The Menopause conundrum - who do we believe?

[Stridingthroughtheglade]

There seems to be a thicket of information out there, at the same time a dearth of actual rl advice and help! Need some advice negotiating my way through the problem please.

I am in my late fifties. Had a full hysterectomy with ovary removal nearly five years ago.

Went on HRT immediately for six to eight months but I wasn’t given any info about it and it didn’t seem to do anything in particular so I stopped taking it.

Only now, when it’s a few years later, I find myself not sad but just flat, no energy, no motivation, physically sluggish, don’t care about anything. My hair is receding and falling out. I have loads of bristles appearing on my chin and dark hairs on my upper lip. My limbs ache. My back hurts. I’ve gained weight. Any minor task that previously I would sail through, seems to be an enormous burden and I need to psyche myself up to do it, for hours and days in advance. Afterwards, I am exhausted. I’m existing, not living.

I have been offered anti-depressants but I am not sad and I don’t have anything to be depressed about. Good long marriage, lovely adult dc, ok job, ok home, supportive family, great friends, interesting hobbies. My life is a breeze compared to most people’s.

So where do I go now?

I see Dr Claire Newsome (is that her name?) all over sm. She talks about HRT as if it is a necessary, preventative treatment for most women. I understand the risks of HRT have largely been disproved but who do we believe? She seems very sincere and obviously I don’t begrudge her a living, but how much do we trust in what she says?

I’m a keen gardener and trust that nature knows best in most things and we get in to trouble when we meddle with it.

So the options are:

** ADs

** HRT

** diet and exercise

Sorry for long op, but what exactly should my next step be please?

How does everyone negotiate this issue?

I'm not personally taking hrt, my feeling is that putting artificial hormones

HRT now is not 'artificial hormones'.

There is still so much lack of knowledge on this.

Modern HRT is made from yams, and is called 'body identical'. The molecular structure is exactly the same as your own. You're topping up your own levels. It's not the same as the Pill or the HRT that was used 20 years ago.

That's what I said. Under 45 you need blood tests, which you had.

Yes me too. My mother has the bone thinning disease, my grandmother had it too, so I'm hopeful of preventing that from happening to me.

The protective effect of HRT on bone density has been overstated - particularly by Dr Newson who has misinterpreted some old research. For an expert perspective on this listen to Dr Liz O'Riordan, a breast surgeon who has had breast cancer and broadcasts evidence-based videos. The best way to protect your bones is with regular weight-bearing exercise.

I am 61 and feel exactly like you OP. I am off the the doctor on Monday and i have the details of a menopause specialist that i will ask to be referred to. I can't take the brain fog, exhaustion, aches and lack of motivation any longer.

@sorrynotathome There are as many opinions as there are drs sometimes!
Prof Michael Baum (on video) says he thinks all women should use HRT till they are 90. He's an eminent breast surgeon and researcher whose mother died from BC (not connected to hrt.)

Prof John Stevenson, metabolic physician and osteo expert, (on video) expounds estrogen as a treatment and preventative for osteoporosis.

There are many, many research papers showing a positive effect of estrogen on bones. I've not listened to the link you left, but it would be odd if Dr Newson was out on a limb making claims that aren't substantiated by rheumatologists and other specialists. What do you think?

@ApolloandDaphne I have terrible brain fog and as a pp said and I've since read, it's meant to get better post menopause, but how do you know when your menopause is over? I've read so many conflicting articles , I'm totally confused.

That's exactly what I want to know too.

That doesn’t make sense to me. There isn’t a stage that is beyond menopause. You’re always in menopause once you’ve gone through it. Or post-menopause if that’s the term they’re using.

Yes sorry I worded it badly, obviously post menopause is for the rest of your life . I meant how do you know when you are post menopause ? I know it's meant to be 12 months after your last period and symptoms are meant to get better but I still get a few night sweats and as I said, the brain fog is really affecting me badly . I had the merena coil so didn't have periods anyway and didn't have any once it was removed, more than 6 years ago.

It's 12 months after your last period that makes it menopause.

Symptoms ( in my experience) don't get better and I've never read they are 'supposed to'. Some people seem to find symptoms diminish though, or they don't have any ( lucky!)

I went on HRT 3 years after menopause as I kept getting new symptoms. I've also had to increase my HRT due to new symptoms. For example I only started having vaginal atrophy at age 57, my menopause happened when I was 52.

My symptoms were debilitating and I really wish I had started HRT during perimenopause.

My issue is that i had a hysterectomy in 2010 so obviously have had no periods since then. I kept my ovaries though so i don't know how to tell if and when menopause happened. I only know i feel like shit now.

@ApolloandDaphne same deal here. My GP said there was no way to tell if I'm in menopause other than to make an assumption based on my age.

(Good user name by the way!)

Such a great thread with lots of different views expressed.

For me I agree it can become a catch 22 if you don’t have motivation to exercise or your joints or muscles hurt. HRT has built my tolerance for exercise. Exercising, keeping your strength, and staying a ‘normal’ weight is perhaps the single thing you can do for your physical and mental health as you age.

I’ve had hormonal issues all my adult life and was diagnosed with PCOS at 28. Doctors were happy to provide the contraceptive pill for years, imo HRT is a safer alternative for me now, at 48.

I am not an expert by any means but do find it a bit odd that breast cancer cases just keep going up and up. They didn’t decrease in the years after the disgraced 2002 study when many women came off it.

It’s just such an individual choice. All we can do is do our research and decide accordingly.

I don't know if anyone here can help me but I'm in a conundrum.

So, I'm 53.5 yrs old and I haven't had any signs of menopause until maybe now. I have many chronic gynae issues (adenomyosis, fibroids, severe PCOS on left ovary, and waiting on ovarian cancer biopsy due to elevated CA125) that cause awful pain and heavy bleeding. These issues have been severe for about 6 years now.

I was severely injured in a botched gynae procedure last year that left me with internal infections, chronic daily bleeding, and scar tissue binding the area I was injured all together (uterus, ovary, ureter, colon). So, since then I've been bleeding all day every day for the last 17 months - I assume from the injury site and not 'menstrual' plus my regular 21 day cycle of hellish bleeding and clots.

I've had one corrective surgery and that helped a bit but the recurrent infection, pain, and bleeding never stopped. I'm overdue a further huge surgery (radical hysterectomy, lymph node removal, scar tissue removal, bladder stents, colon resection) to remove all areas involved, correct all issues, and biopsy the whole lot. Was supposed to be last Weds, rescheduled to next Wed due to 'bed shortage'. This surgery will put me into surgical menopause obv.

Under gynae team, I've been on daily: 40mg Provera (synthetic progesterone), Mefenamic Acid every 4 hours (to reduce inflammation), Tranexamic Acid four times a day (blood clotting agent), plus high doses of codeine / dihydracodeine (for pain). None of this actually stopped the bleeding or pain.

Suddenly, after 17 months of chronic daily bleeding, about two weeks ago the bleeding started to stop and the pain lifted. It's stayed stopped. So about five days ago I quit taking all the above medications bar the Provera. I'm currently in codeine withdrawal and not well mentally / physically but pushing through.

I don't know why I've suddenly stopped bleeding. I'm still in pain when walking from all the internal scar tissue when I take flat steps, never mind elevated steps.

It's a headfk to stop all the symptoms just when I'm about to have the surgery. I will tell the gynae team when I see them on the day but they're barely communicable. The surgery may not take place as it's liable to be cancelled again due to 'bed shortages'. I don't know where I'm at any more! Has the injury finally healed up? Will my cycle period come any day soon? Should I keep taking provera or not? Do I even need such extensive surgery if the bleeding and pain has suddenly abated? It's so confusing.

Please chip in... I'm losing my mind with all this. It's been six years of living hell. I've been bed bound for most of my days the last 17 months and now I'm exhausted with the stress and anxiety of it all, sleeping most days - maybe that's hormonal too? Do I need HRT at this point?

I don't really have anyone to speak to. My GP is 'OK' but not available as per most GPs. My gynae surgeon is batshit crazy eccentric and abs zero comms. I don't know who the other two surgeons are. I have one point of contact at the hospital - a medical secretary for the Multidisciplinary Team. I could possibly email her but I don't want to get my so called 2WW cancer investigation and 4WW urgent surgery bumped if I suddenly start reporting feeling 'better'. Aaarghhhh sorry for being intense but it's A LOT!

Dr Newson is certainly controversial in her views - particularly about use of HRT after breast cancer, which goes totally against NICE guidance and HRT drug licences - but unfortunately she is spot on in terms of lack of attention/interest from medical profession. This has opened a goldmine private market for her and others offering quick prescription of HRT. The hype storm created by Davina & her ilk is a gift to all those with vested interests, from drug companies to book authors via supplement pedlars and clothing manufacturers.

@sorrynotathome I feel sorry for Dr Newson because she has done a lot of good, but comes under attack in the way that other specialists don't. The important thing, perhaps, is she's provided information for women to make up their own minds. There are other specialists who also prescribe off-licence so she's not doing anything unique or new, it's just she's in the media more. The link with BC is interesting because women using estrogen-only HRT have less BC than women who don't use HRT at all. The latest research points to progestogens as the possible catalyst. Prof Michael Baum has prescribed hrt to women post BC for many years , on the basis of quality of life. He's on this video page, about half way down. https://thebms.org.uk/publications/bms-tv/

@LittleMissSunshiner Oh my goodness, that sounds horrific. You poor thing. I doubt whether anyone here (or your GP) can help as it sounds really complicated. Can you get the secretary to book an appointment with a gynaecologist/surgeon? It seems that it's the least they could do after everything you've been through.

Yes I was just about to post something similar LittleMissSunshiner

I am sorry that you have been through such a horrific time in the last seventeen months.

I don’t know what to advise but I think in your shoes I would be trying to get an urgent appointment with my gp and pushing them for an urgent referral to one of the other surgeons that isn’t batshit.

And when/if you get to see them take a partner, family member or friend with you to advocate for you and take notes.

Some very interesting points TheOGCCL, especially about breast cancer rates, is it due to better detection that the rates are going up do you think?

And that’s interesting about HRT being part of a toolkit to help us exercise and keep our weight down.

There are as many opinions as there are drs sometimes!.

^^ Yes to this Jinglingspringbells !

Thank you for the link - I will watch - and that’s so interesting about women using estrogen-only HRT having less BC than women who don't use HRT at all.

And it’s interesting to hear a different view thank you Sorrynotathome

@Stridingthroughtheglade If you want to see some medical stats, without the 'hype' of the media, here is a link. It shows the risks of HRT compared to being overweight, drinking, and other lifestyle factors.

The WHC is the 'patient' side of the BMS.

https://www.womens-health-concern.org/wp-content/uploads/2019/10/WHC-UnderstandingRisksofBreastCancer-MARCH2017.pdf

I had the same issue as I was on the mini pill right up to my hysterectomy but the problem is that the doctors base your likely menopause age on that of your mother’s but my mother didn’t go in to menopause until she was 58!

Thank you again Jingling that is enormously helpful!