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[rabt]

Hi

I’m in perimenopause and currently take 3 pumps of oestrogel daily and Utrogestan from day 15-26 of the cycle.

I took a 50 mg estradot prior to that but tried gel to see if would help more. I’m not sure the gel is much better. I’ve been trying HRT for a year and a half and I’m no further forward. I can’t afford to go private.

I see the Dr again in September. I was trying testosterone too but my first 3 monthly blood test showed my levels were too high and the surgery called to say I’ve to stop it until I’ve spoken to the Dr.

My cycle is now around 21 days. It’s confusing as the Dr said that in spite of this I should continue Utrogestan between days 15-26 (even though there never is a day 26 now).

I have also been taking prescribed iron for 3 months due to the very heavy frequent periods. My levels were just in the normal range the Dr said but low haemoglobin.

I am at my wits end. Up until 3 years ago (I’m 53 now) I could walk the dog for 6 miles get changed and go out for a run of up to 6 miles. Now, I need a nap through the day. I was getting short of breath hence the iron tablets when walking uphill which was very unlike me.

I just need some advice as to what to say to the Dr. You can be referred to a menopause clinic here I believe but she’s not offered that so far and doesn’t seem to think it’s required and that it is about finding the right balance which I’m sure is correct. The problem is it feels like trial and error and every time three months go by and nothing much changes.

I am now a stone and a half heavier, lack motivation to exercise, night sweats for much of the month, tiredness and bloating like I’ve never experienced. On a lighter mood my mood has improved from when I initially contacted the GP but that’s maybe due to antidepressants which I’ve now reduced myself to half the initial amount.

I suppose I would like to know if I’m expecting too much. Should I just accept my fate and live with it. I’m not someone who normally accepts things without a fight but it’s getting harder. I feel like I’ve aged so much in 3 years. I noticed yesterday that the hairs on my arms have disappeared and my eyelashes which were always long are stubby. This appears to have happened recently.

Sorry for the massive rant but I guess I’m just not sure what is okay and what’s not okay anymore. If I win the lottery I will go private but at the moment it’s a wait until my 3 monthly  appointments which I find difficult as I feel like I’m being self indulgent and ungrateful when I see other people with what I consider much more debilitating conditions than my own when I go to the surgery.

Hope someone can decipher my ramblings and suggest some ideas for me. I have considered sticking on the estradot patches for a couple of weeks to see if they are better than the gel but I’m not sure if I then take Utrogestan as well. I did take 4 pumps of oestrogel for a bit but I’m sure the Dr wouldn’t have allowed this as she said no more than 3 and I didn’t feel much difference anyway. I have sumatriptan now for migraines that leave me in bed for 24 hours unable to keep water down. These have been a game changer but also another tablet to take which saddens me as I’ve never been one for taking things.

I’ll stop now. I’ve vented for Scotland. I hope someone can help xxx

[Hurdity]

Hi rabt

Sorry to hear about how you're feeling.

HRT should work for symptoms caused by hormonal changes of the menopause - at the right dose of the right type.

The lack of energy certainly will partly be due to iron deficiency, or rather low haemogolobin, as shown by your results. See how you feel after a few weeks of taking these, re energy and tiredness.

Re the weight gain - most likely to be caused by lack of motivation to exercise and tiredness though I gather some anti-depressants particularly can cause weight gain - though I'm not familiar with the different types myself. Our metabolism slows down as we age so we tend to put on weight ( fat) even when eating the same amount so maybe see if changes to your diet are needed?

Night sweats - at the right oestrogen dose these should be eliminated if oestrogen deficiency is the cause. You are on 3 pumps which is quite high though potentially you may not be absorbing. It's hard to say but if you didn't notice the difference after 4 pumps then sounds like either you're not absorbing or it's not more oestrogen that you need, though the night sweats are usually a sure sign that you do! There are other causes of sweats though...

How you feel will be partly due to where you are in menopause - what your natural cycle is doing. If it is still strong then it is more difficult to work out the right HRT  dose to use because of the hormonal fluctuations in your own cycle.

If your cycle is 21 days and you are taking hRT - not sure if this is your strong natural cyce overriding the HRT? Natural cycles get shorter in the late reproductive phase, just before peri-menopause starts ( according to the medical definition) but hormones begin to go awry before this.

Re the heavy periods - have you thought of having a Mirena coil which would drastically reduce and eventually stop the bleeding? Then you could add oestrogen at the dose required and be easier to control and you may not feel so tired?

Have you had thyroid tests done and a general broad spectrum blood tests to check everything else is functioning normally? You might have to wait 3 months for an HRT review but not for general health questions, and your GP atr your review should look at your other symptoms and arranage for other tests. It is too easy to blame everything on the menopause and important to check your overall health particularly as we age. I would certainly ask for these if they have not been done recently.

No you should not accept your fate and live with it! The medical profession should be there for us and we should not need to suffer especially not due to the menopause!

Hope this helps and gives you some ideas about what to do

Hurdity x

[bombsh3ll]

There are multiple bleed free options, nobody should be left with such heavy and/or frequent bleeding that it leads to symptomatic anaemia and the need for iron tablets!

At 53 you wouldn't be considered for the combined pill on the NHS but you could get the mirena IUS or use desogestrel or even provera if need be to shut you down.

You also have nothing to lose by getting on the waiting list for your local NHS menopause clinic.

Also given you are still having menopause symptoms, have you ever had a blood test to see if you are absorbing the transdermal estrogen?

Some women just don't absorb it very well and either need higher than usual doses or to change to oral estradiol.

[rabt]

Thank you both for your replies. I did try the mirena coil some years ago
at a previous GP practice due to the heavy bleeds. I had spotting for a couple of months and bloating and then it came out so I kind of abandoned the idea. Maybe I need to chat to my GP about it. I have been taking the iron for 3 months and I’ve been getting vitamin b injections when I can afford it but im just trying anything. I’d say I wasn’t quite as tired so maybe it’s improving. I have had to take iron for a number of years intermittently because of the heavy bleeds. My period was regularly 31 days for the last 15 years but has reduced to a regular 21 days I’d say over the last 6-12 months. I asked the GP and she said I could continue to take Utrogestan for 12 days. I’ve also had a thyroid test and it came back okay but I’ve not had that test for transdermal absorption so I will definitely ask about that too. She did refer me for a scan 3 months ago but I haven’t heard anything yet from the hospital. I called them a couple of weeks ago to chase it  and they said they weren’t doing routine scans as they were trying to deal with a backlog and at the moment were working on Februarys. I’ll be lucky I think to get a scan this year by the sounds of it. I agree that the lack of motivation and tiredness has done nothing for my weight. I was doing lots of weights up to 3 months ago and a bit of running and lots of walking but even then losing nothing. My diet is really good. I need to exercise better portion control but I’d say I’m a healthy eater (not perfect)but rarely takeaways and processed foods. I’ll go back and make some of your suggestions. It is frustrating at times. I do really appreciate you both taking the time to write back so comprehensively. It has really been helpful xx