What do I ask the GP?

[Ffsonly46]

Hi, looking for some advice please.
I think I might be perimenopausal and am hoping to see a GP next week but am unsure what tests I should ask for or what my options would be from any result.
I'm having night sweats, dry vagina and an alarming increase in facial hair!
I feel quite down about it and feel a bit young for this. I don't have any reference point as my mum have a hysterectomy in her 30s and is no longer around to discuss.
Thanks

46 really isn’t “too young” to be perimenopausal, OP. This phase can go on for several years prior to the menopause itself.
It depends how much of a nuisance your symptoms are, and how much medical intervention you want.
HRT would treat all of it, but it’s a fair old dose of hormones for years, and you will still get the symptoms back again when you eventually stop.
If the night sweats are not too bad, you can use either topical oestrogen to maintain your vaginal mucosa, or just lube to solve the dryness, and then simply pluck, wax or shave the facial hair.
Women vary greatly in how badly the peri menopause impacts their lives. Some are suffering almost continuous hot flushes and sweats, insomnia and exhaustion, and it’s a no brainer to use HRT. Others have hardly any symptoms and are fine with no treatment at all.
Only you can decide how much you’re suffering and what you’d like to do about it. The GP should just tell you the options and let you decide what you want to do.

Thanks Babdoc, I guess I needed to hear I'm not too young!
I have only recently heard of perimenopause (I know, but there it is) so had this idea that the menopause starts in your 50s unless you have early menopause and it has made me feel old and low. It just seems to have started and I wasn't expecting it.

I'll talk to the GP but think I'll have to suck up the symptoms as we have a history of breast cancer across my family so unlikely to be recommended HRT.

Thanks again

@Babdoc and @ffsonly46

HRT would treat all of it, but it’s a fair old dose of hormones for years, and you will still get the symptoms back again when you eventually stop.

Nope!

At 46, the dose of estrogen you would have is very small- it puts back what you would have, no more, sometimes even less. The risks of HRT do not apply anyway until the average age of menopause (51) so you could have a good 5 years on it at least.

Secondly and you will still get the symptoms back again when you eventually stop

This is a myth and not sure why it's still around.

HRT will stop your symptoms. if you still have them when and IF you stop (you can stay on HRT for as long as you wish- for life if necessary) you will have the same symptoms OR NOT as you'd have if you had never taken HRT. it doesn't 'delay' or 'postpone' menopause / symptoms.

This is explained in the link I left a few threads down under the BMS Menopause Guidelines. This is from Dr Newson, menopause GP.

There is no set length of time that you should take HRT for. Some women take it for a few years to help improve their symptoms of the menopause. If your symptoms return when you stop taking HRT this is not an effect of taking hormones, this is because you would still be having symptoms of the menopause at that time if you had never taken HRT. Some women decide to take HRT for a much longer period of time. It is usually an individual decision between yourself and your doctor regarding the length of time you will take HRT.

Many women wait until their symptoms are really troublesome or even unbearable before starting HRT. However, taking HRT early really will make a difference to your symptoms (and quality of life) and also lead to a greater improvement in your heart and bone health

She herself started HRT at 46- it's all on her website.

Breast cancer..
This is what my meno consultant says...

The risk (genetic) is only a consideration if the woman has 2 first degree relatives who have had BC at an early age. (mother or sister.)

And the risks of HRT do not apply to someone of 46 anyway.

Our lifetime risk of BC is 1:8.
Many factors can promote BC - mainly being overweight, inactive, drinking more than 2 units a day, smoking, never having children, never breast feeding....there are numerous factors. Many of the cases in your family could be lifestyle- who knows!

There are also women who have had BC who use HRT.
It's about quality of life.

The risk of BC with HRT is tiny. My consultant told me I was more likely to die in a car accident than from HRT - and that's right.

All I'm saying is don't believe all the myths and media headlines because they are rarely medically accurate. (I am a medical author so have spent 10 years researching, talking to top UK consultants and using HRT myself for that time.)

The problem with having HRT and then stopping, is that women who have been symptom free for years find it very annoying to then have any level of night sweats etc that they haven’t got used to over time.
I’ve known patients who stopped HRT and were begging to be put back on it a couple of months later!
Menopause is very variable- I’m simply suggesting to OP that if her symptoms aren’t too bad, she, like the majority of women in the U.K., might prefer not to take HRT.
It’s very much down to individual patient choice.
Personally, living in a cold climate, I found hot flushes very welcome!

The question really is why were women a) taken off it and b) not resuming it when they still had symptoms?

Why is this?

Women are fully entitled to take it again after 2 months if they still have symptoms.

The BMS guidelines are very clear (linked to down the page): there is no time limit on HRT use, and for most women the pros outweigh the cons, especially if they use transdermal / body identical HRT.

The old idea- which never had any medical foundation- of 2-5 years' use is dead in the water and has been since 2015- new NICE guidelines.

I have been told by consultants that they still have patients in their 80s and 90s using HRT.

Thanks @jinglinghellsbells I'll go and look for the link.

The BC in the family is linked to age and non child bearing and I have been having yearly mammograms for years.

I will discuss with my GP although I don't know what their level of knowledge is as I don't go often and don't really know them.

Thanks again for all the advice.

Of course the OP doesn't have to take HRT if she can manage without.
No woman takes HRT willy-nilly for a few very minor hot flushes.

But at the same time it's important for drs to be up to date with current guidelines and also appreciate that HRT gives masses of long term benefits, offset by a very small risk.

If you are a dr you should be aware that all the latest research shows BC may not actually be caused by HRT - in some women it may accelerate the growth of an existing BC cell.

This is written by menopause consultant Dr Currie on Menopause Matters

So can we be completely reassured that HRT does not cause breast cancer and can women go back to using HRT without any fear that it will increase their risk of this tragic disease? It seems that it is extremely unlikely that HRT causes breast cells to become cancerous, but it is possible that, if certain types of HRT (combined HRT containing estrogen and progestogen rather than estrogen alone), are taken for more than 5 years after the age of 50, there may be promotion of cancer cells which are already present in some women, but not in the majority. To add to the complexity, even within types of combined HRT, it appears that different progestogens have differing effects, some types appearing to be “breast-friendly”.

If you have two immediate family members with BC, then I can understand your concern. In your shoes I'd be making an appt with a consultant who is a meno expert, rather than a GP who may well be out of their depth with this situation.
You should certainly use vaginal estrogen (which is not classed as HRT) for those issues.

Ultimately, with a well-informed dr, the decision re HRT is yours- that is what NICE says. Your dr has to inform you of the risks and benefits, but many GPs do not seem aware of the updates on these.

There is certainly no need to accept feeling awful or suffering sweats.

women who have been symptom free for years find it very annoying to then have any level of night sweats etc that they haven’t got used to over time.

I'm not sure how anyone gets used to a level of sweats over time? Are we supposed to shut up and put up?

Would the same argument be used for women with migraine or depression?

@jinglinghellsbells you've been really helpful, thank you.

I feel so low at the moment, I don't want to just put up with it but my fear of BC looms large and I know nothing about treatments.

I'll see if the GP will refer me to a consultant.

Personally, living in a cold climate, I found hot flushes very welcome!

Crikey. I'm glad no-one ever said that to me in RL.

One good thing to ask your GP is if they're familiar with the latest NICE guidelines. Mine wasn't, and we a had quite an interesting chat. He retired, but it's still not resolved with my new GP.

Having had a BSO total hysterectomy, you'd think my GP would give a crap about what happened after. But no. And I live in a city with supposedly good healthcare. I've had to do all the running, beg for referrals to gynae services, and I'm grateful for advice on this board from posters like Jingling.

I use patches so no increased risk of breast cancer, but I'm on too low a dose according to Gynae Consultant, but GP has to agree to change the prescription.

Sigh.

I suffer from cold & am quite looking forward to hot flashes. That said, I tend to vomit if I overheat. So maybe will be awful. We shall see.

(ps: can hotflashes lead to rigors? I feel like I'm getting those again when I have a mild fever, could be another challege)

OP at GP: I imagine you should list your symptoms & say you'd like to discuss a form of HRT in case it helps. Let us know what you decide to get for treatment; if you get HRT, let us know how it helped (if at all).

Hot flashes are horrendous.

I have night sweats, too. Cold night sweats. They are horrible and no I won't be grateful to have them during a heatwave. Not when instead of meeting a work deadline I'm drained, fed up and washing another load of cold sweaty bedding.

Im 52 and in Peri M. I have suffered a fair number of years with different symptoms but 6 months ago began to feel incredibly anxious, forgetful and had difficulty sleeping. I read a lot online, Menopause Matters website is great. I saw my doctor and asked for HRT patches and around a week in, the world became a great place once again. It may not suit everyone but for me it has been a godsend.

@AutumnCrow
Agree, waking up at 3 in the morning, every morning, drenched in sweat is horrible and exhausting, takes me a long time to get back to sleep and often I don't sleep properly afterwards.

@YeOldeTrout
I too suffer with the cold but overheating at any given time is not to be welcomed.

I'll come back and let you know what happens!

OP yes to what pp said about writing all your symptoms down.

Anxiety is definitely another one for me. I mean, wtf?? I'm normally a confident, accomplished person used to taking on mountains of responsibility, and suddenly I can't decide how to get to the shops ...

I'm on Evorel 50 patches (standard dose) but need the 75. Fingers crossed GP agrees with the Gynaecologist.

Same age as you OP with similar symptoms & I'm on my second month of HRT & it's been life changing!
At least explore your options - you won't look back