Second menopause 🤬

[HeraInTheHereAndNow]

So, I’ve been on HRT for five years. Had to come off after medical advice from gynaecologist. And I’ve gone right back to the start. It’s bloody awful. And I’m older and less able to cope. The flushing and aches and pains are dreadful.

Any tips anyone?

Can I ask why you had to come off it after 5 years?

Did you have some serious health issues that mean you can't use it any more?

I was told many years ago that once I stopped taking HRT the menopause symptoms came back and they did. But as my osteopenia developed into full-blown osteoporosis during the 18 months I had no HRT I insisted on being referred back to the Menopause Clinic and going back onto it. Bone density has improved thankfully.

Is your gynaecologist a menopause specialist OP? Have you had a BDS?

Heart thing. Meds not compatible and post menopausal bleeds which, have turned out to nothing 🤷🏻‍♀️

Not sure about the specialist. I wasn’t seen at my usual general hospital as no appointments. I attended three times for scan/clinic appointment at a hospital 45 bloody miles away.

If you can give us more info I'm sure peeps here will try to help.
Based purely on what you have said, it doesn't seem a very understandable outcome.

Was the gynae a menopause or HRT specialist? Not all gynaes are.

Meds not compatible

? AS far as I know, there are no neds that are incompatible with HRT. What are they telling you?

post menopausal bleeds

what exactly occurred?
Usually if someone bleeds on HRT ( assume it was the combined, continuous type) a dr would suggest another sort, such as the Mirena coil plus estrogen.

Depending on your age, you may not in fact be post-menopausal (many women have another period quite some time after the 'last')

How old are you now?

What is wrong with your heart OP?

Have you had problems since starting HRT (with your heart)

I’m nearly 60.

LMP aged 54 ish (not entirely sure). I had high bp, cholesterol etc but am not overweight, exercise daily (still run most days). Now taking aspirin, BP tabs, statins so, am at good levels. Have mild angina and use GTN spray as required.Have family history of breast cancer, strokes, heart attacks and by-pass. Sister has just had stents fitted and I’ve apparently got two of three narrowed coronary arteries. Never smoked. Moderate drinker.

Post meno bleed was 3 x episodes of spotting (like the beginning of a period) for several days. Went to GP as had CIN III 20+ yrs ago. My smear tests went from “Borderline changes” for 18 months and the family planning clinic dr referred me to the hospital to “get to the bottom” of constant borderline changes. So, went from borderline to CIN III. When the spotting happened this summer, I just wanted a smear test but was refused because it wasn’t “due” for another two years so instead, my GO stopped the HRT again and I had to see a gynaecologist for a uterine scan. Which was normal.

Have had a chat with DH today and actually thinking, if I go back in HRT but then need to come off again in later life, I’d have to go through it all again! May be I’ll just do it now! 🤷🏻‍♀️

The heart issue is complicated but for women starting HRT within 10 years of menopause, HRT reduces heart disease.

There may be a school of thought that suggests it's beneficial for you to stay on it.

There is no time limit to staying on HRT if there are no contraindications.

There is also newish research out which showed that stopping HRT abruptly might exacerbate heart disease/ stroke/ etc with a rebound effect so the rule is to reduce very slowly over 6 months.

You really do need to see one of the handful of excellent meno gynaes in the UK who would advise you. It would cost you £300 to go privately so up to you if you feel it's worth doing.

@JinglingHellsBells Thank you for that advice.

I’m not sure it’s a GP thing. On the rare occasions I’ve been seen it’s always been “about” something else and then it’s “stop your HRT”. Twice now, I’ve stopped, as in, taken one day…not the next, end of. I’d no idea to come off slowly because have never been told. And I know there’s a shortage of gps and Covid and all that but each time I’ve been it’s someone different and I haven’t felt they know anything about me. I’ve had to query them. It makes sense now that I feel I’ve been plunged into the deep end of sweating, sleepless nights and mood swings!

I live near Chester. How do I find an actual menopause specialist?

I've not used them. My go has been bloody amazing with the start of menopause. I believe this clinic just outside Manchester is great. It is private though.

summerhillhealth.co.uk

OP: I am not sure which of your heart things is supposed to contraindicate taking HRT.

thebms.org.uk/find-a-menopause-specialist/

Try searching for a menopause specialist near you via this link. Perhaps you can find an HRT you can stay on.

How are you supposed to come off HRT slowly over several months?

If you use gel you use a little bit less each week.

I was on Kliofem but they stopped it. Then they put me on Urogestan (?) tabs and oestrogen gel. Each time I was taken off it, they just said “stop the HRT”. So I did.

No wonder I feel all over the place!

@waybill

How are you supposed to come off HRT slowly over several months?

Do you want to stop or are you just 'interested'?

Depending on what someone uses, they reduce the dose. So, gel - reduce the dose daily, then leave gaps so it's used every other day.

With tablets or patches, you can reduce the dose to a lower dose or use them every other day.

There is plenty online about this.
It's not 'new'- been around for a long time on 'how best to come off HRT'.

Some people go cold turkey, others come off slowly

[quote HeraInTheHereAndNow]@JinglingHellsBells Thank you for that advice.

I’m not sure it’s a GP thing. On the rare occasions I’ve been seen it’s always been “about” something else and then it’s “stop your HRT”. Twice now, I’ve stopped, as in, taken one day…not the next, end of. I’d no idea to come off slowly because have never been told. And I know there’s a shortage of gps and Covid and all that but each time I’ve been it’s someone different and I haven’t felt they know anything about me. I’ve had to query them. It makes sense now that I feel I’ve been plunged into the deep end of sweating, sleepless nights and mood swings!

I live near Chester. How do I find an actual menopause specialist?[/quote]
This is from a major report into HRT

journals.sagepub.com/doi/full/10.1177/2053369120957514

In summary, evidence from recent studies and Cochrane analysis suggests that HRT (estrogen with or without progestogen) started before the age of 60 or within 10 years of the menopause is associated with a reduction in atherosclerosis progression, coronary heart disease and death from cardiovascular causes as well as all-cause mortality.

Evidence from the Cochrane data-analysis as well as the long-term follow-up data from the WHI showed no increase in cardiovascular events, cardiovascular mortality or all-cause mortality in women who initiated HRT more than 10 years after the menopause.

OP I have heart problems (though possibly less serious than yours) and am older than you, same type of bleeding problems (I think I still ovulate sporadically). I asked my GP to refer me to an NHS clinic in London 5 years ago and have been on HRT (gel and Mirena) since - just had the coil changed and a hysteroscopy (all under GA, at the London hospital) to check all OK.
No issues with any HRT/heart/bp medication.

Oh and refit of coil has done away with some very unpleasant joint and muscle aches and pains that I had put down to ageing, a nice surprise!

Do you go to the Chelsea and Westminster under Panay and his team @borntobequiet ?

A lot of women don't know that this top meno clinic is available to all women from England on a referral from their GP (you don't need to live in London.) It's for women with more complex meno problems and underlying other health issues as well as POI.

@HeraInTheHereAndNow The clinic has a referral from online under their name.

Do you go to the Chelsea and Westminster under Panay and his team @borntobequiet ?

Yes!

Most recently - spoke to nurse practitioner at GP 12th July (as they contacted me re coil change) saw consultant at C&W 30th July, had coil change/hysteroscopy 17th August. (It helps that I have family in London to stay with before and after surgery.)

@borntobequiet

Most recently - spoke to nurse practitioner at GP 12th July (as they contacted me re coil change) saw consultant at C&W 30th July, had coil change/hysteroscopy 17th August. (It helps that I have family in London to stay with before and after surgery.)

That sounds good.

I was offered the Mirena many years ago as part of HRT but turned it down (had a bad experience with a copper coil before ). I recently asked about it again (Mirena) although I do have doubts as the progestogen in it is the same as in the Pill I once took and gave me acne.

However, my consultant (who's on a par with the C&W team and knows them all) said a Mirena at my age (!) would be tricky as the womb shrinks (am mid 60s.) So it's interesting you had yours under a GA (for that reason?)

How do you feel about using HRT long term? I'm dithering between carrying on or stopping sometime. I might PM you to discuss if that's okay?

@JinglingHellsBells I’m totally comfortable with taking HRT forever! I couldn’t tolerate oral progesterone - makes me feel awful - and didn’t want the Mirena but accepted it as the only alternative. At that time I was bleeding very heavily for extended periods (was early 60s) and it stopped the bleeding as well. (My uterus hadn’t shrunk, apparently even now it’s in tip top condition - weird.)
So I don’t like the Mirena (I can feel it when I get a cramp) but I tolerate it and as I said, to my surprise my joint and muscle pains have improved. I’ve asked repeatedly for a hysterectomy but they don’t want to give me one…
Yes of course PM me if there’s anything else! I tend to give all the details in posts because I think it’s useful for women to know that menopause can be more than just periods suddenly stopping at 50-something and that’s it.

@borntobequiet Have PMd you.