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[HistoryStudent]

Sorry, I think I maybe about to have a rant…

Some time ago - Nov/Dec last year, I left a message on this board as I felt that I was seeing many symptoms of perimenopause - I am 50, and will be 51 in a few months time. After reading many posts on this site, and the helpful responses I received, I went to see a female GP at my doctors. I was told that as I was not experiencing hot flushes, then they could not prescribe HRT. I was given a prescription for Citalopram instead. The symptoms I described were:
Very irregular (but very heavy) periods
Feeling almost permanently premenstrual - feeling quite anxious and upset, for no reason, and emotional and tearful, most of the time.
Tired and no energy - I have just enough energy to get through the work day, and often don't have any reserves left to cook dinner or do anything most evenings.
Palpitations
Non-existent libido
Aches and pains, coupled with regular headaches, feels almost flu-like sometimes
Difficulty concentrating.

I felt a bit fobbed off, so didn't take the meds, but instead went to see another doctor at the surgery just before Christmas. She asked for some blood tests to be done - still refusing to discuss HRT - it turned out that my iron stores were low, and I was given iron for a couple of months.

Since then another test has confirmed that my iron is now within a normal range. However, my symptoms have increased in intensity, and added to the list is:
Nausea - regular but worse in the morning
Dizziness
Daily headaches - and sometimes really bad and come together with extreme tiredness and I guess are somewhat like migraines. I lose a whole day in bed and just sleep for a day. This has happened about 4 times since Christmas. I have never been a migraine sufferer.
Disturbed sleep, and waking feeling hot and sweaty several times a night
Generally feel pretty yuck most of the time and overwhelmed by everything (life)!

So, I decided to try another GP at the practice (again) - this time a male doctor who is usually really good and very nice/sympathetic. I had to wait 2 weeks to see him…

I went today. He was lovely, but was not keen on the HRT angle. Again, because I was not getting hot flushes he was not ‘allowed' to prescribe it!  But, because of the hot, sweaty episodes at night, it may be okay. Hurrah, I thought… but because I had mentioned migraine-like symptoms, he asked if I had ever had the ‘flashing lights'. I truthfully told him that this had happened once about 6 months ago - but I only had the visual disturbance, no accompanying headache. Apparently, this is an ocular migraine and he then refused point-blank to entertain the idea of HRT, as I was a stroke-risk - “...it would be a brave GP who would prescribe you HRT”. But, he was concerned as in the last blood tests my B12 levels were 190 (GP said that threshold for treatment is 180 apparently, that that 190 can be a problem if other symptoms are present). So, more bloods being done, for B12 and iron. I also have another prescription for Citalopram.

I am totally fed up, so I am going to give in and try the Citalopram… I have been feeling like rubbish since last Summer, and I am getting desperate. It's beginning to bring me right down. I have a busy job, and a lovely family, but I just feel so unwell most of the time.

Sorry, for overly long post. Does anyone have any information about the B12 issue, and it's relation to peri/menopause (a work colleague told me she's heard it was linked)? Is this right about migraine and HRT? Will Citalopram help with anything other than my mood, anxiety and emotional reactions?

Sorry for the rant - I was so upset after seeing the doctor, I cried all the way back to work! I've tried to find some info about B12, and it does seem that some of the symptoms could be down to a deficiency.

Thanks for listening.

[MIS71MUM]

Hello
All I can say is that you sound very peri menopausal too me. In fact you describe many of my symptoms.

As far as I am aware, you should be prescribed HRT as a first line of treatment for your symptoms despite having no hot flushes. This is in the NICE guidelines.  Also the amount of oestrogen in bio identical hormones are much much less than the contraceptive pill will does increase chances of stroke.

I think many ladies on this site have printed off guidelines and gone to their GP armed with evidence in order to get HRT.

sorry I'm not sure of any link between vit b12 defiency but would guess that the majority of your symptoms are down to lack of hormones.

[Mbrown001]

You could email Dr Currie for her opinion. Cost around £25/30 I think....it's on the home page.

Hate to say this but some ladies bend the truth a little and say they are having hot flushes/sweats to enable an under informed GP to tick a little box.

I really would get in touch with Dr Currie and explain everything that you have told us, then print off the email and take it to your GP.

ADs shouldn't be the first treatment that peri menopausal women are given. HRT should, if appropriate, be tried first.

Dr Currie is eminent in her field so an email from her should do the trick.

Mrs Brown.

[Annie0710]

Yes, when I first went to docs feeling lousy there were asterisks on quite a few of my bloods

B12 was 197 (range in our area 211-911)
MCV
MCH
MCHC I think it was

They gave me a leaflet on pernicious anaemia and said I should eat cereals with high fortified vitamins

When I googled the other asterisked results it shocked me as I had loads of the symptoms so I went back saying their leaflet suggested injections every 3 months.  They refused saying my results weren't low enough and eventually (prob because I was becoming a nuisance) agreed to b12 tablets for 3 months, they retested and it'd gone up to 219 so they refused any other treatment but said it was peri menopause

Your symptoms sound like both
Also, if you are on Facebook join pernicious anaemia group, they pick away at blood results for you and help you.  I learned that b12 tablets can sometimes only raise your serum levels but not reach cell level so can be useless

Also, I'm post menopause now and haven't ever had hot flushes, there's a small number of women who never experience them

[edelweiss]

Hello HS, good grief, what are they thinking? I agree with other ladies here. Very good luck to you xxx

[HistoryStudent]

Thank you for your support 

I will investigate contacting Dr Currie - that certainly sounds like a good opportunity for a second opinion.

Annie - funnily enough my Dad has pernicious anemia, so I guess there maybe a familial link. I will look out for the group on a Facebook. Thank you

My mother, now in her 80s, also didn't have hot flushes, so I suppose I may be following in her footsteps...

I have read the NICE guidelines now - but can't find anything on this contraindication between migraine and HRT. It seems daft as the migraines are clearly peri-related, as until recently I have never had one!  I guess Dr. Currie may be able to shed some light.

Thanks all - it's good to know I'm not making a mountain out of a mole-hill here 

[Annie0710]

Pernicious anaemia is auto immune (I believe in some cases if not all) so direct family link puts you at risk

The PA and b12d group - join the one with the largest amount of members .  Pat Kornic and her team are experts honestly

Hurdity suffers migraines and on hrt x

[MicheleMaBelle]

Hi historystudent- would echo everything that is said here. All normal peri symptoms and your GP practice sounds utterly useless ( but not uncommon)
You could e mail Dr Currie but it's one question for the " fee"
if you don't want to waste any more time and avoid trying to battle with your GP practice, maybe you should just either ask for a referral to a menopause clinic or if you can afford the initial consultation fee ( in my case a very reasonable £150 but I had wasted 16 months with GP practice) go and see a gynaecologist privately- there are links on the site to specialists according to area. Or ask for recommendations on the site. You should not have been offered ADs as a first line of defence. X

[nearly50]

Hi historystudent

You've got loads of good advice already, just wanted to say that the nhs are happy with iron levels which are really pretty low, ie 20. Good idea to try to get them up to at least 50 as that can make a difference to how you feel. I don't feel as tired since I got my levels up, but need to top up after every period as they're so heavy, and it can be an uphill battle.

Good luck.

[Wrensong]

Hi HistoryStudent, just wanted to say I have been a migraineur since age 18 with both classical and ocular varieties.  I had read that HRT was a no-no for migraine sufferers and for this and other health reasons avoided starting it until several years postmeno.  However, as menopause symptoms were still very disruptive & showing no sign of stopping, I eventually saw a Gynae (& Endo because I am also hypothyroid) for advice & they were both happy for me to try HRT via patch.  I think I've read that the migraine society (or some such body) endorses transdermal types (patch/gel), but please don't quote me on this as I haven't had time to check it out!  My classical migraines had stopped by the time I was prescribed HRT but I was still having ocular episodes.  The HRT has not brought the classical migraine back & the ocular episodes have been fewer since postmeno.  If what your GP says is correct, then my GP must be one of the brave ones, as she was happy to follow the specialists' advice and support the decision to start HRT!  You might find another GP less cautious if you want to take the risk.

[Hurdity]

Hi HistoryStudent

So sorry to hear of your ongoing symptoms and battle with the medical profession who continue to fob you off with anti-depressants or other medication. As has already been said these are not appropriate for hormonal symptoms if you have no history of depression and no reason to be depressed and indeed are not depressed!

You have already discovered that the NICE Guidelines do not give migraine as a contra-indication for HRT. The main ones are listed here on this website: https://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

AS for migraines - mine were hormonal in the first instance but don't know why I still get them from time to time since I never got them before late reproductive stage (when I experienced worsening pms while periods still regular just before peri-menopause). However as Wrensong says transdermal types are preferred if you suffer from migraine as it also says on this website:

Migraine
Migraine is often triggered by hormonal fluctuations and therefore may occur around the time of a period. Such migraine may improve at the time of the menopause. Some women find that migraine may be triggered by the daily hormone fluctuations which can occur with oral (tablet) HRT so the transdermal (patch or gel) route is usually preferred with a history of migraine.

https://www.menopausematters.co.uk/atoz.php#GlossM

As far as I understand it - the danger with migraine is if it suddenly occurs for the first time and/or extremely severely when taking tablet HRT - when women are advised to stop taking it immediately.

As always - if you adopt a healthy lifestyle you are minimising other risks anyway (body weight, exercise, diet, alcohol, smoking, stress vs relaxation etc).

Re the hot flushes - doctors should go on symptoms, combined with age and cycle changes to decide if you are peri-menopausal. You are now too old for the Pill but it may well be that a low dose HRT helps you.

Personally I would not take the ADs! Maybe you have already? I would hot foot it back to the doctor armed with the information from here - and yes backed up with an e-mail from Dr Currie briefly outlining your background and what you've been offered and asking if you need to be having hot flushes to get HRT and is migraine ( as you have described it) a contra-indication. It would be best to work out what you would like to try once you have a reply so that you can ask for this type (whiever this is). They are all listed under HRT preparations and we can advise too....

I take Michelemabelle's point about a private consultation - but as she says, not everyone can afford this but some women are driven to it. If you feel up to it - I feel that those of us who are articulate and assertive owe it to our less articulate and less confident sisters to educate those doctors who are behind the times and shake them up a bit. The British Menopause Society is trying to this from the top down but we can all have a go from the bottom up - there are plenty of success stories on here. However - whatever you feel you want/can afford to do! Some women have had one private consultation and then the gynae has written to the GP with the prescription and this is an excellent compromise!

Good luck and please let us know what you decide and want to try.

Hurdity x

[HistoryStudent]

Thank you so much for all your responses and excellent advice!!

I will seriously consider a private consultation - I hadn't thought of that to be honest. It's an excellent idea.

Special thank you to Hurdity for you very comprehensive response - I did ask the doctor if the ADs would help my symptoms like headaches and nausea... he was noncommittal.  I did actually take the first one last night - we're starting on a low dose of 10mg. I feel conflicted about it, as I didn't want to take them, but I've begun to feel so low that I will try anything 

[Elizabethrose]

Hi HistoryStudent

I've just seen your thread and I'm sorry you're feeling so awful.

You've clearly decided to give the ADs a try and they may offer you some relief, certainly as far as migraine is concerned it's a route that can be successful. However, HRT is certainly not to be avoided if you suffer from either classical or common migraine (with or without aura) though the contraceptive pill is nowadays. HRT was used by some renowned specialists to try to treat my migraine. Though unsuccessful at treating mine, it can successfully treat hormone induced migraine. It's a case of trying it to see if it works for you. Generally patch or gel is considered the best option for migraine sufferers.

So many of your symptoms are common to both migraine and peri and quite frankly your GP needs a good kick up the backside, but I rather suspect you realise that! Migraine is commonly triggered by peri and meno. My peri has lasted many years but the hot flushes started months after my last ovulatory cycle just last year, some women never get them.

As you are feeling so badly you may not be up for a fight but if I were you I would go into battle. Write all of your symptoms down, plot out your cycles, keep a detailed daily diary of exactly what you are experiencing, find references to the NICE guidelines and info that you can easily source on here. Prepare exactly what you wish to say, what you want to try, dress to intimidate and go into your GP guns blazing. Be civil but firm. If you have no success make a formal complaint. In fact it may be a good idea to establish that that is your intention if they don't listen to you and treat you properly. It is an outrage that they are so uninformed. It may well be prudent as suggested to request help from Dr Curry and take that with you as further ammunition.

I wish you well x

[Mary G]

HistoryStudent, my advice would be to have the blood tests but if all else fails, fast track to a menopause specialist and don't waste any more time on that GP.  It is nonsense to say that women who have migraines cannot use HRT because in many cases, it is HRT (usually oestrogen) that keeps migraines away.  I have silient migraines (aura without headache) and borderline low B12 and now take supplements but the real culprit in my case is the combination of synthetic/artificial progesterone and low oestrogen levels. 

I now manage to control my migraines by using Oestrogel (very flexible and easy to adjust the dose) and very low dose Utrogestan used vaginally.  I have to keep my oestrogen levels fairly high to feel good and keep the migraines away. 

I would definitely go the transdermal HRT route, it really does sound like you would benefit from it. 

I hope that helps.