Help me not get fobbed off for a third time please

[Maltybiscuit]

So this week marks my third visit to the doctor's for what I believe is perimenopause symptoms.
On the previous visits I've been told "I'm too young " the symptoms aren't perimenopause related , "take these antibiotics for a UTI even though the dip test and lab test were clear , "maybe you need antidepressants "

So here are the facts and , im seeing a nurse on Thursday as can't get a doctor , do my symptoms sounds like perimenopause?

Aged 44 (45 in three weeks )
Shorter cycles used to be 28/29 now 24/25
Severe anxiety especially the week before period
Night sweats and hot flushes
Urinary urge incontinence
Little or no sex drive at all
Fatigue and exhaustion
Not sleeping
Crazy itching both vaginally and anal
Some feelings of UTI before period
Brain fog
Forgetfulness

I really really need some help this week and if I can't get any answers I'm considering I will have to see someone privately.

I've looked at the NICE guidelines and I believe at 45 they have to listen , I know thats literally a few weeks away but I need help now.

I had hormone blood tests and thyroid done in December and they told me all was normal.

Any advice from you wise people?

I did the same at 42 and was told I was too young.

I finally got listened to at 49 and by then I had osteoporosis. I was in a bad way.

Did you have FSH tested?

That's ridiculous you're experiencing all that and still not being heard.
I had a list half as long and my doctor was happy to go with nice guidelines, took no effort at all to be taken seriously.
My friend went to see a different doctor in the same town (both our doctors are female) and was told "perimenopause is a fad and not real. Here's some anti depressants."!!! 😲😲😲
So if either see a different doctor or look them squarely in the eye tell them they need to get some cpd on endocrinology and if they don't listen and consider the stark staring obvious you'll be making a complaint (as you also down your printed copy of the nice guidelines, only weeks away from being gospel for you).

Me personally, I'd see someone else because if you have to work this hard just to be heard how can you discuss suitable treatment etc. The type of intervention hrt or whatever that gets prescribed might not work first time and getting it right is a collaborative process, a partnership between physician and patient where one had the medical advice and three other brings the lived experience..
For example... I was patches and it was like a magic wand from day one. My other friend tried a few things that made no improvement, until settling on combination of gel and spray.

Good luck. Bloody shocking that is.

GONADATROPHINS
Serum follicle stimulating hormone level 2.9 iu/L
Serum LH level 3.0 iu/L; FSH IU/L Normal

For reference these were the hormone results , apparently normal and from my own reading I can't find anything to suggest they are abnormal.

I was literally in the surgery crying last week and still no further forward , the doctor said have these 6 antibiotics so you know you're going away with something !!!

Jeez sorry for the rant but I feel like this has beat me already and I'm so sad about it

Hm.
My hormone levels were normal, so I took some lifestyle steps to improve self care (increase exercise, cut down sugar and alcohol type stuff) and do what I could. A year later I was still having problems so the doctor didn't retest and went with nice guidelines which say that reported symptoms and age are enough clinical indicators... it was hardly an eyebrow raiser to consider perimenopause as the issue. We went with hrt (no family history of hormone sensitive cancers) and if improvement hadn't followed maybe we would have investigated other options but it wasn't exactly a surprise symptoms responded and I'm back to normal self now. (We did tests to rule out thyroid issues and vitamin levels etc at same time as hormone test)
Trouble is unless you have your levels taken multiple times over a cycle it's a complete roll of the dice because they fluctuate wildly in perimenopause so one sample is just that, one sample, so whatever was going on that day.
Secondly 'normal' is an average and your normal might not be in line with population average normal (as happens with many things).

See the graph on hormone fluctuations in this article:
wellfemme.com.au/what-is-perimenopause/
At various points you could test and the levels would be 'within normal range' but still be way out over the cycle and unless the 'normal level' is linked to what point in the cycle you are, it's telling the doctor very little! Only multiple tests could reveal the full picture.

I could cheerfully throttle your doctor.
The obvious is staring them in the face, why are they treating it as the option of last resort at best, and not even on the table, at worst!! Ffs

My suggestions would be to ask for a trial of HRT to see if it alleviates the symptoms as

-the things they have prescribed before didn't help;

• your symptoms are typical of peri and are affecting you badly;
• you're aware of the risks of being treated and of being not treated (do reading if you haven't yet!) and your assessment is that they are worth it; and
• if you came back in 3 weeks Nice guidelines say you should be offered HRT based on symptoms alone and even before 45 the point of blood tests is to rule out other conditions like thyroidas hormones fluctuate in perimenopause.

Good luck.

I'm not even seeing a doctor this week so probably another waste of my time.
I cannot think they will let me carry on so miserably as I am until my birthday in a few weeks when I'll hit 45.
I will state my case again that's all I can do , there isn't many people in the surgery I haven't seen!

Formally request to start hrt and if declined ask for a reason in writing. Or ask to be referred to the locality menopause specialist. I'm going in next week for the same and like you I have a list of symptoms. I'm taking in the actual list and stating that I request to start hrt. Please don't give up it Def sounds same as me and I'm 51 x

Can you get a referral to a private specialist?

Thank you all for your invaluable advice , I'm armed with information and my long list of symptoms and I'm ready for Thursday , I'm actually feeling okay this week (mid cycle ) so I'm having a couple of calm days but it won't be long before I get consumed again by all the other pre period symptoms. I will update once I have had my appointment on Thursday.
I hope everyone else who is suffering gets to see someone soon and most importantly gets listened to.
Your replies have helped me feel ready for the next appointment (battle !!)
Thank you all

I'm a GP and if you spoke to me like that you'd be removed from the list. We do not respond to threats.

I'd just insist. Ask them if per the NICE guidelines they've got any grounds at all to refuse?

If you log symptoms on the balance app you can then create a health report to show your gp or nurse. That helped me.

I am 44 and was also fobbed off several times before the GP finally agreed to "let me" try HRT.

As a PP says, it might help to suggest to the GP that the only way to work out if it's peri or not is to give the HRT a go. If your symptoms respond then great. If not then no harm done, you can try something else.

It took me a few appointments to get the prescription and I know how much effort it can take when you're feeling worn out. Keep going OP. I hope you get what you need and start to feel better soon.

This fobbing off makes me SO CROSS. I went through this too. I had a hysterectomy when I was 44.

Twice when I was 46 and 47 I saw female GPs with anxiety and they prescribed antidepressants. Then I saw a male GP when I was 49 and said I was sure I was menopausal and he prescribed folic acid. Still not sure why.

It was only when I tried for a fourth time and pretty much said "give me HRT" that they did. It shouldn't be like this. One GP out of 4 who knew the guidelines.

That's a fair point.
I don't think I would actually do this, it was more an expression of what are you left with if you're just talking to deaf ears? You're left with trying to make them pay attention when they're not listening or go elsewhere.
Given what you've said, and its fair comment... Any better suggestions?

Can you ask your DM and any DAunts when they went through menopause? I had Peri in my mid 40s but because I was able to tell the GP (who seemed to think only hot flushes were the symptom that mattered 🙄) that my older sisters had gone through menopause by 50 and were definitely in peri early to mid 40s I managed to get him to listen to me.

@Sarahcoggles

"I'm a GP and if you spoke to me like that you'd be removed from the list. We do not respond to threats."

I don't understand. Why would they be removed? Asked to leave the practice? Because after very poor service they are threatening to make a complaint?

Which bit is a 'threat'? that would justify removal?

OP, I hope you get listened to. I was fobbed off by a GP when I was 44 but got HRT a few short months later by which time I was 45. It was actually a practice nurse who prescribed it for me, so hopefully yours will be helpful. Your symptoms seem very likely to be perimeno.

Thank you all again.
My DM was in her mid forties so it's not unusual per se ,.grandparents not sure I lost them before I was even born.
I'm armed with all my info and I hope I can keep my composure and not get upset , I get into a hot crying mess quite often even talking about all my symptoms , my appointment is only 15 mins and I've a lot to say.
I'm literally counting down the hours until my appointment time tomorrow afternoon , how sad my life has become .
Thank you again for all your suggestions and thoughts , without you here to talk to I don't know what I'd do.
I have a 4yr old DS and he doesn't understand 🥺

It's hard to believe that this is still happening!

The age of menopause (no more periods) is from 45 to 55. Average is 51.
As peri can last for years, symptoms can start long before 45.

The NICE guidance doesn't say categorically that women can't have HRT before 45, or even that they need blood tests to 'prove' they need it.

What is does say is that in women under 45, blood tests can be done to rule out any other causes.

That's totally different to a blood test being some kind of 'pass' to get HRT!

The reason for NOT doing tests over 45 is that in peri they are unreliable. But of course, in early menopause, peri can start at 40 or earlier.

@Maltybiscuit You don't need a referral ( as a PP suggested) to see a consultant privately. Most of then now take self-referrals. However, you shouldn't need to do this for something pretty straightforward.

Good luck OP.

Your post is sadly not rare on this board.

What do all the GPs who refuse HRT (except for medical reasons) think is causing women to go and see them? Do they think we all imagine these things?

I had all your symptoms OP and my GP couldn't have been better. She had the menopause matters website up to refer to as we were talking.

I hope you get what you need. 💐

It's appalling that GP's are still so I'll informed. Mine is great and has been extremely supportive but I've gone private for some Testosterone as I just couldn't face the whole process of fighting for an appointment and potentially being told no. I used Newson Health if you need a recommendation for a private clinic. They are absolutely brilliant.

My GP told me when I asked about peri that I wasn't in menopause as I was still having periods, and HRT has risks.

Prescribed antidepressants instead.

You have to wonder how some of them ever passed their exams.