Low ferritin or perimenopause causing symptoms? HRT or iron?

[FlippityFloppityFlump]

I am 45, periods now range between every 22 and 28 days.
I've been having various low level symptoms for a while but have just kept thinking it's one of those things, particularly as I had H pylori last year whjch took some getting rid of.

But recently on top of symptoms lack of sex drive has become lack of any sexual feeling even when trying to get into it. Feels like dead from the waist down. That has made me think it may be peri.

My symptoms are tired and lacking energy, increased physical symptoms of anxiety (I take sertraline for anxiety anyway) aching hips and knees, poor sleep - very restless which seems to be partly due to aches in legs as well as weird dreams and anxiety symptoms and temperature fluctuations during the night.
I have times when I don't feel as mentally sharp - could be partly due to tiredness as I am have never functioned well with insufficient sleep.

I've got very dry skin and can feel itchy.

I haven't had extreme hot flushes but there is definitely issues with temperature regulation. It is like someone has turned my thermostat up at times.

Also as I mentioned the lack of sex drive or sexual feeling

I know I also have pretty low ferritin, it was 20 in October, and that some symptoms can be due to this.
My GP thinks unlikely to be ferritin as she says it is normal and I'm not anaemic.

She said I could try HRT and see if that helped but I don't want to start that if the cause is actually low iron.

Equally I don't want to spend months trying to increase iron levels to find that isn't the cause and I should have been on HRT,!

Equally starting both at the same time means I won't know which is effective.

I feel somewhat overwhelmed with what is best to do and if I do go with HRT, in what combination - mirena, patch, gel

And because I'm so tired and not very sharp, I am struggling to find the energy or brain capacity to research things or even absorb the meno resources

Added to this I am terrible for thinking I should be able to cope and I'm just being weak etc (something I've been working hard on with the help of counselling) but I know this is also feeding into my thoughts about what to do about my current symptoms

Anyway I'm not really sure what my question is but any advice based on my ramblings would be appreciated!

I was exactly the same at the end of 2022. I started taking iron every second day with a high strength vitamin C tablet AND hrt as I needed both. And FWIW 20 is shit for ferritin, mine is now 70 and I feel much better!

I also started taking 300mg of elemental magnesium which is two tablets of new leaf magnesium glycinate which helps with the restless legs. Sometimes I take three if they are really bad.

Good luck!

BTW I now sleep a full 8 hrs a night - the mirena has been a god send as it makes me super sleepy and I use 100mcg patches and T.

I am seeing my GP today, he thinks it is likely to be both low iron and perimenopause - I will let you know what he says after the appointment this morning. I was supposed to have an invitation for a blood test, but this has yet to arrive...

Ferritin of 20 is low whatever the gps say. I have extensive experience of this and when I get to that mark I always start fighting for an infusion.

It may be "normal" but so is 200, 20 is very close to the borderline.

At a ferritin of 20 I get palpitations, short of breath on doing anything, extreme fatigue.

My hb levels are always normal. Just the ferritin that goes very low.

If you can take iron please do, Feroglobin capsules are gentle.

Ferritin of 20 shows that you are iron defficient. On top of that you might have anemia or not. Your GP should be wanting to investigate especially as you've had h pylori, that must have affected your nutrient absorption.

Apart from that I just wanted to say that I got weird dreams and night sweats on sertraline - both pretty spectacular and both stopped when I came off the pills. Ironically I am now in peri but have no night sweats - but I can relate to the increased anxiety and hip pain. Good luck!

OP, I have so many parallels with you. Reassuring at least to see we aren't alone! My blood test results just came back with ferritin at 8 and I feel sh#t. GP just told me to "take iron", without any guidance as to what/how much, etc. Tired, lethargic and breathless, poor sleep, low mood, irritable, dry skin and eyes, brain fog, etc. I'm also 45. My GP won't talk about HRT until they solve very heavy period issues, for which I've been offered ablation and/or mirena coil by a gynae who I fortunately got to see quickly with my insurance. I don't really fancy either of those though, and she didn't seem to be willing to discuss any alternatives. I thought of loads of questions after I left her office, naturally... Ablation sounds horrible (I really hate the intrusiveness of it all and that it will be under GA) and Mirena worries me as I have hormonal acne which has given me low self esteem my whole life, and I'm pretty sure it'll make it worse. But I think I will just have to give it a try and see, it seems to have very different side effects for different people, or could also be a magic bullet. So just coming on here to say you are not alone - I hope you find a way forward, keep us posted! x

How did you get on at GP?

I decided to contact GP to request the HRT she said I could have but the practice insisted I make another appointment - another 2 weeks to wait!

Thinking of getting my iron levels done privately before then so I can discuss those with her at same time

I seem to tolerate iron ok, it's just so slow to increase with it. In Feb last year it was 25 - it took 4.5 months to get up to 43 taking iron. 4 months later it was back down to 20 as I stopped taking it.

I wonder if it is lower again now which may explain me feeling so wiped out

How do you persuade GP to give you an infusion? Private is so expensive at £700!

Although h I would be tempted if I knew that was definitely the issue and would make me feel better.

I had FBC done in October at same time as ferritin, and they all seem more middle of the road although I don't really understand most of them

I don't think it's the sertraline. I've been on it 2 years and my dose hasn't changed.

It's not really been an issue until more recently. The dreams seem to be linked to the palpatations/anxiety during the night (although not sure which is the chicken and which is the egg)

The appointment for my blood tests never came through so I still need to have that done. He was pretty clueless on HRT - just took my blood pressure and prescribed me Ovorel Sequi, no advice how or when to take, how long to take for or anything - just said "follow the instructions".

That seems very low, my ferritin is about 80. The Gp Said it was very good. I increased My protein intake and have about 120g of protein a day. That's the only thing I've changed in the last 12 months that seems to have bought it up, it used to be much lower.