Just so you know ladies.....

[Laundrytrousers]

according to the consultant I saw last week:

low mood, tiredness and irritability is nothing to do with hormones or peri menopause or HRT (despite the fact I was prescribed low dose citilopram for PMDS)

Utrogestan doesn't cause issues (i am likely progesterone intolerant and couldn't take the pill in earlier years). And the suggestion is that I take it daily now (my periods/bleeds are absolutely regular and haven't changed).

Increase in weight, digestion issues and acid reflux must be my diet, not peri (diet hasn't changed, except that i am having to restrict more foods not to feel unwell)

Buuut if I do stop HRT now "all my symptoms will be worse".

So options are live with it, increase SSRI and acknowledge "not everything is menopause related".

I guess I just have to live with feeling rubbish. I don't even feel very cross about this, just resigned.

I'm really sorry your knowledge of your own body was so hastily dismissed.

I've got every peri symptom in the book but I just can't face going to the GP for help because I know this is the response I'll likely get.

OP that's crappy - can you try a different person??? But consultant sounds like a specialist / referral?!

@PictureFrameWindow please go. I was fobbed off once but then called surgery and asked whcih Dr was their menopause specialist and how do I book appointment.

Stalked her on the online booking app for a couple of weeks until a spot came up. I read out a huge list of symptoms I'd written down and she basically said "what HRT do you want"

I nearly cried and it's changed my life in a week

@Laundrytrousers well he can't have it both ways. If stopping HRT means the symptoms will get worse then those symptoms must be hormone induced and therefore menopausal related.
Surely ?

Jeezo! He’s (I’m assuming it’s a He) is a twat. See someone else op.

So, it's a she and a NHS consultant at Womens health clinic. But my GP is also female and not much better. And when I paid for consultation with the Newson Clinic I found that they were massively over-prescribing, without proper in person checks - so may be it's me? I dunno.

@inappropriateportioncontrol well exactly. Hence my confusion and despair. But the fear of the joint aches coming back is real (though last time she told me that wasn't meno related either).

I am usually good at sorting medical stuff out, I get the referals I need usually, but this is just flooring me.

I feel like I have permanent PMS, very low mood and irritability around the 14 days of Utrogestan, the bleeds are as heavy and painful as my normal periods. And there is the endless list of every other symptom of peri.

I haven't got the energy to see someone else. It's obviously not bad enough that anyone wants to help, so I guess down to me to do excercise, increasingly restricted diet and erm stay in bed when it's unbearable, until its resolved. I am just moaning now, but the evidence on these pages is that much of what I am suffering is peri related, just not much to be done about it.

I know HRT isn't a one stop solution, but a process of monitoring and adjusting would be nice. She kept asking what I want from her - just not to feel like crap all the time? So take more anti-depressents for your HRT induced depression? Huzzah!

Can you ask to try a different combo / method / dose of HRT? Add in Testosterone?

TBH if you can afford to see another consultant privately, who is more informed, it might be money well spent. OR read up on the options and see your GP to discuss them.

I am not medically qualified.
However, I've read the NICE prescribing guidance, as well as having my own personal experience with a very good consultant.

There are many options, covered by the Nice guidance, which your consultant didn't appear to discuss.

There are a couple of points I'd make that you may want to take further.

1 Utrogestan is only one of the several types of progestogens available. It is unlike the Pill as it's body-identical and sometimes suits women well. But when I started it, my Dr told me it was a 'love-hate' drug and to give it a few months.
You don't need take 14 days anyway. The dose (on the Patient leaflet) is 12 days. Dr Newson wrote the GP guidance for 14 days - it 'made it easier' to remember 14 days on/14 days off. Obviously this doesn't work for all women who struggle to get to 14 days.

(And, there is medical info online that it's ok to drop to 10 days per months but I'm not suggesting you do , without talking to a dr.)

2 I linked a few days ago about the 3 month cycle NICE suggests for women who are intolerant to progestogens. This is a 12 week cycle with one sort of progestogen added between weeks 10-12. So you'd get a withdrawal bleed once every 3 months.

3 There is evidence than any progestogen can cause low mood. This is why it's important to trial several, to find the right one.

There is
Utrogestan
MPA (in pills)
Dydrogesterone (much like Utrogestan but sometimes tolerated better)
Norethisterone (in all patches and most pills)
Levenorgestrel (in the Mirena.)

It's just my opinion but the 'obvious' answer is to try other types and/or the 3 monthly cycle.

Unfortunately, there are many similar stories online about NHS menopause clinics. It makes you wonder if the doctors they are using have any actual training in menopause and HRT or, if the clinics are so short of staff, they investing in training for the drs.

I'd report your experience to your GP who referred you because there is so much wrong with what you were told that it needs someone to follow that up.

@FusionChefGeoff can you get Testosterone on the NHS? I thought it wasn't available for women in the UK.

Not necessarily - every time I’ve had contact with my GP since my early 40’s she’s said she’d recommend HRT and to go away and research what I want. I’m 45 now, but don't feel i need it quite yet despite what i think were first peri symptoms at about 38. I’m worried that my mild symptoms may be made worse by HRT or create new ones!

Sorry to hear you are having a bad time OP. I don’t have much advice except to ask if you have tried any other progestogens? When Utrogestan was in short supply, my pharmacist substituted Provera and actually I find it better. When I take Utrogestan I get very low moods and also it makes my allergic rhinitis much worse. This just doesn’t seem to be happening with Provera, so I am going to ask if I can switch.

Wow, that consultant knows nothing.

I saw a male gynae last year privately who was like a cheerleader for the benefits of HRT for women.

My female partner led GP practice can't be more progressive with HRT, prescribing testosterone and when I went with severe utrogestan intolerance and cried on the GP, changed my prescription to pessaries and offered me CBT alongside it.

And when that didn't work offered me the mirena which is the best option for me.

I am very sorry for you OP. you need to look around for another private option I think.

I'm so sorry you feel so defeated. I know exactly how you feel, and I was in exactly your shoes about ten years ago. I was passed from pillar to post by several GPs who refused to acknowledge my symptoms were peri menopausal, because 'I was too young' (I was actually 43).

It was only through my own extensive reading and research that I was able to educate myself properly about HRT and peri menopause.

And, when I finally had an appointment at an NHS Menopause clinic the doctor admitted that I was clearly as informed and knowledgeable as she was., if not more so.

It was only when I bit the bullet and saw a private menopause consultant that I was finally diagnosed correctly (severely progesterone intolerant with reproductive anxiety/depression). I was prescribed a type of HRT that was considered very much 'out there' by the NHS, but it worked.

Urgh I’m so sorry OP. I have no advice, but total sympathy. I saw my GP today - I’ve had 3 bleeds in 5 weeks, and I wanted to discuss my HRT and whether I should change my dose etc. I’m nearly 52. She said that she doesn’t like prescribing HRT, and thinks I should stop taking it (despite the horrendous migraines, joint pain and insomnia I suffered before I started taking it), and then revealed that she had no idea what was actually in it. She didn’t even know that a box of Evorel Sequi patches contains 4 x Evorel 50 (oestrogen only) patches AND 4 x Evorel Conti patches (oestrogen + progesterone). When I asked her what she thought she’s been prescribing me until now, she shrugged and said she didn’t know. As soon as I’ve stopped bleeding and feeling shite I’m making a complaint to the practice manager about her woeful and frankly dangerous lack of knowledge, and finding a private specialist. Gggrrrr 😡

@AnnoyingPopUp WTAF?

That's so appalling. How can there be any excuse to not have this very basic knowledge?

I'm sorry you are bleeding so much. I had three periods in one month last year, I'm now with a mirena and it's been a saver for my ferritin levels. Although I do still get cramps.

Hey ... I have little to add, really interesting read. I had/have all those peri symptoms also..

In Nov my HRT was increased. I had been on the mildest patches.

My B12 was flagged up as extremely low.

I got a run of weekly injections for that. Felt AMAZING.

I never knew if it was the B12 or the increased HRT.

I then got migraines and my GP said ah now we have an issue. HRT halved again.

Meanwhile B12 left to its own devices to see if I can absorb it naturally or if I survive an autoimmmune issue.

Upshot is, I am full of peri symptoms all over again.

Every day (around now) I feel in desperate need for a nap. I'm 49 and work full time!

Bloods tomorrow for B12. Wait for results... see what the course of action is...

None of this is easy, I basically feel like shit all the time, all over again. I don't know who to believe. OP if I'd been told none of this is related to peri/ageing and must be "my diet" etc I'd livid too.

Oh yes, this. Their lack of knowledge about HRT is terrifying, as is their refusal to educate themselves about it.

One GP I spoke to about HRT insisted that I would need to have the Mirena fitted to provide progesterone (fair enough) but also wanted to prescribe me Evorel Combi to take alongside. WTAF?

Just so you know OP - your GP is a fuckwit.

What in God's name do they teach these people at medical school?

I'm so sorry you've had this experience, OP. It's definitely not unusual at NHS clinics. Have you googled said Consultant to see what their area of specialty/qualifications are? They often bung anyone they can get into these roles imo. Just because someone is a Gynae. doesn't mean they have any idea on how to manage menopause.

Oh so many messages - thank you, you are kind when I being a moany olkd bag. Have been working (through the slooow brainfog - but thats probably my diet or something too).

@twoforj0y - relate totally to all of that. Though no one will do the B!2 test despite me asking. If I get asked about thyroid or anemia again. - which they do always test for I will scream. I have none of the symptoms for either. I got doses upped at Newsom - but while intitially better then felt worse again. They suggested testosterone an maybe I am cowardly, but without a proper (in person) assessment that felt risky. GP saw the Telegraph articles last year and panicked when she saw what Newson had prescribed, so down we went again, and that was better for a bit, but I am pretty certain I am progesterone intolerant (so many thanks for the suggestione of alternates).

I have meeting now but so grateful to you all.

@Laundrytrousers You can get online blood tests from a couple of reputable health check sites. Some will even provide someone (medical) to come to your home to take blood if it needs more than a finger prick test.
Not hugely expensive- maybe around £35.

I agree with @SebastianFlytesTrousers There was someone on another forum who was refused HRT beyond age 60 at an NHS meno clinic, even though she'd been on it with no issues up to that date.

I have no personal experience of these clinics, but having read so many disappointing outcomes from them, it does make you wonder what training they have.

The vast majority of women don't need to go to a meno clinic. They just need GPs who know what to offer and as it's all available online for anyone to read, (NICE guides)why aren't they?

@Laundrytrousers The Newson clinics work on the basis of transdermal estrogen +progesterone. They do go 'off piste' with the high doses but that is based on the idea it's a private prescription and patients can access scans/ biopsies etc if necessary, quickly through them.

Hi OP, if your Testosterone levels are low then you have nothing to lose using T.

I use it alongside 100mcgs patches and mirena coil.

It's given me my energy back and there is more of A spark for life again.

I took option 2, it’s called Tridestra. I’m very progesterone intolerant, utrogestan sent me nuts, and my period pain was horrific.

Tridestra is 3 months without a bleed, you then take 14 days progesterone followed by a bleed. Only problem for me is I’m lactose intolerant and these have lactose in them as do all HRT tablets 🤦‍♀️.

Under specialist supervision I have HRT patches for 8 weeks, 2 weeks of medroxyprogesterone, then a withdrawal bleed. I’d love to get rid of my redundant uterus just so I didn’t need progesterone. It’s the main reason a lot of women give up on HRT 🤦‍♀️

That's great @Snippit

I forgot to mention Tridestra.

When I said the 3-month cycle, I meant to say that any combo of estrogen +progestin can be used, at the appropriate dose.

At first, I did it with gel and Norethisterone, but then I switched to Utrogestan.