Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[common-lime]

Hi everyone I'm new to everything menopause-related and doing some research.

I think I've had symptoms of perimenopause for the last 3 years, but I put them down to other things - stress, mostly, especially off the back of the pandemic. It started with irritation, sometimes even feelings of rage, which wasn't like me, but that's why I thought it was stress at first. Then my periods got lighter and less painful, but who would think to complain about that! My stomach became bloated even though I'm right at the bottom end of a healthy weight, and I thought that was because I'd been stuck at home doing less exercise during lockdowns - but it didn't change when I got back to my normal level of high activity. More recently I've started really noticing a lot of cognitive issues - my formerly good memory has failed me, I get my words really mixed up and can't seem to get a sentence straight, and my mood and anxiety levels are all over the place. I'm in a completely black and hopeless mood around ovulation and incredibly anxious before my period starts, and although I've had mental health problems in the past they've never followed any pattern related to my cycle before - I've tracked both long term and there was literally zero correlation until this year. With the cognitive and mood stuff getting really wacky I finally thought of perimenopause. I'm a bit young (40 now, 37 when this all started), but I'm surrounded by menopause talk at work and it finally got through to me!

I have a history of osteopenia from anorexia when I was in my 20s, so if this is peri I am keen to take oestrogen to protect my bones. But I also had surgery for endometriosis about ten years ago, and when I was younger anything that impacted oestrogen really made it flare up (like evening primrose oil - worst month ever). If not for my bones, I'd probably have avoided oestrogen until I actually reached menopause to lessen the risk of making the endo worse, because it was absolutely debilitating before my surgery. I've got a GP appointment in but was wondering if anyone else is balancing health conditions where one might respond badly to HRT and the other needs it for treatment/prevention? It's always helpful to hear other peoples' stories!

[CLKD]

Morning.    

Which symptom would you like to ease first?  I suggest that U keep a mood/symptom/food diary to discuss with your GP/Nurse Practitioner.  There are many ways to deliver HRT .  Several ladies here have osteopenia so hopefully will be along with advice.

Well done on recovering from anorexia!  Not easy as I know.  As for feeling bloated, I could write a book 

Long story short: found that processed foods i.e. scones, buns, croissants- the types of stuff that I would go for when DH and I are out and about are now avoided completely.  We have added a lot more veg at tea time - he's the Chef as some who know me well will attest  .  In November we were away so no muesli/milk, the bloating that would begin mid morning went. Now I eat toast with butter for breakfast and in the main, my gut feels a lot better  .  Although pizza recently caused dire discfomrot  .  As we age we may become less tolerant of foods as well as alcohol  .

MayB a note of what you eat/drink 24/7 for 3-5 days and review? 

[common-lime]

Thanks for your reply! I'm a bit weird for a woman in not being interested in dealing with the bloating - with my history, food diaries and dietary changes lead to all kinds of unhealthy shenanigans. I already have a healthy diet, don't (/can't, really) drink alcohol, and I'm very active, so I'm all set there. The only symptoms I'd really like to get on top of (aside from concerns about my bones) are the cognitive and mood ones. I need my brain to work I work in health care so I'm having quite sensitive conversations with people all day, and it's a nightmare when everything's coming out jumbled up and back to front in the run up to my period!

[CLKD]

Hormone upheaval can cause all kinds of brain issues we have a 'doing stupid things' thread somewhere  and as for That Strange Woman in my House ;-)

I tend to stick to safe foods for weeks when feeling unwell, otherwise I have slowly altered my diet which has eased the bloating issues.  Which means that I feel better. 

[sheila99]

Between a rock and a hard place? It should be possible to give you enough oestrogen to control your symptoms but with sufficient progesterone to stop proliferation. You can ask for a referral to an NHS menopause clinic if you think your gp doesn't have the skills but there's often a long wait. I think you should get the bloating checked out though just to rule out anything sinister.

[bombsh3ll]

Yes, new persistent abdominal distension in an otherwise slim patient should always be evaluated including physical exam, ca125 blood test and ultrasound scan.

Assuming that has already happened, you have tons of therapeutic options.

As long as adequate progestin (and with endometriosis I would use a progestin, not micronised progesterone) is used to prevent endometrial proliferation, you can take sufficient estrogen to protect your bones and optimise your quality of life.

At 40 the best option is probably a combined pill taken continuously, ie no dummy pills or pill free days.

This will eradicate your menstrual cycle and give you back a consistent low dose of estrogen.

I take Zoely myself, which contains body identical estradiol and a really kind progestin, nomegestrol acetate.

[common-lime]

Yes, new persistent abdominal distension in an otherwise slim patient should always be evaluated including physical exam, ca125 blood test and ultrasound scan.

Assuming that has already happened, you have tons of therapeutic options.

As long as adequate progestin (and with endometriosis I would use a progestin, not micronised progesterone) is used to prevent endometrial proliferation, you can take sufficient estrogen to protect your bones and optimise your quality of life.

At 40 the best option is probably a combined pill taken continuously, ie no dummy pills or pill free days.

This will eradicate your menstrual cycle and give you back a consistent low dose of estrogen.

I take Zoely myself, which contains body identical estradiol and a really kind progestin, nomegestrol acetate.

This is interesting to me! I'm a bit of a research nerd (in a medical role at work) - do you mind explaining why you'd go for a progestin rather than micronised progesterone? That's the sort of thing I was hoping to learn

And you're right to assume, I have indeed been tested seven ways to Sunday for the bloating and other gastro issues. Ultrasound, endoscopy, every blood test imaginable...kind of annoyed my GP didn't suggest age-related hormonal shifts in fluid and fat storage at this point, coincidentally she's also the menopause specialist at my practice. I assumed it could be the endometriosis making a come back, but didn't get any pain symptoms, so stopped worrying about it once it was clearly found not to be cancer or anything else sinister.

Oh, edited to say that my GP won't go for a combined pill - it's very rare for me but I've had migraine auras in the past. This has only happened about four times in my whole life, but my surgery was unlucky enough to have a young patient have a stroke on the combined pill under these circumstances a few years back, so they are very wary! I've asked before and got nowhere.

[flo69]

Micronised progesterone is reputed to not be as effective as synthetic progestins at stopping the uterine lining from building, but I don't think there's a lot of research to back any opinion on it, either can be used. With endo the "stronger" synthetic option is normally used, it certainly has more side effects!
It's the negative side effects of progesterone/progestins that causes the problems, while apparently the positive effects of oestrogen help symptoms but also can cause an unhealthy build up in the uterus.
All the rest is to find a balance between the two and if your own progesterone is still enough, taking more can cause an excess with flu like side effects.
If your own oestrogen was working properly you'd not be getting symptoms, so I agree you need HRT for your bones.

I was also worried about my bones, I've been underweight most of my life, so when my GP turned out to be completely ignorant of HRT I was put on the gynae waiting list, back in June 2023. While I wait for my gynae appointment I take tibolone. The GP said they couldn't give me oestrogel and utrogestan like others my age get, because women can't be trusted to take both properly, it's their decision. Isn't that appalling? I wrote to the practice manager, but nothing changed. I guess it's like your GP getting scared after one patient on the pill gets a stroke, they aren't always scientific or logical about it. So I read up on tibolone and it's actually a very good option for bone health, possibly better than oestrogen and I don't need to take any progestins at all.

I was bleeding every month until November 2024, then my monthly bleed just stopped, a couple of weeks before I turned 55!
The age ranges they use are a bit too tight as well, only capturing 80% of women, so don't be afraid to call it menopause just because you're younger.

[CLKD]

flo - have U not been seen in that time?  Has an appt actually been sent to the Dept.?

[bombsh3ll]

This is interesting to me! I'm a bit of a research nerd (in a medical role at work) - do you mind explaining why you'd go for a progestin rather than micronised progesterone? That's the sort of thing I was hoping to learn

And you're right to assume, I have indeed been tested seven ways to Sunday for the bloating and other gastro issues. Ultrasound, endoscopy, every blood test imaginable...kind of annoyed my GP didn't suggest age-related hormonal shifts in fluid and fat storage at this point, coincidentally she's also the menopause specialist at my practice. I assumed it could be the endometriosis making a come back, but didn't get any pain symptoms, so stopped worrying about it once it was clearly found not to be cancer or anything else sinister.

Oh, edited to say that my GP won't go for a combined pill - it's very rare for me but I've had migraine auras in the past. This has only happened about four times in my whole life, but my surgery was unlucky enough to have a young patient have a stroke on the combined pill under these circumstances a few years back, so they are very wary! I've asked before and got nowhere.

Progestins are much more potent than micronised progesterone. None of the commonly used doses of micronised progesterone will shut down your own cycle, and it is the weakest agent for controlling endometrial proliferation, both in your uterus and any endometriosis deposits in your pelvis.

If you can't take the combined pill due to migraine with aura, (involving focal neurological symptoms not just nausea etc) which I agree with your GP is a legitimate contraindication, then you could take 2 *desogestrel 75mcg pills daily, or Slynd daily, as the progestin component to shut you down, and then add transdermal estrogen titrated to your needs via either patch or gel.

[KatyB]

Just confirming my doctor also feels utrogeston has much weaker effect on endometrium proliferation. She got me to go on Mirena coil (at 62!) to provide a full time source of progesterone locally. Might be a potential option? Definitely worth thinking of the progesterone and oestrogen elements as potentially separate rather than all in one package by the way, it frees up thinking about routes of delivery and doses. I found patches worked for me for oestrogen, and was happy with Utrogestan till the breakthrough bleeding....The emotional and cognitive stuff certainly sounds like perimenopause to me....