56 and something needs to change

[Justwantabitofmeback]

I am 56, last period was 2 years ago. In the last 4-ish years so much has changed, I don't recognise myself anymore and I just want a bit of me back!

The weight has piled on, but this year I have lost 4.5st (still more to go) and I am feeling a bit better because of this. Insomnia and night time hot flashes are back with a vengeance (although I haven't had anymore night sweating for a couple of years, I am just waking boiling hot), not sure if it coming back is also related to weightloss. I constantly tired from broken sleep as I need to get up to cool down.

Other symptoms include REALLY not caring about much and avoiding any conflict which is a problem at work. I am also starting to avoid socialising which is making the world a bit smaller.

Something needs to improve, I have at least 6-7 years of working still and I can't keep going like this. I want more now.

I have a telephone appointment with the Dr on 30th December (impossible to get an appointment sooner) to discuss but want to be prepared to be able to advocate for myself at the appointment.

I am also worried about hair loss from HRT, my hair has never been full but has been thinning at lot over the last 4 years to the point it is embarrassing now.

Am I right in thinking NHS will/should offer oestrogen and progestogen to me as I still have a uterus or will it be oestrogen only and will I be allowed to choose if I want oral, patches or gel?

What happens if they agree I should try it? Do they do blood tests first to confirm hormone levels then regularly to check after?

Thanks for any guidance, especially from anyone who started at a similar age/stage.

Make it clear that you want HRT for your flushes / heat. If you have uterus you must have progesterone in addition to oestrogen to reduce chances of cancer of womb lining. They should offer you choice. But absorbing oestrogen through the skin is safer so try gel or patches first would be my advice. Be prepared that sometimes first choice will need some tweaking. Good luck

Oh and blood tests not needed because you are post-menopausal.

I cannot help sorry op but I always read these threads with dread as I'm late 40s and hitting this stage of my life myself and have noticed changes within myself. Anxiety is awful and I'm also avoiding social situations. periods becoming irregular, aching joints, feel massively overwhelmed with everything, my once tidy home has become an untidy cluttered mess which I hate and am struggling to cope with. finding it difficult to focus on anything. I also don't recognise myself as I was never like this. just want my old motivated self back. I really managed to keep on top of things when my dc were little and much more demanding, now they're older and almost independent I cannot seem to cope and keep on top of things. I don't know what has happened to me.

It's worth having a look at this website and perhaps downloading the app. It gives you templates for emailing your Doctor but also lots of information. I appreciate you have an appointment but it might just help you know exactly what you want from the time with your Doctor and what the guidelines state you are entitled too.

www.drlouisenewson.co.uk

Thanks @notsohot - progesterone seems to be an oral tablet (I don't fancy an IUD). I am currently prescribed privately Mounjaro/Tirzepatide injections which can impact the absorption of oral contraceptives, so I need to check with the Dr that prescribes that if it could also affect oral progesterone.

Good info about the blood tests, so they could potentially prescribe after just the phone call if they agree? If they don't do blood tests do they just go by how I am feeling to decide if it is working for me?

@ffsfindmeausername it is similar for me, the don't care feelings extend to the house - both housework and decorating/maintenance.

@pantsalot we have the full Balance+ app free through my work, I did have a quick look before and didn't find much in it, but I will revisit it again and dig a bit deeper.

HRT fixed my “Don’t care” feelings 100%; I’m interested in life again. No blood tests needed for me, although they did do them before prescribing testosterone. Many GPs are brilliant about HRT - we hear the bad stories but not the good ones so give them the benefit of the doubt for this first conversation. At your age (post 45) they can prescribe on symptoms alone. Hope it goes well.

Hrt improved my hair density, OP. It was thinning before I started and still falls out when my oestrogen is low, but it's mainly back to normal.

Body identical progesterone can be used vaginally. There is also a combined oestrogen and progestogen patch but the progestogen in that is not body identical. Some women find body identical progesterone of great benefit when taken orally. Body identical simply means chemically identical to what your own body produces.

Usually transdermal oestrogen is prescribed first and oral is only if trandermal isn't absorbing.

If you have any discomfort in vulva or vagina or urinary frequency of any sort, more frequent UTIs or thrush, then localised vaginal oestrogen in addition to your main hrt will be helpful.

You might have some bleeding when you first start.

Well done on the weight loss.

You've had a lot of great advice here so far and I also suggest you look at some medical-based websites written by doctors. Menopause Matters is good and has a complete section on HRT, types, risks etc etc. Also the British Menopause Society (their site is a bit more for professionals but the Women's Health Concern is their other site for women.)

When you talk to your doctor, I'd suggest you avoid waffle' and go straight in with

'I'd like to try HRT...because for the past 2 years I've had these symptoms [list them] that are really affecting my work and quality of life. I've done a lot of reading on medical websites and I think I'd like to try transdermal estrogen and micronised progesterone.'

Not sure why you think hrt might cause hair loss- generally it doesn't and actually makes hair better. Loss of estrogen often causes hair thinning(as experienced by older women.)

Thanks all, I have learnt or it has helped make sense of some of the confusing information I have read.

@JinglingSpringbells The hair thing was mainly from forums where some said their hair got worse on HRT, very good news if it is more likely to help.

The hair loss thing...

Some types of progesterone - like Northisterone- are called an androgenic type. This means the hormone is similar in some ways to male hormones and can cause some side effects like acne and maybe hair loss. You'll find Norethisterone in most patches and tablets.

It's individual- I used it for 6 years before swapping to Utrogestan and didn't have hair loss.

Hair loss can be caused by low iron & ferritin (often an issue in peri). stress, diet, etc.

I'm not an expert on hair but I know that the hair growth cycle is several years so the cycle could have started years ago in early peri and only becomes more obvious at the same time as starting HRT. I don't disagree that some women have hair loss on HRT but it's very rare and usually changing the dose or the progesterone helps.

thanks @JinglingSpringbells that is very useful.

I am already taking hair vitamins, including biotin, iron, B12, D and marine collagen for the last 3 months, but I am aware it will be a slow process if it is vitamin related. I was taking prescription omezraprole for acid reflux, which long term use can interfere with B12 absorption, but I have also managed to stop taking this for the first time in 7 years so that may also help.

You also need enough protein. It's really important for hair growth.

Evidently it's 1gm for each kilo of body weight.
So if someone weighs 60kgs they would need 60gms protein a day.

There are lots of tables online where you can work out how much you're getting- eg 1 chicken breast = X grams, 1 salmon fillet, an egg, 1/2pt milk, etc etc.

@JinglingSpringbells oh yes, with the weightloss this year/ongoing protein is right up there to hopefully help with muscle and hair loss, and introducing some basic strength training too!

Would love to know how long it took before the 'don't care' symptoms improved, I'm completely incapacitated by them at the moment.
I realise this will vary greatly but good to hear from others regardless

Immediately for me, well within the first couple of days anyway.

From what I can see, because I am 2 year post menopausal, if I do go on HRT with oestrogel and, I assume, continuous progesterone my periods won't return? (maybe some spotting/breakthrough bleeding in first 6 months I read)

I was speak to a ex-boss/friend today and she said she never looked at HRT because all her friends periods returned and she couldn't be bothered with that.

Am I missing something?

Sounds to me like you have it right, Just.

Next questions!

I am reading some threads on here and see some are having oestrogen via a patch (Evorel 50) AND gel sachets. Is that so they get a continuous dose through the patch and then adjust it when needed with the gel?

There seems to be a lot of complaints about a new version/style of bottle of Oestrogel not working as well and they think the formula has changed and they are thinking about trying something else? Does anyone use it and find the new one is still working for them?

I have patches and top up with gel. The patches release less as they wear out so I can have a return of symptoms on the last day before a new patch, and as I still have a cycle, when my oestrogen disappears at the end of the month.

@Apileofballyhoo could you not change the patch a day sooner? or, use gel all the time instead? I've never heard of anyone doing what you describe. if it works, fine, but is there not an easier way?

After 5 weeks of waiting for my phone call appointment reception told me I had to make, I talked to a Dr who was not expecting to be asked about HRT in a phone call.

She asked some questions, I led her in some places with all your input and reading suggestions - told her what I wanted, and she says she will talk to the Dr in the practice that deals with HRT and someone will get back to me next week.

Got to love the NHS. 😭

So that GP isn't trained enough to deal with 51% of the population- ie women?

Apparently not her specialty, all she really asked was if there was any history of breast cancer, heart disease and something else. Told her all my symptoms, what I had been reading, and exactly what I wanted to try - patches first to see if I get on with them and if not I would try the gel, micronized progesterone and topical estrogen cream for vaginal atrophy.

Sleep has been dreadful, worse than usual the last two weeks - room is freezing but spend the night cooking, then freezing, duvet off/on all night. Wore my fitbit a couple of nights and I am lucky if I am getting 4-4:30hrs of broken sleep and it is killing me. I was quite teary coming off the call as I am seriously worried about going back to work in January this knackered. Told her that too.

Being off work for the holidays has been good as I have been able to have afternoon naps which helps catch up on some sleep, but ffs this just can't go on, just bad timing now with new year coming up.

I'll be back on the phone to them on Monday after new year if they haven't come back to me by then.

I just find it a bit baffling @Justwantabitofmeback that she can't make an easy decision. And TBH it's YOUR decision. The whole point of the NICE meno guidance is that it's a mutual decision where drs listen to women and give them what they want unless there are strong medical reasons not to. This is in the first few lines of the guidance.

It's so different from the experiences many women have with private specialists. And it really ought not to be!

If you don't get anywhere and have the cash, think about investing in an appointment. Choose carefully, but you should get 45 mins of time.

There are some lovely, brilliant consultants around now who will work with you and be supportive- just like a GP should be.

It shouldn't need to be that way but that's how it seems until ALL Gps get up to speed.

Not sure why I didn't think of it before, but need to check out my company's health care plan to see if menopause is covered. It wouldn't pay for the prescription but maybe the consultation......wonder if GP would do it as a shared care arrangement and prescribe.