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[pineneedles]

Hello everyone,

I am just about to turn 43 and have been confirmed as having had an 'early menopause' although it is a bit hard to tell exactly when it happened... Here is my potted history.

Was on mini-pill for 15 years so wasn't really having any periods during that time.

In the last 5 years or so started to suffer with vague symptoms, main ones being vaginal dryness and pain, low libido, night sweats, heart palpitations. Took me a while to think about menopause being the potential cause of those because of my age, and then took a further while to get referred to a menopause clinic.

First saw the menopause clinic gynaecologist in November 2024 and based on symptoms was prescribed HRT (Evorel 50 patch twice weekly + Utrogen 100mg 12 days per month). That has improved some symptoms but not all.

At follow-up appointment with menopause clinic nurse this week, discussed symptoms again and had a blood test which confirmed oestradiol levels were too low (124 pmol/L), so she has recommended an increase to Evorel 75.

Main symptoms at the moment are general lethargy/fatigue, joint pain, brain fog and forgetfulness, mood swings and low libido, lack of concentration and interest in work... Since March this year I have also had internal tremor/buzzing in the torso in the early hours almost every morning. Neither GP nor menopause clinic seems to think that is a menopause symptom, but I know I have seen it mentioned by others here and elsewhere... so will be interested in seeing whether increasing the HRT dose makes a difference to it. Also waiting for a 24-hr ECG to see if that spots anything of interest, all blood tests etc so far have come up normal.

I also have suspected arthritis in hands and feet so that is being investigated.

And over the last few years I have also had intermittent pelvic pain which is finally being investigated and could be endometriosis.

Initially I put on a bit of weight on the HRT but have now managed to lose that over the last three months and am back at a healthy weight (BMI 23.5) and a diet I'm happy with (lowish-carb mediterranean). Have given up coffee (replacing with decaf) and alcohol (by and large), drinking plenty of water. Something in these dietary changes has made a big difference to reducing the recurrence of the pelvic pain, but I haven't been methodical enough yet to identify the triggers.

Anyway, since it seems I am on the HRT journey for the long run to protect bone and heart health, I thought I would join here to discuss and keep track of ongoing diagnoses and what works! Looking forward to being a part of the forum.

[CLKD]

 

[Wrensong]

Hello pineneedles &    Thank you for including your history, it all helps us get a picture of how things are for you & with luck reduces the number of questions you may have to answer as a newbie!

Sorry to know you are having so many symptoms at such a young age, but it's good that you are now being treated by a menopause clinic.  With luck you will see a further reduction in symptoms with the increased oestrogen dose. 

I hope no endometriosis is found, but there are women on here who do have it should you need to talk about that in future.  To my surprise, I was found to have a minor degree of it on hysterectomy in my 60s but have no prior history of managing it, so others will be far more knowledgeable than me.

You're right that internal tremors are reported by many women on here & it's not unusual to find clinicians have no knowledge of one symptom or other when it comes to menopause!

If testosterone has not been mentioned, as you have low libido it would be well worth discussing with your specialist.  It can be helpful for quite a range of symptoms, but currently is usually only considered for this indication.  Have a read around & if you have any concerns or questions lots of us on here have taken it.

Have given up coffee (replacing with decaf) and alcohol (by and large), drinking plenty of water. Something in these dietary changes has made a big difference to reducing the recurrence of the pelvic pain

I wonder is it possible the pelvic pain stems from the bladder, as these 3 measures often help reduce the GU irritation we are prone to as hormone levels decrease.

You also mention vaginal dryness & pain.  Many of us find we need local (vaginal) oestrogen replacement to help manage GU symptoms (inc bladder), even some of us on systemic HRT, me included.  I would mention this to either your GP or menopause clinic.

Many of us are also referred for cardiac evaluation at menopause, palpitations being quite a common symptom that can be very unnerving at first.  Usually no abnormality is found so please don't worry about the pending ECG.  Always sensible to have things checked out though for our peace of mind.

Hopefully others will be along to welcome you later.

W x

[bombsh3ll]

My concern is your young age and the subtherapeutic estradiol level that has been achieved so far.

I wouldn't personally consider a 50mcg patch an appropriate starting dose in POI/early menopause, and as you only achieved 124 pmol/L on this it is extremely unlikely that 75mcg will improve on this significantly.

The first priority would be achieving a therapeutic estradiol level to prevent osteoporosis and cardiometabolic changes. I would consider this to be 400pmol/L although NHS literature cites 250pmol/L and Professor Studd 300pmol/L as the minimal level to protect bone. Resolution of all hypoestrogenic symptoms, especially in younger women, may require higher.

You should also have been referred for a DEXA scan.

Regarding the internal buzzing/tremors, as estrogen is known to affect nerve endings, it is difficult to understand how "formication" (feeling like ants crawling on the skin) can be widely accepted by clinicians as a hypoestrogenic manifestation, yet the symptoms you describe dismissed as unrelated.

The only way to know for sure if a symptom is due to menopause is to adequately replace the missing hormones, all three of them, and see if it goes away.

I second the comment about testosterone, we have androgen receptors in pretty much every tissue and its lack can really do a number on our health and quality of life in many ways, although you will have to say it is for low libido to get it on the NHS.

[Wrensong]

When women on here mention the internal buzzing/tremors I've often wondered if what they were experiencing was a deep (non-visible) manifestation of benign fasciculations (BFS) - random muscle twitches that often occur at rest.  I've had the latter for a couple of decades, in hindsight probably coinciding with onset of perimenopause, checked out by neurology at the start & attributed to BFS.  Sometimes they are an isolated twitch, but often come in rapid succession in which case they can feel more like vibration.  Many women on here also report fasciculations. 

This is what Dr Newson has to say about "internal tremors":-

https://www.drlouisenewson.co.uk/knowledge/internal-tremors-and-menopause-what-you-need-to-know

I agree with the comment about the importance of DEXA scanning.

[pineneedles]

Thank you so much for the welcome, and for the kind comments and advice.

I was writing in a rush yesterday and forgot to mention a couple of other things in my history which may be relevant.

I started menstruation very early (age 9!). Absolutely hated it then and all the years afterwards, too. I had bad period pain, totally unable to function without a lot of ibuprofen. So it was a huge relief to finally get suitable hormonal contraceptives in my 20s and not have periods. (Having to have progesterone bleeds on HRT has been a bit of a disappointment! Especially since I cannot now use a mooncup or tampons like I used to because it is too uncomfortable, so back on the old pads, which feel bulky and messy. But hey ho. I get cramping but nothing like as intense as I used to.)

I also don't have children (out of choice).

I understand both are possible factors in making early menopause more likely.

I have a family history of DVT (mother, when she was in her 40s) so that rules out some forms of hormones, I believe, but patches are considered safe?

At the most recent menopause clinic visit, I have also been referred for a bone density scan.

The pelvic pain - from what I am reading it seems similar to what is described as 'Protaglia fugax' - a cramping pain across the whole pelvic floor from tailbone to pubic bone, sometimes quite intense but comes on gradually and the lasts about 10-15 minutes. So I don't think it is bladder-related, and I have luckily not had any bladder issues so far. Pleased that whatever I am doing right with the diet is helping, though.

And yes, I had seen that Dr Newson blog about internal tremors and mentioned it during the recent consultation but I felt like there was a bit of a roll of the eyes ... is she not considered an authoritative source? Or is it just general contempt for people doing too much of their own research? 

Thank you, I am a little concerned now that even the higher dose patch won't be enough. My next menopause clinic appointment isn't until January but could raise this question (and possibly the testosterone) with the GP in the meantime. My other hormone levels came up as:
Free Androgen 0.9
SHBG 97.4
Testosterone 0.9
Which all seem to be within the reference range given on the report, but I would appreciate any insight on these numbers.

Thanks again!

[bombsh3ll]

There are multiple bleed free options even if you can't take the combined pill - however a DVT in a family member isn't an absolute contraindication especially if provoked.

You could use a mirena IUS or take a continuous oral progestin such as desogestrel 150mcg or slynd alongside your estrogen.

Nobody needs to suffer from unwanted menstrual or withdrawal bleeding.
.
If your periods have ceased naturally, you could simply take your existing micronised progesterone continuously instead of sequentially.

The treatment regime should basically meet your needs, not you meeting its needs by having to spend every 4th week bleeding.

Your testosterone is within normal limits but on the low side and personally I would want it higher.

SHBG is on the high side - androgen replacement can also bring this down.

[Kathleen]

Hello pineneedles and welcome to the forum.


I am amazed that some medics are unaware that internal tremors are a menopausal symptom. I first read about them in a book written by an MD and published in 1994!

Wishing you well and take care.


K.

[Wrensong]

Pineneedles I'm glad to know about the referral for DEXA.

Thank you, I am a little concerned now that even the higher dose patch won't be enough.

Please don't worry about that at this v early stage in treatment - there are lots of options for the future.  You could go beyond a 75mcg patch if need be or swap to a different transdermal method if that's your preference.  Or potentially combine patch with gel if need be.  I would see whether your GP will test your oestradiol after a while on the 75mcg patch rather than wait until Jan for the menopause clinic appt. I'd hope she'd feel able to do this with a view to achieving optimal levels to safeguard bone health even if your symptoms improve on the higher dose.

Re the suspected proctalgia fugax, I wonder whether menopause related changes to the pelvic floor might be involved.  Again, quite common to develop pelvic floor issues as hormones decline.  Perhaps another thing to raise with GP or menopause clinic if a degree of pain persists & you haven't already.  Some of us benefit from input from a specially trained "Women's" Physio on maintaining pelvic floor health at & beyond menopause.  Or your GP may think Colorectal referral for specialist opinion worthwhile.  Hopefully the improvement will continue & you'll not need to take it further.

Can't comment on the eye roll except to say I'm sorry you had to put up with that.  Whatever was behind it, it's not likely to put patients at ease.
Wx

[pineneedles]

There are multiple bleed free options even if you can't take the combined pill - however a DVT in a family member isn't an absolute contraindication especially if provoked.

You could use a mirena IUS or take a continuous oral progestin such as desogestrel 150mcg or slynd alongside your estrogen.

Nobody needs to suffer from unwanted menstrual or withdrawal bleeding.
.
If your periods have ceased naturally, you could simply take your existing micronised progesterone continuously instead of sequentially.

The treatment regime should basically meet your needs, not you meeting its needs by having to spend every 4th week bleeding.

Oh! This is so useful to know. No one told me I could have just continued to take desogestrel which I had been using for contraception for so many years and continue to not have bleeds. Presumably it also works as contraceptive, unlike the 12-day progesterone regime? I will ask about this.

I think my natural periods have stopped but not 100% sure because they were being suppressed by the contraceptives. I stopped the mini-pill in April 2024 (just to see if periods would come back because by then I suspected I had menopause symptoms) and had no bleeds by the time I went to the menopause clinic eight months later. Since then, only the progesterone bleeds.

Thank you again all for the advice! And I will ask GP if can have another hormone test after a couple of months on the higher dose patch.

[bombsh3ll]

Just to clarify, if you are taking one desogestrel tablet daily, you do need to still take micronised progesterone although you can take this continuously if you prefer not to bleed.

Or you can take two desogestrel tablets daily ie 150mcg and no micronised progesterone.

The latter is off label so may not be supported by your NHS prescriber, although is perfectly safe, supported by the British menopause society and increasingly used by specialists.

If need be you can get one desogestrel daily from the NHS for "contraception" and buy additional supplies from a pharmacy in order to take 2 daily.