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[Nellymoker]

Hi everyone.
I've finally got to the point where I can take no more. At 52 and almost 6 years after a hysterectomy (ovaries intact) I have decided I need hrt asap. I have been back and forward with my GP due to chronic insomnia, anxiety, mood swings, brain fog, joint pains and depression since the op. Menopause was never mentioned and my dr attributes most of my symptoms to stress! In the last year I also had hot flushes and crawling itchy skin. So I don't think I need a medical degree to figure out what's going on . Anyhow... I've an appointment to see aforementioned Dr on Monday and I'm pretty sure I'm going to have a struggle on my hands getting him to prescribe hrt. I am heterogeneous factor v Leiden, which means I have a slightly higher risk of deep vein thrombosis, but am I right in thinking that as I have had a hysterectomy I need only take estrogen, thereby lowering risk of a clot? I've never smoked and am only slightly overweight. Do any of you lovely ladies have any advice for a slightly confused, very exhausted and fed up newbie? Thank you in advance

[Freckles]

Hi Nellymoker

Been there, done that, eaten the stew and the t-shirt doesn't fit anymore!
I really empathise as my NHS GP was crap and ill informed too.  Ended up going privately as she just wanted to prescribe AD's which are for me as I knew my problems were primarily caused by very low oestrogen levels (and I was right)
I'd suggest do your research so go informed.
Psychological/mood problems are clinically  consistently linked to hormonal imbalances and also the menopause, as well as the usual physical symptoms (hot flushes, etc).
I'd read up on the NICE guidelines for HRT treatment (although I do not agree with their "guidelines" for using progesterone as I think they are unnecessary and extreme, but NHS cost effective)  and also Professor John Studd's web site (Google) as he provides some very helpful lay readers info on HRT.
Suggest you need to get blood tests done regarding your hormone levels and if lacking in oestrogen, ask for Oestrogel as a prescription as it's much easier and more clinically effective to apply as a gel than tablets or those horrible patches!  Usually prescribed at 2 pumps a day
If you have had a hysterectomy, fortunately you won't need progesterone supplements, which cause problems  for so many women, especially at current NHS recommended doses.
That way you can politely challenge your GP's views.
Read around/search on MM too so you can get an idea of different opinions posted in the past, too?
Getting proper help for my symptoms was life changing for me, so if your GP doesn't want to help you, maybe consider other options for treatment?
Good luck  Freckles x

[Nellymoker]

Hi Freckles.

Thank you for your kind answer.
I have been feeling like I'm slowly going nuts for years now. Ive regularly seen each of the 3 drs in my GP practice and not one has put 2 and 2 together. I was told by one "there's no way the menopause can be responsible" and even after a blood test confirmed I'd "about a year" before I was "fully menopausal" ( her words!) My symptoms were due to depression in her opinion. I was too exhausted to fight my case and went away with my tail between my legs.
 I'll definitely be doing a lot more research before Monday's appointment as honestly I'm pissed at being fobbed off and want to armed and ready to fight my corner.
I'm happy that your feeling better after getting proper treatment, it gives me hope and if I can't get it from my GP I shall look into seeking private treatment.
Thanks again for your kind help, now I'd better be getting on with my research

[Dancinggirl]

Hi and welcome Nellymoker
Yes, you will only need oestrogen but if your GP is reluctant for you to have oestrogen then ask for a referral to gynae or meno clinic for specialist advice. Your GP should have recognised your symptoms as typical for menopause- we get so cross when we hear GPs being so perdantic. oestrogen will protect your heart and bones for the longer term and your GP should be better informed about the benefits, particularly for women who have had a hyster - research shows that oestrigen treatment for hysterectomised women actually reduces risk of breast cancer.

Print factual stuff off from this site to show the GP and you could do an email consult with dr Heather Curry on this site as well if you want ( small charge though) - she is a specialist and one of the panel that drew up the new NICE guidelines on treating the menopause. DG x

[Freckles]

Hi Nellymoker

Glad I might be able to help

It's appalling that GP don't recognise that psychological problems do occur from the menopause as well as other hormonal conditions.
As you can tell, I don't agree with the rigid adherence some GP's adopt with the NHS guidelines, as one size doesn't fit all and the as re many variations in prescriptions depending on an individual's history.
I'm aware that some regular posters on here are very much against private consultations and treatments by Consultants, advocating NHS services.  They don't always work, obviously, given the consistent evidence cited by posters on MM.
If you get the same poor service from your GP do please PM me and I'm happy to discuss my experiences .
Freckles x

[Hurdity]

Hi Nellymoker

 

So sorry to hear about your dismissive treatment from your GP - but quite right you should not and do not need to seek  an expensive private consultation in order to be prescribed HRT (notwithstanding that many women have benefited from private treatments). That is what this website (through Dr Heather Currie) and many GPs and gynaecologists are aiming to change, along with organisations such as British Menopause Society and Women's Health Concern.

Blood tests cannot conclusively tell you where you are in menopause but a raised FSH level (which would have been measured) is an indication that you are peri-menopausal. I gather there is evidence also to show that some women who have hysterectomies retaining ovaries enter menopause before they would have done otherwise.

Regarding your factor v Leiden - HRT does increase the risk of developing clots if you have this condition - according to the info on the web here:
https://ghr.nlm.nih.gov/condition/factor-v-leiden-thrombophilia#genes and here:
https://www.mayoclinic.org/diseases-conditions/factor-v-leiden/basics/definition/con-20032637

Taking oestrogen only because you have had a hysterectomy puts you at lower risk of breast cancer (than HRT that also includes a progestogen) not blood clots. If you do take HRT then it is transdermal oestrogen HRT (gel or patches - by the way I don't find patches "horrible" - I have been using them for 10 years + very happily and successfully!) which does not increase the risk of blood clots whereas oral HRT (tablets) may do so.

As you know there are other factors which increase this risk - notably body weight, smoking, blood pressure amongst others. If your BP is OK and you take plenty of exercise it sounds like you are minimising your additional risks anyway. Perhpas you are taking blood thinners or other meds?

In your position if your doctor refuses to prescribe oestrogen due to the concerns about your genetic condition I would ask your doctor to refer you to a specialist - not sure quite which one - whether a menopause specialist or a consultant who specialises in your condition - to talk this through with you and see if for example there any tests that can be done to assess your specific risk?

Interestingly there was another new member who joined recently called Connolly ( scroll down the new members' thread) who also has a similar genetic condition (thrombophilia tendency) but she didn't know which one, but she has been refused HRT - maybe she is investigating whether she can or not? Perhaps you would like to look at her posts and maybe even post on her thread so she might notice you? 

Hope this helps and good luck with all your endeavours to get the right treatment - but it is important in your position that this is achieved though the proper specialist channels

Hurdity x

[Nellymoker]

Hello Dancing girl and Hurdity.
Sorry for not replying sooner, it's been a tough week. I'm struggling to think straight and exhausted due to lack of sleep, even writing this seems like much harder work than it should be! I just wanted to say thank you to you both and Freckles for your advice.
I've been doing a bit of research and I think that although I would be at a slightly higher risk of clotting because of the factor v, the risk with transdermal oestragen is only slightly higher than in general, as I have only one set of the faulty genes, if I was homozygous (faulty genes from both parents) now that's an entirely different kettle of fish.
I'm not on any blood thinners, Hurdity as l have never had a clot and my hematologist says that as I don't smoke and try to lead a healthy lifestyle it's not necessary at present. I must scroll through to see if I can find Connolly's post. Factor v is actually fairly common, about 5 people in every 100 are heterogeneous factor V, most will never have a clotting incident if they follow a healthy lifestyle. In fact I would never have known I had the condition but for an investigation for recurring miscarriages (a heart breaking symptom of factor v Leiden).
I believe the benefits for me personally far outweigh the risks. Especially as you say Dancinggirl, when the risk of breast cancer and heart disease are lowered. Hopefully I can persuade my GP to agree;
I'll be going well armed with all the relevant information to fight my case, thanks to your knowledge advice.
Thank you again for taking the time to reply. I'll let you know how I get on on Monday.

[Conolly]

Hello again Nellymoker,

I have just answered your post in my new member thread.

I'm looking forward to reading your post next Monday. Good luck!

Hello Hurdity,

I just would like to clarify that both GP and haematologist said I could have transdermal HRT, but I am still anxious about it mainly because they said there is no transdermal progesterone available on NHS, only oral capsules or coil. Is that accurate or have I missed something?

Conolly x

[Dancinggirl]

Hi Conolly
Of course there is transdermal progesterone - it is available as patches with oestrogen - so are transdermal combined patches. I'm afraid Utrogestan capsules are not licensed for vaginal use here in the uk yet, so GPs can only prescribe this for oral use - you might need to seek specialist advice about this.
I despair - GPs are so ignorant about what's available - some training is badly needed.
Look under TREATMENTS on this site, print the info off to show the GP.
The Mirena can be a great option as part of HRT - do consider it, as it often results in no bleeding at all after the first few months and you can then use Oestrogel or oestrogen patches in any dose alongside.
DG x

[Conolly]

Hello Dancinggirl,

Thank you. I'm afraid my GP is not to blame, I forgot to say 'bioidentical' progesterone. My health anxiety is so bad that I wouldn't take any oestrogen/progesterone combo that is not identical to my own. He has offered me the Mirena coil but again I can't even think of having it fitted inside my uterus... Silly I know, but that's who I am right now. This is one of the reasons why I'm very tempted to try an anti-depressant therapy before taking HRT, maybe the anxiety will subside and I'll be willing to accept more HRT options.

Conolly x

[Hurdity]

Hi Connolly

As Dancinggirl says there is no non-oral progesterone licesned for use as HRT but as she says utrogestan can be used  vaginally (and is licesned this way elsewhere in Europe) - and it is how I and many others on here take it ( I'm a nil-by-mouth gal when it comes to HRT and always have been!). There is also another preparation of progesterone called Cyclogest - also used for fertility. I used this for several years (from my GP) before Utrogestan was used - or at least widely known about. It is a waxy pessary which can also be used as suppository and is bio-identical - would have to be prescribed off licence though. I think the transdermal HRT being safer for stroke risk only refers to the oestrogen - because of its effect on blood vessels - as I understand it, and taking progesterone orally (if bio-identcial) would not be any more risky? I stand to be corrected there though if I have somehow got the wrong impression along the way - as I haven't looked this up recently.

Hurdity x

[Conolly]

Hello Hurdity,

Sorry I didn't see your post before, as this is Nellymoker's thread. GP has mentioned Utrogestan but not Cyclogest. I'm afraid I also know nothing about the effect of progesterone on blood clotting, will have to ask GP or research it myself. Thank you.

Conolly x