Starting HRT when you still have periods -what types have people tried?

[Aspergallus]

I'm embarrassed to say I have just realised that I am perimenopausal. Embarrassed because I'm a doctor and have been tolerating strange things for about 4 years without realising that this was the answer. I'm 45 and I think this all started when I was 41.

I'd had my second child at 38. It took about 2 years for my periods to come back (was only breast feeding for 6 months). While I waited for my period to return, I felt hellish. It was like permanent PMT and the night sweats drenched my bed and mattress. If I sat up at night I had a river running down my chest. Then my periods came back and were pretty regular (28 days) but sometimes lasted 10 days, sometimes 1 day. And my PMT was more like the whole second fortnight rather than a few days. I remember meeting an old friend and when she asked how I was I blurted out "ANGRY. All the fucking time."

Then at 41 I fell pregnant with my third child. Pregnancy was a blessed relief. I felt like me again -the world was crystal clear and I was content. But I knew I was different, better, and started to dread the end of the pregnancy and returning to what had been going on. I actually thought it was just PMT worsening with age and started researching ways to deal with PMT in preparation.

Delivered my third when I was 42. Got my periods back 18 months after she was born. Same experience as before while waiting. Night sweats were insane. Settled when my periods returned. But gradually, the anger, volatile moods and random period duration has returned. Instead of just being in the second half, it's solidly the second half with random spikes at other times when I am just in the red fog. My husband looks like me like I've gone mad and says "why are you so angry about this now, you've never been angry about this before?".

What else...

I'm tired all the time
My weight "set point" is about 20lbs higher than it has been. I can lose with a huge amount of effort, gain easily but generally sit at the same place, just in the overweight BMI cat.
I feel hungry most of the time.
I wake a lot at night having been a very deep sleeper my whole life
Occasional night sweats but nothing like when I had no period at all
My tolerance for normal behaviour from the kids is very low, and out of keeping with who I think I really am (if that makes sense)

Last month I had a frightening experience when I lost my central vision in one eye. I had an emergency appointment. GP/optician assumption was that I had a retinal detachment (I'm very short sighted and this is a known risk). Turns out it was my first ever migraine. I realised then, that on reflection I had been having visual aura for a while.

I asked the eye dr why I'd have migraine for the first time at 45 and they said, "menopause". And that's when the penny dropped.

I definitely don't want another baby just to escape this for 9 months...so I do think I'd like HRT...for me, for household harmony, to get my energy back...

Wondering what experiences other women have had with HRT at my age, while still having periods. Would love to hear thoughts on specific types.

A big issue for me is acne. I have had lifelong issues with hormonal acne and my skin is actually pretty good right now. I wonder if this would play a part in any choice here.

Grateful to you if you read this and can offer some thoughts!

@housework1977 The main casualties of the rapidly dwindling NHS seem to be women and children. And ADHD is a whole other ballpark where few areas seem to be meeting targets to catch up with historic under-diagnosis. It's crap. I live in a very remote and rural area (Scotland, North coast) and fortunately our GP practice is on board with acting on private opinions because services are so limited or have enormous waiting lists but I know that side of it is another lottery for most people.

@FlatteredFool

We are in such similar situations. It's not a cure but isn't it so helpful to hear that you aren't alone. That migraine really knocked me for six and I was absolutely astonished that something so awful could hit me like that, for the first time, at 45. I had never heard of migraine as a menopause symptom.

Yes, it possibly has a slightly lower risk of clots. That's a risk you take.

@Bryonyshcmyony It's not a case of possibly it's well established science.

All GPs are now being advised to offer transdermal HRT as the default type. There is no reason for women to use tablets any more unless they have a personal preference not to wear one or to use gel instead.

All GPs are now being advised to offer transdermal HRT as the default type

Do you have a source for this as would be useful to show gp.

I, for one, am so pleased that the likes of Louise Newson, Naomi Potter and all of the menopausal celebs are highlighting the way the menopause can ravage a womans body and mind. Without these women championing the cause, we would be back where our mothers were, at least things are changing, albeit slowly. I agree it's a total disgrace that it comes down to affordability, but rather than bashing the private docs who agree with us and who are mostly practising privately because their NHS surgeries would not let them prescribe HRT, we should be getting on side with them and driving change within the NHS. How can it be right that a man can buy Viagra over the counter yet a woman can not get a a vaginal estrogen pessary without a prescription?

I don’t begrudge anyone who can afford to pay privately, what they do with their own money is their business. And hopefully their good work will change the way the NHS treats the women suffering.

@Bryonyshcmyony

All GPs are now being advised to offer transdermal HRT as the default type

Do you have a source for this as would be useful to show gp.

I don't have time to search it- you can though- but it's certainly around on the web so just pop the search terms into google.

It might be on resources on GP/HRT training, it might be BMS statements, but it's out there.

(I write on women's health and read all sorts all of the time.)

@Rina66

I, for one, am so pleased that the likes of Louise Newson, Naomi Potter and all of the menopausal celebs are highlighting the way the menopause can ravage a womans body and mind. Without these women championing the cause, we would be back where our mothers were, at least things are changing, albeit slowly. I agree it's a total disgrace that it comes down to affordability, but rather than bashing the private docs who agree with us and who are mostly practising privately because their NHS surgeries would not let them prescribe HRT, we should be getting on side with them and driving change within the NHS. How can it be right that a man can buy Viagra over the counter yet a woman can not get a a vaginal estrogen pessary without a prescription?

I think it's important to know that Louise Newson has set up a business and most of her team are GPs. She herself, I doubt very much, is doing it for the money (I think she's married to another consultant - not menopause) and the reason she has built up her practice is because of demand from women. She's not creating demand. She's passionate about menopause.

There is simply masses of free info on her website.

Also, once you have read all of her website, or that of the BMS/Womens Health Concern websites, take all the info you need to go to your GP and ask for HRT and the precise type you want.

I know that some women are brushed off but equally, ones who come here and have got what they wanted from their GP, have persisted, politely, and not refused no as the answer.

All GPs are now being advised to offer transdermal HRT as the default type

Certainly seemed to be what Davina was saying

@DinosaurDiana

I don’t begrudge anyone who can afford to pay privately, what they do with their own money is their business. And hopefully their good work will change the way the NHS treats the women suffering.

I don't begrudge them either! I don't believe they will work very hard to change the NHS though, why would they? They'd have no business! Presumably they realise the NHS will never change and budgets can't stretch to gel etc

I don't believe the private consultants will work very hard that should read

@Suzi888 The NICE guidelines say blood tests aren't needed after a certain age -I think maybe 41? The combination of age plus symptoms should be enough information. The reason is, you are supposed to be able to get symptomatic hormone replacement, and perimenopause is a time that you can get symptoms due to your previous levels of hormones falling. So even if the levels look normal (and a one off test doesn't really tell you much anyway; there's a lot of fluctuation), you could be symptomatic because things are dropping off from where they were for you before.

I’ll think I may have difficulty though and if a blood test can ‘prove’ it I’ll have a better chance of obtaining treatment. My GP isn’t the best. My main symptoms are being very irritable (angry!) and a terrible memory, periods are heavy, bloating and insomnia. Not sure my GP will take it seriously so I tend not to go anymore.

Is having migraines going hold me back from HRT? Suffered period migraines for over 25y told never take pill because I get migraines. Only got migraines when had period. Had last 8y with none Now they starting back before I’m due and can’t face being told can’t do bugger all about migraines because I get migraines!

@Akire you should still be able to have HRT but it does make it more important that you have transdermal oestrogen - oral would further increaebclot risk.

@Bryonyshcmyony the NICE guidelines don’t quite recommend giving everyone transdermal HRT but they are explicit that there’s a lower risk of DVT / stroke with transdermal rather than oral. I’d suggest showing that to GP - I think very hard to justify not prescribing the lower risk option to a patient who wants it.

[quote chinateapot]@Akire you should still be able to have HRT but it does make it more important that you have transdermal oestrogen - oral would further increaebclot risk.[/quote]
I’ve no idea what most of that says but I shall
Look it up! Is there some hideous risk increase with migraines. I thought was only tiny tiny risk personally rather have choice than wanting to blow my head off for week out of the month for next 8-10y.

Sorry! Mistyping horribly. Basically having migraines can increase your risk of stroke / clots if you have extra oestrogen especially if it’s focal migraine (eg visual symptoms)

• that’s why you shouldn’t take the combined pill. But if you have transdermal oestrogen for HRT it’s fine. Transdermal better anyway in terms of risk. Have a look at the NICE guidelines and menopause doctor website.

Basically having migraines can increase your risk of stroke / clots if you have extra oestrogen especially if it’s focal migraine (eg visual symptoms)

Rubbish

Thanks I will see GP this week after bloods but I know they highly unlikely to be expert or offer you anything at best of times. Didn’t want oh well migraines off you go nothing we can do.

@Bryonyshcmyony I’m sorry - that is not rubbish. Migraine with aura has a small increased risk of stroke. Oral oestrogen further increases the risk of stroke so combined oral contraceptive pill and oral HRT are not usually recommended for people with migraine with

Transdermal oestrogen for HRT doesn’t come with increased risk of stroke though so this would be recommended for people with a history of migraine with aura.

Sorry if that was unclear - it’s all in the NICE guidance.

@Akire d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/458/Migraine%20and%20Menopause%20v21-02.pdf

Try this link. Transdermal is the way forward and hopefully it’ll help your migraines.

Tha yes amazing thank you so much. I will print to take to GP when try fob me off

[quote chinateapot]@Bryonyshcmyony I’m sorry - that is not rubbish. Migraine with aura has a small increased risk of stroke. Oral oestrogen further increases the risk of stroke so combined oral contraceptive pill and oral HRT are not usually recommended for people with migraine with

Transdermal oestrogen for HRT doesn’t come with increased risk of stroke though so this would be recommended for people with a history of migraine with aura.

Sorry if that was unclear - it’s all in the NICE guidance.[/quote]
I apologise. I really did think it was rubbish but I see there is a link. Shows what I know 😐

Presumably they realise the NHS will never change and budgets can't stretch to gel etc

@Bryonyshcmyony This is the cost of HRT. You can click on the options at the top of the page for other sorts incl post menopause types.

Gel is actually cheaper than some sorts of HRT.
If your GP won't offer anything except tablets, it's not down to cost.

You might find MM website helpful.
Masses of info.

www.menopausematters.co.uk/treatafter.php
www.menopausematters.co.uk/perimeno.php