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.

@WahineToa thank you, I just couldn't see anything that gave clear guidance on when/how to test for suspected peri under 45. I could only see the advice for suspected meno under 45. You are right of course that interpreting the results of testing would be better handled by a meno expert.
@ArcticSkewer of course if a patient presents with symptoms that could be a thyroid problem or a deficiency problem those things should be ruled out. But the vast majority of women over 40 are, as @WahineToa says, likely to be perimenopausal and should be treated accordingly.

I had all the symptoms of peri menopause at the age of 21. It wasn’t. After blood tests I was diagnosed with a prolactinoma. It was thought to be a rare endocrine disorder but my specialist said that it was probably more coming than thought but was misdiagnosed as early menopause.
It can also be secondary to thyroid problems. It is really important to rule out other causes with blood tests if you are “too young” for menopause.
Unfortunately, because of the current media frenzy regarding menopause GPS are swamped with menopause related problems making it difficult to weed out more serious endocrine problems.
I was convinced that all my symptoms were menopause related but they started in my early 50s. I tried HRT but the only thing they helped were the hot flushes. Due to my “obvious “ age nothing else was investigated. My biggest problem was muscle and joint pain finally diagnosed as Vit B12 defiency ( a consequence of taking antacids for years).
I came off HRT when I was diagnosed with breast cancer.
I would caution about taking HRT from an early stage. All the current data available regarding the link to breast cancer is based on women who have had a surgical induced menopause and until recently HRT was not prescribed for peri menopause only when a women had not had a period for 12 mnths. We don’t have sufficient data for women who still have a regular cycle and therefore are still producing their own estrogen. Perhaps the exponential increase in HRT prescribing for perimenopausal women will build up data to look at possible increase in risk of breast cancer by taking HRT earlier and for longer.
Please remember that HRT has not been widely prescribed for perimenopause. Recent analysis of a large number of studies linking HRT to breast cancer concluded that taking HRT for up to 12 months does not increase your risk. Over 12 mnths and there is a risk of developing breast cancer for up to 20yrs after starting taking HRT.
The relative risk of developing breast cancer while taking HRT is low but our overall risk of developing breast cancer as women is very high. 1 in 6 will be diagnosed with breast cancer in their lives.
The other problem I had with HRT was accelerated growth of fibroids something they don’t warn you about. Fortunately I had a Mirena coil which stopped most of the symptoms normally associated with them but mine were putting pressure on spinal nerves and led to chronic sciatica.
I am now hormone free thanks to anastrozole. Life without hormones is great. My bone density is monitored and normal. I don’t have mood swings, I can cope with pretty much anything life throws at me. I am living with side effects of cancer treatment but it’s so much easier without hormones.

Sorry I didn’t make it clear that HRT was historically given to either women who had had their ovaries removed or women who were post menopausal.

@Angrymum22 if you are “too young” for menopause The OP isn’t though, it starts at around 40. This wouldn’t be ‘early’ perimenopause. It’s a little tricky because menopause and perimenopause are used interchangeably.

You have some facts wrong too and I really urge you not to repeat stuff on HRT unless you’re sure about it.

All the current data available regarding the link to breast cancer is based on women who have had a surgical induced menopause and until recently HRT was not prescribed for peri menopause only when a women had not had a period for 12 mnths. This is completely false. HRT has always been an option for peri, plenty of women have taken it across the world before periods stopped as that’s when symptoms are often most severe. There’s lots of data on HRT that involves women in peri.

We don’t have sufficient data for women who still have a regular cycle and therefore are still producing their own estrogen. Perhaps the exponential increase in HRT prescribing for perimenopausal women will build up data to look at possible increase in risk of breast cancer by taking HRT earlier and for longer. Where did you get this from? We have data that shows if you start it earlier, you have less risk of breast cancer.

Recent analysis of a large number of studies linking HRT to breast cancer concluded that taking HRT for up to 12 months does not increase your risk. Over 12 mnths and there is a risk of developing breast cancer for up to 20yrs after starting taking HRT.. No, it’s 5 years. As for ‘risk’ you should state what it is.

I don’t like this scaremongering. It’s wrong to do especially with false information.

I think though, that the reason the NHS are 'swamped' recently following 'media frenzy' is that women have been suffering in silence.
I felt really awful. I was badly fatigued a lot of the time. I had zero energy for exercise. I couldn't work effectively due to the brain fog. I had no energy for my two young children and that was breaking my heart. I frequently returned to bed whenever I could. Now, three months in to HRT my life is so completely different. I am running again, I am sleeping again, I am working properly again (thank goodness) and best of all I can be the Mum I want to be again.
I couldn't go on, the way things were. I was desperate.
Yes make women aware of all the data there is regarding the breast cancer link. Yes women can work out for themselves that data is constantly being built and further pictures may come to light in the future.
Let women make informed choices. But make it THIER choice.
No one ever seems to talk about the risks of alcohol. No-one seems to warn women in their forties about drinking 1.5 bottles of wine per week ( and the rest).

Historically - that HRT was very different to the options available now.

After diagnosis I spent a lot of my enforced free time reading up to date studies.
Longterm use of HRT significantly increases the risk of breast cancer. Women starting HRT in their early forties may be taking HRT for 20+ years.
scholar.google.com/scholar?hl=en&as_sdt=0%2C5&as_ylo=2018&q=recording+women+who+have+been+diagnosed+with+breast+cancer+while+taking+hrt&btnG=#d=gs_qabs&t=1666612335800&u=%23p%3Dg9Iu_O3a7WoJ
The above meta analysis shows that the longer you are on HRT the greater your risk.
Risk assessment is the individuals responsibility. I did my research prior to taking HRT, if I could go back I would still take it. I thought the benefits outweighed the risk. HRT helped me get through a particularly tough period of my life. Do I regret it? No.

Somewhat irrelevant to women being diagnosed with breast cancer while on current forms of HRT.
Hormone sensitive breast cancer isn’t really fussy about where the estrogen comes from. And in fact modern adjuvant treatment includes aromatase inhibitors, tamoxifen and ovary deregulatory to stop estrogen activity in our bodies. The female equivalent of chemical castration.
I’m not advocating that you shouldn’t have HRT but you should be aware that some risks increase the longer you take it.

That’s a poor meta analysis that makes no differentiation between types.

Women get given the most up to date information from their doctors. Some of the links the layperson can find might not be relevant at all to their type of HRT, may now be debunked or may be a poor study design. I recommend looking at some of the information from Newson Health on more recent studies and understanding.

Newson does not follow Nice guidelines. I know a few of her patients personally and dosage is often much higher than advised. She uses a bespoke approach and tweaks dose following regular blood tests. Her patients are big fans but she charges a lot of money to provide a gold star service.
Most women cannot expect the same service from their NHS GP, to use a phrase that is popular on MN it is like comparing apples to oranges.
Most of her own research is very recent and actually Covid related. Quite rightly she has been looking into the link between the vaccination and menstrual/hormone problems.
She has been a specialist for a relatively short period of time. She is not always popular with the oncology community because of her generalisation of HRT for cancer patients.
She has found a profitable niche.

NICE guidelines are quoted here because they’re what our NHS GP’s are meant to follow, but they’re not the gospel and plenty of private practitioners take slightly different approaches. I’m not aware of any NHS guidelines on dosage or maximums, they use the same brands and types of HRT available at Newson, except for testosterone. People get prescribed based on symptoms over 45, same as NHS is ‘meant’ to.

@WahineToa
I recommend looking at some of the information from Newson Health on more recent studies and understanding.

So I have just explored the menopause library and could find zero scientific studies or references to studies in the FAQs, Factsheets and articles. I obviously have not listened to the podcasts. Perhaps I am lost on the website? Can you help me find these more recent studies?
www.balance-menopause.com/menopause-library/hormone-replacement-therapy-hrt-the-basics-factsheet/

They’ve changed their website from when o became a patient, they give info booklets to patients obviously, but you can find info through their other resources, like their new society linked there, that has citations attached to info… They aren’t the only other menopause source out there, but I definitely wouldn’t rely on links to studies left on a forum. Unless you know how to interpret studies it can be a bit confusing. As I said, women who are interested in or prescribed HRT, are always given information or should ask these questions of their doctor.

Whatever you decide to do listen carefully to the advice your GP gives you. It can often take months for HRT to work so don’t expect overnight results. It doesn’t work for everyone. If it is not helping with some of your symptoms go back to your GP.
Remember that low risk does not mean no risk.
I never expected to be one of the statistics. I was lucky that I was in my fifties and part of the breast cancer screening programme. Responsible prescribing should include screening for possible disease that can occur as a result of using certain drugs. I take a drug that can increase the risk of damage to heart valves. It is a type of hormone regulator so I have an echocardiogram yearly to make sure it hasn’t damaged my heart valves. The risk is very small but my endocrinologist follows policy.
There is a lot of campaigning in the breast cancer support groups for much earlier screening with either MRI or CT since under 50 the breast tissue can be dense. Unfortunately, HRT can increase density rendering routine mammograms useless.
Advocates of HRT need to address the potential problems that may arise as a result of its widespread use. Support is needed for the many women who are not suitable for HRT. It’s not just breast cancer that precludes it’s use.

You’ve made several posts discussing risk now @Angrymum22 and I think it’s really too much. You’re scaring women here unnecessarily. You’ve made the point, I’d appreciate it if you stopped.

Thanks for checking in with me. Tough week this week. Mid cycle which for me is always harder than any other time of my cycle. I had bloods taken on Thursday and have the results of those the week after next. I am fully anticipating them not to show too much and therefore being told everything is fine. I have taken on board other comments about one set of bloods not showing the full picture which makes total sense in my head but it's a fragile me vs the doctor and I think I'll just be rail roaded. I saw a Davina McColl post in the week and she mentioned she got dry eyes. It's another thing I have been dealing with. I was at the opticians in the summer due to one eye watering all the time (had it for 12 months and had just had enough) and they said my eyes are very very dry. They have changed my lenses and suggested less lense wear. It's just another thing I've been dealing with and haven't previously attributed it to possibly being part of peri.
I got my sewing machine out yesterday and had to remind myself how to get it all set up as haven't used it in a while and I had to read the user manual text (large text, small paragraphs, so not a hard read) a number of times just to understand what I needed to do. The difficulty in concentrating and brain fog is really noticeable in my own little world.
I started iron supplements yesterday. I wanted to wait for my bloods to be taken before I started taking anything. Obviously too soon to feel any different there.
All in all just feeling pretty despondent about it all 😔 My GP outrightly said I'm too young to be peri. Whilst I know that's not true, I can feel I am going to be pushed towards the pill and I haven't got the mental strength or clarity to challenge that right now.

dry eyes - thyroid

www.healthline.com/health/dry-eye/dry-eyes-thyroid#thyroid-conditions

@TheMindfulMum I'm sorry you're having a crap week.
I had the dry eyes too and dry mouth. Try and steer clear of oral antihistamines and ibuprofen if possible.
What iron tablets have you started? I would recommend floradix liquid twice per day. If you've been having heavy periods and haven't been supplementing up to this point then your iron levels are likely to be far from optimal.
I was on ferrous sulphate for 6 weeks to get my levels up quickly and now I take Wellwoman Max (which contains 12mg of iron) and top up with the floradix when I'm bleeding and in the follicular phase.
You mention feeling rough mid-cycle. Me too! Mine used to start about day 6 and then build until I did or didn't ovulate. I would feel instantly better one day and 11 days later get a period. 11 days has always been my luteal phase. What I have come to understand is that you need a lot of iron in that phase, so the low iron could have been at least part of the problem.
However, I also wonder if low progesterone was/is a problem. I delayed the start of my progesterone tablets this month because I was trying to get to a set date to take them each month and here I am feeling ghastly again in all the same old ways. Wondering is my iron dipped again or is it the progesterone?
Apologies for waffling on about myself. What I am trying to say is that these bloods may show something you are not expecting so try not to guess ahead.
I am actually going to start another thread about progesterone...
I read that progesterone is involved with fluid levels in the body which made me think of my dry eyes and mouth.
Why don't you write everything down about how awful you've been feeling, every symptom and then e-mail it to your doctor. That would prevent the railroading and it's a paper trail. I'm not saying it will necessarily, or even should, result in an HRT prescription but you deserve to be taken seriously and you deserve to be helped. Don't give up. If these bloods show nothing 'abnormal' ask for a referral, ask for a second opinion.

I had dry eyes it wasn't my thyroid.

You'll find dry eye listed for loads of health conditions, including actual eye conditions, auto immune diseases and fibromyalgia to name a few.
OP is having thyroid checked along with everything else.

You'll find dry eye listed for loads of health conditions, including actual eye conditions, auto immune diseases and fibromyalgia to name a few.
@TheMindfulMum is having thyroid checked along with everything else.

Dry eyes is also a peri menopause symptom @ArcticSkewer lots of symptoms can be found in various hormone issues.

Absolutely true. Which is why GPs don't just dole out HRT for random symptoms like tiredness or dry eyes.

My money is on thyroid, personally, as every single symptom - and age of op - matches my experience exactly (including now the dry eyes. next she'll be saying she's got that peri-menopausal symptom of cold hands and feet) but the best advice always is to actually do the blood tests, then check them yourself, with an open mind rather than listening to everything Davina witters on about.

Wow.