What to expect from this GP appointment?

[BreakfastOfChampignons]

Apologies for the length!

Since late 2024...
Irregular periods
Bleeding between periods
Shortened cycle lengths
Missed periods
Massive mood fluctuations, mood drops off a cliff around 2 days before a period.
Increased impulsivity
Anxiety (non specific and never experienced before)
Hair loss
Poor sleep/insomnia/fatigue
Joint/muscle aches (approx 7d duration around each period)
Left sided low abdo/pelvic pain - sharp/stabbing
Vaginal dryness
Zero libido
No abnormal discharge

May 2025 - private GP consultation via video. Very thorough, referred back to own GP for investigations. Told to expect bloods, scans, probably under 2 week wait pathway but they felt pointed towards maybe early perimenopause

June - seen GP at own surgery. Didn't feel particularly heard, quickly dismissed idea of perimenopause but did refer for various bloods and pelvic ultrasound

Bloods - HbA1c, calcium, liver function, creatinine, electrolytes, full blood count, ferritin, B12, folate, TSH, coeliac screen - all normal range. Only abnormal result was slightly low vit D and advice to supplement. No hormonal panels or anything.

July - Scan - normal anatomy, mirena coil correctly positioned

I finally have a follow up GP appointment next week and am wondering what I should expect to happen next. I have managed to get an appointment with a GP I have found to be very proactive in the past, and she specialises in women's health. I am aware I'm feeling particularly exhausted and worn down, and not advocating for myself as well as I normally would right now though, and will probably just sit and cry and achieve nothing. But I cannot carry on as I am for much longer (currently on the 3rd bleed this month already!) and the emotional side of things is really taking its toll day to day now.

Any advice, guidance or insight gratefully received and with thanks.

How old are you @BreakfastOfChampignons
its Does sound suspiciously like perimenopause/menopause?
I’m glad all your bloods/scabs came back clear!

scans…… 🙄

You’re still having all that irregular bleeding with a mirena? How long have you had it? How old are you?

Coil has been in for 4 years. Bleeding is all over the bloody place (excuse the pun), I have been keeping a record to take with me to the appointment. It's not particularly heavy, probably because of the coil and partly maybe due to skewed perception, my periods used to be debilitatingly heavy pre coil. But they are now heavier than they were before all this nonsense started.

I'm mid 30s. Previous GP I saw dismissed perimenopause pretty much immediately on the basis that I wasn't having hot flushes 🤨

I read your list and immediately thought perimenopause.

What do you want from the appointment OP? What are your treatment goals? Both short and long-term.

It'd getting up to 4 years for the mirena, so I would look at a new one. The newer ones are licensed for 8 years now for contraception but 5 years for heavy bleeding etc, I'd get a new one soon. For the bleeding between periods ask for tranexamic acid to take it is very good at reducing bleeding, so GP should definitely prescribe.

Make sure for the appointment you take paracetamol and ibuprofen 1h before, get licodaine into the cervix, numbing gel and it correctly positioned.

Also ask for NSAIDs (reduce pain and inflammation) such mefenamic acid and naproxen. You need to start taking NSAIDs days before your period starts so that it can work at best capacity. That will help a lot. You must take it with food and omeprazole.

For the vaginal dryness, ask for low dose topical oestrogen. Then also look at getting your vit D up.

I would say I think you have PCOS, with the hair loss (can happen as well as hair growth), the issues with Irregular periods despite the mirena, the missed or shorter periods etc. To get diagnosed with it you only need 2 of the 3 symptoms. So lots of small follicles etc - they should have seen on ultrasounds, so rule that out. Then Irregular periods, missed periods and shorter ones, which you have. Then certain hormones being higher and others lower.
I'd ask your GP to do:Hirutism PCOS blood panel
• Total testosterone
• Sex Hormone Binding Globulin
• Free Androgen index
• Fasting glucose + insulin
• Lipid panel (cholesterol, triglycerides)
• Vitamin D
• Thyroid panel (TSH, free T4)

@TheLivelyViper thank you.

What do i want to achieve? Mainly to stop feeling the way I am mentally/emotionally. This month has been particularly bad in that respect. I can handle everything else, the bleeding isn't that heavy (but heavier than it used to be), but there are times where i honestly think I'm losing my mind.

I've had scans in the past to ix heavy periods and have always been amazed never to have had PCOS mentioned.

Coil fitting isn't the easiest so will make sure I get a referral for that. My GP surgery dont do them and the local sexual health service won't do it because of a totally unrelated health condition so I have to have it done by gynae in a hospital, so will get the ball rolling on a re-referral for that as there will be a wait

I would have blood tests done to check your thyroid levels because not all GPs are u to speed. Your list of symptoms could suggest a problem with the thyroid gland.

Yes I'd definitely get on with Tranexamic acid, it stops both heavy bleeding but also bleeding which is spotting throughout. I'd get on that referral for a new coil as well, so that hopefully it's not too long, better to start the process now and make sure it's down well. I'd definitely ask your GP about starting a low dose of vaginal oestrogen as well to help with the vaginal dryness and low libido. Also ask them to prescribe an NSAID like mefenamic acid, perhaps only for your period but when you have ant extra pain to help.

Then get a good vitamin D and vitamin B6 supplement, to help with the emotional side and cognitive/brain fog issues, ask the pharmacist etc for a decently priced ones but still medium to high dose. I think you could also have PMDD, I would look into starting an antidepressant from once you've ovulated to when your period starts.

Then bring up those list of blood tests I mentioned earlier to the GP, I'd get all of those ones done and then see if you meet the criteria for PCOS with them, as you do for Irregular, shorter and missed periods, but need 1 more to get a diagnosis (you likely don't have the lots of small follicles etc as they'd spot that on a transvaginal ultrasound so it would be the Hormones). From there if you do have it, there are medications for the hair loss issues as well.

What day is your GP appointment?

https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/getting-a-pmdd-diagnosis

https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/treatment-for-pmdd

https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd

Thank you so much for taking the time to share all that info, I really appreciate it.

Appointment is Thursday morning.

Can PMDD start out of nowhere? I've never experienced anything even remotely close to how I've been over the last 9-12 months. I think the mental/emotional aspect is particularly tough because I try and outwardly carry on as normal, I probably need to make some allowances for myself.

To be honest I dont really care what it is, we're done having kids so zero concerns about fertility or anything, I'd just like to know and to do something about it!

Getting a PMDD diagnosis tends to be more persistent as diaries shoeing symptoms across lots of months and years, sort of thing. I'd say for now, I'd focus on the vitamin D and B6 (perhaps some iron due to the intermittent bleeding) to help with moods, vaginal oestrogen, if you do have PCOS meds for the hair issues, a coil and tranexamic acid because bleeding so frequently is also mentally hard. Then after a few months of that and being consistent see how it is.

Yes I completely understand the just wanting to deal with treatment, and it will require a group of different things most likely. Maybe see if you can make the appointment a double appointment so you have enough time to go through everything.

Hey I was wondering how your appointment went? Did you make any progress, get some meds prescribed and scans booked?

@TheLivelyViper thank you for asking, the appointment went well I think, I definitely felt heard this time round. GP was very reassuring that this is just the start of a process and that I won't be left floundering.

We went through all previous blood/scan results and she thinks either PMDD or perimenopause. I've been started on cerazette and am due to go back in 8 weeks. I started it straight away (Thurs) and I feel like all I've done is cry since, and already started bleeding again. It's going to be a fun couple of months I think! GP mentioned various future potentials including more bloods, other HRT medications and cyclic SSRIs, depending on how things go.

Hair loss and joint and muscle pain can be attributed to low vit D - has it improved since supplements? If not it’s worth mentioning.

But I agree you need to decide what you’d like. Go with that in mind and take it from there.

Although in my experience if gynae issues Gaps who specialise in woman’s health are the least helpful!

It took a young male locum to be horrified at my experience to get a referral which led to a hysterectomy for adenomyosis.

Been on the vit D for a month and no changes as yet. I was only very slightly out of the reference range when tested, and was within l ref range last time it was tested about 9 months before (and all the times prior to that) so I'm not drastically or chronically deficient. The joint pain is also in sync with my periods.

I’m 45 and peri and could have written your post! I have started taking a raft of supplements and I had my menopause appointment with specialist gp she said that it would help massively here is what I take :
collagen
biotin
d2+K
iron
b12
zinc* she added this in
magnesium
ashwanganda

I got mine from nutrition geeks and 100% worth the investment if you have the money - I think I spent £50 for 6months supply

ita Not been life changing but helps

good luck op. It’s awful being chronically ill and all you do is hope to get better

Thanks @cinnamonbunlover, I'm so fed up with feeling the way I do. I'm currently taking my usual vegan A-Z multi vit with omega 3, vegan D3, magnesium, vit B complex, then the cerazette and my usual daily medications. Between the mood swings, random anxiety over absolutely nothing, lack of sleep and trying to be a functioning adult and parent, I feel like im losing the plot!

Just wondering how things are going? Have you and your GP made any progress?

I started HRT and supplements in August and improvement and honestly though I was having a burnout/ breakdown because I felt so unwell all the time and have now been prescribed Sertraline Antidepressants and 4 weeks on a feel like a new person and my old self after two years of fatigue, illness and poor wellbeing. The physical aymlroms
of depression where overwhelming more significant that the emotional/ psychological

I have been on the cerazette for just over 2 weeks and feel like a different person. The biggest change is that my mind is much calmer and clearer. No anxiety, I'm getting proper, solid periods of sleep too. No bleeding either. Only a couple of weeks in so time will tell, but feeling much more stable mood wise at the moment too.

I'm so glad it's been getting better, all those things sleep etc are so important to just have a better day-to-day quality of life. Yes time will tell but for now all sounds amazing. If things change definitely go back, as there always options with new meds, different dosages, types of pills (e.g triphasel so dose increases/decreases at certain point etc).

Thank you, I was told in no uncertain terms by the GP to go for the follow up appointment regardless of any improvement, so I'm not entirely sure what her plan is (if anything!). I guess I can just carry on as I am without needing any formal diagnosis of anything? Clearly there's something hormonal going on, but as I have zero care or concern about fertility, does it matter, if things stay on the current improved trajectory? Osteoporosis risk factors maybe?

There aren't too many risk factors atm especially for short-term use. I think it's just key to have it in the back of your mind and check in with it, especially if there are any changes.
But it would be good to ask at the follow-up if there's anything she thinks to be on the look out for, to check for things like that.

You can always ask if she thinks there is a set formal diagnosis but it's likely a mix of peri and PMDD, but it wouldn't hurt to have a more set diagnosis to help with any further issues. But the improved trajectory is the most key for your day-to-day.