Advice needed - asking for HRT at 40

[DoubleDinnurs]

I'm going to my GP tomorrow and want to ask for HRT. I've felt terrible for ages since the birth of my child a couple of years ago. Looking at perimenopause symptoms I realise I pretty much ticked all the boxes apart from night sweats, hot flushes and my cycle changing length, although my periods are now heavier. I am a bit less tolerant to heat, but they don't feel like how people describe as a hot flush, more of a need to fling a door open or take off a layer of clothing.

I'm pretty desperate at the moment. I feel down for one half of my cycle, which results in feeling suicidal in the last few days of my cycle - i'm actually looking up how to do this. After my period this goes, but it worries me due to having kids. At the time I feel they are better off without me. I generally feel a bit flat, but it's unbearable then.

I'm really worried about being offered anti-d's instead. I can feel pretty good during the second week of the month. It just goes downhill for a couple of weeks after that. I'm struggling to function. How do I convince the GP to prescribe HRT instead of anti-ds at my age? Anti-Ds won't solve some of my physical symptoms either and will probably make these symptoms worse.

I already exercise and eat fairly well. I try to Minimise alcohol too. Not sure what else I can do.

I'm so sorry to read what you have been going through, that sounds absolutely awful. I'm very glad you are reaching out.
Have you heard of PMDD? It sounds as though this is very much worth looking into for you.
On the subject of HRT - it does sound as if you are having hut flushes, not everyone goes bright red and sweats, I never did. I also didn't think I was having night sweats but now I'm on HRT I never have to peel off my damp jammies at 3am or change my sheets three times a week. I have a friend who wakes up drenched nightly and has to sleep on a towel. I thought I wasn't having night sweats because I didn't experience that - but everyone's different. However, I do think your cycle being very regular might be a barrier - but I don't know.
All the other symptoms of menopause can also happen in lots of other scenarios. In the end, I decided to try HRT because if it didn't resolve my problems (it did), then it wasn't menopause after all... given how loathe they are to test hormones because levels are so wacky for years during peri sometimes trying it is the only way to know if it's what you need.
I had a really rough time, hormonally and mentally, for years after the birth of my second. But I'm in a completely different place now - this WILL get better.
If you don't want anti-d's don't accept them. Be very firm that you feel the problem is hormonal and be very clear that you want action/a referral. Do tell them about the suicidal thoughts, having the thoughts doesn't mean you'll act on them and it doesn't mean you would ever want to leave your children and you have nothing to be ashamed of. Will you update how you get on?

Thanks for your response and kind words. I have looked up PMDD before, but I get other symptoms like brain fog and sleeplessness and frequently needing the loo throughout the month, which is why I think it's peri.

I'm hoping I won't get fobbed off, but my doctor surgery are very good at giving dustbin diagnoses in the first instance, presumably to get you off their back. I'm going armed with a list of symptoms tomorrow. I expect they will try and go down the anti-d or hormonal contraceptive route, which I really don't want as I have never responded well to contraceptives in the past which is why I no longer take them (no need for them either!).

Exercise used to really help, but barely has an impact on my mood now, might just maintain the 'meh' mood I have.

I will let you know how i get on. Did you have to argue with the doctor to get it? I hope you don't mind ne asking but how old were you when you started it? I'm worried my age is a barrier, but I heard its important to start taking it early if you are having peri symptoms earlier.

Go armed with your symptoms (hot flushes, heavy periods, brain fog, severe anxiety, low mood). Be clear that these are greatly affecting your quality of life
Have a read of the NICE guidlines before you go - www.nice.org.uk/guidance/ng23
www.nice.org.uk/news/article/nice-sets-out-further-details-on-menopause-guideline-update
Try and see a female GP of the right sort of age, but be prepared that she might not be the one to help, but it's a good place to start
Tell the GP you've read the guidelines
Ask outright for HRT
If they refuse you HRT ask them on what basis they are refusing you
Take a pen and pad and write down what they say to you
Be very officious!
If they offer to test your hormone levels, discuss that you are aware that hormone levels are wildly unreliable during peri and whether they are offering to test daily for a whole month....
I you leave without HRT go back and see a different doctor
Just because you are youngish to go on HRT does not mean you don't need or qualify for HRT :)
If you have a fight on your hands then in the meantime, you could consider trying black cohosh, red clover or isoflavones (do your own research on those to be sure you're happy to take)
I went to the doctors a couple of weeks before my 45th birthday. She didn't want to prescribe because of my 'lack of symptoms'. I really, really did not have a lack of symptoms - regularly being too fatigued to go about my day.
I pushed and she relented. Three months in and the way I feel is night and day compared to how I was feeling.
Please do ask for them to do full bloods on you though and get the results to look at yourself. Have a look at your B Vitamin levels and particularly your iron as you have heavy periods. My iron was very low for a very long time and they didn't tell me until I had dipped into dangerous territory. I highly recommend quaffing down floradix.
Finger's crossed for you!

Hi, just a quick update. GP has agreed to try HRT which I am really pleased about. Picking it up next week and will get bloods done too. Thanks for your help. I will let you know how it goes....

Fab news OP! Really hope you see some improvement in how you are feeling X

Oh that’s a great update! I hope you feel better soon. Can I recommend for your low moods also perhaps things like meditation and yoga nidra? I started getting horrible anxiety and depression with perimenopause so they both help me.

Would be really interested to see how this goes. I’m considering antidepressants as have had a lot of anxiety that has got worse over the last year- however do suspect it might be hormones as I have totally black moods last half of my cycle and then the fog lifts when I get my period- which sounds similar to the OP (I’m 42)…

Hi @DoubleDinnurs
I am 30 mins away from my own GP appt to ask for the same. I'm 39. I sat for hours last night and again this morning worried about how to convey what I am feeling and how debilitating day to day life is when I struggling with all these symptoms. I am convinced I am peri and I am scared I am going to get fobbed off with antid's or birth control to level out my hormones. I don't want either, I want to address the problem through HRT. I went a few years ago and got told hormone levels were fine but having read one of the responses to your post I am going to make the point that one test doesn't show the full picture. Since then I have been straddled with an absolute barrage of peri symptoms and I am limping through life now. It's hard.
I am feeling so overwhelmed by this appt, I am praying I am listened to. It took so much of me just to call and make the appt itself.
Anyway, just wanted to say thanks for posting and thanks to your contributors. I am using some of this to help unscrambled my head and tell my GP I need help x

How did it go @TheMindfulMum?

Yes interested to know how it went… I have mental health appt tomorrow whereas suspect it’s a hormone issue…

Not as well as I'd hoped. She outrightly said peri menopause doesn't happen at the age of 39. I did contradict her and say yes it does but she was pretty firm in her stance and said it's very very rare. She's booked me in to take bloods and check iron and hormone levels 😔 She is already veering towards iron tablets and a contraceptive pill to iron out the peaks and troughs of hormones within the monthly cycle and I think she mentioned possible mild anti-d. I'm not where I hoped I'd be this afternoon 😔

I feel I need to go along with the bloods and challenge again when I see her in a few weeks. It's very hard though. It took so much of me to make and attend the appt today that when I was in there I didn't have any strength to really challenge what was being said. When k wrote down what I'm experience - mentally, physically, emotionally - I tick so many of the peri boxes but she was so dismissive.

I have had a great relationship with her over the years so it's easier said than done to dismiss her and see someone else so I think I need to play it her way - even though deep down I really do think she's got it wrong this time.

I've just had the almost identical conversation with my GP.

I turn 39 at the end of the month and ever since having Covid in Jan 21 (pre vaccine) I haven't been right.
All bloods come back normal, waiting on a rheumatologist appointment (7 months and counting), GP 2 months ago put my sertraline up to 150 from 100 and that unsurprisingly did nothing.
Spoke to another GP last month who said I could have a 1 month trial of HRT (patches) but during my review this morning she's pulling me off it all as apparently bloods need doing again and I'm too young for any sign of peri/non peri menopause and she's adamant that that's not going to change.

Bloods normal?? What does that mean? NHS is notoriously bad at treating peri & womens health in general and this is part of it. Being in a normal range for hormones really doesn’t say much. The lab ranges are averages for the area they cover. Just because other women yoir age in your area have similar levels doesn’t mean you all aren’t experiencing the effects of lowering hormones. Some clinics will want to give you Estrogen if you drop below 250, some 500, but the NHS seems to think you should be down to nothing sometimes.

For the op, your symptoms and timeline match mine a decade ago and it was low thyroid. Is your tsh under 2.5? If not then your symptoms could well be thyroid.

I don't really understand why everyone on this thread is rushing to hrt as the answer and eyerolling on the idea of blood tests to check iron etc. It's quite likely something else other than peri, at your ages.

I've also had low folates which caused terrible brain fog.

I'd highly recommend blood tests and then check your results yourself

Just wanted to give a positive experience - went to my GP - a new one, no history with her before, explained my symptoms, which hit a lot of the peri boxes. One of the biggest things for me was the rollercoaster of emotions, probably down to my hormones being so imbalanced. Due to my age at the time (39), she said the process was for me to have bloods done a couple of months apart to get a better picture. One came back just off average for my age, the other more like post-meno levels! Due to the fluctuations, and my age, she said she didn’t feel comfortable prescribing HRT, but would happily refer me to a meno specialist. As the wait would be so long though, she asked if I would mind her just contacting the specialist and asking if she would review by email and give her guidance.

The specialist was happy for her to prescribe hrt, and I’ve now been on it for about 18 months, and I would genuinely say it’s changed my life, I feel like I have managed to find myself again.

Not sure if it factored into her decision, but I do have a family history of early meno. I really wish that this had been talked about more by the women in my family, it would have been very helpful to know earlier on!

How are you doing @TheMindfulMum ? For me, getting my ferritin levels up was a really good start to feeling better. Have you started on any iron supplementation? Remember your levels may come back as in the 'normal' range but be far, far from optimal. Try and get yourself as tip top as possible nutritionally and continue to seek answers and help from the doctors regards your hormones.

I don't really understand why everyone on this thread is rushing to hrt as the answer and eyerolling on the idea of blood tests to check iron etc. It's quite likely something else other than peri, at your ages.

The OP says she ticks most boxes for menopause symptoms, that’s why. Nobody is eye rolling at checking other things via blood tests? However interpreting hormone blood tests is an issue on the NHS. They’ve likely already checked her iron, although low iron has some crossover symptoms with menopause it’s not likely you’ll present with most of the symptoms of menopause if it’s just iron. Heavy periods can cause low iron, for me and a lot of women heavier periods can be experienced during the start of perimenopause.

Thyroid is worth checking too, but as OP you are feeling hot, it’s less likely. Low thyroid or under active hypothyroidism, usually makes you feel really cold. I have that condition too and there’s a difference in symptoms for me.

Good gynaecologists understand that most women over 40 will be in perimenopause.

No.

I had the same and finally went at 42 and she refused to give me HRT or do any tests.

7 years later I finally get a male doctor to listen and my FSH was so through the roof he panicked and sent me for a DEXA which confirmed my osteoporosis at that point. Which usually triggers a response of you should have been doing more physical stuff but at the time I was a head gardener and was on my feet, digging, carrying stuff around, using machinery etc and had done 10,000 steps before the first coffee break of the day.

So do stop this 'too early' bullshit. You could put women off and they could also end up with fragile bones that never really properly recover.

This. The nice guidelines are clear
No blood test required and hrt rather than antidepressants.
Fingers crossed.
If you get the choice get the gel as it doesn't raise your risk of breast cancer.

The NHS guidelines say no blood test required in women aged 45 and over, not give HRT to anyone who asks for it... it's not impossible to be peri at 39 but it does make sense to do a blood test to check FSH and other things.

@Littlefidget2 The guidelines recommend FSH testing for women under 45 where menopause is suspected. Not peri. FSH levels fluctuate wildly during peri - even from day to day. So - are unreliable during peri regardless of age.
They could test a few times and try and get a picture. That might be worth asking for @TheMindfulMum
I agree with @AlisonDonut that we need to stop putting women off or deciding it's 'too early'.
My ferritin levels were 'normal' range at 12 for many years and I was frequently unwell - they were talking FM and antidepressants.... Only picked up on my iron once I saw yet another (young, female) GP who pointed out my borderline levels and got me retested by which point my levels were 7, I was anaemic and on the cusp of being dangerously unwell. My point being that mean and median numbers are often not very helpful. Guess what? A biological male would get treatment for low ferritin if he dropped to 20. Any reason for the difference? No. Women have periods so their levels are often lower, so the mean number is lower. If I was a man it would have been picked up, I would have been treated and not felt so ill, for so long. Mysogyny is alive and well in the NHS and even the NHS recognises this.
@Littlefidget2 In response to your comment about giving HRT to 'anyone who wants it', the NHS seems pretty keen to give Hormonal Contraception to 'anyone who wants it', unless there is a good medical reason. The same could perhaps be said about antidepressants. Why should a woman not be listened to and taken seriously about menopause symptoms regardless of her age? Especially if she is nearing a time when perimenopause is becoming more likely. If a women has no serious medical barriers and wants to try HRT for a 3-6 month period to see if it clears up her problems then I cannot see why she should not. I agree that FSH levels could be checked to rule out a menopausal state (which should then be treated accordingly) but those results should not be a standalone to discount peri. The NHS knows now that the results are unreliable for a long time before becoming reliable and that during that time a symptoms can seriously affect quality of life. If a woman thinks she is perimenopausal and needs help and the GP won't treat her she should be referred to a specialist who can.

No to you too.

I'm sorry you had that experience. Your advice however might leave women dead, as underactive thyroid left untreated eventually leads to coma and death. (do I really think that's a likely outcome? no, but while we are throwing ridiculous accusations around, why not)

It's a blood test. It takes a few days. No-one is going to have crumbling bones while they wait to rule out low iron, low b12 (common to start in your 40s as your stomach works less efficiently), low thyroid, and frankly God only knows what other very common conditions that cause these kinds of symptoms in your late 30s.

What exactly is your issue with a few cheap blood tests and a wait of, essentially, a week, then checking your results yourself? How ridiculous to suggest that advice might lead to crumbling bones. If anything, it might lead to many many many many women not suffering from low thyroid for years, or low folates (better hope they don't get accidentally pregnant in that case), or undiagnosed celiac/pernicious anaemia.

@BatsAtHome no, the NICE guidelines include peri. Menopause is technically the end of the 12 month period you haven’t had any periods. But the guidelines state at the top it’s ‘perimenopause and menopause’ and later in the doc it says: ‘Menopausal women This includes women in perimenopause and postmenopause.’

The blood tests are going to be up and down on peri, but they’re not totally useless and can be part of the diagnostic process for those under 45. However you need someone who is good at interpreting them and doesn’t just look for ‘in range’ or ‘normal for age’. Private doctors will often look for optimal estrogen levels for example.

Sorry I was responding to this: The guidelines recommend FSH testing for women under 45 where menopause is suspected. Not peri

it does include perimenopause. Menopause is easy to identify as it’s simply the part you are no longer menstruating for at least 12 months.

@ArcticSkewer you’re not paying attention and going off on a tangent. Nobody objected to blood tests. She’s had them, a normal CBC standard test includes thyroid tests. She has symptoms of perimenopause. Some might indicate low thyroid function, but not hot flushes. That would almost rule out a thyroid problem. B12 deficiency is rare and again, usually part of an initial standard blood test. It is very likely any woman 40 and over is in perimenopause actually.