Can't Take HRT. Need SOMETHING

[SlightlyJaded]

I feel like I am losing my mind. In fact I've probably posted before but can't recall. I have been through menopause (am 52) and no bleed for over two years. I am still getting occasional hot flushes but can cope with that.

What I can't cope with is the bone and muscle ache which is extreme, the exhaustion & fatigue, the anxiety, the sudden rage and mostly, the absolutely appalling low mood day after day. I feel completely dead inside. As an aside, also dryness and zero libido.

I have REALLY high blood pressure - managed but on a cocktail of medication due to it causing episodes of unstable angina at one point - so cannot take HRT.

I have been to the GP four times in the last year and they keep telling me they will refer me to the menopause clinic but nothing. I have also repeatedly asked if there is anything I can take - that won't conflict with my meds - and they just say they aren't sure.

The thing is - I KNOW there are lots of things out there: Black Cobosh, menopace, Vitamins, Supplements etc, but it's almost too much and overwhelming, andI just don't know where to start.

I don't have a lot of money, so can't be taking a million things a month, but really need something.

Can anyone recommend a good place to start? If I could target bone ache/fatigue and mood, that would be key for me. I can work with the rest for now.

Thank you.

My friend takes this one and really rates it
I've used their multi vitamin before and was happy with it too

wearefeel.com/products/menopause

Oh and keep your vitamin D level up too
I had the most awful shin pains and it turned out my level was 9
Had a high dose course and now I take 4000IU daily

For the aching bones and general tiredness I take a magnesium supplement from Holland and Barrett- it's cheap on offer a lot of the time but really helps me. I also take a Vit B tablet and find it helps me feel a bit more like me. It's a shit period in your life- it has to pass soon- that's what I tell myself!

I always thought you could take HRT of your BP was controlled,which yours is if you take meds.

I suspect your BP would come down if you did take HRT. I would ring your GP and ask why you haven’t yet been referred!

One thing the doctor can prescribe is the simple vaginal moisturiser, 'Yes VM.' That will at least help that aspect.

Which magnesium please ?

@SlightlyJaded I'm on three different meds for high blood pressure (they work) and am also on HRT. I'm 59. It's relieved all the symptoms you describe. I'd double check with the doctor as medicated high blood pressure shouldn't necessarily preclude HRT. And insist on a referral to the menopause clinic, don't take no for an answer.

As for the dryness, you need topical oestrogen for that. The doctor can prescribe or you can get it over the counter, brand name Gina. Not a vaginal moisturiser, btw, you need your oestrogen replacing. It should help the libido too.

I have a couple of suggestions, maybe have a read up about HRT alternative 'Tibolone' and if you think it seems suitable, ask GP for Tibolone/Livial and tell them what you've learnt about it if they are feigning ignorance! It can help with most symptoms and is taken by ladies who aren't able to take usual HRT and it can reduce BP as an added bonus.
Also definitely ask for some vaginal oestrogen cream as it doesn't affect BP!

I have REALLY high blood pressure - managed but on a cocktail of medication due to it causing episodes of unstable angina at one point - so cannot take HRT.

Your GP is incorrect @SlightlyJaded

HRT is not contraindicated with high BP as long as the BP is being controlled with meds.

https://www.balance-menopause.com/menopause-library/high-blood-pressure-factsheet/ See the quote here.

Can you take HRT if you have high BP?

For most women, it’s perfectly safe to take HRT if you have high blood pressure or you’re taking medicines to lower your blood pressure. Your doctor will simply need to keep an eye on your blood pressure and adjust your medicines if needed.

There is a lot of confusion around HRT and blood pressure and some women have been needlessly advised against HRT. However, a review of the evidence showed that postmenopausal women with normal and high blood pressure had a very low risk of a rise in blood pressure with all forms of HRT, and in fact their blood pressure was often lowered.

Either, see another GP, or if you can afford it, see a private menopause gynaecologist. It will cost you £250-£300 but if you can afford it , it will get you out of this nonsense loop and you can probably get an appt within a week or 2/3.

There is information online about BP and HRT and your GP ought to be familiar with it. https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease#:~:text=HRT%20tablets%20can%20slightly%20increase,a%20patch%20or%20gel%20instead.

@SlightlyJaded If a private appt is out of the question, you should print off the above information and take it to your GP. If they refuse again, say you want a referral to a gynaecologist who has expertise in menopause.

The idea that HRT caused high BP is now quite outdated. It used to be more of a risk with tablet forms and a synthetic estrogen made from mares' urine.

The sort of hrt used now- gel/patches/spray doesn't have the same risks.
Also, the progesterone you could be given (Utrogestan) can actually help lower BP.

You can see from the links here that HRT is beneficial to hearts, not the opposite.

It's sad and also shocking that GPs aren't taking women's health seriously and doing some training on HRT. It's readily available as short courses through the British Menopause Society, for around £100, and they run training all year round.

Thank you so much. I'm working this morning but I'm going to read through every single post really carefully and make some notes. I'm really shocked at my GP – they have been poor across-the-board when it comes to women's health, yet always excellent in every other aspect

It really is a difficult time to navigate, and he would think that by now it wouldn't be so hard to get simple answers and suitable solutions. Thank God for Mumsnet. I'll be back

Also don’t underestimate Venlafaxine for helping to alleviate meno symptoms. (I use that and oestrogen gel)

@Fraaahnces There is a very big campaign to stop ADs being prescribed for menopause. Too many GPs reach for those first despite NICE guidance saying they are inappropriate. If the are helping you, ok and of course on one knows your medical history, but they arent recommended now, only for women who can't use HRT perhaps due to cancer .

Exactly - they are for ppl who can’t take HRT. That is what OP stated.

@Fraaahnces The OP appears to have been given misinformation by her GP. There are some links in the previous posts which she is going to read and perhaps take to her GP to discuss. High BP is not a contraindication according to the British Heart Foundation.

I think you can still have HRT if your blood pressure is controlled. Don't give up. I didn't have high blood pressure but even so my GP was hopeless, I dont think he actually rated HRT and I just got fobbed off again and again. So I went to a private consultant, pricey but worth it. Then there was COVID and I moved house (and GP) but again I went private but to a different provider. What they did was write to my new GP who then prescribed the HRT they recommend. Be great IF THE CHEMIST ACTUALLY HAD THE HRT I NEED. Capitals because the chemist is waiting for a delivery and I have run out 😔 to be honest you have to persevere to the point of being a nuisance which seems weird.

Well controlled high blood pressure isn’t a contraindication for HRT but sadly ischaemic heart disease is (OP mentions episode of unstable angina). I would also suggest topical estrogen and a trial of eg venlafaxine whilst waiting for the menopause clinic- you should be able to confirm you are on a waiting list by ringing your local hospital appointments line- but the waiting list may be extremely long sadly. I’d also second /third advice about vitamin D especially in winter. Best wishes.

@checkedroses I wonder if this is the sticking point? I have never heard the phrase ischaemic heart disease. My unstable angina diagnoses came following fairly clear MRI and CT scans following chest pains with tiny raised troponin levels (single digits above what it should be). Cardiologist said that there was one tiny speck that might have been calcium but they really weren't sure what it was but not hugely blocked arteries (and no heart damage). This episode came about six months after it was discovered I have really high BP - now managed.

I will definitely ask GP if this the contradiction rather than the high BP although I have always been led to believe it was the BP. I've also taken lots of notes from this thread. Thank you all so much.

I buy my black cohosh from Amazon - it’s around £10 for a few months worth and vitamin D from Aldi. Black cohosh has been brilliant for me. It stopped my hot flushes, itchy skin, rage and anxiety. Good luck!

I am also on venlafaxine (Effexor) for very bad anxiety and feelings of not coping, and it's been great for me, low dose. I didn't get on with any HRT I found from my GP, and I have a history of endo and just felt bloated, huge and sick, and didn't want any additional oestrogen.

I agree anti-depressants shouldn't be given out instead of HRT, but not everyone can take HRT or even wants to take it. In my case, they have been extremely effective, and I have no menopause symptoms at all now, as well as feeling calm and normal, which I thought would not happen again!

Surely it's about options, and where one thing doesn't work, another might, although I do agree the OP needs up to date info on whether, in fact, HRT might be possible for her.

I use
citslopram (SSRI) for anxiety
magnesium glycate for sleep and joints
omega 3 for brain fog, joints and sleep

I have read on these boards that it’s not merely ‘dryness’ but vaginal atrophy and that you need to get that treated asap. If you can’t take systemic HRT (and you might be able to, as some posters say) you can get the pessaries - Vagifem or Vagirux. Definitely follow things up. You don’t need to suffer like this.

@checkedroses @SlightlyJaded It's not a straight forward 'No' for one episode of angina. According to my consultant, a heart attack, or stroke (recently) is a no-no, but other things like heart disease (if proven) may or may not be depending if someone is on treatment for it or not .

Is there any chance OP you could be referred to a cardiologist? Just a thought because sometimes menopause clinics are staffed by GPs. (I know of someone on another forum who was given completely the wrong advice as it turned out, by a menopause clinic.)

@Fluffywhitecloudsinthesky I think the concern in the medical profession about ADs (from reading things online from medics) is that they have side effects (sometimes weight gain), and possibly serious long term effects yet unknown, they don't give any protection to bones and heart, and they can be extremely hard to get off (huge concern generally about the number of people on some sorts of ADs and the inability to stop.)