Is it time for HRT?

[Muffinmanfromdrurylane]

Good morning all,

So I feel like I have been struggling with peri menopause symptoms for quite a while now. I'm nearly 46. I went to the GP July 2023 and had full bloods taken. These showed up low Vit D and calcium. I was advised to start taking supplements which I did. My GP also recommended starting taking the mini pill to try and regulate my cycle and hormones. Whilst initially this did seem to improve things, I just feel like I'm not me anymore. My main symptoms include:

Sleep issues - feel like I'm always half awake all through the night, then feel dreadful in the morning like I haven't slept

Joint and body aches - constantly - sore feet, like really aching, heavy legs, sore shoulders, cricky neck and back

Brian fog - forget words, what I went to do etc - this really impacts me at work, I work in education in a senior management role

Anxiety - particularly with driving or social situations. Actually avoid most social situations now and spend my weekends just recovering from the exhaustion of the week

Rage - not always but maybe a couple of times a month. Feel like I could smash things but end up sitting in my car or bathroom in tears

Low mood - yesterday just had such a down and bleak day for no apparent reason, like a black cloud over me. But I knew I'd wake up today and feel brighter

Flushes during the day and night sweats then freezing and can't regulate my temperature which keeps me awake even more

Lack of motivation to do anything

Weight gain, particularly on my arms and middle - dieting amd exercising but it is slow to come off

I know I need to build myself up for a GP visit but feel like I need to arm myself with lots of info and know what I want before I go so I'm not fobbed off with birth control or vitamins again.

Thanks for reading and any help and advice is much appreciated.

Yes. In a word. I'm 48, been on HRT for two years. Life changing. Insomnia and horrific hot flushes disappeared almost immediately.

It sounds like it would be sensible to consider HRT given that list of symptoms.
Just go to GP armed with symptoms and ask to start HRT. They should be able to start based on symptoms alone

Thanks so much for your replies. I went armed with symptoms last year and was fobbed off with blood results saying my hormone levels were fine. I now know that NICE guidelines state that a blood test isn't required and over 45 to go by symptoms so I will definitely stand firm on that. I was in such and emotional mess last year when I saw the GP that I just wasn't strong enough to push.

Is there any HRT in particular that I should be asking for or is it really just trial and error?

I would say start off with oestrogen gel because it takes a while to adjust the dose and get it to the right level for you and that's easy to do with gel (just add pump or sachet). Inthink most people get the body identical progesterone which is called utrostrogen or something like that.

HRT and maybe something for the anxiety (I went on Sertraline), push for it if you have to although you shouldn’t have to - I always joke those two things would have to be prised out of my cold, dead hands, lol - changed my life (everything you mention, I had, it was awful). I’m on Provera and Sandrena gel now - but it’s defo trial and error to get the right combo. Good luck op, there is light at the end of the tunnel.

The addition of SSRIs are only suggested when HRT has been optimised and shown not to be working for mood/anxiety. NICE guidance 2015.

GPs told then to stop using SSRIs for moods etc in menopause. Dr L Newson has a lot on her website about this and how they don't work, and how women need the right dose and type of hrt.

@Muffinmanfromdrurylane You may not know this but the use of calcium supplements is being changed/explored due to new research. Growing evidence shows it can cause blocked arteries because it's laid down in the arteries, compared to natural sources in food.

DIET should be the main source of calcium. I took calcium for years and have now stopped. You can easily get what is needed from dairy, cheese, nuts, pulses, beans, green veg, oranges, dried fruit and oily fish.

@JinglingSpringbells thanks for that information. I have got lost down a rabbit hole on Dr Newsons website this morning and made lots of notes so I don't ramble to the GP.

Interesting about the calcium supplements. I took them for about a month and the nurse repeated bloods and said calcium levels were now fine so I stopped them. I do still take vit d though. I do eat lots of dairy, green veg etc so hopefully get enough calcium through diet now.

I have suffered from low level anxiety for a while but up until a year or so ago I found it manageable. It does seem to come in waves but it would be amazing if HRT helped that a bit. The joints and physical pain along with the irritability are probably the symptoms I find the hardest to push through. I don't want to feel old and creaky in my 40s!

Interestingly, blood tests show bugger all in peri as your hormone levels only dip when you're having the symptoms. So unless they test you in the middle of a hot flush they're going to be normal.

Absolutely push for hrt. I went on HRT at 42, having gone through ovarian failure at 37 and it changed my life. Because I was considered young my GP had to refer me to a specialist and the wait was so long that I went private. £180, appointment immediately, HRT the next day, or a six month wait on the NHS. Then my prescription was transferred to the NHS and my treatment continued there.

Ah thanks for that @OneAndDon3 as far as my GP was concerned last year the blood tests were the end of it. As you say, they aren't a reliable source of info for peri. I am so glad I posted as I feel more confident going in and putting my case for Hrt forward. If I don't get anywhere, I will go private. There's a private menopause clinic locally but I've been put off booking as 2 mums from the school I work in are specialists there and after being fobbed off by my GP last year I just lost confidence and felt maybe I was being ridiculous and the GP was right and I was too young. Now I know that's not the case and will push.

Kate Muir's book "Everything you need to know about the menopause but were too afraid to ask" absolutely gave me the confidence to push for the treatment I needed. I highly recommend it to anyone struggling with accessing the treatment they want.

Well I phoned the GP surgery this morning and a GP called me back asking me to come in for bloods 🤯 I asked what the bloods were for and she was very vague. I as armed with my NICE guidelines and was basically told I had to have bloods or the Dr wouldn't see me. This Dr was calling me on behalf of the menopause trained Dr within the surgery and said she didn't really know much about the guidelines. Anyway I have been and given the bloods, the nurse also did blood pressure, height and weight and said the meno Dr would call me back later in the week.

I am not willing to be fobbed off again and actually cried with frustration when speaking to both the nurse and Dr today. Apparently in Scotland between 40 and 45 still need blood tests. I am literally 6 weeks off turning 46 ffs.

When you speak to the doctor later start your symptom list with the hot flushes.

Your list is great but it's easy for a doctor to get distracted looking for other causes if you list all the other things first.

Start with the hot flushes and then list everything else as it gets the doctor in 'this is about HRT' mode, not 'this is about diagnosing joint pains/low mood' mode

Oh gosh, OP, how frustrating for you!

When the meno doctor calls you back, tell her firmly that you are at the stage where your symptoms are making you miserable, uncomfortable and are affecting your work and that you want to try HRT. If she's woolly about it, ask if there is any clinical reason why you can't - I bet there isn't.

It's awful that we have to fight for it, it really is. I had a bit of a battle, my GP even brought her colleague in so they could both discuss it with me, but once they were sure I'd done my research they agreed.

I was back to my old self within a couple of weeks, it worked wonders.

@AnnaMagnani I never even got as far as mentioning a single symptom today but thank you for suggesting starting with flushes, I will definitely do that. Don't want sent away with anti depressants etc and I know if I waffle on she'll probably switch off and just heard me mention mood etc so great point, thank you.

@DramaAlpaca I have no underlying conditions or history of breast cancer in the family so I'm sure there aren't any real medical reasons that they can throw at me so I will definitely use your advice of saying how miserable and uncomfortable I am and how it is negatively impacting my life. It is a different doctor from the one who sent me home with the mini pill a year ago so I am keeping my fingers crossed she will prescribe hrt. If not I will have to go private which I can't really afford with 2 kids at uni as of next month but needs must and I'm not coping any more.

Skim read. Very frustrating for you. I'm 51 and went to the GP aged 49 in aug 22. Previously never anxious. And was riddled with it. My mum had died 2021. Sleepless nights started then. Periods stopped Feb 22. I always had rage (awaiting an Asd diagnosis...or not!) But it went off the scale. Weight gain actually came after hrt patches. Also was losing hair. I went to see a nurse. She said you're in the menopause. No blood tests. And was just given patches (already had coil fitted) needed upped after 3 months and seems to have calmed everything down. Seems so wrong you have to fight for this

Bloods can be to rule out other causes of symptoms. If they come back clear then that confirms peri rather than ruling out as far as I'm concerned. I know they've done bloods before, so annoying, but it was a while ago

Update

GP called this morning and said she had left a prescription for Evorel patches at the desk for me and just to pop in for them. So I have just put on my first one and have my fingers crossed this makes a difference and the patches agree with me. I've got a follow up in 4 weeks to check how I'm getting on. Thanks for giving me the confidence to phone on Monday 🙂

That's great. Well done for advocating for yourself.

You should be on progesterone as well though. Is it really just estrogen patches she's prescribed? I would be questioning that if I were you.

OP - read up about vit k2, it puts calcium in your bones rather that your arteries. Our gut microbiome is supposed to make enough to do this but modern diets are so crap it we don’t have the bacteria for it, or something like that. Good luck

@OneAndDon3 apologies it is the Evorel sequi patches. So Evorel 50 for 2 weeks then onto the conti patches.

The first step in planning HRT is to consult your healthcare provider. This way you will be examined and assessed according to your lifestyle, health status, and underlying health conditions. This way you will have a tailored medication.

I decided the time had come earlier this week.

My symptoms are not horrendous but my DH had had words with me about levels of rage and irritation on a couple of occasions lately - i I didn't think it was too bad but he assured me I was over the line from annoyance into rage.

My periods have been like clock work - 27 days - since I was 14 - but this month no period has turned up yet - and I'm on CD 45 - just a tad ny bit of spotting last week.

Definitely not pregnant (see "rage" above🤣) and anyway at almost 50 I am too old.

I phoned up, got sent a simple questionnaire and some info/videos and then have a phone appointment in a couple of weeks.

The receptionist said that if you are over 45, have some of the symptoms in the questionnaire then you'll definitely be prescribed HRT - the phone appointment is to talk through the options in terms of types etc.

It's been super easy - I don't think I will even need to physically go to the doctors.