Advice please - HRT or not?

[neverbeentherebefore]

Hi, I would really appreciate some advice from people who went through similar experience before.

I'm nearly 48 and was never aware that perimenopause could be within sight. I've been through an extremely difficult 6 months, mentally and physically challenged to beyond what I could bear. I tried to put things together and suspect it's to do with perimenopause but I'm still unsure.

I've begged the GP to provide some help due to constant suicidal thoughts and immense sadness which I couldn't shake off in the past many months. GP has agreed to prescribe HRT for me to try for 3 weeks. But she's very reluctant due to risk of breast cancer and others. So she will see me after the 3 weeks and if I didn't find any improvement, she will put me on anti-depressant instead of HRT.

Then let me give a bit background information about my situation:

1. Have subclinic hypothyroidism for many years but I was unaware as GP has never shared this piece of information to me until I installed the NHS app and saw the results directly. Since it's subclinic, GP has been reluctant to prescribe treatment.
2. I had an episode of cancer scare last year. It started from investigating my heavy period which was ongoing since my period returned after postnatal. It turned out to be thickened endometrium and before the biopsie result came out clear. Then mirena coil was planted last April. Since then I have been bleeding 25 out of 30 days until this month. Still unsure if it's really settled.
3. Have been very unhappy for maybe 3 years. When DC2 was born, I was already 42. I was very happy for his arrival. But from his toddler years, I really got stressed out due to various reasons and had been really moody, tearful and shouty to everyone. I have been really unhappy with my husband too. In my eyes, he's not been supportive or understanding of my stress enough. I've been the only person to shoulder the chores and all the to-do-list of the entire family without being recognised. He seemed to think he's done his part and he's spent all his disposable energy for work (WFH 4/5 but high earner senior job). We hit a really rocky patch last October and I proposed counselling but he refused on the ground that he believed nothing will change. I almost wanted to move out until decided it's not practical and out of fear. I thought I still loved him and was torn by the fact he ignored all these and just let it fall apart. It was a very dark winter... Many many many times, I was crying behind them and sometimes broke down in front of the kids, but nothing changed his mind. -- I'm giving all these details because I can't decide if it's me being moody resulting in my suicidal thoughts or it's to do with the situation itself. In the past few months, I felt I was living outside my own life. I couldn't recognise my life and I didn't feel life is real anymore. I felt no joy and couldn't find anything to make me happy. Before Easter, I finally reached peace with my marriage and gave up the thoughts to change his mind or crave his approval. I accepted I shall face my own path and take care of myself. But still, that feeling of not living my life is scary.

My blood test result:
TSH: 4.64 and 5.82
T4: 12 and 11.8
Serum FSH: 25.8 IU/L (10.4 back in March 2024)
Serum oestradiol: 102 pmol/L. (461 back in March 2024)

GP is also willing to prescribe low dosage of levothyroxine for me to try. The only thing I'm unsure is if my mental state is to do with hormone change/perimenopause. Shall I give HRT a try? I don't want to be on anti-depressant though.

Plus, since I find my peace with the situation, I feel a bit improvement with my mood. I now know where I shall position myself in front of my husband (entirely neutral without any desire for pleasing anymore). I found I almost could find some joy in day-to-day life again. But then, I'm unsure if this is just temporary due to hormone fluctuation.

Any comments or advice please? I'm heading to Boots to collect the HRT gel in a moment.

When I was weighing it all up - my very helpful doctor said that it doesn’t have to be permanent- just try it for a few months and see if it helps.

The breast cancer risk has been debunked. Don’t know why GPs are not up to date with this fact. The WHI study was hugely flawed. (And was done with old the old forms of HRT and in much older women - ave age 63)

The new forms of HRT are very safe. For most women the official guidelines state the the benefits outweigh the risk. You can start on a very low dose too and increase if needed.

Your GP sounds terrible though. It will most likely take longer than 3 weeks to see any benefit (some feel better straight away but not all). Can you ask to see another doctor? Do you have a menopause specialist at your GP practice? Trying it for 3 weeks then running out seems like a bad plan.

@Delatron , Thank you. Really appreciate your comments. I did feel she's a bit less than sympathetic than last time when I broke down in tear admitting that I had suicidal thoughts. But during this appointment, she didn't intend to pick up on that until I pushed so to have HRT prescribed. I also mentioned the time required for this to work but she dismissed by sticking with the plan. The gel was only made ready today at the pharmacy and it will be less than 3 weeks before the next appointment.

I will try to delay the appointment till 4 weeks from today. If it fails, I will just tell her that I do feel improvement and want to carry on. That way, I can always stop if I decide there's truly no effect.

Yes good plan! I do hope it helps you and you start to feel better soon.

So sorry you have been struggling OP, l think your plan to put yourself and children first and to stop trying to please your unsupportive husband is a sensible one. Concentrate on your needs first!
Definitely give hrt a try, as a pp mentioned the risk of cancer risk is tiny and the health benefits of hrt by far outweigh it.
Do tell the GP you think it's helping as you need to give yourself a chance to feel better before she takes you off it too soon! Sometimes the oestrogen dose need tweaking too as one size does not fit all, it can depend on how much you need. I agree your GP sounds awful, try to see another Dr if possible. Sadly a lot of GPS are not clued up on hrt. Wishing you luck and really hoping this helps you physically and mentally.

Sounds like you’ve had an awful time of it. Knowledge is power when it comes to menopause - some GPs know v little as it didn’t feature in their training. You need to do a little bit of swatting up before you go - the Dr Louise Newson podcasts are great place to start and some cover mental health and menopause. Also read the NICE guidance so you’re clued up.

Take a look at the Balance website which also has some articles on how to have the conversation with your GP. Is there a friend you could take for support? Or write stuff down before you go? It really grinds my gears when this stuff isn’t taken seriously. It’s not just about awful symptoms now, but also protecting your future health.

You want facts and evidence based info - there is a lot of woo out there too!

The coil has no progesterone in it - it’s synthetic. Some get on great with it but some don’t and it doesn’t have the same properties as body identical progesterone. Also a factor to consider. I’m going to dig out some links and spam them below to get you started.

podcasts.apple.com/gb/podcast/the-dr-louise-newson-podcast/id1459614845?i=1000691006714

Jeezo, get a new GP, she sounds awful! Things are often trial and error to get a mix of things that work for you as an individual. That might involve HRT, maybe A-Ds, maybe other things. Your GP sounds very lacking in menopause knowledge - I asked to see a specialist meno doctor and it made all the difference. I felt heard, and helped. (I’m on HRT and Sertraline - game changer).

menopause and mental health:

https://podcasts.apple.com/gb/podcast/the-dr-louise-newson-podcast/id1459614845?i=1000654759670

Read the advisory notes on this one first in case you feel the time isn’t right for a listen:

https://podcasts.apple.com/gb/podcast/the-dr-louise-newson-podcast/id1459614845?i=1000658552992

How to talk to your GP about HRT:

https://www.drlouisenewson.co.uk/knowledge/how-to-talk-to-your-doctor-about-hrt---and-get-results#:~:text='Show%20them%20your%20health%20report,want%2C'%20says%20Dr%20Louise.

Also have a look for Dr Nighat on YouTube or instagram. Good luck!

@Pheckwittageisms Can't appreciate enough. I also didn't know the coil doesn't have progesterone in it. I thought that there was some sort of imbalance before the extra estrogen intake from the gel. Will spend some time looking into all the resources myself. Thank you.

@Purplecatshopaholic I probably should see a specialist - do you think the GP would write up a referral? Apparently I have health insurance from work but haven't tried so far.

@neverbeentherebefore, I asked my GP for a referral - she was happy to do so but I would not have taken no for an answer, lol. If I had known how long it would take (over two years, but covid got in the way), I would have gone private right away though. If you have private healthcare defo look into that. I have largely got my mental and physical health back now, and I was in a really bad place before.

Do you have another gp at your surgery who is more interested in women’s health. I find it completely different talking to her, she asks the right questions about symptoms, offers advice, listens and we agree together what to try next. It is a pain if I need an appointment when she is not available, and I will wait longer for one if I can.

If you have private healthcare, check the policy and see how you need to be referred. My aren't has private and I just ring up and say I need a referral for xyz and they organise the letter. Then I call the insurance company and they give me their list of approved consultants.

Definitely go private if you have it, your GP seems uninformed. HRT has been a revelation to me. (progesterone capsule and oestrogen spray). I am fortunate my GP Practice has meno specialist nurses. I was told you need to take HRT for at least three months. I did have thyroid checks first to rule out any issues there.

I'm not on HRT yet but I've been recently diagnosed hypothyroid and my understanding is that some people can have symptoms at your TSH levels. A colleague who has had it for many years says she aims for TSH of about 1. It might be worth considering trying Levo -the Thyroid forum on Health Unlocked can be good for advice. I was also told to get a full vitamin panel. I hope you feel better soon.

Both of those things cause a myriad of overlapping symptoms. While I would advocate for treating both, if you’re worried about the HRT then start with thyroxine first. Give it a good few weeks to kick in and settle down before you add the HRT.

Your body is missing hormones that help regulate everything from metabolism, mood, skin and hair health, memory and so much more.

Treating the deficiency of both thyroid and sex hormones could make a huge difference to your quality of life. For me that made the small increased risk of cancer well worth it. I also learned that being overweight (which I am) increased my risk much more than HRT would, so I put it into perspective and feel like a new woman several years down the line.

For some current info on menopause please watch the Davina McCall documentary. She changed the way menopause care is handled by the NHS almost overnight. It seems your GP needs some training.

Agree about the TSH. Mine is near zero at all times or I feel awful.

At 4-5 I would be in a huge amount of pain and barely functioning.

Mine was 200 when I was diagnosed, so my thyroid produces virtually no hormone by itself, so having a TSH of anything above 0.5 is pointless - asking my body to make more of a hormone it’s incapable of producing just leaves me feeling terrible.

In other countries they aim for under 2. The NHS considers under 5 to be ok and if you’re 5-10 they’ll often watch and wait, leaving patients in horrendous pain to see if it fluctuates (which it may well do, but if they treated based on symptoms and taught patients to understand their own bodies like diabetics do, they could adjust the medication as needed).