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[KittyBee]

I have an appointment with my GP on Monday, and although I've had a read around the information on here, I'm not sure what to expect.

I'm 43, struggled with infertility for years, and was told by a consultant to expect early menopause based on hormone tests/response to fertility treatment done some years ago. Last period was in August (might be July) and blood tests (done after a panic attack/anxiety) showed hormone levels suggesting menopause (don't know exactly what the numbers were so will ask at appointment). Oh, and I don't think I mentioned it in my first post, but I'm expecting a baby through surrogacy in the Spring, so would ideally like to be feeling a bit better by then before the real sleepless nights take a hold. 

Symptoms:
Broken sleep, aching joints, heartburn (that could be anxiety related) dry skin, lack of concentration, poor memory, bloated stomach/weight gain. No hot flushes (at least, not like the ones usually described) or sweats. IBS slightly worse and changed from IBS-C to IBS-D (again, could be anxiety related).

I've been prescribed short term meds for anxiety, but I don't want to take them in case they make me drowsy. My performance at work is getting worse (due to lack of concentration but also my boss is not helping the situation). I'm pretty much counting down the weeks until I can go on surrogacy leave and not have to go to work.

Is my GP going to be able to anything to help on Monday or am I likely to need a referral?

Thanks in advance. 

[Dancinggirl]

Hi and welcome KittyBee
I did a long post to you earlier and then my internet went down - so frustrating.
It's so tough going through fertility treatment so you must be mentally and physically exhausted with all this.  How exciting to know you will have a baby in spring - my sister has twin boys by surrogacy - she and her husband so enjoy their boys. To now have your hormones pack up is also very tough.
I started my meno in my mid 30s so know what this is like - I had luckily had my 2 children.

I am now 60 and have used HRT on and off for the last 25 years and have tried just about every HRT there is to try.
You GP should be able to prescribe HRT for you although if there is a menopause clinic locally that is worth exploring.
The problem with most GPs is that they are often not very clued up about HRT - so it's worth getting clued up yourself and go prepared with info to discuss with them.

As you have digestive issues I would like to suggest an HRT combination that worked for me very well in the early stages.  You may well still be peri menopausal so hormone levels could be fluctuating, therefore a sequential HRT regime will be best and will involve a monthly bleed.  Most GPs will offer HRT combined pills but transdermal HRT can be better for those that have digestive issues.  The combined HRT patches are unfortunately medium dose and when I tried these the dose was too high.  It is good to start low and then increase as and when needed.
Therefore my recommendation would be:
Oestrogen as patch or Oestrogel used continuously - maybe 37.7 patch or one pump of Oestrogel each day.
Add in progesterone for 10-12 days each month - this would be in pill form and I would suggest you try Provera first as this is a kinder progesterone that is well tolerated and should control the bleeds well. I know these are pills but when only taken for 10 days per month for so shouldn't be a problem.  The alternative is Utrogestan but this can bring a sedative effect and there can be issues around absorption as well.
As life settles with the new baby and the joy it can bring - your digestive issues may settle anyway and HRT can help you feel better generally.

Here are the links on this site that give the info to print off and show your GP:
http://www.menopausematters.co.uk/treatafter.php
http://www.menopausematters.co.uk/to_progestogens.php

There is comprehensive info on all HRT TREATMENTS in the link at the top of this page - it could be worth printing all these off so you can discuss your options more fully with the GP.

It is important you have HRT when young to protect you heart a bones for the long term.  If you experience vaginal dryness then local oestrogen like Vagifem is also a good idea and this is often needed alongside systemic HRT.

Do find out about local mothers groups or NCT group - one of the joys of having a new baby is getting to know other mums who will often end up life long friends.

Do keep us posted  DG x

[Hurdity]

Hi KittyBee

Just to say fantastic news that you are expecting a baby through surrogacy in spring after years of infertility treatment - you must be so excited, and apprehensive too I imagine . I can understand your wanting to feel at your best.

Dancinggirl has already given you excellent advice and I agree with all of it. Just to add that I use Utrogestan (micronised progesterone) for the progesterone part of HRT as this is bio-identical with our own progesterone made in our bodies. To minimise side effects I use this vaginally although if you are in a relationship you might not want to do this as I am not sure how effective it is after sex in terms of delivering a consistent dose - although I am sure you could manage (insert it afterwards?).

Although blood tests are unreliable for predicting exactly where you are in menopause, the fact that your periods are erratic and you haven't had one for a while combined with what I presume your blood tests show - is a good indication but even very high FSH levels don't actually mean you are post-menopause as they fluctuate so much.

I agree it is so important to replace oestrogen at your young age - for your future health and also so that you feel as well as you possibly can for the new arrival and all the challenges that will bring!

To avoid anything going through your digestive system you could also have a Mirena coil which delivers progestogen to the uterus where it is needed and then you add in oestrogen as Dancinggirl has suggested. I know you won't need contraception (which Mirena provides) - unless you want to give your ovaries that last chance gasp which they sometimes do before packing up - but it does avoid having to digest and metabolise the HRT (progestogen) through the liver.

Hope this helps and all the best

Hurdity x

[KittyBee]

Thanks both. 

I have taken Utrogestan before (post transfer when we did IVF a few years ago) and I remember the progesterone 'Skittles' fondly.  I had to insert them twice a day, and could cope with using them again if needed. Preferable in my mind to getting a coil, as I have a tilted uterus (and am a wuss).

Work performance is no longer an issue - was given the option to leave with a pay off on Wednesday (was quite a shock to be honest) so once that's all sorted, I am hoping that will do a lot to reduce my anxiety levels.  I also expect my IBS to reduce as I think that might also be stress related. As I will have more time on my hands, I am hoping to be able to spend a bit of time relaxing and then getting my diet and exercise sorted.

Will be spending some time over the weekend doing my homework before the appointment on Monday.

[Dorothy]

HRT will make a HUGE difference once you have found the right one.  I'm 41, on HRT can function very well - not quite at my pre-peri level, but pretty good.  Off it, I turn into some kind of zombie, in constant pain, unable to sleep, think...  As the others have said, it's really important to have it at your age. 

Congratulations on the baby!  Lovely news.

[CLKD]

As oestrogen levels drop off so muscles can become lax = aches and pains and the possibility of a hiatus hernia.  I get vicious acid reflux if I take meds too close to going to bed.  Heartburn is often background  but does respond to Rennies - 2 of.

We have several threads on exercising here  as well as various diet suggestions.  Browse round.  Join in.

You will be able to knit now that you don't have to go to work ;-).