Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: ElleJay888 on July 22, 2022, 01:51:51 PM
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Hi there,
My name is Lynsey and I'm 42, single, childless and was told this week I've begun early menopause.
In my mind I'm still 25 but in reproductive terms, I'm apparently 47-50. I naively thought my choice to be in a relationship and/or have kids would continue until I wanted to do something. Now I'm so stunned by what my GP has told me, I can't form a single coherent stream of questions to ask about what I can expect.
If you were in my shoes (pretty sure many have been), what would you have wanted someone to tell you? What experience can you pass onto me that might've helped you deal with a new diagnosis of perimenopause/POI?
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Hi! :welcomemm:
My Mum was upfront about periods, to the point that school friends (1960s) would ask me questions to get the answers from her. What no one told me about those upcoming years was the mess; excruciating pain; nausea; dizziness ........... she told me not to ask questions of elderly relatives about hairy chins, "You'll know about that when you get there it's The Change."
Yep. Two words. Too far away from when my periods eventually began to wax and wane to be bothered with.
What do I wish - for myself, that I would get more bolshie to the point of eventually not taking crap from any1. That friends would come and go - how I remember how important it was to be part of the crowd. A form of security I suppose? What I knew about The Change was that periods would stop. For me it couldn't arrive soon enough. There might have been a few hot flushes :-\
I wish that GPs had been more educated, ready for us!
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Hi - It can come as a shock...
I don't have kids either and have never wanted them. But there is something about not being ABLE to have them, which feels like a loss. A choice taken away, is still a loss - even if you never made use of that choice, in the past.
What tests did your GP do, to come to this conclusion for you?
In terms of how you feel, it can often be the start of feeling a lot better - because you can now get started on HRT and feel much better...
The other thing to say, is I did get a little depressed and feel as if it were the beginning of the end. Getting old. Only going in one direction. The only sure thing in life is death. And all that. I found Lara Briden's book 'Hormone Repair Manual' really useful as she reframes it as a second puberty and a separate process to that of ageing. Which has helped me.
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The only sure thing in life is death : I would add taxes ;-)
Oh I feel 17 but my body tells me stories ::) and 'that old woman looking back from the window' surely can't be me !
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Hello Lynsey and welcome to the forum. I can understand this has come as a shock to you. I was 38 when I started premature ovarian failure. I am now 40. I really wish I knew what menopause was and what to look out for. One thing especially, I wish I knew what vaginal atrophy was and to know to push for ovestin cream. I was told I could not be going through the menopause or have vaginal atrophy and this hindered my treatment.
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Yeah I too wish I'd known more about vaginal atrophy. Knew what it was but had no idea it could hit you in perimenopause nor that it could cause UTI like symptoms. Fortunately there are many knowledgeable people on here.
And yeah, I can imagine you are reeling a bit. It can be a lot to take on board. I think I'd have wanted someone to tell me it would be ok. Still do really. But you'll get that on here too.
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I thought it meant end of periods; hot flushes; night sweats and feeling a bit grumpy. Totally unprepared for the reality and how long my symptom would be going on for. At 61, have only just started HRT after 8 longs years of coping (not) 'naturally'.
I would want someone to tell me that it is not something that you go through and then just pop up out the other end.
That some women have no difficulties during this time and that some women have a horrendous time. For the first set of women, to be considerate and mindful of the second.
I wish I had known that in taking HRT, my joints would immediately feel better, my mood would lift and my resilience and self worth would reappear, and that although this happens for some women without HRT, I wouldn't be one of them.
I wish someone had told me to be prepared and look at all the options regarding HRT. I fought against it for so long and could now kick myself. Do not put yourself through any unnecessary mental or physical hardship that might be avoided.
My periods started changing at 46. I remember crying in the loo at work, knowing I would probably no longer be able to conceive. I didn't even like babies much, but yes, it is a shock when the choice is taken from you and that this shock will pass.
Watch the Liz Earle YouTube video on her menopause experience, don't dismiss HRT out of hand, even if medically you think you might not be able to take it And finally, sending you a very big hug and letting you know you are not on your own xxx
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Great thread by the way!
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Hi Lyndsey, 👋
I’m sorry to hear that you’re going through an early menopause, this can be tough both mentally and physically.
I was 28 when I started the menopause and was not fully diagnosed until I was 35, at which point Dr advised that I would not be able to have children, which was a tough pill to swallow.
I too felt like all choices were taken from me, felt I was less of a woman because I couldn’t get pregnant.
The one thing I wished someone had told me, is to get the right diagnosis and treatment of HRT asap. Also what to prepare for when the symptoms kick in and that it’s ok to not feel like yourself some days.
That my body would change dramatically, I would ache and feel older than my years, that my tolerance to accepting bs would be less and that it’s ok to be angry at the world on the days you feel like crap.
But mostly is to surround yourself with good supportive people, get help if you feel like you’re struggling and be kind to you!!
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Are you sure the GP is correct and has made the right diagnosis would be my first question. Is there any doubt?
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So sorry ClaireB - lack of knowledge by the GP there then?
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You have certainly come to the right place to prepare yourself for what is to come, you will find on here all of the symptoms you might experience in the future. I had a saying at the time after my periods stopped, when you think its all over it isn’t, it’s the beginning of something else!
I am much older than you and was totally unprepared for the condition called Vaginal Atrophy, I was so angry and completely unprepared for this awful condition that I had never heard of. Other than that my menopause was a good one but well into post menopause it has been a challenge.
This won’t happen to you as you have all the information at your fingertips to find out everything you need to know about the journey ahead, I wish you luck!
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Sorry for all the women who didn’t get the chance to have children, I can only imagine how difficult that would be.
I wish someone had told me it isn’t something that happens at 50+, that perimenopause comes first and can last 7 or more years and starts usually in your 40’s but sometimes sooner. I wish the key symptoms were more well known, I truly didn’t know much more than I would be ‘emotional’. I really would want to know that anxiety is a major symptom and to get help as soon as I started experiencing it so that it didn’t take years of my life. I wish I knew that HRT was safer than I had been told so that I didn’t wait years to try it. I would have liked to have known sooner that my thyroid condition impacted my sex hormones quite a lot. Basically, I’ve learnt almost everything I know about peri & menopause only after years of experiencing symptoms and I wish I had known all of it much much sooner.
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Great question. I wish I had known that just because a GP gives you an HRT regime, it doesn't remotely mean that that particular formula will work for you.
My GP failed to suggest any review/follow-up/testing when I first approached them which meant I lost 4 years of my life on a much too low dose of estrogen with bad consequences.
So one should know that it is entirely possible that you might need to try different products/doses/delivery channels until a good formula is found.
I know many here speak of going on symptoms alone but for me regular hormone testing has been crucial to monitor my absorption (or lack thereof) of estrogen and consequently adjust my dose, which is very high, until some relief was achieved.
Also, apart from symptoms in the here and now, it's important to know that a certain blood level of estrogen is necessary to pre-empt osteopenia/osteoporosis, around 300pmol.
Not knowing this and not being invited by my incompetent GP to review my regimen and test resulted in my developing osteopenia.
HRT can also stave off cardiac and cognititive problems in the longer term so it's important to keep in mind what is happening right now and what might happen later if you don't supplement.
More generally, as others have touched on, I wished I'd known about perimenopause which should be a term as familiar in the broader culture as 'puberty'.
I can now retrospectively piece together everything that was wrong with me from my mid 40s, resulting in another batch of lost or at least very diminished years in terms of quality of life.
I can understand your shock Linsey. In my naivety, when a doctor asked me at age 42 whether I still had my periods, I was both offended and uncomprehending because it seemed impossible that a woman would no longer menstruate at that age and my fairy tale view that women these days can have children through their 40s meant that I didn't have children.
Yyou will need time to process this news but I think the concept Joziel mentions of a 'second puberty' is useful (the HRT specialist Nick Panay refers to the menopause as middle youth! I don't know that I'd go quite that far but you don't need to view this as the beginning of an inexorable decline by any means...
If you find the right HRT regime you can regain lost ground and you might be lucky and get the right combination quickly.
p.s also wished I'd known that in general (and of course there are exceptions) GP support for menopause is abysmal
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I second everything in laszia's informative and kind post.Thank you especially for the previously unaware of 300 pmol knowledge. Its not just the here and now we have to think of; its about protecting ourselves for the future. X
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As well as telling every young girl to exercise well, eat plenty of dairy and enjoy Life. When she gets to her 20s, she needs to be aware of The Change !
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I'd say that the 300pmol thing depends on who you ask. There are many research papers (and so, doctors) who say that any amount of estrogen, even a low dose, is protective. There are many who refuse to consider blood estrogen levels as relevant and advise you just to treat until symptoms go (including Dr Currie who is behind this forum). I guess if you maybe have a predisposition to get osteoporosis (but maybe don't know you have that predisposition) you probably want more - you can actually build bone at higher levels. Otherwise you can just maintain what you have. If you can tolerate estrogen to get up to 300, then that's great. But not everyone can...
Oh and that's another thing I wish I knew, that I shouldn't have assumed how much estrogen I'd be aiming for before I'd even started it. I thought I'd need a 75-100mcg patch. So I went whacking up through the patches heading in that direction - and hit huge estrogen sensitivity problems and had to come back down again to 37.5. I wish I'd taken it really really slowly and really gradually with increasing. But not all women are as sensitive as me, so not sure this advice is useful generally!
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I'd say that the 300pmol thing depends on who you ask. There are many research papers (and so, doctors) who say that any amount of estrogen, even a low dose, is protective. There are many who refuse to consider blood estrogen levels as relevant and advise you just to treat until symptoms go (including Dr Currie who is behind this forum). I guess if you maybe have a predisposition to get osteoporosis (but maybe don't know you have that predisposition) you probably want more - you can actually build bone at higher levels. Otherwise you can just maintain what you have. If you can tolerate estrogen to get up to 300, then that's great. But not everyone can...
One source I've come across time and again re the 300 pmol minimum recommendation is from Professor Studd, arguably this country's leading indeed pioneering HRT specialist who also trained Nick Panay who is his de facto successor and not only them. And up to 800 pmol for anyone with hormonal depression according to their research.
Versus the official guidance on this site, both the information pages and the email consults (I don't mean the forum) which I find really retrograde: to cite just a couple of examples, saying that testosterone is only to be used for libido otherwise why bother (ie it has no connection with cognition, bone density, energy, mood etc), or that agnus castus can't be taken if on HRT, or that vaginal utrogestan needs to be taken as often as oral on conti rather than on alternate days.
I know whose guidelines I'd follow between the two though of course I realise that not everyone can tolerate higher doses of estrogen to up their plasma levels.
I haven't come across any of the research papers you mention that say any amount is protective - can you point me in the right direction?
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Hi there, my ovaries went to sleep at age 36. I’m can sympathise & I’m so sorry you’re going through this. It’s a heartbreaking diagnosis. I met the man of my dreams just as all this was happening & was robbed of having my own children with him(we are both childless).
I wish I had known more about hormones in general and how they work. I wish I pushed my Drs more on things and that I had contacted a specialist sooner. A string of GPs poo-pooed my concerns for soooo long in such an appalling manner. In fact, my GPs continue to show their incompetence when dealing with POI. I bypass them at any opportunity now as I don’t trust them to provide good care to me with this condition.
I also wish I was more aware of VA (as many others have stated here) and started treatment for that sooner. I had no idea that it was even a thing. I suffered unnecessarily for some time.
I also wish I’d known that it wouldn’t be as simple as getting a hrt and all would be well in my world. I wish someone had told me there’s a lot of trial and error involved for most women.
Finally, be gentle with yourself. It’s ok to not be ok with this. Lean on your support network. Take care❤️.
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Wish I had known that you can go through peri and meno for years whilst thinking you are getting through to other side - not easy but getting through. Then you can get hit by the lot later on..... no one told me I could get worst symptoms ever 5 years post meno and at the age of 58!!!! I wish I had known that you should educate yourself on what can happen and how you can best look after yourself to be prepared for it.... I had no female relatives to get information from so no one to talk to about it. Wish I had thought about HRT sooner in my early meno years as it may have saved me a lot of the nightmare issues I have now - but I was coping ok till now so probably would not have felt I needed it.
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Yes, wish I'd known I'd become worse post meno. Very confusing, as most information is aimed at peri meno women and therefore, completely complexed as to what was happening to me.
Please don't be scared by these accounts. Just take note, take good care of yourself and learn from all of our mistakes and lack of awareness. Knowledge is power! I'm hoping that for my nieces and great nieces, menopause won't even be much of an issue, as we will have laid all the groundwork for them and I'm sure there will be greater advances made with regard to treatments. X
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I haven't come across any of the research papers you mention that say any amount is protective - can you point me in the right direction?
Here:
https://www.webmd.com/osteoporosis/news/20040504/ultra-low-dose-estrogen-patch-helps-bones
"The study enrolled more than 400 postmenopausal women aged 60 to 80. All had thinning bones and were at higher risk of having a spine and/or hip fracture -- as indicated by bone mineral density tests. The women also had blood tests to look for markers of increased bone turnover.....Researcher Bruce Ettinger, MD, of Kaiser Permanente in Oakland, Calif., tells WebMD that the ultra-low dose patch significantly increases bone density in the spine and at the hip.
"The dose in the patch is only about "one-fourth the traditional 0.625-milligram dose" contained in most estrogen pills used in menopausal hormone therapy,""... The study results are good news says Nahum. He tells WebMD that the new study confirms something that he and other obstetrician/gynecologists have long suspected: "A little bit of estrogen goes a long way."
The patch which they made is now on the market and is called Menostar. It is just 14mcg of estrogen: https://www.rxlist.com/menostar-drug.htm#indications I think I'm right in saying that it actually doesn't need any progesterone to oppose it because the estrogen is so low, but don't quote me on that - I read it in one of the research papers.
And here:
https://pubmed.ncbi.nlm.nih.gov/16607111/
And here:
https://www.uptodate.com/contents/menopausal-hormone-therapy-in-the-prevention-and-treatment-of-osteoporosis
"Women who seek MHT for menopausal symptoms in their late 40s or early 50s will have the additional benefit of a reduced risk of bone loss and fracture [3,4]. In such women, a separate first-line drug for prevention or treatment of osteoporosis is usually not required with estrogen (estradiol) doses equivalent to or higher than 25 mcg/day of transdermal or 0.5 mg/day oral. Lower doses of transdermal estradiol (14 mcg) have also been shown to have skeletal benefits. With this ultra-low dose of transdermal estrogen, bone density should be monitored in women at high risk for osteoporosis and fracture as another agent (eg, a bisphosphonate) may be needed."
And here: https://academic.oup.com/jcem/article/85/12/4462/2852143
"The purpose of this study was to examine the effects of three doses (0.25, 0.5, and 1.0 mg/day) of micronized 17β-estradiol on bone turnover, sex hormone levels, and side effects compared with placebo in healthy older women...All markers of bone resorption significantly decreased at 12 weeks on treatment compared with placebo and returned toward baseline at 12 weeks posttreatment. ... Based on equivalence testing, the response of markers of bone turnover to therapy with 0.25 mg/day was similar to that seen with 1.0 mg/day.... We conclude that low dose of estrogen (0.25 mg/day 17β-estradiol) reduced bone turnover to a similar degree as that seen with usual replacement therapy (1.0 mg/day 17β-estradiol), but had a side effect profile similar to that of placebo. In our study additional increases in estradiol levels, as seen with 0.5 and 1.0 mg/day 17β-estradiol treatment, resulted in more side effects without evidence of additional benefit to bone. These data suggest that 0.25 mg/day 17β-estradiol may be an effective and tolerable agent for the treatment of osteoporosis in older women. "
And there are many more.... Most of the women in these studies were post-menopausal and 60+ so whether this translates across to younger women with earlier menopauses, I'm not sure. But it's promising.
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Those links are really helpful Joziel. Thanks for posting.
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Re perimenopause, I wish I knew then what I know now about the process women go through (and how it can vary from person to person).
I can't be sure when peri started for me but, at 57 now (and 5-6 yrs post meno), I have only recently started on patches for symptoms that simply got too much for me to cope with. Trouble is, I didn't realise what was happening to me, maybe, 10 years ago and, at 54, had to give up work as I simply wasn't coping. Had I started on an HRT regime years ago, I'm confident I would still be working.
Having said all that, I'm enjoying my retirement with OH and am feeling really well on my current regime.
Hope all goes well with you, Lyndsey 🙏
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Thanks for the links to the studies Joziel. While the amount of estrogen the women were consuming was low, I found nothing on their plasma estradiol levels.
So personally I would still use the 300pmol minimum as a reference point for bone density protection and probably quite a bit higher for other symptoms such as depression.
I also wonder why they gave all the women calcium and vitamin d supplements alongside the low estrogen given that they are protective of bones as one can't isolate which was responsible for the improvements.
Also seems odd that they used women of 60-80 years old.
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There are several different studies there, margherita.
The last study definitely looked also at plasma estrogen levels and concluded (as pasted above): "In our study additional increases in estradiol levels, as seen with 0.5 and 1.0 mg/day 17β-estradiol treatment, resulted in more side effects without evidence of additional benefit to bone."
The second study mentioned also didn't use women who were 60-80: ""Women who seek MHT for menopausal symptoms in their late 40s or early 50s will have the additional benefit of a reduced risk of bone loss and fracture [3,4]. In such women, a separate first-line drug for prevention or treatment of osteoporosis is usually not required with estrogen (estradiol) doses equivalent to or higher than 25 mcg/day of transdermal or 0.5 mg/day oral. "
I appreciate that one didn't look at serum estradiol levels but I doubt many are going to be sky high at 25mcg.
I'm currently reading everything Lara Briden has written and she is also against higher doses of estrogen and/or testing bloods, since blood levels vary so much on a daily basis. She quotes Professor Prior (Canadian endocrinology professor) who says 'no menopausal woman should need more than 50mcg' and she agrees... I'm not sure I'd go that far as clearly some women do better on higher doses, but it's reassuring anyways. She also reminds people that progesterone (body identical) is also really important for bone health, and often overlooked - and should be taken even if people have had a hysterectomy.
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Difficult to believe any 'professional' who makes such statements when every lady is different :-\.
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Well, you could look at it like that - or you could think... wowsers, here's a doctor who sees bazillions of menopausal clients and hasn't found it necessary to prescribe estrogen higher than 50mcg? What is she doing...? Is she just ignoring the experience of loads of her clients, or is she doing something else which results in this?
The answer seems to be - starting with body identical progesterone only (which she says helps with most symptoms) and only then adding in estrogen. Starting at 25mcg and only increasing if needed up to 50mcg.
I know what she says doesn't really fit with what I've heard online from other women - but it's also very possible that, whilst some women may need high doses, there are many women on them who don't need them: Many women are just started out on a high dose so never get to trial lower doses in the first place and then end up increasing and increasing because they know something isn't right - and/or they don't remain at the lower dose for long enough to see if it could be enough. (Newson told me to increase from 25 to 50 after just 2 weeks! Having emailed Dr Currie via this site, any dose should be trialled for 12wks before you know where you're at with it.) The starting dose in the UK seems to be 50mcg (that's the basic dose in the combined patches which are available) so people only want to go up from there...
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Yet many women on the Forum complain that the progesterone part of their regime causes most of their problems. "bazillions" ::). Would be interesting to see any published studies from Prof Prior., also ages and ethnicity of women treated.
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Just a few:
https://www.tandfonline.com/doi/abs/10.1080/02646830600974071
https://pubmed.ncbi.nlm.nih.gov/24753856/
https://www.tandfonline.com/doi/full/10.1080/13697137.2018.1472567
https://www.endocrinologyadvisor.com/home/conference-highlights/endo-2018/oral-micronized-progesterone-may-decrease-perimenopausal-vasomotor-symptoms/
https://pubmed.ncbi.nlm.nih.gov/22453200/
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Difficult to believe any 'professional' who makes such statements when every lady is different :-\.
Couldn't agree more. I literally wouldn't be here had I not greatly increased my estrogen intake but know perfectly well that other women do better with much less. And reaction to progesterone is also extremely varied though is often negative.
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It's probably important not to throw the baby out with the bathwater. Just because someone says one thing you don't agree with, it doesn't mean that everything they say is wrong and not worth listening to.
Due to the brakes put on things by the WHI, this is a new field where practitioners often need to think outside the box whilst best protocols are determined.
Not sure how we got to this from the bone protection thing, since those other studies are by a wide range of other practitioners from all over the world.
And just because one person needs high estrogen, doesn't mean that it isn't best practice to start low and titrate upwards only if needed - so that those who do best on low doses are not accidentally put on high doses to start with and then only moved upwards...
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A great thread started by ElleJay888 but no response from her as yet, hope she wasn’t frightened off by all the wonderful answers!
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Hi Songbird,
You're lucky to be retired at 57.
Some of us will have to retire at 67 and if we still have meno symptoms that's going to be extremely tough.
I don't think employers, especially really care about the female staff going through the menopause, especially if they are male.
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Like this thread. L.Booth