45, peri for 5 years. Useless GP

[queenrollo]

I've filled out another econsult form this morning and just have this sinking feeling it will be another pointless phone call tomorrow.

A few months ago my PMT was so bad that I lost it with my husband, stormed out and when I came back home he very gently said I needed to address this with my GP. He's right...but I've had at least 5 consults already and they keep saying I am 'too young'.

What I got last time was a call from the nurse who offered Citalopram, and when I refused said she would do nothing more unless I had blood tests. I know these are unreliable, I had them anyway and everything came back in normal range so it was Citalopram or nothing.

My latest addition to health woes is crushing fatigue, horrendous hair loss/thinning (and I don't have much to begin with!) and dark patches of skin appearing on my face. I am so cold all the time.

I already have irregular periods/changes (due to fertility issues I have tracked for 15 years now), heart palpitations, anxiety for no reason (different from my previous anxiety which I had therapy for and is now mostly controlled), brain fog, disappearing labia and vaginal atrophy (they DID give me Estradiol cream for this but not on repeat!).

Night sweats, hot flushes, voice issues (still waiting to be seen by ENT), weight gain on my stomach (I have struggled to gain weight my whole life until now).
Basically if you look up a list of peri symptoms I can tick them all.

I'm functioning, but I am not me and I am bloody fed up with it now. I am on a regime of supplements which have really dampened down the PMT to a level that my husband and kids can cope with.

I just needed to offload this in a place where someone will come and sympathise with me!
Let's hope I get somewhere with the GP when they call!

If you can go private
If you can't print out the NICE guidelines and make sure you quote them
If they still refuse bloods and hrt then report them to the CCG.

My peri menopause started at 40 BTW...

Phrases such as;
▪️Is there a reason you are not following NICE guidelines for perimenopause?
▪️guidelines state blood tests are not needed if symptoms start prior to age 45
▪️Anti depressants are not a recommended treatment for menopause
▪️Why haven't I had blood tests taken for the symptoms such as hair loss/thinning, weight gain etc?
▪️Would you do blood tests on a man presenting with those symptoms?
▪️you are not following NICE guidelines and therefore I am reporting you to your CCG

Hi Jenthefredo
My own mother was fully menopausal at 48....I asked her, and I told my surgery this during one of the (pre-covid face to face) consults. So I suspect this might be my path too.
I've been told so much rubbish by them - I can only take HRT for 5 years, so I need to wait until I am older. I'm normally very good at standing up for myself but all this actually made me timid :(

I've quoted NICE in my econsult, and hopefully that will help.

We have Private medical insurance so my husband said he's going to look later to see if this is covered and if not then we'll just pay for a private consult out of savings. We both have chronic health conditions which cannot be 'cured' but he pointed out I can do something about Peri so we should. He wants me to feel well again as much as I do (he's brilliant, he asks me for links/books to read so he can understand what I am going through)

You poor thing OP. Totally understand where you're coming from - I think many of us have a bit of a battle before we find a GP who is educated about peri-menopause and how incredibly debilitating and personally damaging it is.

Do you always see one GP? Might it be worth consulting a different one? @Jenthefredo's advice is good and would be a good approach for this next consult.

I decided not to ask the GP's advice on what was wrong with me, since having educated myself I already knew, so instead I went in and said 'I want to got on HRT' and then listed the reasons why. GP asked some questions about my family health history and clarification on the symptoms I was experiencing, which I'd written a list of in my phone beforehand so I wouldn't forget any, and after that he couldn't really refuse. You already know that you tick multiple boxes for peri symptoms and I'd be explicit about the problems your symptoms are causing with your moods/marriage/sex life too. Good luck!

zafferana I have spoken to 3 different GP's at the practice. The one who prescribed me the Estradiol was like you said - I told him my labia had shrunk and I had dryness/atrophy and he just gave me the cream! I suspect he was the peri expert....he's left

I spoke to a female GP, a little older than me, and I did TELL her that it was peri and she is the one who said I couldn't take HRT for more than 5 years. I think I saw her 3 years ago now. I spoke to her again a while later and she wanted me to take something that I had to combine with a Mirena - but I already have a copper coil and I don't want to change it. (Partly because it's working well for me and partly because it took my friend 8 months to get ger Mirena removed when it was making her very ill. It would be the same clinic as my GP doesn't fit coils)
She refused to discuss any other options with me.

I have always prefered natural approaches over medication and this has worked reasonably ok for me so far but now I think I have reached my limit.

My DH has just texted me to say if the GP isn't helpful tomorrow to just drop it with them and go private. He says he will pay whatever it costs to help me feel well again.

@queenrollo This is just appalling.

I despair at how bad some GPs are re meno. Honestly, if they were so lacking in knowledge over other issues, where would their patients be?

The NICE guidance came out Nov 2015. They have all had time to read it and take training courses in meno and HRT. The British Menopause Society runs these every few months and the cost is very cheap. There is NO excuse for GPs to be so out of date.

I agree with @Jenthefredo that in cases like this, you need to be very business-like and go in (or by phone) with a list of quotes from NICE and the BMS (who have a consensus statement on HRT and how long it can be used, etc etc.) Obviously it won't pay to be rude, but being firm and informed is the way to do it.

I am sorry to say that private medical cover does not include menopause as it's regarded as 'natural' and also long-term. (I've had private cover for years.) It would cover you for tests to rule out anything else (ie hair loss) to see if it's a thyroid issue. But to be honest in women your age, NICE says do not do blood tests and start with HRT - if it helps, that's the answer.

Also, your useless GP ought to know that age of menopause is hereditary. Your Mum's early menopause is the clue!

Also, modern body-identical HRT is not medication. It's replacement that's the R and it's the same molecular structure as your own. It's not like the Pill which is a synthetic version of our hormones. The gel and micronised progesterone in HRT are made from yams.

If you have got £300 I'd say - like other posers- just cough up and get sorted. If not, be more assertive with your GP.

If you do see a private consultant make sure they are au fait with HRT and menopause as some are not, and you will be no further on.

thank you JinglingHellsBells

Fingers crossed I get somewhere with the GP tomorrow, but i'm going to look into Private options this afternoon just in case.
The money isn't an issue, we have savings and as my DH says the money is better spent on good health than sat in a bank account.

To be honest I am not surprised to come up against archaic attitudes given how ill informed they were about breastfeeding when I was on that journey. Fortunately I knew what I was talking about!

I am usually quite assertive and have had to deal with lots of medical issues for my youngest son and my husband but it's so much easier to be bolshy when you are doing it for someone else!

OP have they done full thyroid function, iron, B12, vitamin D ?
Many of your issues could be thyroid related. Do not let them fob you off with “normal” , actually check your levels.

SirVixofVixHall

I have had a thyroid screen I think 6 times in the last 10 years as the fatigue and feeling cold have been problems in the past but they always say my levels are normal.
My last thryoid check was 4 years ago, and they said the levels were fine but my cousin looked at them (she has been on medication for a thyroid problem for over 20 years) she said if she had that reading her Consultant would treat. But my GP wouldn't do anything or give me a referal because my readings were in range (I was so busy dealing with my son's medical condition I didn't have the mental energy to argue)

They did iron, B12 and VitD a few months ago, levels all 'within normal range'
I do take a VitD supplement from Sept to April though.

A few years ago one of the GPs (now retired) queried Fibromyalgia. It was ruled out.
My DH was diagnosed with this earlier this year - and he mirrors a lot of the symptoms I have. I told him that he got diagnosed because he is a man and even though I feel the same I'm expected to just bloody get on with it because I am a woman...
But I do know that I am in peri because a lot of the symptoms are recent

Check what your TSH was when last tested. Also whether it has been creeping up. If so they should test you for antibodies and give you a trial of thyroxine.
I get so cross about the way GPs treat thyroid problems. I went back and forth for a decade before they finally put me on thyroxine.

Have they also ruled out autoimmune? It often takes years to diagnose AI conditions.

Are you experiencing heavier periods? Recommended VitD levels tend to be very low so worth continuing these if we don't get much sun (like a soggy Bank Holiday!)

Can you ask to try HRT, if symptoms improve you have proof of declining hormones.

Did you all hear me explode?

I actually spoke to the one GP I like. He said I need blood tests, and I told him I had some just a few weeks ago. So he opened them up and asked what I was told? I explained that the Practice Nurse reviewed them and told the receptionist to tell me they were normal but I needed to take a VitD supplement.
Then he made a noise and said what he was looking at indicated early menopause.
We discussed how variable hormone bloods can be (I do understand all of this) and that he wants me back in for a full blood panel, he wants to check my thryoid function and get a proper overview.
I'm just going to go with this for now, because if I get nowhere with my GP after that then I at least will have a full set of blood tests to take to a Private Consultant.

@SirVixofVixHall he looked back through my records and my thyroid function was last tested in March 2019, but he didn't look at the levels.

@Fireflygal my periods are quite variable. Last month was three days of light to medium bleed on a 16 day cycle. This month (i've just finished bleeding) was a 30 day cycle and two days moderate flow and one day heavier. Sometimes some flooding and clots, but generally I wouldn't consider my loss 'heavy'. It's just a change from my own normal.
There are a raft of autoimmune conditions across my family and I have been told I am higher risk of developing one because of family genetics, but so far I have never been diagnosed with one. I definitely don't have the one my mother suffers, I have none of the symptoms.

If your thyroid isn’t working well then that will make your periods erratic, and often goes hand in hand with low vitamin D.
Ask your levels of everything and write them down so you can track them over time. I had extremely low vitamin D yet my GP had ticked it as normal. I then saw a private gynae for peri meno symptoms and he was shocked when I told him my vitamin D levels.
Low vitamin D will also make you tired.

It's commendable in some ways @queenrollo that this GP is being thorough. I appreciate that thyroid issues can go undetected in some women. But the pendulum seems as if it's swung the other way at times with thyroid and Vit D being tested when 'if it sounds like a duck, walks like a duck, looks like a duck...' You know the rest! (Every sign of peri meno but let's look for something else. ) Peri from the age of 40 IS early so the obvious answer is to try HRT and if it works, that's what you've got.
Hope you get some answers soon.

The too young BS really hacks me off. My mother and I were both perimenopausal by 45 and one of my best friends was 35. Keep seeing different doctors. Surely one of them will not be this crap. I got lucky on my third.

Well I had my follow up call today to discuss the test results. Everything is within normal range, including my hormone panel this time.
I had to speak to a different GP, it's someone I know personally so I generally only speak to them if it's an emergency or no-one else is available.
It actually worked to my advantage that they know me, they trusted my judgement about my own health and what is happening with my body and have prescribed HRT with no hesitation.
I am waiting to find out which type as they need to check with pharmacy for availability but they know my preferences and we will review whatever I am on as time goes by.

Finally, after 5 years of this bullshit I am being listened to.

Well done on persevering op.

I'm 41 with no thyroid due to Graves' disease which was diagnosed at 35

I am on thyroxine daily and have to adjust the dose from time to time however the last 6-12 months have been erratic in that some of the symptoms of peri menopause are the same as fluctuations in thyroid levels.

The palpitations,coldness,drained lack of energy,headaches, and changes in my period etc.

Trying to get an appointment with my own gp who knows my history is like gold dust.

You feel like your going round in circles and even though you know your not right we just bloody get on with it don't we

Anyway just wanted to say well done for finally getting somewhere.

Please keenthread updated with how it's going as I'm about to start quoting nice guidelines if I don't have any luck soon

I'm happy for you OP. I was told by one Dr at my surgery that there is no treatment for peri and that I should wait until I literally could not stand my symptoms any longer before I could have HRT. I called back a couple of weeks later after having read the NICE guidelines and thankfully got a GP that knew what she was talking about and prescribed HRT. It's so frustrating that we have to fight for it though.

Just a thought, did they check your thyroid hormones, all your symptoms could be down to that too?

Well done OP! I've had to go private, frustratingly I kept getting the 'within normal ranges' too when I'd have blood tests ... ok but within normal for who ?!!? Why should an otherwise healthy 48 year old accept her body and brain shutting down due to a lack of estrogen for the next however long because the surgery seems it acceptable despite having the ability to help me ??! My GP surgery is well known for pushing anti d's before HRT so I emphasised how I didn't feel that was my issue and the private doctor said 'gosh no, I didn't get that from our talk at all, I'm definitely not going down that road'. I've put on 3St in 3 years despite running regularly, running half marathons, doing HIIT classes ... but my whole body is creaking in pain and I've had to stop exercising for the moment. I just hope for the pain to stop so I can restart the exercise to hopefully help the weight gain 🤷‍♀️ and being able to finish a sentence would be nice ...

@Opentooffers yes they checked my thyroid. When I originally requested HRT at the beginning of May my GP called me in for a comprehensive blood test. He was particularly looking at thyroid, but they also did all the usuals, a full hormone panel, VitD, B12, liver and kideny function and infection markers.
I'm going to request a printout of the results though as my iron has been 'in range' before but for me if it's at the low end then I suffer.

@MiniCooperLover i really feel for you! The weight gain is a noticeable change for me as most of my life I was 'underweight' and really struggled to gain.
My surgery tried to push anti d's twice too and I have been on them for actual depression and anxiety enough times in the past to know that what I have now is NOT the same at all. The anxiety I have now is totally different, and has no trigger at all unlike the anxiety I have worked so hard to overcome.
I hope that your private Consultant can help you to feel much better, both mentally and physically.

as for brain fog....I forgot my mum's birthday last week. I have NEVER done this....I was mortified, but she knows what I am struggling with and she just said 'it's your hormones, it's not your fault'...