Can I really be menopausal already?

[Kai1981]

Had a private appt with a well known menopause clinic.

I’m on Utrogestan, oestrogel and vagifem already, none particularly working brilliantly for me due to Vaginal atrophy and low mood. I’m currently 45.

Two years ago I had an FSH test following my first peri symptoms (reduced periods to every 8 months and hot flushes) which came up as 53. I told the specialist this result today and she said I am not peri, I am already menopausal at that rate of FSH.

It just seems like a very quick turnaround to go from first peri symptoms two years ago to menopausal now?

And three years before that I’d had fertility tests which said there was no natural issues for me with conception?

Should I just follow the new HRT regime (daily utrogestan, increased oestrogel to 4 pumps from 2.5 plus vagifem or get a second opinion?

I think the blood test is a red herring. At 45 you treat the symptoms.
Are you getting your prescriptions from them ? Ie are you paying them ?

Peri just means your oestrogen is declining, menopausal isn’t really a thing - it’s just an extension of peri. You’re considered post menopausal when you haven’t had a period for 12 months I think (you’ll need to check me on that). So menopausal and peri is one and the same.

Blood tests are notoriously unreliable.

I was having regular periods in my early 50s and an FSH test did come up as showing post menopause. My consultant said it simply proved how these tests are unreliable because I had periods for another 18 months after that. (The test wasn't to do with menopause.)

I'm not sure what you are asking now? Could you explain a little more?
You've not said what's going on with your periods now.

If your FSH was high, 2 years ago, it is possible you are now post menopause if you have not had a period for 12 months. Also, the fertility tests you had 5 years ago are out of date. You can go from being fertile and postmenopausal in 5 years.

When you say that your HRT isn't working because you have vaginal atrophy, what are you experiencing?

Just a bit confused!

if you have VA you should be using vaginal estrogen as using systemic estrogen doesn't always reach the parts it needs to! 1 in 4 woman use both.

Thank you all!

I asked for a letter so I can get my prescriptions via NHS (I get them free due to thyroid) so they aren’t getting any extra money from that.

Current regime is 12 days Utrogestan a month, 2.5 pumps Oestrogel and Vagifem twice weekly. Plus mini pill. I have VA despite this (though it is a bit better) and low mood.

I have been on either contraception or HRT since the blood test two years ago so who knows re my period, I get a monthly withdrawl bleed though.

She wants to change Utro to daily, as I am ‘menopausal’, up oestrogel to 4 pumps and continue Vagifem. She also wants me off the mini pill (condom in interim, then nothing required in 6 months if my bleeds don’t come back). 🤷‍♀️

I just want to know if I should accept quite a big change or get a second opinion really.

Is this the Newson clinic?

You could think about upping the vagifem (sorry- I missed that when I read your post.)

The dose is tiny and some women use it daily or 4 times a week.
It's now 10mcgs, but a few years ago it was 25mcgs (no idea why they reduced the dose) and of course that is a big difference in the amount.

I'm not sure I understand the 'logic' of 6 months with no periods= no need to contraception.

In women under 50, they are supposed to have 2 years with no periods before ditching contraception.

If the dr is relying on your FSH test from 2 years ago to diagnose post menopause, and therefore you can ditch contraception after 6 more months, I'm not sure I agree with that!

TBH the only way to be sure you are post menopause is to stop all HRT and birth control and wait for 12 months- which you won't want to do?

You could have more tests - an ultrasound scan/ blood test to look at your ovaries (for follicles) all done privately.

Is the issue that you are finding it hard to accept possibly being post meno at 45?

It's within the realms of possibility, my MIL was peri at 43 and all finished by 45...

Thank you.

It is tough to think it’s happened so soon but I’ve had a v stressful for years so maybe it’s pushed it much earlier than my Mum’s. I’ll take whatever is right for me but it is quite a big change so I want to be sure.

I’ll double check exactly what she said about contraception, maybe I misunderstood the post menopause logic re contraception but she definitely said 6 months before you can stop any contraception (and to see her again first).

Yes Newson clinic, which I thought was reputable?

She also said I could take Vagifem nightly for a month and then drop down to see if it helps.

*few years

Mini pill doesn't have week off/ withdrawal though.....

If I were you and you can afford it, I'd see a menopause specialist (a consultant) with fertility expertise. Get more blood tests and a scan of your ovaries, again by a fertility consultant. There are some really excellent doctors who can advise you.

The Newson clinic has expanded hugely and there are over 100 drs there now. Many are just GPs who have done a bit of meno /HRT training.

Stress can mess your cycles up, but you are born with a finite number of eggs so they won't disappear through stress.

Ok thank you. Just so I’m clear, is the reason for checking fertility a way of confirming I’m menopausal (and therefore need a different regime)? Plus checking whether I should still be on contraception or not?

The only reason I mentioned fertility originally was to show how quickly my body seemed to change over the past few years but I understand it can be quite quick.

Yes. You may find there are other ways of checking your fertility other than the FSH test. Scans of ovaries can identify emerging follicles.

The post meno regime is as you have described- daily Utrogestan.

However, this is a CHOICE. Many women (me included) have never moved to daily Utrogestan, because of side effects on it.

Also, be aware that the N clinic has come in for criticism by the BMS (they were not named but as such) for increasing estrogen to high levels.
4 pumps is the highest dose. Some women are on more than that (unlicensed) and that is where the BMS has queried the very high doses.

At 45 if you are post meno you may well need 4 pumps, but you might feel more comfortable doing this gradually by trying 3 to start with.

All the best with it.

Thank you this is so helpful. The jump to 4 pumps was particularly concerning. Will look into it all!