). I tried SSRIs in the past but had bad side effects but might ask to try another one as the change in me over the month is unbearable. I just want to be normal all month round...

God you lot are so helpful thank you so much!! I am going to try DHEA supplements (available online) and go back to try and get a gynae referral. I don't want to go on SSRI's which the doc suggested, been there done that and wasn't keen on the side effects. Mind you the HRT/pill might be just as bad. I just want to be stable not even normal. I feel possessed half the time. Fat, furious and possessed! haha

I'm following as I completely sympathise....and unfortunately feel the same!!

this link is super helpful
www.pms.org.uk/support/suptreatmentguidelines

it says that SSRI's just for half the month (the bad half) can be as effective as SSRIs full time (but presumably with half the side effects... might be worth a bash. I am glad I am not alone but sorry there are other ladies suffering like i am.

I tried fluoxetine just half the month but it didn't work for me. Had the side effects but no improvement in the rage cycling.

I am FFP as well

Just to give an alternative view, which I usually get a tiny bit slated for, you could always look into trying a non-drug approach using plant oestrogens. I take a sage supplement with yams in and it knocked my hot flushes on the head. Took 3 weeks to kick in but got there eventually. I had an early meno and have been managing symptoms for years and am 'only' 46 now.

www.menopausematters.co.uk/forum/index.php?topic=34185.0

Apparently anti-depressants are prescribed because it's easier. You're 'depressed' because you're reacting to progestorone in your Mirena, mostly because your oestrogen levels are out of whack. Thyroid issues tend to go hand in hand with perimoneopause too.

I had all the symptoms of an underactive thyroid, tests can back 'on the range of normal' even though what was happening with me isn't normal for me. I kept on, found a new GP, and kept persisting until one listened to what I was saying. You know you're body better than them, and no, 40 isn't too young to be perimenopausal.

See another GP and keep trying until one does the tests of refers you to either an endocrinologist or a specialist menopausal clinic. If you're based in London demand to be referred to the Chelsea & Westminster menopause clinic.