I'm going to a menopause clinic tomorrow - what can I expect?

[JustGettingStarted]

I'm 50 years old. Still getting periods, although less regularly (close together sometimes). I have a copper iud that I suspect is causing very heavy flow and I might want it removed.

My symptoms are mainly night sweats, and poor sleep. However, around the time those started I started getting joint stiffness. Shoulder and hips, mainly. I had a hip injury (exercise) and it has turned into arthritis. I have started seeing a physio about that and I only just learned last week that menopause can be related to the joint pain. That prompted me to look into a clinic.

I found a doctor on menopause matters who works out of a private hospital in Cheadle. She seems to be very supportive of HRT, based on her profile. I have little faith in my gp and would rather just go private, since I can afford it.

What might happen tomorrow?

And is there still a shortage of HRT medicines?

What will happen...

a discussion of your symptoms, quality of life, your own feelings on whether you want HRT or not . She will explain the risks/ benefits and the various types. She may have a preference for some sorts. My gynaecologist offered me gel 12 years ago before it was so popular in the UK.

There is no shortage of many types of HRT but still a shortage of some patches I believe.

If you choose HRT she will probably ask you to see her again in 3 months to discuss how it's going.

I definitely want HRT.

I don't have depression, and my BMI is good. I sort of assume that it will be offered.

I get confused reading about the different types. I guess she will explain it.

I went on her for menopau s e symptoms and found within a week of starting that a running injury to my hip/ hamstring got 50% better. It was unexpected amd very welcome. I'm on 1mg with a coil now and have been for 2 years, thinking abour increasing to 2mg as I'm getting tendon pain and other things (sleep for one, I ve been awake for 2 hours!) It increases the risk though so I haven't decided on that yet.

How did you get on? Local to me so very interested.

Have you looked at the Menopause Doctor website - Dr Louise Newson?
She has so much info on there and lots of stuff you can print out and show your gp.
I know you've chosen to go private and hope you've got on ok, but worth looking at.
I think the shortage is better, there is definitely oestrogen gel and progesterone tablets in my area (south east) as thats what I am on and never have any problem with supply.

Watching with interest OP. Am calling my GP tomorrow for a private referral to someone who specialises in menopause. I need more information than I get out of the NHS. Also local to you so would be great to hear how you get on.

She's concerned about the heavy bleeding so I need tests, scans and a hysteroscopy before anything else.

I'm undecided about paying for all of that.

Ahh yes, that was my first port of call when things started going awry. Can she not see you on the NHS now for all that? If not, maybe have a word with your GO and advise then if your consult and ask them to refer you to an NHS consultant. Did she seem knowledgeable or did you not get past discussing scans etc? X

@Justgettingstarted Sorry OP but that sounds like over-investigation at this stage.

Why does she think anything is amiss rather than simply heavy periods in peri meno- usually a result of missed ovulation so the lining builds and builds then eventually sheds.

Did she examine you to see if you have fibroids and that your cervix and ovaries were okay? (If not she should have!)

For women in peri menopause, heavy bleeding is very common. Who is the consultant?

I can tell you that they can now see LOADS with a transvaginal scan and usually this would be enough to rule out a thick lining or anything more serious.

They can also do a biopsy of the womb lining without using a camera (hysteroscopy.) This is around 80% accurate.

Costs- a private scan can be around £250-£300 (I have had many, some paid for by insurance.)

I had a hysteroscopy which was covered by insurance and the fee in total was almost £3K. That was for the consultant, use of the room and histology. I didn't have a GA or pain relief.

I think if I were you I'd find another consultant for another opinion.

It's not usual to explore heavy periods in peri meno with such invasive treatment straight away.

I agree. I had investigations for very heavy bleeding with persistent flooding pre-commencing my HRT. This involved abdominal and trans-vaginal ultrasound scans. A hysterscopy at this point seems OTT. Be interesting to know her clinical reasoning for the further investigations.

Hysteroscopy is usually (but not always) the last step in any investigations in women still having periods and who are in peri @JustGettingStarted. It's invasive, there is risk of perforation or infection and it's not really a first case procedure.

Abnormal bleeding is more serious post menopause when it's investigated urgently. If your bleeding is not outside a normal cycle, it's not irregular bleeding.

She ought to a) examine you (my gynae said I had a small fibroid when he examined me), b) perhaps take out the coil to see if it helps and c) do a scan if she is worried your bleeding is very abnormal.

I disagree with over investigation. It would be remiss of a consultant NOT to rule out any sinister cause before putting it down to Peri menopause.. imagine her saying... ‘it’s your age’ and leaving it at that... ? I’d definitely get a second opinion if that was the case.

She ordered an ultrasound first. Then I am to get a hysteroscopy.

She couldn't do a cervical smear because I am still on my period.

I do know that there's a polyp on the cervix at the entrance. It made putting in the copper coil difficult.

@JustGettingStarted

She ordered an ultrasound first. Then I am to get a hysteroscopy.

She couldn't do a cervical smear because I am still on my period.

Hopefully you won't need the more invasive (and in your case, costly) hysterscopy if your ultrasound results are normal.

It's just my opinion, but if the NHS ordered scans for every woman in peri who had heavy periods, the queue would stretch from Lands End to John o Groats.

How experienced is your dr?

Lots of drs say they are experienced with menopause but sometimes it's a case of jumping on the band wagon as they know women often don't get help from their GP.

I'm sorry but in your case I'd ask for another opinion or go back to your GP. If all you want to do is try HRT your GP ought to be able to manage that.

I have never been to my gp about it. I have had bad experiences with gp.

The polyp does need looking at.

I'm not sure if I can't do both hrt and getting that investigated. I suspect polyp must be investigated first.

If your polyp has been there for some time, why didn't the dr who put your coil in do something about it ? ie remove it, or tell you it was not an issue?

All I'd say is that as this is private care, be mindful that some unscrupulous drs can suggest all kinds of tests and investigations as they are paid for doing them, when possibly they are not necessary.

I have never ever found that with my meno consultant, but they are incredibly well established and experienced.

Are you covered by health insurance or not?
If you are, they won't pay for menopause and HRT treatment but would pay out for bleeding issues that need investigation.