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[Jahou]

Hi everyone. This is my first post and wondering if anyone is able to help please? I have gone into menopause at 44. I am feeling extremely depressed, can't sleep, some hot flushes. I am really panicking about the future as I have complex health problems and going into menopause is very likely to make these worse. My GP has referred me to the menopause clinic at the local hospital but I have rang today and I can't get an appointment for 4 months. I have a history of very severe endometriosis,due to 13 year diagnosis delay, so have to be careful that hrt doesn't reignite the disease. However I also have congenital scoliosis which has lead to me getting severe osteoarthritis and stenosis throughout my spine. I underwent spinal fusion surgery in 2014 and during surgery they discovered I had multiple pedicle fractures in my spine. I waited 18 months for surgery and was repeatedly fobbed off and told my pain was imagined until I paid to see a good surgeon who confirmed I did need surgery and had major spinal problems.I also have a family history of osteoporosis. Due to this I have to take hrt to maintain bone density. My GP has put me on evorel 25mg at recommendation of nurse she spoke to at the menopause clinic and given me calcium and vitamin D tablets. However the 25mg is doing nothing for low mood etc and I have done my own research and found the only everol over 50mg is recommended and licensed to prevent bone density loss. I have told my GP this but she has told me to wait til I go to the menopause clinic but I am really concerned about the resulting bone density loss whilst I wait 4 months to go to the clinic. I feel like I am between the devil and the deep blue sea. I would rather risk an endometriosis flare up than more spinal fractures so want to go onto 50mg but it doesn't seem that GP will do this. I have totally lost it today and can't stop crying. Due to the chronic underfunding in the NHS and my previous experiences of not being listened to I have no confidence that I will be properly monitored re keeping a close eye on my bone density and osteoarthritis. I can't afford to go private as I am no longer able to work full time due to severe pain (had to borrow money to go private in the past for fear of losing my job due to massive wait list delays)I just despair and I am getting nowhere. Is there anything else anyone can suggest please or anyone who has gone through similar ? I can't do high impact exercises to try to maintain bone density due to my spine. Many thanks.

[Hurdity]

Hi Jahou

 

So sorry to hear about all your health issues and to cap it all having an early menopause.

Was the endometriosis confined to your uterus? Another question - what progestogen are you being given to protect your uterus from thickening? Maybe you have a Mirena coil. If not you must have some form of progestogen as well.

Yes you are right about 50 mcg being the minimum estrogen patch dose to help protect against osteoporosis. If your endometriosis is confined to the uterus I think a Mirena coil is all that is needed (I'm not an expert!), but if you have deposits elsewhere in the body a systemic progestogen is also required ( ie transdermal - patches) or tablets - containing a progestogen as well as oestrogen.

This is what it says on this site:

Endometriosis
There is a small risk of reactivation of endometriosis with HRT use and any recurrence of symptoms should be reported. If a hysterectomy has been performed for endometriosis, the choice of HRT use thereafter should be influenced by the extent of endometriosis at the time of the operation. Since hysterectomy often causes a premature menopause, it is often advised to take HRT until the average age of the menopause; 51 years. HRT after hysterectomy usually consists of estrogen only. However, in the presence of endometriosis, estrogen may cause stimulation of residual deposits and consideration should be given to using continuous combined (estrogen plus daily progestogen) therapy, or tibolone, though little research has been done on the effect of different types and duration of therapy. Medical treatment of endometriosis often involves ovarian suppression which, along with ovarian removal, may increase the risk of osteoporosis.

I can understand the reluctance to prescribe a higher dose until you get to a menopause clinic - but I would have thought the GP should be able to give you a 50 mcg dose. In any case - even 25 mcg should not be given without additional progestogen and especially in your circumstances.

You will find a higher dose should help with mood too.

Hang in there and try not to get any more upset   

Hurdity x