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[Spazziepants]

 Hello

I am a newbie here and just want to say hello and ask for some advice 

I am 46 years old but I was diagnosed with premature menopause at 40 but had symptoms from the age of 38 just never realised it was menopause until I finally went to the doctors!

I have been taking Kliovance for 6 years with no issues and it has been my wonder drug!

On 29June I had surgery on my ankle which was keyhole to tidy up the joint and soft tissue after I broke it 6 years ago. Then on 25 July I again had surgery to remove my gall bladder. Everyone said would be fine as there was 2 weeks or more between anaesthetics so surgery went ahead no questions and no one asked me to stop taking my HRT at any point Upton either surgeries.

I had pain in my calf that felt like muscle cramp/knot and just put it down to my ankle surgery. This improved slightly then had my gallbladder surgery and the cramp/knot in my calf was back again but further up. Had my husband massaging it trying to relieve but it moved up to behind my knee. By this point I realised not muscle cramps so phoned NHS 111 and was sent to OOH GP who refereed me straight to A&E for d dimer test which was positive but could have been from the surgeries. So a few days of anticoagulant injections and finally an ultrasound scan on Monday I had a blood clot and it had made its way into my thigh 6 inch away from my groin.

I am now taking tablets for 3 months to prevent further clotting but they have told me to come off my HRT and I may have to come of it permanently?! This is what scares me! I don't want all the symptoms coming back as I was pretty ill with menopause!

Is there any alternatives I can safely take as they say I am more prone to clots now. What are the best solutions is it patches, tablets or gel? Anyone's experience and advice of DVT, clots and HRT would be so very much appreciated. 

Thank you. Xx

[Hurdity]

Hi Spazziepants

 

So sorry to hear about your blood clot as well as early menopause.

In general terms if you are at risk of blood clots then transdermal HRT ie patches or gel with separate progesterone are recommended as a safer route. Hoiwever from the info on this website it does look like an active or recent blood clot is one of the few contra-indications for HRT
http://www.menopausematters.co.uk/contraindications.php

Contraindications for HRT.

Pregnancy
Undiagnosed abnormal vaginal bleeding
Active or recent blood clot or myocardial infarction (heart attack)
Suspected or active breast or endometrial (womb) cancer
Active liver disease with abnormal liver function tests
Porphyria cutanea tarda


 and here is what it says about thrombosis:

"Thrombosis
Since HRT is associated with a small increased risk of venous thrombosis, care must be taken when considering HRT use in women with a past or family history of thrombosis. Depending on the indication for HRT and on the cause of the thrombosis, risks and benefits should be assessed. If HRT is to be used, preference would usually be given to the transdermal route (patch or gel) [ref 22]. Specialist advice should be requested. Vaginal estrogen may be used for treatment of vaginal and bladder symptoms."

http://www.menopausematters.co.uk/atoz.php#GlossT

I would definitely consult a specialist (ie gynae at a menopause clinic as well as the specialist treating you for the clot) as above to see what your best option is.

You are still young so protection of your bones and heart should be given due consideration in any decision, because ideally you should still replace oestrogen until the natural average age of menopause. In terms of symptoms the only alternative methods to HRT that will help are some anti-depressants - but they would not give the same protection to bones and heart. These are listed here:
http://www.menopausematters.co.uk/prescribed.php

Hope this helps

Hurdity x

[CLKD]

  how awful that NO ONE thought to discuss your medication prior to surgical intervention  did your GP not add your requirements in the referral letter?

I was given long length pressure socks to avoid such episodes - very sexy (not) which Ihad to wear for a couple of weeks after elective surgery.  I also had a Heparin injection prior to going to Theatre to avoid clots! 

However: it has been diagnosed and I think that finding a Specialist with menopausal knowledge is the way to go.

Let us know how you get on [I'm fuming at the lack of consideration to you, that the above measures weren't instigated  ]. 

[Taz2]

Hi Spazziepants - you can have a blood test which shows whether you have a clotting disorder. I had this as a few of my uncles all had DVT's but my clotting factor was found to be good. This would be useful as you would then know whether your clot was caused purely by your operations. It seems very strange that nobody told you to stop HRT although, now I am thinking about it, I was the one who actually had to ask the gynae before my hysterectomy whether I should stop. He was amazed that "nobody" had told me but he wasn't sure who that "nobody" was!

Taz x

[CLKD]

The buck stops with the Anesthetist!!!!

[Spazziepants]

Thank you all for the information and nice welcome. Really appreciate the advice and information.

My doctors have telephoned me today to make an appointment about my HRT.....makes a change! They must have had notification from hospital on my DVT diagnosis.

I will suggest the patches or gel as replacement. I still have my womb so I think I only need oestrogen replacement?

From all the medical care staff responses they were all shocked that I had 2 operations so near especially after the ankle surgery. The anaesthetist questioned what Kliovance once before we went down to surgery and I told him HRT and he never said a word or showed any concerns!

Too late now I have the clot and now have to worry about my HRT! 

Thanks everyone! Going to do lots of reading before my doctors appointment! Xx

[Hurdity]

Hi Spazziepants

Thanks for the update. If you have a womb then you need both oestrogen and a progestogen  as you did with Kliovance. If you opt for patches there are combi patches (listed here - scroll down http://www.menopausematters.co.uk/postmeno.php)  which have oestrogen and progestogen in them or you can have oestrogen only patches or oestrogen gel with separate progesterone (Utrogestan) which is usually taken orally as a capsule. Some women find this (the Utrogestan) makes them tired when taken continuously.

Hurdity x

[Spazziepants]

Thank you Hurdity. I thought because I still have my womb I only needed oestrogen. Looks like I will have to ask for patches if I need both oestrogen and progesterone. I will have another read on the patches 

Xx

[CLKD]

Let us know how you get on. 

[Spazziepants]

Hi all just an update after my doctor appointment today to discuss HRT and taking Rivaroxaban for DVT. The DVT was provoked by the operations but my doctor said I had to come off HRT. I have told her my symptoms are so bad and being 46 and early menopause I want to still take HRT.

My doctor didn't know of any safe HRT to take now that I have had a clot so is going to speak to gynae at hospital and let me know what is ok to take if anything.

Again I'm left not knowing what the future holds! Just don't want to stop my HRT. If the hospital had sent me home with anticoagulant injections to have daily after the operations then I wouldn't have had a clot and I would have been happily taking my HRT 😥.