Confused!

[WhereIsMyGlasses]

I've posted before but I'm even more confused now, hoping someone can explain things to me more simply.

My periods stopped December 2020 and after blood tests my gp diagnosed premature menopause. I'm 43, 44 this year, so 42 on last period. I've not taken any hormonal contraception for years, and when I did it was the mini pill as I've had high blood pressure since early 20s, on meds from around 25. It runs in the family.

Last year when my gp suggested hrt I expressed concern as there is a history of breast cancer (my mum) and breast, ovarian and cervical cancer (paternal gran). I know there are a lot of myths around hrt too, I'm just not well enough educated on the subject despite reading a lot, I feel even more confused. Anyway my gp referred me to the menopause clinic and I've just had a telephone consultation which has left me even more confused.

The clinic gave me some waffly facts that basically said they can't tell me if taking hrt will increase any chances for me. She said if I was 33 I would definitely need it and if I was 45 or over it likely wouldn't be offered to me so it's up to me. Basically it's advised to protect my bones and cardiovascular health as I don't want to be living more years post menopause than before menopause, that were her exact words.

She is writing to my gp and recommending patches of estrogen and i thought she said progesterone (but may have been progestin?) which I don't need to use, it's my choice. Basically because I have a womb I can't have only estrogen. I asked if that would restart periods and she said no. She said there won't be any build up of lining in the womb. I've read some more after the call and this contradicts what my gp said, and what I've found online. Online also suggests I will have a bleed, which I don't want, I'm done with that.

Over the past 5 years running up to my last period I had experienced a lot of bone pain in my feet, I didn't really relate this to perimenopause at the time and I altered my diet and reduced caffeine and at some point it went away. Last year I experienced hot flushes but they weren't terrible or long lasting. I occasionally get them, I also occasionally get ovulation pain which I'm told is normal despite no period. I don't sleep well but I can attribute that to a lot of things over the past 2 years and the same could be said for low mood and fog.

Overall my symptoms haven't been that bad, I do have a lack of fucks to give and I'm generally less tolerant of trivial things that no longer matter but is that menopause or is that due to the last two years of life, which included my sons autism diagnosis so a lot of stress and difficulty with school. In addition im at that stage in life of having a parent in their 80s and whole shes great, it's still added stress. I take vitamin d tablets which may be a placebo but I feel they've helped my mood, which could also have improved because of my son being in a better place too. Plus I take blood pressure meds, but nothing else.

I'm sorry this is so long, I felt I needed to give background info before asking for opinions. I know nobody can tell me what to do, but it's always good to hear different thoughts and perspectives.

It's hard to proof read on a phone and I'm good at typos so apologies!

Briefly- and can come back tomorrow.

Early menopause is before 45.
So that's you.

The guidance is that using HRT up to 51 (average meno age) does not increase your risks of cancer. You need the estrogen to protect your bones and heart in years to come.

You are topping up your hormones, nothing more.

i thought she said progesterone (but may have been progestin?) which I don't need to use, it's my choice.

I think you have misheard.
All women with a womb need progesterone. So you do need it.

As you are post-meno, you can use it so it doesn't give you a bleed. (Unlike women who are in peri or have had a period within the last 12 months.)

Basically, although you are coping to an extent with your meno symptoms ( and you have quite a few- bone pain, short temper, some flushes, poor sleep, brain fog etc) the most important thing is to protect your future health - in 10 years and more from now.

Losing estrogen at 42 rather than 52 really does impact on bone density and heart health.

This is what you need to consider- the long term outcomes.

I hope this helps but maybe also do some reading around the risks of early menopause.

Thank you, I probably did mishear what she said on the progesterone. Why is it that it won't give a bleed? I've read a lot, possibly too much and still confused.

Also, she did suggest either taking it until 51, or not taking it. She did say don't start stop it. Won't symptoms return when stopping at 51?

This link will tell you about different types of HRT

www.menopausematters.co.uk/postmeno.php

Your drs have given you good advice on the whole.

If you were much younger, HRT would be absolutely necessary.

However, re the cancer in your family, a lot depends on certain factors. I don't think your paternal gran would count. They usually consider a mum and sister as relevant, and at an early age (rather than in old age.)

Have you considered the BRACa gene test?

If you decide not to go down the HRT route, you really ought to have your bone density checked now and every 3 years for life.

Most bone loss happens within 5 years of menopause, then gradually each year.

Your GP could refer you for a DEXA scan for your bones now and then make sure this is repeated every 3 years. (You can also pay for these scans privately if the NHS won't.)

Hope this helps.

Thanks so much for responding, I'll admit that my fear is from my own lack of knowledge and understanding. I have previously read that website which was helpful, it's just other bits of info from other sources that have confused me. I suppose it's weeding out opinion from fact.

How would I go about getting a BRACa gene test? I've mentioned it a few times to different professionals and they gloss over it. I've also been to the breast clinic for a mammogram for a lump myself and they were very dismissive. At the time I was about 37 or 38 and I also explained the history with my mum and they dismissed that too as she was 60 when she had it.

I do wonder though, and I will ask my gp who is also very good, why would I take it until 51 if I wouldn't even be offered it if I was 45.

It's funny how I didn't think twice in my 20s about putting contraception hormones in my body but I'm so worried about something that (I think?) is probably no where near as bad!

I do wonder though, and I will ask my gp who is also very good, why would I take it until 51 if I wouldn't even be offered it if I was 45.

It's not an exact science.

The reason (to answer for your GP!) is that menopause at 42 is considered 'early'. Menopause before 40 is called 'premature'.

The medical guidance is that for either of these, HRT should be offered owing to an increased risk of loss of bone/ heart health.

There are some drs who even now regard menopause before age 47 as early (because that's 4 years ahead of the 'average' of 51.)

For every year that you have low estrogen, your bone density will be falling. So even though you might think there is not much difference between being 42 and 45, you could lose a lot of bone in those 3 years (up to 5% a year in some women.)

So that could be a 15% bone loss in 3 years (without the ongoing loss throughout your life.)

There is also some research showing a link to dementia with early menopause (though not conclusive.)

I guess that 1 case of BC (your Mum) is not considered 'serious' enough to warrant no HRT. It's also important for you to know what gives the greatest risk.

Being overweight increases the risk of breast cancer 8 times more than the risk with HRT (cases of women each year.) The next biggest risk is drinking more than 14 units a week. HRT risks come further down the list. At the moment, using body-identical estrogen and natural micronised progesterone has been shown to be safe (no BC) if taken for 5 years.

I completely understand why you are worried about HRT re. your Mum. If you can cope with the minor symptoms of meno that's fine, but you really ought to take on board your risk of bone loss ( 1:3 women get osteoporosis, even with a normal menopause age) and it can happen earlier than you might think.

I'd push your GP for a bone density scan as a baseline for your bone health and then make a decision over HRT.

Thanks @JinglingHellsBells for all your advice and knowledge, it's much appreciated.

I've been listening to a podcast today with Davina McCall and Dr Louise Newson which was really interesting. I'm going to find time to watch the Davina McCall programme on menopause too.

I'm feeling a lot better about it now, I'll keep researching and it is reassuring that the patches and skin version, which have been recommended to me, are lower risk again.

I started going through menopause in 2015, no symptoms other than periods stopped. I've remained symptom free (it seemed) very lucky until last week. I woke in the middle of the night with pain in my chest tummy area and my body was shaking all over. Checked my BP, it was very high 200 - 105. Went immediately to the hospital. They reduced it, checked bloods. Thankfully, it wasn't a heart attack, all bloods were fine. No explanation as to why it occurred could be given. I hoped it might have been something like a bad dream.
Unfortunately, the following 4 nights this continued. Saw lots of specialists. Have had lots of blood tests, the hormone results will not be back for a week or so. All ultra sound exams are clear.
Please has anybody else had experience like this? If so what did you have to do or take to resolve it? At present, until all test results return I'm taking a beta blocker everyday and have BP tablet that I put under my tongue only if it goes over 150.

You might be better starting your own thread to get answers to your question.