How much are we supposed to handle?

[ChristmasLightsLover]

I am perimenopausal. 48. Don’t want to drip feed so here’s where I am at: Mirena coil + 4 pumps estrogen + 2 progesterone every day all month round. Migraine supported by sumatriptan. Taking all the supplements inc magnesium at night. Using GLP1 successfully for 2 years and lost 7 stone a
to date. History of awful periods and adenymosis. Diagnosed ADHD in October and meds are working well for that - perimenopause meant that came to the fore quite quickly!

I have been spotting since the 23rd December. Pain. Period symptoms. Doubting myself. Struggling with decision making. Teary. Struggling to cope.

I work FT in leadership role. DS1 at uni. DS2 taking A levels. Husband. Dog. Ageing mother.

How do I figure out as to how much / how long / how intensely I am supposed to cope with life and all it throws at us?

Do I google “what does a breakdown look like”? I just can’t work out if I’m supposed to crack on with this? Or do I go for the hysterectomy which is my only other route? Or do I need anti depressants? I already do therapy once a week. What am I missing?

I am suspected adhd and peri has absolutely kicked my arse. I would describe the physical symptoms as 'not fun' but the emotional ones have ruined my career. Luckily DP can handle the bills so i only have to earn my own pocket money and i dont have elderly parents to care for as i think that would all break me. I'm too teary and tired to hold a position of authority and the biggest one is the complete loss of drive and ambition. I am happy doing grassroots jobs but this has a big impact on earnings, future plans, pension, which already took a battering from childrearing. No one prepared me for this!?

I said I’d come back with an update…

Had an ultrasound today.

My coil is in the right place. The lining is within normal limits as I just had a prolonged bleed. I have a polyp nestled in the junction at top of my cervix and where my uterus begins. Radiologist says it is irritated and bleeding, and that my uterus is contracting trying to expel it. That’s why I am having so much pain.

A private gynaecologist will remove it. Likely under general anaesthetic because of where it is. Polyps were found in my previous exploration surgery 18 months ago so there will be a conversation about how many times we should do this vs having a hysterectomy.

I’ve started sertraline as a short term measure whilst we get this figured out. She thinks my mood will be impacted by the ongoing pain, disrupted sleep, and hormonal disturbance.

NHS GP also suggested, before my ultrasound, that I consider adding more progesterone in - a mini pill - to try and control the bleeding. I am not keen but will see where I get to.

Hope that’s helpful for some of the other people in similar places and reading this thread.

@Slowdownwardtrajectory
I am sorry this has been such a shit time for you.

It is good that you don’t have the pressure around working. I earn more than DH so I need to work. But I also love my job and want to keep it going.

I think RunLyraRun said that they’d consider a hysterectomy in my shoes. I am considering that. My NHS GP is not thrilled with it. She says it’s an anchor in my body and is concerned about prolapse etc without it. I need to do more research…

And big un MN hugs to everyone who is finding this hard, and shit. I have so much privilege in being able to use my DH’s private health insurance and my own supportive employer. I am grateful for it.

4 pumps is not a massive dose. It is the maximum that NHS GP’s will prescribe. I am on the equivalent of 7 pumps prescribed privately and feel really exhausted on anything less. Some people do not absorb as well as others. It does seem strange to be on progesterone and have Mirena as I thought it was either or. Stella App do appointments through Tesco for £40. Might be worth a try if your GP is not advising you properly.

4 pumps is not a massive dose. It is the maximum that NHS GP’s will prescribe.

4 pumps is the maximum licensed dose. It is possible to deviate from this with a specialist but that may need an increase in progesterone at the same time.

The British Menopause Society guidance says that no woman should need huge doses beyond the maximum. Their advice is to try different sorts - tablets or patches or spray - rather than increase estrogen. Or look for other medical reasons why a maximum dose is not effective.

My GP told me when you take GLP and increase the dose you need to increase the oral progesterone alongside it, as your stomach is emptying more slowly it reduces the absorption of the hormone, so maybe your dosage needs to be reviewed.

I had terrible peri symptoms plus painful periods (endometriosis) and heavy bleeding. Was on HRT - estrogel and the mirena coil. They didn’t touch the sides. A scan showed a massive fibroid which was a cancer risk so I had no choice but to have a full hysterectomy, including my ovaries and cervix. I just about got away with keyhole surgery (they weren’t sure due to the size of the fibroid). Recovery was tough - and I’m quite fit and average weight- but it’s been life changingly positive. My peri symptoms have all evened out, no more periods, my mood is better, my brain fog has declined. I’m back to being me again at aged 50 with a leadership role. Don’t rule out surgery- it’s been nothing but positive for me. Good luck to you.

Oh good grief. I wrote a post here. And then realised I replied last week. That shows I’m still tired and confused! Thank you to the people who are replying and providing input. Still figuring it all out…

Like PP I would highly recommend uterine abalation for heavy periods.
Its a minor operation and omg the joy of stopping that heavy bleeding/flooding and sleeping through the night not having to dash to the loo every several times an hour because your soaked through again. And of course being so tired as you losing so much blood and disturbed sleep.
Definately ask your GP your about it and get referred to a gynaecologist.

Can I ask did ADHD symptons really kick in around menopause, i mean i know you must have always had them but did they get loads worse??
Because I have DC with autism and adhd and since menopause my concentration is really shocking I cant focus on anything so am thinking of doing right to choose to get myself assessed.

I also take 3/4 pumps of oestrogel and 100mg of utrogestan a day.
I am also taking escitalopram ssri.
Are there disadvantages to ssris with hrt??
Anyway i sympthahise OP.
I have DC with SEN , a DM with dementia and work fulltime for a boss that is not at all supportive.
I actually want to stop the world and get off
So I do sympathise its a lot to deal with.
I hope you start it starts to improve for you soon.

Sorry just seen you have a polyp you are getting removed. Thought id read the whole thread but missed that bit, ignore me about uterine abalation!

Thought I would come back and update. Gynaecologist has said I have two routes forward. One is polpys and the other stuff that is growing there removed etc removed under GA and then stop HRT for min six but more likely twelve months to see if the bleeding stops - the estrogen might be ‘feeding’ the womb lining. That would mean all of the physical and mental symptoms returning. I would not be able to work so that doesn’t feel like a route forward. The other option is hysterectomy.

I have chosen the second and will have ovaries removed at the same time so we can track estrogen in a patch as a steady state of input to titrate and add in testosterone as well.

Feels like a route forward. Am looking forward to not bleeding and being in so much pain.

If you're unsure I'd ask for a 2nd opinion.
It's incredible how different consultants suggest different things.

Good luck @ChristmasLightsLover . I'm glad you've got an ending in sight. It's awful being in pain and bleeding

I only take one progesterone daily.That sounds too high but I'm no expert.