I think I'm in peri. It's hell. What are my options?

[WhereAreWeNow]

I'm 44. I've always had bad (heavy and painful periods) and my PMS has been getting worse over a number of years but it's now just totally out of control.
I'm exhausted, achey, and I have terrible insomnia for 2 weeks before my period,.
I'm so irritable, tearful and angry for a good two weeks before my period - I veer between depressed and raging. I'm horrible to be around.
My periods are still regular but increasingly heavy and painful.
I can't concentrate and I have the worst memory.
I've also had a lot of joint pain. I had been worried that I have osteoarthritis but I'm now wondering if it's another symptom of perimenopause.

So the first question is, does this sound like perimenopause?
Second question is what can I do about it?

I've got a GP appointment (phone) on Friday. What should I be asking for? I'm scared of HRT because of cancer risk.

TIA

I was also a bit surprised that she suggested the combined pill. From my reading I thought it was the mini pill (progestogen only) that was more commonly prescribed for women in their 40s.

@Whyisitsodifficult Just 2 points really.

You can’t compare getting cancer or Covid to menopause. The fact is all women will go through the menopause it’s inevitable like dying, cancer or Covid isn’t!

A few stats for you

1 Osteoporosis kills more women each year than cancer (around 100K deaths from complications owing to hip fractures or other disability from osteo in the spine etc.)

2 More women die from heart disease (biggest killer) than cancer.

Both of the above can be prevented/ risk reduced by using HRT.

These are medical facts, not an opinion.

HRT reduces the thickness of the carotid artery by 50%. When it's thick that's when strokes occur.

Most specialists now believe that HRT should be used by women if they a) have symptoms affecting quality of life and b) a medical or family history which means they could reduce the risk of dying early by using HRT.

I'm sorry to hear about your mum but no dr can say that her HRT caused the cancer. I asked this very question of my consultant (someone in the media often says hrt caused her cancer) and he said it is impossible to put the blame on HRT.

The risk of B cancer is 28 x higher (numbers per year) if a woman is overweight compared to the risk of hrt, and the risk is also higher if you drink 2 units or more a day.

@WhereAreWeNow The combined pill is sometimes offered to younger women as a form of hrt as it has a higher level of hormones. It's used like hrt, not birth control in that instance.

@TheBlueStocking

I really recommend getting some black cohosh tablets. They're amazing for PMT.

I wasn't sure about them when they were recommended to me. But I can really, really tell the difference.

Agree. Sage complex was a game changer for me, which contains black cohosh too.

You’ve had some great advice, but have you also considered fibroids causing the v. heavy periods?
My sil developed them in her early-mid 40’s.
Hope you feel better soon, peri is miserable ( I’m 46).☹️

The NICE guidelines specifically say GPs should NOT offer anti depressants to women after 45 with peri symptoms. So many gps are not up to date with training.

Hrt alone seems unlikely to cause breast cancer under 50. Alcohol and being overweight are bigger factors but obviously every woman is unique. I’m very sorry for your loss x

@Newgirls I'm under 45 though (just!)

@JinglingHellsBells I hope you don't mind me directing this question at you but you seem to have a lot of knowledge/expertise on the subject. Do you have any thoughts on whether the combined pill or HRT is the better option at my age/with my symptoms? I've tried googling but I'm not really finding any information to help me make a decision.

I had the exact same as you. I was given Oestrogen gel and progesterone tablets. I felt worse.

Then my GP nurse implanted a Mirena coil. 3 days later I get better, 2 weeks later I dropped the Oestrogen gel and have been in bliss heaven ever since. No PMT and no premenopausal symptoms because my periods have stopped.

I am a new woman.

Ask for the Mirena coil and if that is not enough, perhaps some Oestrogen gel as well.

GP's who give you anti-depressants are showing how behind the times they are. They haven't even bothered to read the WHO recommendations or just don't care.

Any decent GP won't give you AD's.

I let my Mirena coil lapse (stupidly!) and experienced terrible peri symptoms. Coil replaced, symptoms more or less went. That was three years ago. Over the past 18 months I started having meno symptoms - the odd hot flash, disturbed sleep and dry mouth being the worst of it, not really too much to deal with, but I also began suffering from what I thought was depression.

Finally plucked up the courage to speak to the dr who has put me on oestrogen only HRT (don't need P because of the coil) and I am transformed. TRANSFORMED. Already sleeping better, tonnes more energy, but best of all the mood swings and depression have gone. Like, disappeared. It's actually frightening to look back and see how much I was suffering.

I'd take a tiny increased risk of cancer over the increasingly high risk I was going to throw myself off a bridge any day. I look back in horror that I was having suicidal thoughts - all gone.

@WhereAreWeNow I can just give my opinion :)

What I'd say is it's not a one-way street, whatever route you choose. You can easily swap to something else so it might need a bit of experimenting to get what's best.

You could try the Pill and see how that felt after 3 months- they recommend Qlaira for women your age who want to use it as HRT.
The Pill will control the heavy bleeding.

If you choose HRT then the Mirena plus estrogen is one option which means you would not have much or any type of period.

On the other hand it is a synthetic type of estrogen and progesterone and you may get more emotional or physical side effects on it. OR you may not!

If you do choose HRT I'd put the cancer risk out of your head when choosing that option because at 44 the risks do not apply. You would maybe re-think when you got to 50-52.

On balance your symptoms appear to be pointing more to the use of HRT except for the heavier bleeding (which may get a bit worse- hard to say.)

It's not black and white.

Your GP is very wrong to offer ADs- NICE guidance pinned at this page says they are not to be offered as first choice line of treatment.
It's disappointing that so many GPs seem not to heave read this guidance (now 5 years old) and don't bother to go on menopause training courses which are fully available by the BMS and some meno consultants.

Just go into this with a positive attitude that something will help, but it might need a bit of fine tuning to get it right :)

Above was to @Whyisitsodifficult, sorry! That's why I don't care about what's 'natural'.

During periM my periods lasted up to 3 weeks and were so heavy I would have to change my jeans 2 or 3 times a day. Now I have a very irregular tiny bit of menstruation. It doesn't even need a light tampon, perhaps just a panty liner for 1 day a month. I had terrible dark thoughts too and thought I wouldn't survive it.

Not now though. I am a lovely person to be around.

@WhereAreWeNow I hope you don't mind me posting on your thread.
@JinglingHellsBells I'd really appreciate it if you could give me your opinion as you seem very knowledgeable. I have read up on it and I think what I'm doing is the way to go but would appreciate another opinion. I had horrendously heavy periods every month only escaping them during my three pregnancies. It impacted on my life and hormonal contraception didn't suit me so I had an ablation which reduced my flow. I am just 50 and am post menopausal not having had a period for 18 months. I've been very lucky to have had very few symptoms but I think perhaps mother nature is being kind as my periods were so bad for so many years! I've been taking menopause vitamins for almost 3 years since my periods became irregular with peri and these may have helped. I'm thinking, through my reading on the subject, that they should reduce my risk of heart disease and osteoporosis. I've never considered hrt because I've escaped lightly symptom wise. Do you think the vitamins are sufficient to protect me in old age?
Sorry for the post length but I wanted to give the full picture.

@Family143

I'm thinking, through my reading on the subject, that they [vitamins and supplements] should reduce my risk of heart disease and osteoporosis.

Sadly no vitamins or supplements can do that.

You can get calcium supplements but the latest medical opinion on those is that you ought not to take them unless your diet is limited and you don't get between 800mgs - 1 gram calcium from your diet per day.

Too much calcium from supplements can cause kidney stones or even heart disease- they think it is deposited in the arteries.

Most vitamins other than Vit D are a waste of money because you get better health from eating the food, which also gives your fibre and trace minerals from the skins etc of fruit and veg.

If you have no meno symptoms I can see why you don't take HRT BUT in an online interview, Nick Panay- menopause consultant- said he would offer HRT to women with no symptoms who wanted to use it to improve their long term health.

@JinglingHellsBells Thank you so much for your reply. I'll look at that interview and I can see me having to pay to see someone as my GP surgery are reluctant to prescribe friends with symptoms never mind me without any. Thank you so much.

Thanks @JinglingHellsBells

That's incredibly helpful. My periods are incredibly heavy and painful so I'm not keen on taking anything that could make the bleeding worse. I've been experiencing flooding and often feel a bit light headed from the blood loss (I take iron tablets).

I'm going to do a bit more research on Qlaira and HRT this weekend so I can go back to the GP with a clearer idea of what I'm asking for next week.

It's really helpful to know that anti-depressants aren't a good solution. It's a bit worrying that ADs were her first port of call.

@Family143 The interview is on the Liz Earle Wellbeing site - under HRT and Nick Panay. it's an hour long and his comments re, using hrt as a preventative are almost at the end of the interview. Or he may say similar on an interview with Diane Danzebrink on a Youtube video August this year.

@Family143 @WhereAreWeNow This is the interview- pretty good interview for anyone wanting to know more.

lizearlewellbeing.com/making-sense-of-hrt-nick-panay/

I'm trying to dodge Peru by staying on the minipill. This means I have no idea whether I'm still ovulating or not.
The surgery have just called me in for blood tests though. At 53 they think i'm too old to be on the minipill. I guess I should come off it if my periods have stopped 'behind the scenes' so to speak.
I only have one other possible symptom of Peru- have been a poor sleeper for a year now. I'm dreading having to come off the minipill and suffering irregular periods- and the hellish pain I've suffered since the age of 13.... and any of the other assortment of symptoms you read about. Dreading it, as Im sailing through my fifties at the moment- fit, strong and happy.

I'm loving Peru for peri . "I'm in Peru" sounds so much better than "I think I'm perimenopausal"!

Thanks @JinglingHellsBells - I actually stumbled across that podcast earlier when I was madly googling HRT/peri stuff. I haven't listened yet but I will when I get a chance.

@JinglingHellsBells
Thank you so much.

I much prefer being in Peru shall remember this.

Thank you hippospot, I shall google Studd clinic, and speak to DH if he is still talking to me ! poor man has listened to me moaning, or worse raging for weeks now.

Love ‘being in Peru’!

The meg Matthews book The New Hot is excellent for all this. She introduces it with her experience and then Dr Louise Newsom and other experts give balanced advice. Worth every penny.