WWYD with this dr's advice?

[Howtosolveit]

Hi, I am 42 and have had very irregular periods for the last year. They went from totally regular to anything from 19 days to 3 months, all within a year. I have had investigations and the dr. now says peri (initially she ruled out on the basis of age).

I have no other obvious symptoms, but do feel tired and low a lot. I can't separate the moods and tiredness from the impact of the pandemic, though. I had long Covid last year, then 'normal' Covid 3 more times. I also live alone and now wfh full time since the pandemic, and it's very lonely. I am looking for a new job but lack the motivation to make change due to the tiredness and low moods. Does this sound like peri, or something else?

The dr. has not suggested HRT, only natural remedies - black cohosh and some other things. Would you accept this? Has anyone tried natural remedies? desperately want to get back to normal in terms of energy and mood.

If you are going to go down the natural route i would recommend seeing a medical herbalist who could assess you fully and provide the herbs best suited to you.

I havn't started yet so can't offer my experience.

It does sound like peri, and as they’ve diagnosed it I’m surprised they haven’t offered HRT.
Have you been checked for anaemia and hypothyroid ?

Kind of - I had blood tests and have seen the paperwork. There were two things flagged in red and from what I can understand via google, one related to underactive thyroid. The other was related to a low-ish white blood cell count. The dr. didn't mention either of these on our follow up call and I was a bit thrown by the conversation and forgot to ask. I have emailed asking to follow up.

The peri markers were inside the normal (non-peri) ranges, but I think possibly slightly outside for LH and FSH for the specific point in my cycle that the blood test was taken. My next period just arrived a week early though, and I am unsure what impact that could have. Oestrogen was normal.

Thanks @Wanderinghome. I guess my question is, if this is peri, is this route worth it? I hear so many positives about HRT that I think I would prefer to go straight to that unless I hear others say they have had success with natural remedies. I would be surprised if they helped with tiredness and moods but maybe I am uninformed.

Hopeful bump.

Yeah, bollocks to the herbal shit (might work for some people) but my Dr also ruled out peri due to age (antiquated BS as I had all the friggin symptoms) and recommended evening primrose. Sort of worked for a bit. Then WHAM full on symptoms. So I just paid to go privately as I couldn’t be arsed to faff getting an appt, and justifying it. Saw a fantastic Dr, got HRT PDQ, and boom, all the shitty symptoms have gone / under control.

Ask your dr for a six month HRT trial, to see if it relieves symptoms. They’re often more open to trials for some reason.

Blood tests aren't used or accurate to diagnose peri-menopause. I was I peri-menopause at 40 and was on HRT by 41. I'm still on it now at 50, and 42 is absolutely not too young for peri-menopause. Peri-menopause can last 10 years or more and I firmly believe that many, many women are peri-menopausal far earlier than the currently accepted "normal" ages.

Go to a private clinic. It is not as expensive as you think, and worth every penny. HRT is extremely important for bone and heart health.

I treated my symptoms with lifestyle changes and supplements, but there was one symptom nothing would help, and that was mood/rage. I’m on HRT for that alone.
As you’re under 45 you can’t demand HRT as per the NIcE guidelines, so I’d ask your GP for a 6 month trial to see if it alleviates your symptoms, or I’d go private and get it.

Thanks @DustyLee123 I did not know that you could ask for a trial. Looks like the next step is to get a specialist appointment. Funnily enough, the consultant that did the blood tests IS a private specialist in all areas of gynae / women's health, including HRT. I find her a bit perfunctory though and would like a better conversation about options, vs. just 'buy some evening primrose oil'. I initially went to see her for a different reason (under the two week rule for suspected ovarian cancer, thankfully now ruled out) and this is where we have landed. Maybe if I saw her / someone else in an HRT clinic (what is this even called?) I would get a better dialogue.

Really appreciate the replies here. This has been going on for over a year now and is proving surprisingly tricky to navigate.

I'm not sure there is such a thing as an HRT clinic. At my surgery all the young GPs (late 30s and mid 40s) are brilliant at HRT.

I think if you want a specialist meno clinic you might need to go private.

What was your thyroid result? Thats what I would focus on. It affects your monthly cycle as well as everything else eg tired, low mood

There are menopause clinics both NhS and private.

Op if you can afford it, I would go private in your situation - you can possibly see the same consultant?

And you then avoid the drawn out process of getting your Gp to refer you etc which, as they don't seem keen to prescribe HRT, might be a struggle.

NHS referral and treatment is a bit of a postcode/Gp/cog lottery - I was lucky that Gp is good and got a referral with a wait time from referral to appointment iof about 5 months - took about 9 months from requesting referral to getting to where I am now: patches, utrogestan and testosterone. Plus I am now 54 so no age related issues to deal with.

Insist on a gynae referral no one should have to put up with horrendous periods and if you cannot get an NHS referral then pay for a private consultation at least you will know what you are dealing with then.

Another vote for a private menopause clinic, if you can afford it, it would have been cheap at twice the price as the right HRT prescription including testosterone has completely changed things for me. Peri hit me like a ton of bricks much younger than I'd anticipated, I was floored, but I feel more or less back to "normal" now.

I tried the herbal route and it did alleviate some symptoms for about six months when I was in peri. Finally started HRT 16 month or so after my last period . I went to see a private menopause specialist who was amazing I tried many different products before we found the right combination for me. After finding the right HRT she signed me off saying that I could just request my prescription to her whenever I needed it then I’d pay privately for it to be delivered directly from their chemist which is very pricey.
I get my very reluctant GP to prescribe HRT now because I have brought a HRT prepayment certificate private menopause specialist informed them of what I was talking.

@ArcticSkewer my Free TS3 is 3.3 and the normal range given as 3.9-6.8. The dr. has said it is noting to worry about but it is flagged in red on the readout and the thing that is most obviously outside of normal.

This dr. IS a private gynae specialist, but I was seeing her because of the cancer scare, which resulted in minor surgery (not cancer related, thankfully). It sounds like I need to see a specialist with peri as the actual focus in order to have a thoughtful approach. Getting an appointment with my GP is a major undertaking (not to denigrate the wonderful NHS).

what was your tsh as well?

I would agree with all that.

Do you know the rest of your thyroid panel results? Yes, it says Free T4 is 12.7, TSH is 1.44, Free T3 is 3.3 and Testosterone (listed with the thyroid tests) is 1.2 Would be very appreciative if anyone can translate any of that. Only the Free T3 is flagged in red.

@user333334 please can you share more about your experience? I was tempted to accept that the low T3 is irrelevant. How did you feel before and after treatment?

I find it so coincidental to find this post as I am one week to the day on medication for under active thyroid and oh my goodness...what a game changer! Sitting here tonight and could cry with happiness! Would normally be in bed soon after 9 with exhaustion, mood is brilliant and have bundles of energy! Genuinely didn't even realise anything was wrong, guess I just got used to a slower pace of life, general fatigue etc and was just living with it. Routine blood test flagged it last week and here I am one week on genuinely in shock how my life has changed! Please do at least check on those thyroid results and best of luck! Mid forties myself by the way so close enough in age to you!

oh, wow - thank you for sharing @heretohelpGB ! Do you know what your blood test results were??