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[Berto77]

I am 43 and suspect I may have been perimenopausal . My symptoms are fatigue, low motivation, increasing migraines (after years of them being well controlled), hair and nails getting worse, burning pain when I pee, itchy skin, palpatations, hot flushes, restless legs, insomnia, digestive issues, sweating, weight gain and changes to my menstrual cycle. There is literally always something going on with me physically, some days i feel like an alcoholic in withdrawal I feel so awful! Sometimes I feel ok for a week or two, I'll still be bothered by something but its not everwhelming but I'm always dreading things getting worse again.

My periods have been intermittently irregular either very close together or far apart for about 18 months now, sometimes they are normalish. I haven't had a period for 2 months now and for 6 weeks of that time I felt like death with back to back migraines, insomnia, restless legs and hot flushes. I have an appointment to see my GP about HRT this week but I am worried about a few things.

1. I have some contraindications to HRT, I suffer from migraines, I am very overweight and I'm not sure how my blood pressure will me, its been borderline in the past, I also have a small fibroid (2cm in my womb). On the plus side I am vegetarian, I've never drank alcohol or smoked. From what I have read being overweight, having migraines or high blood pressue should stop me having the more modern body identical forms of HRT or things like patches and that it might even help me but I'm worried that my GP will use these as a reason to not proscribe these for me.

2. I am still having periods somewhat regularly (at least until may) and when I spoke to my GP on the phone she said I was too young to be taking hrt, that it only delays the inevitable etc. Is she correct about this? Would using HRT now when my homone levels are so variable be harmful in anyway? Does taking HRT damage my bodies own hormone producing abilities? If I start younger is my risk of cancer increased? Will I be forced to come off HRT earlier than other women if I start young? My thinking is that it is better to be on HRT sooner rather than later to protect my bones, brain and heart and that hopefully I would be able to stay on it long term / forever as long as I had not major issues in future? I have no breast or uterine cancers in my family history.

3. I am in scotland and the nhs guidelines up here don't seem as up to date as in England. I believe that the body identical transdermal estrogen is available but the body identical progesterone is harder to get here. I also don't know about things like testosterone or topical estrogen for the vagina (which I might need). If anyone is in scotland can you let me know your experiance please?

4. How best do I approach the gp appointment so that I don't get fobbed off. All I want is a chance to try HRT to see if it helps me and my symptoms but appointments are short and it can be difficult to get everything across in that brief time. I know I don't want antidepressents which I am wondering if they will try and offer me as these do not get to the root of the issue and offer no long term protection but I've heard that currently trying to presuade doctors with the long term benefits is ineffective, they are only interested in symptoms, any advice on how to tackle the appointment would be great!

If you can offer any advice on any of these points that would be amazing! I do have loads more questions but will read around the fourm and perhaps as some later!

Thank you!

[Denise Didi]

Hi Berto I had lots of appointments with my GP re the various symptoms and was referred to menopause clinic Dundee but waited over a year for my first appt however GP corresponded with the clinic and had to try various options at their suggestion. . My BP was a little bit high but was still allowed to take HRT. I am on antidepressants, hrt patches, totesterone gel, BP tablets and recently started getting ovestin cream for sore vulva oh and had a mirena coil inserted 2 years ago!!! It's a long journey to find what suits a lot of trial and error but don't give up. Ask the practice manager which gp knows the most and start there. I wish I could say all is good but think I am entering a new phase as my flushes are back again. So will be asking my GP if I can increase my oestrogen. Good luck
Denise Didi

[Cookie25]

Hi Berto77

I am in Scotland and eventually got a menopause clinic referral at 46. I'd been having symptoms for maybe 6 years but wasn't taken seriously until this year. I would say that your symptoms sound pretty conclusive so I reckon the GP should do a full blood count and thyroid check first, then if nothing shows up you should be offered hrt or referred to clinic. Do others agree?
I got a phone consultation very quickly with the meno clinic but I guess it just depends where you are. Good Luck xxxx

[sheila99]

1. High BP can be a contra indication for hrt but as long as it is controlled it should be OK. Depends on your gp if weight is an issue but if it is perhaps you could agree a weight loss program if she let's you have hrt?
2. Oh dear, another ignorant gp. Yes, you will benefit from hrt in peri though it can be harder as you have to deal with your own peaks and troughs. It won't make any difference to what you produce yourself.
3. Not in Scotland but I think the only problem is with utrogestan?
4. Get as educated as you can about it so you can argue your case and have a look at the NICE guidelines. Bad temper was one of my symptoms and my gp bore the brunt of it when she suggested ads instead of hrt. If you know you're right and she's talking through her backside tell her so (but make sure you're right).

[TrustandHope]

Hello Berto77! I am also in Scotland. Your GP is haverin'. You are not too young for HRT (my mother was on it from her early 40's back in the 1980's, and that was in Scotland!). Some GPs are just not clued up and there is absolutely no excuse. If they just read this forum plus Louise Newson's site they would be well on their way.

Being overweight should not automatically exclude you from HRT unless there is a particular health condition too? I suffered from migraine with aura, caused by hormone fluctuations, and HRT has helped that so far. So no automatic ban there either. Depends on what the origin of your migraines are and even then should be case by case.

Re. utrogestan, I have got it no bother at all in Glasgow and Aberdeen. They just don't like to offer it because it is not the recommended first line of supply. I had to get oestrogel ordered in, but the pharmacist was very happy to do so and it arrived within a day.

The key is to do your research, refer to good sources of information and be very specific about what you do and don't want. It can be tough being your own advocate. If no joy, I would recommend changing GP (looking for someone who specialises in women's health) otherwise bite the bullet and pay for a private appointment with a menopause specialist who can guide your GP to a more satisfactory position.

Let us know how you get on. X

[SamEdin]

Hello Berto77, Utrogestan seems difficult to get from nhs Lothian. My GP wouldn’t prescribe and referred me to the Menopause clinic but there’s still no guarantee they will prescribe and it’s an eight month wait. I think I might need to go private. Seems a 2009 SMC report felt it wasn’t worth the extra cost even though it’s only £1-2 more.

[Berto77]

Hi Berto I had lots of appointments with my GP re the various symptoms and was referred to menopause clinic Dundee but waited over a year for my first appt however GP corresponded with the clinic and had to try various options at their suggestion. . My BP was a little bit high but was still allowed to take HRT. I am on antidepressants, hrt patches, totesterone gel, BP tablets and recently started getting ovestin cream for sore vulva oh and had a mirena coil inserted 2 years ago!!! It's a long journey to find what suits a lot of trial and error but don't give up. Ask the practice manager which gp knows the most and start there. I wish I could say all is good but think I am entering a new phase as my flushes are back again. So will be asking my GP if I can increase my oestrogen. Good luck
Denise Didi

Thank you for replying Denise, thats good to hear that you were able to get HRT with higher blood pressure, I am not sure what my gp will say but hopefully she will m try to see if it helps. Its quite overwhelming and worrying when you learn that gps are not up to speed on the new research but I will ask for a referral to a manopause clinic if need be, I think in Glasgow its the sandyford so not sure if that is any good. Thanks again and good luck with sorting out your flushes!

[Berto77]

Hi Berto77

I am in Scotland and eventually got a menopause clinic referral at 46. I'd been having symptoms for maybe 6 years but wasn't taken seriously until this year. I would say that your symptoms sound pretty conclusive so I reckon the GP should do a full blood count and thyroid check first, then if nothing shows up you should be offered hrt or referred to clinic. Do others agree?
I got a phone consultation very quickly with the meno clinic but I guess it just depends where you are. Good Luck xxxx

Hi Cookie, thanks for the feedback, I have an appointment with my GP tomorrow so not sure what she will say, I mentioned the menopause clinic at the sandyford to her but she wasn't sure if it is running at the moment due to the pandemic, but perhaps a phone based consultation is an option for me as well. I had hoped that my GP might just do a prescription for me and let me try hrt but it does seem like many don't quite know where what to do with us lot! Thanks again!

[Berto77]

Hi Shelia,

Thanks for the detailed reply! I am worried about my weight and blood pressure being an issue although I do think that some of the weight gain is down to me feeling to tired and unwell to exercise much over the past couple of years and eating for the energy to get through the day. I know I do need to tackle my weight for my overall health and well being into the future so I'd be open to a weight loss program as you suggest. Hopefully I'd start to feel a bit better on hrt to be able to do more exercise!

Yeah I was so dismayed when the gp spoke like that it was just such a rote answer! I'm hoping she will be more open minded in person and thats a relief to know that the supplemental estrogen won't affect my own natural hormones!

Everyhting I'm reading seems to suggest that the body identical, micronozed progesterone is better so that would mean utrogestan but it does seem to be a bit of a lottery as to if it gets prescribed here, but I will ask about it.

I am trying to get all my info straight but in scotland it seems all over the place I can find the nice guidence which is great but "sign" the scottish equivalent doesn't seem to have anything and I can't find anything for nhs glasgow which is where I am. I think I'll have to just go on the nice guidence, that is fairly up to date anyway!

Thanks again for the advice!

[Berto77]

Hello Berto77! I am also in Scotland. Your GP is haverin'. You are not too young for HRT (my mother was on it from her early 40's back in the 1980's, and that was in Scotland!). Some GPs are just not clued up and there is absolutely no excuse. If they just read this forum plus Louise Newson's site they would be well on their way.

Being overweight should not automatically exclude you from HRT unless there is a particular health condition too? I suffered from migraine with aura, caused by hormone fluctuations, and HRT has helped that so far. So no automatic ban there either. Depends on what the origin of your migraines are and even then should be case by case.

Re. utrogestan, I have got it no bother at all in Glasgow and Aberdeen. They just don't like to offer it because it is not the recommended first line of supply. I had to get oestrogel ordered in, but the pharmacist was very happy to do so and it arrived within a day.

The key is to do your research, refer to good sources of information and be very specific about what you do and don't want. It can be tough being your own advocate. If no joy, I would recommend changing GP (looking for someone who specialises in women's health) otherwise bite the bullet and pay for a private appointment with a menopause specialist who can guide your GP to a more satisfactory position.

Let us know how you get on. X

Hi Trust and Hope!

It is frustrating on the lack of knowledge gps have on this matter. I have been reading the Louise Newson website and listening to her podcast and I was think oh great things seem a lot better now then they did when my mum was going though all this 20 odd years ago but of course most gps aren't up on that sort of thing at all sadly.

I am over weight, I've had migraines since I was young and my new blood pressure monitor is saying my BP is on the high side. So it might be an issue. I do feel that my blood pressure is due to my weight / lack of exercise and that both my diet and exercise have been impacted by having perimenopausal symptoms such as migraines, insomnia and tiredness and that perhaps hrt would help with that but I don't know I might need to lose weight before I can start. It was good to hear that your migraines were improved with hrt, I do think mine are much worse (incontrolable really) when my estrogen levels drop.

That is great you managed to get the utrogestan in glasgow (I'm in the greater glasgow area), how did you manage to get it did you just ask for it? From my current research my preferance is for a continuous estrogen patch (which is supposed to be better for migraine) and the cyclical utrogestan. I will ask about that as a starting point.

Can I ask what sources you refered to when you went to your doctor? I'm having trouble finding scotland specific guidence, it it find to use UK or english based guidence like the nice guidence?

I will look into the option of a private menopause specialist if need be, I am concerned about costs but could potentially fund an initial appointment if that info could then be transfered over to my gp to go on with.

Anyway, thanks again for the brilliant info!

[Berto77]

Hello Berto77, Utrogestan seems difficult to get from nhs Lothian. My GP wouldn’t prescribe and referred me to the Menopause clinic but there’s still no guarantee they will prescribe and it’s an eight month wait. I think I might need to go private. Seems a 2009 SMC report felt it wasn’t worth the extra cost even though it’s only £1-2 more.

Hello SamEdin,

Sorry to hear that you have had trouble getting Utrogestan proscribed, I think I saw that report as well online when looking for info. It does seem like a lottery on if you can get it or not and it really is shocking how poor menopause treatment is, an 8 month wait is terrible! I'd prefer the utrogestan as its seems to have better safety and it is body identical but then I've also read that some women haven't felt great on it at all but perhaps that is more down to progesterone intolerance?

Good luck with it though!

[TrustandHope]

Hi! My GP in Glasgow gave me the patches straight off - her recommendation. This is because they are on the list (see below). Utrogestan 100mg is NOT on the Greater Glasgow and Clyde list, but I said I was not comfortable using anything else. The Evorel Sequi patches contain norethisterone and I know I react badly to it. You may be OK. The GP did roll her eyes when I mentioned Louise Newson, but wrote the prescription anyway. I now use oestrogel and utrogestan but you can also use evorel oestrogen-only patches and utrogestan, so both are body-identical. Interestingly, Lenzetto spray is on the list?

The list: https://ggcmedicines.org.uk/formulary/endocrine-system/sex-hormones/

I am positive that since Davina's Channel 4 programme there will be many women asking for a review of their HRT.

From past experience, if the GP will not prescribe something you know they could (e.g. oestrogel) it is worth paying the couple hundred pounds - if you can - to see a specialist. They will then write to the GP with a prescription recommendation, which often means you can access HRT not on the list. That's how I got oestrogel on prescription eventually. And, of course, it is free in Scotland.

If that doesn't work, you can obtain a private prescription from the specialist and pay for the prescription. I had to do this when moving cities and between GPs. Oestrogel and utrogestan together cost me £18 from Boots (they ordered in the oestrogel and said they could do that easily).

I wouldn't worry too much about being overweight. I am not overly skinny myself! Migraines might be a different matter but I would also see a menopause specialist rather than a GP to discuss that.

All the very best!

[TrustandHope]

Have just noticed that oestrogel is in fact on the list, but not as first line prescription.

[CLKD]

I haven't read all the responses but your GP is living in a Cave!

No one is too early for menopause: girls may have 1 peroid or non at all.  So it can happen across the whole age range.  GPs still tend to think that 52 is the age ....... Certainly, HRT will protect heart and bones in the main.  As will brisk walking 10 mins several times a week.  Eating well - mayB have a lookC at your over all diet?

A drop of oestrogen may well cause the skin to become dry: inside and out as well as muscles may become lax = aches and pains.  Do read the 'bladder issues' and 'vaginal atrophy' threads.

What support is your GP offering regarding any weight loss regimes? 

Browse round.  Make notes ;-)  Let us know how you get on.

[Berto77]

Hi Trust&Hope,

Thanks for getting back to me with all that information! I think I will ask for estrogen only patch and the utrogestan at least to start with. I will consider seeing a specialist privately if I need to but will see how I get on at the GP first. Thanks again!