Help me out with a diagnosis...

[MiddleAgedAndMad]

I am 44 years old (45 in June)
I am on the progesterone only pill (2 years now)
I am on B12 (150 mg a day) my levels were normal in Nov (but don't know what the numbers were)

I have had insomnia 2 yearsish, hot flashes at night (soak the bed) that come and go (about 18 months), a beard (if I let it grow that big), thinning hair, exhaustion on some days where I can barely put one foot in front of the other. I also get anxiety like dreams that I have to wake myself up from quite frequently? Some in technicolour. Its weird.

The insomnia, I have NO PROBLEM falling asleep. I'm out like a light. I wake after 2 to 4 hours sleep. Then I lay awake. I'm either up at 8 zonked from so little sleep, or fall back asleep around 8/9 and get up at 12, which is crap. Often still tired.

I have had hormone levels checked, 2 weeks apart...I got the results over the phone so apologies for the inaccuracies

IGA levels Normal
Testosterone levels Normal
Free Androgen index Needs follow up (and has not been followed up?)

I had another set of tests, as apparently my thyroid levels were low to borderline last Feb.
TSH - 2 Normal
Vitamin D - 30 (will be followed up I understand)
Bone profile Normal
Calcium 2.52 Normal

So I have a face to face with the nurse next week. Do I continue to push for HRT? Or is there no chance at all this is Peri menopause?? I have NEVER had such an issue with insomnia.

Just very frustrated and at screaming point now...!

TIA for any knowledge or wisdom

Have a look at Jane Pangbourne's facebook group 'HRT truth collective', she's a menopause specialist, lots of useful advice and info

Here's the link:
www.facebook.com/groups/hrtandhormonehelp/?ref=share

Thank you! Will go look x

Diagnosis?

You sound 100% peri menopause.

-Right age
-Many symptoms

-Blood tests are a waste of time for this which is why NICE says do not do them (on women 45+ and you are almost 45) as they are inaccurate.

LOADS of info here @MiddleAgedAndMad which you might find helps. From a meno GP running this app and a clinic etc.

www.balance-menopause.com/?s=perimenopause+symptoms&post_type=menopauselibrary

Start HRT and see how you go.

Thank you for the link and validation (I'm not going mad) @JinglingHellsBells

@CrotchetyQuaver I have been asking since November. They check my bloods. I was told by a female Dr the insomnia was probably caused by anxiety, I told her I was fine, got sleeping pills prescribed (she acknowledged they help you fall asleep, which she acknowledged I dont have a problem with) and told to book another appt in month. So I then went to my go to advanced nurse who I thought was open minded. Back in 2020 she said my night sweats were a peri sign, tested my hormone bloods (only one set of bloods taken) and told they were fine. This appt she tells me in Feb last year my thyroid was low/borderline so she got my bloods for that, vit d and calcium.

F2f with her on 21st and I'm just in despair at being listened to. I keep asking for hrt. Tell them my list of symptoms, they check my hormone levels 'oh you're fine' then look for something else, other than the other bleeding obvious thing it is to say it is as they WONT SAY ITS PERI!

Feel like I'm being treated as a hypochondriac. Or over emotional woman. Before 2020 I was going to drs once every few years??? But now I seem to be there once or twice monthly.

So...I would love hrt but the GPS will not prescribe it and I can't afford it privately. It's driving me mad. 5 more sodding more months of this...and 3 months of being fobbed off, after 2 years of insomnia. Its affecting EVERY part of my life. But no, I'm just fecking well imagining things.

You have to try to be more assertive with your GP or see another one.

Are you in the UK?

If so, your GP ought to be following the NICE guidelines. They are pinned as a post at the top of this meno forum, or you can search online and bring them up.

They were written in 2015.
They state what GPs ought to do. This includes no blood tests for women around your age.

Menopause is to be diagnosed on symptoms. That's what it says and that is what you have.

Go back to your GP (or see another one, or register elsewhere if you need to.)
Take the NICE guidance - print it off.
Explain your symptoms again and how they fit peri meno.

Tell them you want to try HRT and that unless they can find medical contraindications, they can't refuse a safe treatment.

If they refuse, tell them you want referring to a gynaecologist who knows about menopause, for a 2nd opinion.

It's not acceptable they are withholding treatment.

From Nice...

1.2 Diagnosis of perimenopause and menopause
1.2.1Diagnose the following without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms:

perimenopause based on vasomotor symptoms and irregular periods

menopause in women who have not had a period for at least 12 months and are not using hormonal contraception

menopause based on symptoms in women without a uterus.

1.2.2Take into account that it can be difficult to diagnose menopause in women who are taking hormonal treatments, for example for the treatment of heavy periods.

1.2.3Do not use the following laboratory and imaging tests to diagnose perimenopause or menopause in women aged over 45 years:

anti-Müllerian hormone

inhibin A

inhibin B

oestradiol

antral follicle count

ovarian volume.

1.2.4Do not use a serum follicle-stimulating hormone (FSH) test to diagnose menopause in women using combined oestrogen and progestogen contraception or high-dose progestogen.

1.2.5Consider using a FSH test to diagnose menopause only:

in women aged 40 to 45 years with menopausal symptoms, including a change in their menstrual cycle

in women aged under 40 years in whom menopause is suspected (see also recommendations on diagnosing and managing premature ovarian insufficiency).

So- looking at the above guidance, your GP ought not to be doing blood tests at all AS YOU ARE ON HORMONAL CONTRACEPTION.

She clearly knows nothing about all of this.

I started HRT (patches) 6 months ago - sleep is much improved. I didn't realise I had stopped dreaming until I started dreaming again when I started HRT.

I think as a result of having much better sleep, my mood is much better - I'm less impatient and much more tolerant. The 'rage' has subsided, not completely but I'm a better person. Still having a some temperature control problems but these are also much improved.

My GP has listened to my symptoms and yesterday increased the dose of the patch from a 50 strength to the 75 strength (I started on 25).

But I'm a fair bit older and had a hysterectomy 15 yrs ago. Probably should have started HRT 10 yrs ago. It's quite a nice felling realising how bad you've been with menopause symptoms when they are finally improving.

I also have an under active thyroid and had to battle a little with the GP (had to find an understanding consultant) to be prescribed T3 in addition to the T4 usually prescribed. So I understand the feeling that the GP doesn't listen. Some would argue (on thyroid forums) that TSH is better at 1 or under. Some countries don't treat until TSH is over 5, some countries treat when TSH is over 2.5.

I was also advised to also take a 'good' (short for expensive) menopause supplement.

Thank you again @JinglingHellsBells

I've looked at the NICE guidelines over and over but I wasn't sure if my progesterone pill was classed as a high dose.

So far I have had two appointments with a female GP (the one who suggested it was anxiety) and my regular health practitioner is the nurse. I feel I have been pretty assertive with them, but I guess each time I accept their 'need' for them to chalk these symptoms down to a vitamin or thyroid deficiency and I thought if they do all these tests and find nothing much then they have to take the peri symptoms as they are. I was thinking if the nurse suggests its nothing, I will ask her to book an appointment for me on x day in June ie my 45th birthday, as then she can follow the NICE guidelines and prescribe the HRT without a bloody blood test...

I just feel like I'm being treated as difficult and slightly hysterical (I am after no bloody sleep for so bloody long, its bloody understandable!)

Sorry if its a bit blah...got kids around and distracted!!!

I would also add that it seems odd that they're worried about the risks of HRT but happy to prescribe you sleeping pills which are much riskier. I'd suggest asking them for a trial of HRT to see if it alleviates symptoms - if it doesn't then it probably isn't peri, if it does then it definitely sounds like hormones are at the root of it!

what really annoys me is that these drs and nurses are just ignorant. And you are suffering. They behave in ways that meno consultants and experts wouldn't! It all stems from lack of training and expertise, as well as confidence to prescribe for women like you.

The NICE guidance states at the top that treatment has to be individualised. So the fact you are weeks away from 45, ought to be something they consider- medicine is not an exact science FGS!

So my appointment to discuss blood results is this afternoon. I feel like I'm going to be fobbed off again. I was planning to print NICE guidelines re 45 years old diagnose by symptoms. A print of a quote from the British Menopause society website stating symptoms are a better indicator rather than bloods. Also a checklist of my symptoms. Any further ideas? The only other thing she can point at is my borderline vitamin D. Do I accept trying 3 months or whatever of vit d to see if that is causing insomnia, or push for hrt now? I don't like being pushy but...

@MyOtherCarIsAPorsche sorry I missed your post, you did well to get your GP to listen especially over the thyroid prescription, after another 4 hours of sleep night I'm feeling angry and emotional.

@UnaOfStormhold, what an appropriate name...I will ask for a trial but the nurse is focused on my normal hormone results.

@JinglingHellsBells I am at screaming point and I don't hold out any hope I will come away with anything but a vit d prescription. I'm also worried accepting hrt from a nurse who is not fully on board and I have to ask for further support if its not suiting me?

One more thing, I've struggled with thrush 20 years now. Is hrt very likely to trigger it? That also makes ne feel utterly desperate. I am treated fir b12 deficiency, as the thought was that had caused the soreness (as they cannot always find thrush) but I've recently had another bout...so need to maybe suggest a higher dose of b12 too...

Sorry for the long post, any hints or tips welcome, thank you