Please help me with my GP, she's not listening

[GlomOfNit]

I'm 46 and have had odd symptoms that could be related to perimenopause for about 3 years now. Mostly things have come on gradually, to the extent that now when I look at a checklist on a website entitled something like 'could you be in perimenopause?' I can tick most of them.

I know it's a tedious litany but I'll list the ones I can think of here:

-cycle length shortening and no longer predictable and regular (after childbirth, it was as if I was reset to factory settings and my painful, often long cycles set to 28 days and very little pain). I can have anything between 33 days and 18 (those are both outliers though) but it's mostly around 23-27 days.

-Sore breasts at the sides and some cycles at the nipples, reminiscent of first trimester breast pain. Sometimes really bad. I'll get a cluster of 'bad breast' cycle and then for a few months won't get this at all.

-Pain at hip tips, quite acute. Sometimes this is the whole bloody cycle, sometimes it's worse from ovulation to end of cycle.

-General pelvic discomfort and pains, mostly from ovulation to end of cycle.

-night sweats. Not aware of daytime hot flushes as such but I'll wake in the middle of the night and have to change my PJs sometimes.

-depression and anxiety. While I think I've always been inclined this way, it's much more pronounced now. Seeing a sort of counsellor occasionally about this.

-fatigue

-weight gain in new places - the 'apple' pattern, dammit. Also thighs.

-DEATH OF LIBIDO (which was never great but it's as if I'm dead from waist down. Only on anti-depressants have I ever experienced this)

-I think my armpit sweat smells worse and stronger, and even Mitchum doesn't really work. By morning I smell like a goat. And recently I think my vulva is smelly too.

-itchy skin and vulva.

-heartbeat irregularities (I've had a couple of ECGs and an 'event monitor' and they said, yes, ectopic heartbeats, nothing to worry about. Still get them ALL the time, it bothers and worries me)

-spotting mid-cycle. Had already had the odd smear at ovulation which is normal, but in the last 4 cycles I've had two that weren't really proper cycles - they were short (21 and 18 days) and once my proper period had stopped I then had on-and-off bright red smearing in vaginal canal. Not enough to come onto pants but definitely enough to look dramatic on loo paper if I wiped up there. Smelt 'old' though was fresh red and came with lots of mucus. Ended both times with 'proper' period - slight cramps, enough to fill my mooncup etc.

I know this last one is alarming (it alarms me!) but the GP who saw me said it's probably stress, let's wait out the next two cycles and see if it's persistent, and if it is, you'll need to have a hysteroscopy. So I did - I had two clear cycles after the first one, and then it happened again last cycle. :-( That was the 18 day one, which ended on Boxing Day. What I want to know is, how usual is this sort of mid-cycle bleeding in a woman of my age displaying all the other stuff?

Sorry, I know this is tedious!

So. I've taken my symptoms to GPs frequently over last 3 years. They are getting increasingly irritated by me. They seem to think all I want is HRT - what I want is to be taken seriously and maybe referred to a local, very good menopause clinic at local city hospital.

My main GP is dead-set against HRT. She also dislikes me talking about being 'perimenopausal' and has said very firmly, in manner of admonishing small wayward child, 'Glom, you are NOT in perimenopause. I would only regard you as being in that if you had a) very irregular or missed periods, b) hot flushes and c) dry vagina'

I've since extrapolated from this that she based her criteria on the NICE guidelines for prescribing HRT (or am I barking up the wrong tree?). But as far as I know there is no NHS-used definition of perimenopause that has to tick those three particular boxes and that's been verified by a friend who's a GP. Could anyone confirm this, please?

I was also told by a more sympathetic GP that in a few years' time I might be prescribed HRT but not yet, because I'd only be 'allowed' to take it for five years and if we started too soon, I might have to come off it before I 'really needed it'...

Anyway, having had another cycle where I mostly bled, I need to see the GP AGAIN. I'm not massively keen on having a surgical procedure but I'm also shitting myself about cancers. The other thing that's worrying me is that I often have the sensation of a Thing in lower pelvic area, like something is caught or tugging at me, and pain (intermittent twinges not agony) in that area. Currently have this in lower right ovary area. I've seen a (male) GP with this in the last 2 months and he had a quick palpate and said he can't feel anything, it's probably normal and I'm just stressing, and that if it were a cyst it would probably have gone by the time I got scanned. (to add, I've had a clear smear test within the last year or so, and a blood test a year back for something or other didn't show up inflammatory markers associated with cancers.)

I do have health anxiety, I always have done. The GPs know this and I feel that when I go in with any of these symptoms, they treat my anxiety and not what I'm reporting. I'm pretty much at the end of my tether here.

I'm sorry, I'm not really sure what I'm asking here. I need to see GP again about the most recent cycle of bleeding, and again about the pain/feeling in my lower right pelvis. I want to be taken seriously. I'd like a referral to this clinic at the hospital, I suppose, but I'm entirely expecting them to say no because I'm not ticking their boxes.

And that's part of the problem at the GPs - when I go in, my fears and symptoms come out in this bloody brain dump and it's all muddled in together. That up there is what they hear. No wonder I'm not being listened to. Help me to be concise and organised at the appointment, please!

Is there any reason why you can’t change GP? I changed practice & have a totally different level of care now.

Change your GP or surgery. A simple blood test can determine whether you are or not, but it does sound like you are, to me anyway.

Of course your GP is wrong! Google says so!

Why not just change your GP if you actually think is she wrong?!
She's not going to tell you want you want to hear. In her professional opinion you don't have it. If you arent happy then get a different opinion.

You have all the symptoms of peri menopause.
The NICE guidelines are not as you (and your GP?) think- you can read them online anyway- easy to find.

@AngusThermopoyle NICE says no blood tests for menopause in women over 45- tests are not reliable.

If you want HRT you have to say so. She has no right to refuse unless you have one of the very rare illnesses which prevent using it.

You need to go back and say you have all the symptoms of peri and unless there is a sound medical reason not to have hrt, you want to try it.

If she refuses, see another GP in the practice or change surgeries.

This is not complicated stuff what you have and you do not need a menopause clinic. You just need a GP who treats your properly and is refusing you a treatment that might help.

I was also told by a more sympathetic GP that in a few years' time I might be prescribed HRT but not yet, because I'd only be 'allowed' to take it for five years and if we started too soon, I might have to come off it before I 'really needed it'...

This is complete bollocks. When are these GPs going to get up to date? It's diabolical.

You need to do your own research and then go in armed with the facts.

There is NO time limit on hrt- you can use it for life. This' 5 years' nonsense went out years ago. The British Menopause Society say women are not to be given time limits.

Have a look at the website of Liz Earle Wellbeing.
There is a tab on the menu for podcasts and videos.
Listen to the one by Nick Panay- top uk meno gynae.

I did leave a link to it many threads back on this forum if you can find it.

You will hear him describe all symptoms of peri meno and the fact he has women in their 80s on hrt.

The other thing- sorry- is you need to get a grip on your anxiety.

Reading your post (again) it appears you have irregular periods, night sweats and some odd bleeding. All signs of peri meno.
Nothing more serious it seems.

You do NOT need to keep seeing your GP about your bleeding as this is par for the course with peri meno- longer cycles, shorter cycles, more blood, less blood and anything in between.

It's normal :)

You've written your symptoms down really clearly here. Maybe take a written copy of them in to your gp so you don't get distressed trying to explain them. And if that doesn't work, change gp.

I’m a GP, with a special interest in the menopause, and agree you sound peri meno, I’m sorry you feel like your GP isn’t listening to you. I have to agree with you that perhaps it could be clearer exactly what your concerns are and what you want doing about them.

HRT could be beneficial for your symptoms, but you don’t need a referral for that. Why do you want to go to the menopause clinic? The vast majority of menopause related problems should be managed in GP, so I don’t think you’re being ‘fobbed off’ by not being referred, but your GP is incorrect about the time limit for HRT use etc that you’ve mentioned above.

But to me it doesn’t sound like you just want HRT. Do you want further tests doing? Blood tests are not actually recommended as a PP said. If you’re concerned about pelvic pains/ heavy bleeding I think an ultrasound could be reasonable. You’ve mentioned a lot of other symptoms that do to me all sound like they are related, but you’re still worried. Eg the ectopics - what do you feel isn’t being done? More tests? Treatment? Etc

I think you need to decide what you want and then clearly ask your GP to discuss it.

I know a woman that had a hysterectomy due to endometriosis and has been on HRT for about 9 years now. Not sure what this 5 year rule thing is? You take it as long as is needed surely?

Thanks for all the helpful replies (bluebella4 thanks for the (?) sarcasm - according to several posters here, my GPs have not been informing me with the most recent research/have been giving me incorrect information). And I need a bit of robustness too.

WRT changing my GP - it's certainly something I'm considering but she's very highly regarded and we go back decades really. But I do feel she's very biased against HRT generally and seems to have blinkers up regarding my symptoms. The other GPs I've seen (ideally would only see my registered one but she's hard to get hold of) seem to be singing from her hymn book and I wondered if there's a practice-wide policy regarding HRT (it's a pretty small practice). But who knows - if I do manage to get a place somewhere else, I might not find a GP who is any more open to it.

WRT getting a referral to the local meno clinic - no, I agree I probably don't warrant that but if my existing GPs are so negative towards prescribing, I thought it might be my main chance of being listened to. I'm sure it has a waiting list of women who have worse issues than mine.

WRT not taking HRT for more than 5 years, it's good to see that refuted here. I knew this was wrong but felt a bit blindsided at the time. I was also told by my registered GP that I wouldn't be allowed to have HRT because I'd twice had a migraine aura (no pain, just the pretty sparkling lights!) and this put me in a higher stroke risk group therefore I couldn't have HRT because that exacerbated my stroke risk ... I ran that one past a GP friend of mine who was spitting feathers on my behalf and sent me a peer-reviewed article saying it wasn't contraindicated. We also have never discussed transdermal types which (forgive my vagueness, I'm only getting started looking into this) I think carry little or no additional cancer risks - what about stroke risk?

WRT my health anxiety - yeah, I know. It's a bit shit. I'm starting a running group in a week and hoping to restart my martial arts class soon too - both are good for my mental health. I also need to maintain my 'mental health hygiene' by keeping up my CBT exercises, which I'm pretty crap at doing. At the moment, I tend to assume everything aberrant is going to be serious. But in my defence, no HCP has actually SAID 'you're just having typical perimenopausal symptoms, so chill and stop thinking you have cancer' - they refuse to acknowledge that this IS perimenopausal stuff. So I'm floundering rather.

Bobbypins - thanks for your response. I agree that I'm almost certainly not being clear enough, which was one reason I posted here, as I'm having problems seeing the woods for the trees at the moment. And while I'm definitely not a GP Surgery Crier, I cried a bit last time I saw one because I feel overwhelmed by all the changing symptoms and my stupid worries. That can't help.

With the heartbeats thing, it's been pretty much unremitting since last summer. I rarely have a day without noticing them. I try hard to tell myself I'm fine, I can do my martial arts and not fall down in a faint etc, and that I've had an ECG and the event monitor recorded 'normal' ectopic beats. So I need to try and ignore/relax, but when I notice them and feel a bit dizzy, it's hard to. I'm sure that all the indicated tests that could be done, have been done. I read here somewhere that palpitations can be related to fluctuating hormone levels but not sure if that's the same as what I've experienced.

Would you consider acupuncture? It’s very good. Balances your whole body. Can help with your anxiety a lot. Can start and stop periods. Removes night sweats. All sorts of things, all without using fake hormones and increasing your risk of other health issues.

Expensive, though I go as I’d rather be skint and healthy than have money in the bank and incurable health issues.

Bobbypinseverywhere- it's a shame there aren't more Gp's available specialised in this area like yourself. Luckily my new gp is also very knowledgeable and helped me greatly.
I will tell some of my friends about the blood test thing though as our surgery still does them , it worked in my case however it's good to know and If i see my gp anytime I will ask her if they're up to date on this. Thanks for your good professional advice.

We also have never discussed transdermal types which (forgive my vagueness, I'm only getting started looking into this) I think carry little or no additional cancer risks - what about stroke risk?

@GlomOfNit The pros of transdermal apply only to blood clots (not cancer.)

There is no difference between types re cancer though there appears to be a difference between the types of progestin and cancer (but more research is needed.)

Re migraines- the Migraine Trust has info on this and states clearly that migraine is not a contraindication for HRT (I have migraine and it's never been queried by my consultant.)

Textbook peri meno. I'd change gp and tey HRT.
I'm in a similar place but a bit younger and it only started last year. My gp said there is nothing theyd do at this stage. It's very frustrating.

Hi! I was told the same from my first gyn, that I can take hrt only for 5 years and I was only 41 with severe symptoms. It is completely wrong, my endo and my new gyn say that I can take hrt at least until 51-2 and afterwards it is my decision for how long I can take hrt. If I have no other medical problems I can take it forever. Actually I cannot imagine my life without.

I'm just about to turn 45 and have most of these. It's def peri (in my case including the mid-cycle bleeding which for me was every other month) as I've been on hormones since the summer and most of symptoms have lessened (MCB now stopped). I took low dose HRT for a few months and while it helped, it didn't touch the raging anxiety that was prob my most pervasive prob. Now on the pill which seems to have pretty much 'cured' the anxiety but isn't so good for some of the other symptoms. Going back next week for a review. Anyway, my take home message would be that your symptoms are very consistent with peri menopause and maybe you should try a different GP as mine has been happy to prescribe HRT etc even though I'm still having periods (regular-ish short cycles as you described). Good luck, it's truly shit

The only other factor to check on peri.menopause that I could ask you/suggest (and this was, weirdly, asked of me by a work occupational Dr who is an excellent GP and I wish I could see him rather than mine!) Is - what age did your mother or even grandmother go through peri menopause?

I have early peri menopause and I didn't realise what my night sweats, hot flushes, anxiety, complete lack of periods (note, I'm on depo and at the end of the 3 months I would commonly get a teeny bleed/spotting.. but no more!) Until this occupational Dr mentioned it!

His criteria were 1) symptoms 2) mother's menopause age 3) any gynocological trauma 4) that famous blood test thing (follicular something?)

In his opinion.4) was last on his checklist.

My GP was a lot more cynical, and apparently my blood test was 'borderline'. As I have a serious cancer history in my family I am choosing to not pursue HRT anyway so I've left it and just toughing it out!

Having done my own research on what helps (this is not exhaustive, I can only speak from my experience!) My depo injection really does help reduce the sweats, I am doing weight bearing exercise to protect bone density, I take a few supplements like calcium etc, and I've dropped my caffeine to one coffee a day, and cut out as.much refined sugar as I can, oh yes, and yoga to try and help with anxiety and keep me supple.

Good luck with your journey to get this sorted. never take no for an answer and if you have to been a pain in the bum at the GP and ask for refferals and even change GP surgery if you need to (understanding of peri menopause varies between Drs, even though it darn well shouldn't!)

I'm really sorry your GP has not listened to your concerns.
But I just want to clarify a few issues on HRT.A lot of people on these threads say that HRT is contraindicated in small groups of people with "rare conditions " this is not true .It is not recommended in loads of really common conditions but it's prescribed on a risk benefit basis .
I think you should change GPs the thing is at your age you don't need to be diagnosed as peri-menopausal this is only needed in premature menopause.What you do need is to address your concerns and symptoms .
I think you might need an internal exam and an ultrasound .I am baffled by the recommendation of a hysterscopy as while your cycles aren't normal and regular at your age it's not unusual .If you were bleeding heavily that would be different .
If you wish a trial of a transdermal combined HRT is the way forward and maybe some topical estrogen for the vulva /vagina .An itchy vulva is usually mirrored within the vagina .

But I just want to clarify a few issues on HRT.A lot of people on these threads say that HRT is contraindicated in small groups of people with "rare conditions " this is not true .It is not recommended in loads of really common conditions

@Thismeanswarfarin The guidance for GPs (it's online as part of a training 'manual' for them) lists a few absolute no-nos for HRT.

These include

A recent blood clot or heart disease/ stroke
Active liver disease ( although transdermal HRT can be offered)
Active breast cancer

There are several other conditions that women should mention ( gallstones, and blood clotting disorders for example) but in almost all these cases of other diseases, HRT can be used if it's transdermal.

There is a lot of confusion over this and many of the 'reasons' for not using it don't actually exist. (ie migraine, distant family history of certain cancers, high BP).....

Not an expert at all so this is just my own experience in case it’s useful - I experienced most of the symptoms you list during peri-menopause; I also have generalised anxiety disorder. I have had episodes of palpitations. Re the palpitations specifically, I found that cutting or at least significantly reducing caffeine made a huge difference. I got palpitations again when my iron levels dipped (because of the frequent bleeding in peri) and took supplements for a while. I also take b vitamins, flaxseed, magnesium and vit d. Might be nonsense but I have found them helpful.

The other things that I found helpful with peri symptoms and anxiety are: no alcohol; exercise; plant-based diet (I’m not vegan tho); and most recently, yoga. Alongside all of this, therapy input when needed/available.

Peri can be pretty miserable but there’s quite a lot of self-help that’s well worth a try.

And HRT... I tried it, it was great, then got nasty headaches and had to stop. Considering giving it another go on a lower dose.

Just to add, I think I’m nearly past the peri stage, and I actually feel pretty good at the moment. The one problem at the moment, and it’s an absolute bastard, is the insomnia. It’s the main reason I’m wanting to try HRT again, because while I was on it my sleep was the best it’s been for years.

@JinglingHellsBells I'm familiar with said manual .However this is such a complex issue .If a distant family member had breast cancer and it's type was not known/it was too long ago for the testing to be done than that it not an issue .But if a women had a grandmother or aunt with HER2 + ,ER+ ,PR+ breast cancer than the use of HRT HUGELY increases there risk of developing this and it should not be discounted .
While high BP is not itself a contradiction to HRT ,HRT can worsen this and leaves the patient at increased risk of stroke and MI among others .
There is a lot more to HRT than the GP training manual and lots of GPs are under qualified to prescribe it imo.At the same time it a GP refuses always ask for an explanation.It is usually out of concern for the patient and associated risks .Also women who have migraine that has previously been associated with the use of OCP should not be prescribed HRT because it increases the risk of stroke .

@Thismeanswarfarin Are you a GP or meno specialist? Be good of you to say so if you are then posters can ask you questions.

I'm sorry to come back and point out some incorrect statements you have left.

My own meno consultant (one of the best 2 or 3 in the UK) says that 2 first degree relatives who had B Cancer before age 45 is a factor to consider. Nothing else. I'm not sure where you get your facts from about aunts and grandmothers, as they aren't ones I've ever seen before from consultants. Could you link to that please? It would be helpful.

Also, the only type of HRT which may increase high BP are the CEE which are rarely prescribed now and the trend is for all women to be offered transdermal estrogen which does not increase BP according to guidelines.

The Migraine Trust has a very good feature on use of HRT and they say that for most women, HRT is fine. Many women do get migraine on the OCP but it's usually with the withdrawal stage when hormones fall at the time of the bleed.

The risk of stroke with transdermal HRT does not increase above the woman's baseline risk, but may be slightly higher with tablet form.