Early menopause and confusing medical advice

[Lycia80]

I’m 43 and have been missing periods since 38. I found a private gynae who told me about risks and put me immediately on HRT. She put me on continuous HRT - 4 Oestrogel pumps daily, and 200mg Ustrogestan daily. After 8 weeks I then went to NHS GP for a review (to avoid spending again £200 for private care) and to get a new prescription and they told me that’s totally wrong and I should be on cyclical HRT as I should still get periods of not peri menopausal yet...They we’re absolutely positive about it and refuse to prescribe so much Utrogestan. I was confused so went to see the private gynae again recently for a yearly check up and she said - guess what - the GP is absolutely wrong and they don’t know what they’re talking about… She said early menopause means I need to high doses to protect me from health issues, and that I should not experience mood swings as I did till then. So now I’m back to continuous regime, as she scared me off. But I’m honestly going mad, and I don’t know who to believe anymore. I did extensive research online and all official bodies support what the NHS says. I don’t think I’m post menopausal yet, as I had a heavy bleed in the summer which I’m pretty sure was a real period… Now it’s obvs impossible to know as continuous HRT means no bleeds at all. And I don’t like that… I’d just love to hear what other people in a similar situation have been prescribed. A third opinion may help but also add more confusion so I’m hesitant. So sorry for the long rant, it’s just been a very stressful rollercoaster I’m facing completely alone - no partner, no friends who are on a similar path. It feels hard and lonely 😞

Hopefully@JinglingHellsBells will see this.

I'm also on continuous HRT even though I'm still having periods. (Mine were heavy and lasted 8-10 days and I'm quite anemic). After I returned home with my first batch of continuous HRT patches I phoned the GP surgery to check I'd been given the right ones. GP confirmed that those were the right ones.

I've tried to read about taking continuous HRT while peri menopausal and haven't found much. I found a sentence on a Scottish NHS website which said it wasn't dangerous to take continuous HRT if still having periods.

Good luck OP, I hope you get a suitable prescription soon. Not fair at all that you're having to pay.

Following, as while I'm older then you I am having premenstrual symptoms and had extremely heavy periods. So painful to painkillers weren't helping. I've actually gone back on the pill (mini-pill) but am wondering if I've done the right thing.

Did you consider a Mirena coil? I wish I’d had mine years earlier than I did.

I'm always curious as to Jinglehellsbells qualifications?

From what I’ve seen she doesn’t claim to have any.

@hashbrownsandwich I've never said I have any qualifications. My posts are based on 16 years of personal experience with a private menopause consultant (regular check ups over the years) 15 years of HRT , asking lots of questions and being given expert advice.

If I can offer help to anyone based on that, I'm happy to do so but they are of course not obliged to follow it!

@Lycia80 To get back to some basics, you can choose whether to use HRT (and progesterone) on a cycle (as the NHS says) or continuously. HOWEVER the risk of using it continuously if you still have periods, is that your own cycle may break through. This is here, and it's written by a consultant - Dr Heather Currie awarded MBE for menopause work. https://www.menopausematters.co.uk/postmeno.php

For women in peri, NICE offers the prescribing option of both or even a 3-monthly cycle (progesterone once every 12 weeks.) This is often helpful for women who have some periods but aren't post meno (all of this is online in the NICE prescribing guidance so you - or anyone- can check it out.)

The other thing is that using 200mgs of Utrogestan is a grey area. It's suggested for women on 4 pumps of gel, but it's not mandatory.

Again, this is not my opinion, but medical advice.

A few days ago I left a new thread about the BMS guidance on HRT and progestins. You should be able to find it down the page of posts.

Some women feel unwell on that amount of Utrogestan every day so it's supposed to be individualised.

If you want to carry on seeing a private specialist, maybe the one you chose isn't that clued up?

Thank you all for the info. What my private doctor prescribed is actually to take Utrogestan ‘until the spontaneous onset of periods’ then stop it for 10 days and then start again following the same principle.
However, since I’m taking it this way I haven’t had periods nor bleeds. The NHS doctors told me I won’t ever have them as this is what happens when on continued progesterone. My gynae disagrees. I honestly don’t know who to trust.

Her reasoning is that I am too young to be menopausal and that higher doses of continuous progesterone are needed to protect my health long term. It’s not about symptoms management, but a preventative cure. What makes me unsure about the NHS guidance I find online is that it’s focused on average menopause age and symptoms alleviation, not early menopause and prevention of long term issues. I have history in my family of dementia, had eating disorders as a teen and beginnings of osteoporosis. So part of me thinks the private gynae is taking the whole picture in consideration so I should trust her (the GP never asked any questions about my background and clinical profile, they just looked at national guidance). But another part of me is dubious as I honestly can’t find any research online that supports what she prescribed. And to be fair the problem is there’s not much clear science about HRT recommendations specifically for early menopause… I’m not asking for medical advice here. More to hear from other women going through early menopause what their HRT regime is and they’ve also been recommended a similar cure than mine.

Hi @Lycia80

Is it definitely early menopause causing your lack of periods? Have you been tested for your prolactin levels?

I thought I was in early menopause from the same age but after a bleed in my early forties and subsequent investigation it was discovered that my prolactin levels were through the roof - I had a prolactinoma (small benign tumour) on my pituitary. A course of treatment saw my periods return.

Interesting you say this as my prolactin levels have been slightly higher than average for a few years. My GP never thought it was worth investigating. But the same gynae above referred me to an endocrinologist who confirmed I’m not outside of the norm enough to be worried about, that nothing is wrong essentially.
I’ve also taken several blood tests to check hormone levels, including FSH that signal I was close to menopause (this was a year ago). Prior to that, a different gynae confirmed that through an ovary scan.

To be fair though, I’m still unclear about the prolactin levels and would like to investigate more.

Can I ask what kind of specialist did you consult?

@Lycia80

Your consultant is saying some stuff which, to my knowledge is not correct.

Her reasoning is that I am too young to be menopausal and that higher doses of continuous progesterone are needed to protect my health long term.

This would apply to estrogen but not progesterone.

Progesterone as part of HRT is only used to protect the womb lining. It has no other function and women who are post menopause don't have any naturally. (It is only produced after ovulation, so not post menopause.)

The way that HRT is usually prescribed in peri is on a monthly, or 3 monthly cycle. (You can find this in the NICE guidance, all online - put in the search words for HRT/menopause/prescribing.)

For women with occasional periods in peri, a 3-monthly cycle is often great because it is estrogen only for 10 weeks, then 2 weeks of progesterone (followed by a bleed.) I did this for several years.

If you are using 200mgs daily, you won't get a withdrawal bleed because the progesterone stops the lining growing. And the dose for that it 100mgs daily, not 200mgs. To be blunt, your Dr seems confused. (Is she registered with the BMS as a specialist? )

The advice of specialists is to use as little progesterone as possible, enough to protect the womb lining, but no more than necessary because it can have short and longer term side effects. There is one exception - if a high dose of estrogen is used (and 4 pumps is high) then there is the option of using 200mgs a day to control any bleeding. But this isn' t usually done unless bleeding or heavy withdrawal bleeds occur.

As before, this was reported in the British Menopause Society report on use of progestogens in HRT (I left a new thread to that a week ago and a link) and also my own experience.

I'd find another private specialist to be honest if you aren't happy.

Thank you for taking time to reply, I really appreciate. However, please be careful spreading medical information if you don’t have professional qualifications - if you do, apologies, and perhaps make them clear when you post? As I said, I’m only here to hear about other women with a similar clinical profile to mine (early menopause), and what their experience with medical advice and treatment has been. But thank you for you willingness to help.

@Lycia80 I'm sorry if you feel that my comments are 'opinion' rather than facts taken from medical sites.

I am careful to provide advice that is found on the British Menopause Society website.

Specifically, you may find help on the Daisy Network which is run by doctors, for women with POI. There is a membership fee but you can find basic info on the site.

You may like to look at the site Menopause Matters and Balance (by Dr Heather Currie, consultant gynae, and Dr Louise Newson.) They have detailed there on early menopause.

https://www.mumsnet.com/talk/menopause/4966293-bms-guidance-on-progestogen-in-hrt-dosage @Lycia80 This is one report I referred to and perhaps it will answer your questions on doses.

But do read the other websites which have information.

You will also find info on the videos of the BMS.https://thebms.org.uk/publications/bms-tv/

I think there is one on early menopause.

I have never pretended to be medically qualified. I'm posting info that you or anyone can find and trying to make it easier for you :)

Haha sorry I've had the marina coil several times before and unfortunately for me I was one of the few women who suffered a rupture of the uterus. They had to surgically remove it from my abdominal cavity. So I won't be going there again.

Although it was great when it worked.