GP: ‘You can’t be perimenopausal if you are still having regular periods.’

[BoPeeple]

Is she right? She is the menopause specialist at my surgery and I’ve had three appointments with her for a range of symptoms:

Insomnia
Vaginal dryness
Aching legs and bottom
Other muscles aches

I also have irritability, dry eyes, brittle nails etc.

But I am 40 and still have regular periods, although my cycle now varies between 25 and 31 days. She says that I am too young for perimenopause and as I am still having regular periods it’s very unlikely.

She’s referred me for blood tests for auto immune conditions.

Can anyone set me straight? Do regular periods mean you can’t be perimenopausal?

I feel rubbish and am at the end of my tether.

I'm sort of appalled that a menopause specialist is giving out such incorrect information. I started having perimenopause symptoms just like the ones you describe in my early forties and saw a consultant who is now the top consultant for hormones in the UK. He immediately diagnosed it as perimenopause and put me on birth control pills rather than HRT. It pretty much solved all my symptoms. I am 58 and still on the pill. I still have the symptoms but way less. And have yet to ever have a hot flash. I was taking the birth control pills continuously so never had a period so can't tell you if they would have been regular or irregular. But I have many friends who are in their 50s and still getting regular periods even while having menopausal symptoms like hot flashes.
Might be worth looking up the North American menopause Society at menopause.org. They are the official Medical guidance body kind of equivalent to the NICE guidelines in the UK.

Oh and just to add.... When one OBGYN tried to switch me from birth control pills to traditional HRT (lower dose patches and a pill). It was a disaster and I ended up with such bad joint pain that they thought I had rheumatoid arthritis until another doctor put me back on the pill and it all went away.

@SofiaAmes

Oh and just to add.... When one OBGYN tried to switch me from birth control pills to traditional HRT (lower dose patches and a pill). It was a disaster and I ended up with such bad joint pain that they thought I had rheumatoid arthritis until another doctor put me back on the pill and it all went away.

@SofiaAmes I seem to recall you posted before and many years ago saw NP (specialist.)

The thing is, the way the US offers HRT is quite different to the UK.
I am pretty sure that if you were still in the UK you'd be taken off the CCP because of the risk of blood clots as it's a) tablet form hormones and b) synthetic not body identical like modern HRT is now.

In the UK, drs do prescribe the OCC to younger women as an option as it doubles up as contraception and has a higher dose of estrogen compared to HRT. However, they would not continue to offer it beyond 5o-ish due to clotting risks.

[quote BoPeeple]@JinglingHellsBells

It’s truly depressing. She actually runs a menopause clinic in the nearest big town. [/quote]
Sorry I misread your 'regular' for irregular'.

But if your cycle is around 6 days out each month then that is not exactly regular is it?

In women who are not in peri, periods can vary by anything up to 5-6 days and still be considered fairly normal, but as you are having other peri signs, then you variation of a week is certainly bordering on irregular.

It's the start. Irregular doesn't mean you miss periods or have huge gaps etc, it can mean a 28 day cycle becoming 23, or 35, or whatever.

So IMO your cycles are irregular now!

JinglingHellsBells I haven't actually found great differences in the way that the UK offers HRT to how it's been offered to me here in the USA. Here in the USA, just like in the UK, the knowledge and understanding of the current guidelines varies enormously from doctor to doctor. The same risks of blood clot etc are quoted here in the USA, but since I don't have any of the other risk factors at all (I am thin, healthy, don't smoke, don't have high blood pressure etc.), I was able to review all the medical literature with the doctor (and several OBGYN's) and together we decided that the risk was minimal enough that it was worth the risk when balanced against the complete reduction in lifestyle (when on HRT I was in so much pain/discomfort from the joint ache, migraines, asthma attacks and bladder leakage that I was essentially non-functional) that occurred when I wasn't on the pill.

But @BoPeeple you aren't having regular periods are you?

You used to have regular periods with a cycle that you could set your watch by, you are now still having periods but with irregularly and your cycle may last anywhere between 25 to 31 days.

You also have new symptoms of vaginal dryness and insomnia.

I'd be very clear that you view this as irregular periods, as yours used to be like clockwork + new symptoms typical of peri.
If you have any longer or shorter cycles keep track as it is all evidence.

Here is a quote from a paper (2016 IMS Recommendations on women’s midlife health and menopause hormone therapy
R. J. Baber, N. Panay & A. Fenton the IMS Writing Group) published by Mr. Panay (and colleagues) who was the doctor that I saw in the UK almost 18 years ago regarding my early 40's peri-menopausal symptoms. Here is a link to the paper.
(Note that MHT includes HRT and traditional birth control pills)

*There are no reasons to place mandatory limita-
tions on the duration of MHT. Data from the WHI
trial and other studies support safe use for at
least 5 years in healthy women initiating treat-
ment before age 60.
*Whether or not to continue therapy should be
decided at the discretion of the well-informed
woman and her health professional, dependent
upon the specific goals and an objective estima-
tion of ongoing individual benefits and risks.

@BoPeeple @AnnaMagnani

Yes. It's the difference between regular and frequent.

If something is regular that means it happens at predictable intervals. If it is frequent that means that it happens a lot. Two different things.

@SofiaAmes

Here is a quote from a paper (2016 IMS Recommendations on women’s midlife health and menopause hormone therapy R. J. Baber, N. Panay & A. Fenton the IMS Writing Group) published by Mr. Panay (and colleagues) who was the doctor that I saw in the UK almost 18 years ago regarding my early 40's peri-menopausal symptoms. Here is a link to the paper. (Note that MHT includes HRT and traditional birth control pills)

*There are no reasons to place mandatory limita-
tions on the duration of MHT. Data from the WHI
trial and other studies support safe use for at
least 5 years in healthy women initiating treat-
ment before age 60.
*Whether or not to continue therapy should be
decided at the discretion of the well-informed
woman and her health professional, dependent
upon the specific goals and an objective estima-
tion of ongoing individual benefits and risks.

Fully aware of that quote and know NP anyway from conversation with him on a professional basis.

The combined pill is not usually given to women of your age owing to blood clot risks.

It's a very different formula compared to body identical HRT.

What you use is up to you but in principle, I doubt anyone in the UK would carry on with the CCP in their late 50s without trying the other types of HRT. Drs are now trying to get transdermal hrt used for all women, even younger women and without blood clot risks.

I’m in the same boat OP. 36, shortening cycles, dryness, hair/skin changes, shit mood.
GP doesn’t give a shit!
And I can’t seem to find help/advice for being under 45, despite family history of early menopause

she insists I'm too young

That alone proves beyond any doubt that she doesn't know what she is talking about.

I've had my hormone levels checked, as I was experiencing much the same as this, and all my levels are normal.

Iron was low, so on supplements now.

Had bloods done, and the shower version of this story is now I'm being tested for rheumatoid arthritis and lupus.

Was very low in vit d, so also on supplements for that too.

I've had more bloods, scans, x rays and got MRI booked for next week x

@BoPeeple How old was your mum when she started hers?

Am younger than you and seen my gp last week she said you can still have regular periods altho they might be lighter/not last as long. I got some blood tests to check pretty much everything including my hormone levels.

@Sweettea1

Am younger than you and seen my gp last week she said you can still have regular periods altho they might be lighter/not last as long. I got some blood tests to check pretty much everything including my hormone levels.

My periods are also lighter than they used to be and much shorter in duration - 5 days instead of 7 or 8. But she doesn’t seem interested in that.

[quote supremelybaffled]@BoPeeple How old was your mum when she started hers?[/quote]
My mum had a hysterectomy aged 50ish because she had very bad fibroids. She was still having periods (in fact, bleeding more or less all the time) then. I don’t recall her talking about bad menopausal symptoms, but she did have awful insomnia that started in her early forties.

@SofiaAmes

This same doctor did put me on the pill a while back because of my insomnia as I said I thought it was linked to my cycle (so she’s not joining up her thinking AT ALL). I tried two different types and neither suited me unfortunately - I felt permanently sick, was bloated and had no sex drive. So I came off it.

@Seriously79

Lupus is one of the things she’s testing me for. I don’t have any of the other symptoms of lupus and I actually thought it was pretty rare - why she thinks that’s more likely than peri is beyond me.

"I doubt anyone in the UK would carry on with the CCP in their late 50s without trying the other types of HRT. Drs are now trying to get transdermal hrt used for all women, even younger women and without blood clot risks."

@jinglinghellsbells I guess I wasn't clear. I DID try transdermal HRT and multiple other types of HRT in my early 50's and the results were disastrous (I basically became non-functional with chronic pain, migraines and asthma attacks, in addition to a severe skin allergy to the HRT patches) and was then put back on birth control pills and all the symptoms disappeared again. The approach is similar in the US to the UK...try the path of least hormonal intervention and work your way up if it's not effective.

What's absolutely clear is that every woman has different needs and a-one-solution-fits-everyone should NOT be the approach a medical professional takes. I think that both the UK and US guidelines clearly state this.

@boPeeple so sorry the pill didn't work for you and even more disappointed that the next step wasn't HRT. Ironically when they switched me from the pill to HRT, the resulting symptoms were so severe that they decided that I had rheumatoid arthritis and/or Lupus and sent me for PT twice a week for 9 months until I finally got switched back to the pill and it all cleared up in a matter of weeks.

@Sweettea1

Am younger than you and seen my gp last week she said you can still have regular periods altho they might be lighter/not last as long. I got some blood tests to check pretty much everything including my hormone levels.

Periods can also often be heavier in peri...

I am really sick of the quote "you're a bit young"...

[quote BoPeeple]@AlwaysaLittleBitTired

The irony is that, if it was found that I had a thyroid issue, they’d prescribe me hormones to fix it. Why are they so reluctant to prescribe HRT when everything is pointing to a lack of oestrogen?[/quote]
Would she be more likely to prescribe a low dose contraceptive pill? That might help.

The fact that she's testing you for a bunch of things is a good thing in my opinion. She can rule things out and then find the right treatment. I know it takes longer but at least you can be more certain that it is peri and not something else.

Sorry you're feeling s* in the meantime though

@DaisyNGO

We’ve tried that - she put me on Levest but it was horrible. It didn’t help my sleep, made me feel sick ALL the time and I was really bloated. Also no interest in sex. The only thing it did was clear up my back acne…

I’m worried that HRT won’t be the silver bullet I think it is, even if I can get her to prescribe it.

@bluejelly

The fact that she's testing you for a bunch of things is a good thing in my opinion. She can rule things out and then find the right treatment. I know it takes longer but at least you can be more certain that it is peri and not something else.

Sorry you're feeling s* in the meantime though

Yes, I’ve sort of come to this conclusion. I’m just impatient and pissed off with her lack of compassion.

I don't understand why she's testing you for lupus either OP. Aching /swollen/ stiff joints can be part of it but usually Drs look for more than one symptom before testing.