Time To Upgrade My Perimenopause Plan (don’t open if your own MH a bit iffy)

[AlienatedChildGrown]

… Just to clarify. In order to explain I’ll have to use terminology that I know I found could jar me into a fat worse state when my mental health issues were untreated. And please don’t feel you should read and post despite that in order to give support. I’m OK. I’ve got this under control. I just need some technical/medical signposting rather than empathy and understanding.

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Right. Diagnosed with ADHD, depression and perimenopausal symptoms when 48. Now 55. Only other health issue is small holes in brian due to covid, which caused a TIA in 2020. Memory back to mostly normal.

Accepted the ADHD diagnosis. Refused medication. Did not accept other diagnosis’s cos… stubborn.

2020 Post covid making holes in my brain, with an 8 month recovery in front of me, accepted the depression diagnosis. Accepted medication. Worked wonders in a few months.

Post vaccination periods went all over the place, I was having too many of them. Then disappeared for a while. Returned to monthly. Then longer gaps. Couldn’t tell if they were right about perimenopause or it was extended covid high jinx. Cos they went berserk after every covid vax (had three). Talked to GP a couple of months ago, he deffo on the side of perimenopause but won’t consider HRT unless I submit to a pelvic exam. Can’t do that. My then GP sexually assaulted me after he made me get naked at 17 years old. I have no idea how I got through pregnancy and childbirth (c-section in the end). I just know I won’t have anybody medical down there. So kicked it into the long grass.

For just over a year, thanks to the ADs my mood baseline was good enough to work with. I’ve used an app for better routines of self care, diet, daily exercise, meditation. Been amazing. Never felt better. No seriously, mind, body and soul better than it’s been since 1984. Carried on ignoring potential perimenopause kicking up a notch.

48 hours ago woke up to find suicidal ideation had returned with a bang. Been completely absent from my life since the ADs kicked in over a year ago. Mood very very low. So did the normal, Daily Stoic, Water, Breakfast, Gratitude, took dog for a good walk (live in the Italian countryside). Then for the first time ever, the ideation went from impossible acts, to very specific and very near where I was walking. Took dog home. Did all the CBT squashing work. But I’m shaken up. I’d forgotten how low the lows can go. And despite near constant suicide ideation since 1984, it’s always been of the distant undoable type. Not like a realistic idea.

I’m fine, mood stabilised as I suddenly started spotting last night. Light period turned up during the night. Been about 7 weeks since the last one. But I’m not risking a rerun of that. Not cos I’m going to do it, I’m not. Got a kid, a husband .. and my poor sister would never recover. But they can’t live as they are now if I go to that dark place every couple of months. And fucking hell, I don’t want back down there either. I’m genuinely shaken up at how cold, low, dark and scary it was when my mood suddenly dropped like a stone.

I’ll organise an online consult for the prescription with a private doc. Cos I’m not submitting to a pelvic exam, and I’m at the top range possible already for antidepressants. Higher than the GP likes. But he doesn’t have to live in my head when the dose is lower.

But can I have the short and sweet of what HRT products any of you have have found to have a good impact on mood stabilisation. I’ve got a good handle on the other stuff (so far, we’ll see what the next erratic cycle chucks at me, I might change my mind), but I think I’m going to have to bite the HRT bullet sooner rather than later.

I repeat. I’m OK. The mood has risen, the intrusive thoughts gone. Dealt effectively with them at the time and will do so again if they have another go at me. But I do need to get my skates on and not kick the menopause into the long grass anymore.

Cos the fucker evidently doesn’t want to stay there and keep being ignored via the great diet, exercise, anti depressants, meditation and mindfulness routine. It’s bringing the really big guns and I need to fight back with superior weaponry. I did not work my arse off to FINALLY get to a really good place, just for my poxy hormones to have a mass protest and try to snatch it all away from me.

For anybody reading in the future.
If you can, tell somebody.
If you can’t, or telling somebody didn’t make you feel safe enough from ..l the insides of your head. I’ve found this. selfhelp.samaritans.org I already use mood trackers, and all the other stuff in it. But ! It helps with making a safety plan.

That’s what the others don’t do. It helps to know that while you are sorting the logistics of treating the root of the issue, you have a way to keep yourself sake.

I'm 55 and have been trying the healthy living, increased exercise, supplements, gratitude lists, no alcohol route. I started HRT last week for the nightly hot flushes (3-5 times each night since mid November). Oestrogel 2 pumps and Utrogestan 2 weeks on then 2 off and I have not felt any of the gripping anxiety bouts that I had before. Other external problems have also currently resolved which must help too.

Just to say Op, I am currently in that deep dark hole sitting along side you.

OP I just wanted to add a bit of solidarity.

My own mental health has generally been fine, but with what I assume is peri has come hormonal surges causing mood changes of the like that knocked me off my feet.

I've always been independant, strong, capable. To suddenly find myself feeling completely incapable, lost, in despair, with every thing feeling insurmountable was SHOCKING. Absolutely shocking to me.

Fortunately I have two close friends of a similar age and we're regularly dicussing symptoms and helpful advice, and that's my safety plan, it's so helpful to be able to be open about it.

I hope you're able to access the help you need.

I’ll be OK. Talked to DH, he’s on board with me having an online consult (I know about Dr. Newson, any other recommendations?) with British specialist because he knows my Italian goes to pot when discussing headspace medical issues. As long as I do all necessary scans, bloods, exams privately locally. We’ve come up with a bit of a sledgehammer approach. Drive into town and park. I take 2 xanax. Quickly go to waiting room. He’ll lug me into the Up Knees Chair of Evil Memories and hold my semi comatose hand while the doctor pokes around where I don’t want medical hands poking. Then just get all test results translated ready for an English speaking consult for what kind of treatment options are my best bet for HRT.

He doesn’t know exactly what was in my head, but he has enough of the gist to know its skates on time. That Samaritan’s self help was really good. I feel more in control. I liked the idea of making a safety plan and working through it has settled quite a bit of my ARRRRRRRGGGGGGHHHHH

@Tootsey11 It’s an eye opener isn’t it ? I had no idea this could happen. Not to this extent. Overnight (am sleep deprived as a result) I discovered it is not typical, but not rare either. In fact may account for some unlovely stats for our age/stage group.

We deserve help. From ourselves, from each other, from The Qualified.

The good news is that it looks like The Qualified are taking this aspect very seriously. Came accross a ton of recent professional webinars in which The Qualified were bringing fellow professionals up to date on this aspect.

OP I'm wondering if you explained to the docs maybe they would give you the HRT without having to have the exam? I write letters / emails to mine as it is so hard to get an appt. It seems to work. best of luck

As long as I do all necessary scans, bloods, exams privately locally

I have never heard of anyone needing to have a pelvic exam before getting HRT.

Why is your dr asking you to have this?

It's not done in the UK and I doubt it's done in Europe either.

Have you asked around friends or other women in Italy to see if they have had this experience?

Talked to GP a couple of months ago, he deffo on the side of perimenopause but won’t consider HRT unless I submit to a pelvic exam.

This is nonsense. Find a different dr.

what on earth is he hoping to find?

You don't need a pelvic exam for HRT!

@Orangesandlemons77 No way my own Doc is going to prescribe me anything until I submit to pelvic. He’s amazing. Best doc I’ve ever had. But intransigent on this point. And I can’t tell him why I don’t want to, cos .. I can write it down, but I can’t say it out loud or talk about it in person. It sets off a video in my head and then it’s like it’s happening again. Will anlso open a can of worms for my headspace if it goes down on my records. If whoever I can get an online consult with in Britain doesn’t require anybody near my nether regions, that’s fine by me.

I have several mates who are pharmacists and will flog me the necessary under the counter. But given the stakes, I don’t want to go completely wild, wild west in terms of treatment. I think I need some informed, qualified oversight. Because with my ADHD in the mix I don’t trust myself to make the right calls, all of the time.

I’ll take all and any personal recommendations for an English speaking online consultant in Britain or the EU. And go from there.

All my friends seem entirely unsurprised by the need for a proper gyno visit with mucho poking prior to HRT treatment. They’ve been on my case for 20 years cos I won’t go for a pap test.

I did go in about 2003. It was awful in itself, like I’d been reduced to livestock. They left the door to the waiting room open AFTER I was knees up. And the old experience decided to join the party. So I’ve not attempted since.

I can’t change to another doctor. For one, he’s brilliant. The best I’ve ever had. And I don’t think he’s doing anything unusual based on the medical culture here. Secondly, two GPs retired early and one died (of Covid) during the pandemic. We were already short 2 GPs before that due to retirement & an unexpected death. My GP now is the only substitute for all the missing GPs. There’s a massive GP crisis going on in my area. I think it’s a recruitment issue, but not sure why.

His tenacity and attention to detail revealed I’d had a TIA caused by Covid. He sorted my complete rehabilitation from not being able to stand up without falling over, to being in the best shape I’ve been since my 20s. Took 8 months, but he got me through it. Gently talked me into anti depressants and got me out of 3 decades+ depression. Kicked the arses (by phone) of all the consultants in the ER when they weren’t taking my chest pain seriously enough for his liking. He really really is an exceptionally good doctor. But just not the one I need for this. Cos I have issue around that kind of test. And also I need to do this one in my own language cos all my alarm bells are clanging too loudly to do it in Italian.

I'm only guessing, but perhaps the pelvic exam is because you haven't had the usual routine smears so he doesn't know whether there's an underlying, undiagnosed problem that could be exacerbated by HRT.

Re telling him- how about writing it down briefly and handing it across
'can't have exam due to trauma from previous assault by an HCP. Please note I am not able to discuss further'.

By the way, I'm impressed by your ability to be calm and rational while working around your personal circumstances. Well done.

Talked to GP a couple of months ago, he deffo on the side of perimenopause but won’t consider HRT unless I submit to a pelvic exam.

What on EARTH??? Why does he want to do this? None of the (many) women I know who are on HRT have had anything like this done. Are you in the UK?

Menopause hit my mental health very badly, didn't help that it coincided with Coviid 19. But I found that I couldn't cope with situations I had previously taken in my stride. Burst into tears at the GPs surgery. Twice. Couldn't eat, wasn't sleeping well - couldn't drop off, waking early with that awful feeling of doom in my stomach. Quite regularly planned my own funeral as I was sure I was dying. Finally joined the dots about what was going on myself and practically demanded HRT from the doctor - over the phone as they were not doing face to face. GP agreed, wrote the prescription for patches. Started on 25mcg which is a low dose but felt better within a week - sleeping was better almost the first night although that might just have been the utter relief of someone taking me seriously. The only check the GP asked for was a blood pressure check after 3 months on the HRT which I did myself at home with my mum's machine and phoned in the results.

That was a year ago and although it's not all been amazing as I've had to tweak different prescriptions and find the brand of patch which works for me, I'm 100 times better.

I think you need to change GP, @AlienatedChildGrown. Would finances allow for you to see someone privately?

@AlienatedChildGrown My understanding - correct me if necessary- was that in France and Italy many women, as a matter of routine - have a gynaecologist - and I know from posts here that women in Europe can self-refer to a specialist. (As can we in the UK now in most instances.)

So why are you doing this through a GP? One who is talking rubbish!
If he thinks you have issues with your ovaries or uterus he should refer you for a scan, not want to examine you.

Have you had smears etc over the years? would it help to have someone with you, they can arrange that I think.

Newsome is good, OP. I would also advise looking around on sites like Facebook for local menopause groups. I am in one for Scotland and there is lots of chat about who the good specialists are. Your issue is that you see the private doc who prescribes patches or gel or whatever. Your own GP is not going to allow you to access that on the NHS, so you are paying privately for the meds. If money's not tight this is a perfectly reasonable solution, as long as you know the implications.

If whoever I can get an online consult with in Britain doesn’t require anybody near my nether regions, that’s fine by me.

well, no one is going to examine you during an online consultation and they won't ask you to have one anyway. It's not done like that in the UK.

OK, have done a quick ask of assorted friends of the right age. It’s not unusual to want some tests done before getting down to business. Particularly if there are no recent test results on records. And given that mine record contains a Big Empty Box where all my test results should be, nothing surprising at all in his insistence on a pelvic first. Which, for clarification, he wasn’t intending to do himself. He wanted me to go to the dedicated clinic that does all the tests.

And then I got mithered by all my friends banging on about the necessity of going regularly and what’s more when was my last mammogram. I will be pleading “busy working” on whatsapp for a while to avoid all the awkward questions. If you see an SOS Britannia message in the sky floating above the alps, it’s me, cos several of my mates have bundled me in a van and pushed my boob into the squishing machine. Send help. And a tool to aid with levering protesting boob out of the flatteners.

The Plan, is to get an online consult.

Get a private prescription. And/or any other notes.

Translate them. Have DH hand deliver them during the evening rush hour at GP’s practice, then scarper, in the hope Doc will be too knackered to do much other than scan them into my file and add me to his ever growing to-deal with-later list.

Conspire with pharmacist mate to work out what the Italian equivalent is of the prescribed HRT.

Cough up

Suck it and see.

Continue working down my Bad Stuff From Past that Has Impacts On Current Ability To Deal With Certain Aspects of Life Properly list. It’s long. I’m on number 17. Being able to do fluffy bits inspection without handfuls of xanax is still a fair way down under some bigger, more pressing stuff. I know it’s important. I really do. But each time I tick a bigger one off successfully, the next one is faster, easier cos I have all the tools I practiced with on Last Bit of Life Rain Damp Spot.

Just got to knock out my admin from today’s work, then I can get a shortlist of Brit consultants with a view to booking in with one. Which one may depend on their availability, cos I know all health systems, public and private, are struggling with demand at the moment. Fingers (and legs) crossed that by the time my period decides it wants to turn up randomly again, it won’t get to try and stuff my pockets with pebbles cos it’ll be HRTed into behaving in a civilised fashion with my brain.

Oh god. I’ve still got to meditate as well. Might do that before bed today because I can see myself falling asleep in the middle of it. I had completely forgotten how much energy corralling bad thoughts in head takes.

If it all works out well I won’t catch any doctor requiring lurgies until I’m over my pelvic inspection issues, and can triumphantly have recent records appear on my record and he’ll forget all about my “off piste” approach to medical direction. Then I can switch to normal prescription through him. Just so he has a complete ongoing record of what I’m taking. In case any other medical issues occur in the future that make the HRT relevant info.

That’s the Updated Plan. Thank you all. I can unclench a bit now I can see the road forward, with proper signposting at all potential crossroads.

Women in Spain can buy HRT over the counter, if that's any help to you.

Many types are interchangeable (no language issues) as estrogen gel is also sold a lot in France, for example.

I'd recommend the Menopausal not Mad website and FB page.
Private consultations are available via the website but there is a waiting list ( as there is with Dr. Newson )
Also the HRT collective is an informative FB group
Good luck

Fantastic. I like it. Difficult things seem less insurmountable when you have a plan.
Keep eating that elephant one bite at a time. Have a good strategy to decide which bit to bite next.

I'll keep a eye alpsward for any smoke signals requiring urgent assistance. I bet Amazon have a gadget for levering yourself out of a boob flattener.

UPDATE

My new improved HRTed Mental Health

Just in case somebody else is one of the few who plunged into scary depths, found the thread and wants to know how it turned out.

ADHD and making appointments led to procrastination mode. And then impulsive hijacking of pharmacist friend. Who would rather I went to a doctor. But has known me and my ability to stubbornly self sabotage for 20 years. She’s working with me on the basis that as the HRT kicks in I’ll become “more reasonable” and start to see her personal Gyno for proper oversight.

I’ve been on Sandrena for six weeks. Started with a quarter of a sachet. As my confidence that it wasn’t going to hurt me grew I worked up to what appears to be my happy place of one and half sachets. Split dose because the ADHD and waiting ages for stuff to dry is not a good combo. It’s been wonderful.

Pretty fast uptick in mental well being, then I noticed a lot of less important perimenopause symptoms fading. My joints feel amazingly non glitchy. General aches and pains gone. Brain fog slowly receded. Memory and concentration better than they have been for years. Libido came back with a bang ! 🤣

Generally feel very, very well. Especially in my head space. A lot of past unfortunate events that I lugged through life no longer take up much if any of my thoughts. Close to 0 suicide ideation at this point. No return of sudden drops into wanting to do the unthinkable.

I also seem to look younger. At least I think I do. Maybe my eyes have cheered up as well and stopped looking so critically at my face.

Only side effect is a little breast tenderness. Which I hope isn’t around when the date for the mammogram comes around. Or there may be mucho squawking when they trap reluctant boobs in the squashing machine.

Oh, and … I just don’t feel so “over my dead body” about the prospects of any medical intrusions of my nether regions. Which is odd. Perhaps the anti-Ds’s plus Sandrena have given me a level of “letting the past stay in the past” I’ve not met before. So a non meno related pap smear is on the cards when I get the mammogram. And I think it wouldn’t be so awful to go and see the Gyno of the pharmacist.

As the first of the month came around started vaginal micronised progesterone. Am supposed to stick two up there. But had a wobble the first night. Because I take a Xanax at night for lifelong insomnia and convinced myself the sedative effect of that & the progesterone might turn me into sleeping (not so) beauty.

So wussed out and only jammed up one the first night, waiting until 2am to finally take the xanax cos it turns out it’s not that sedating for me. Was going to attempt 2 up there last night. But then had another wobble about potential over sedation. So put one up last night. And a second this morning. Slightly sleepy, but in all likelihood that’s due to my wussy attitude towards the progesterone meaning I fucked about with my normal anti-insomnia routine and brought sleep deprivation on myself.

I was really worried I’d be one of the women whose headspace gets all fucked up by progesterone and I’m so very very leery of giving up my good headspace that I’ve probably overcomplicated things.

This morning’s up the foof progesterone seems to have coincided with a nice sense of calm. Optimism that I may be one of the women who really benefit mentally from addressing falling progesterone levels is currently rising.

TLDR
Very bad peri headspace ? Give HRT a whirl. Slow, tiny dose start is better than completely putting off “proper dose” start altogether cos you’re too worried about potential fall out. If it works for you, the results can be a dramatic uptick in how life feels in your head. The side effects are not awful for everybody. Worth a try, even if it is a “tip toe with tiny doses” try just to get over the fear hump of New & Scary Medical Stuff In My Body.

Whatever you do don’t sit there alone with Very Bad things in your head. Come to this board and post. It’s not just you, you aren’t going mad, and if nothing else saying (well.. typing) it out makes it less of a dirty secret you feel is your burden alone to carry. Just that is better than being isolated in your fear.

I just want to say how much I admire your approach to tackling your mental health. I've been in dark spots and I totally recognise the 'Christ on a bike, I'm not going there again!' Feeling, but still, doing something about it is really tough sometimes. Amazingly well done, and thank you for sharing your experience.