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[Lulu_A]

Hi all,

I'd be very grateful for any advice please as this is all new to me and my situation is a little complex.  I appreciate this is long but your guidance will be invaluable.

In Jan 2020 I started suffering weird temperature fluctuations - hot flushes AND cold flashes (people never talk about cold flashes!?)  I saw a Dr who was dismissive saying it was impossible to tell whether it was menopause related and blood tests could indicate little.  I was then 45. The problem being that I've been on a continuous POP since 2016 so have not had a period since then.  My "cycles" cannot be monitored.  In Nov 2020 I had a blood test where I was told everything was "normal".  I now realise that wasn't exactly the case.

The hot/cold problem continued on and off and has recently got pretty unbearable especially at night. I spoke to a Livi Dr who said in Nov 2020 my FSH and LH levels were already quite raised, though this was dismissed at the time due to potential monthly fluctuations (even though I'm no the pill).  Speaking to her again on Saturday she confirmed my new blood test shows I'm definitely mid-menopause, if not through it:  FSH of 84 (should be under 30 if still fertile); LH level of 39.6 (should be around 25).  Whilst I accept that one blood test alone cannot definitively confirm where you are in the process, these levels seem high enough there's little question over it?  However, as I'm 47 it's possible that I could still be producing the odd egg so I need continued protection.  She suggested I come off the pill and start HRT.

Herein lies the problem. I'm not averse to the estrogen pills or gel, or the progesterone tablets. But I am averse to coming off the pill which has suited me so well all these years and getting a mirena coil fitted.  They've been trying unsuccessfully to coerce me into this for 10 years and I don't intend to get one now when I'm clearly at the tail end of my fertility at best, and when it took 8 attempts to find the right pill for me.  It's easier to stop taking a pill than it is to remove a coil.  My issues/queries are...:

-She said 'in theory' I could continue with my Noriday POP and take HRT, except the POP is not licensed for that so she couldn't prescribe it.
-She was unable to discuss that option so would refer me to a menopause clinic, except the waiting list would be 'very long' and I've no proof the referral has been made yet.
-If my hormone levels are that high, do I still really need to think about contraception?
-If I go onto HRT in whatever combination (ignoring the coil) will I get periods which I haven't had to endure for 6 years?

I've tried to find clear answers online but it's a minefield.  Guidance seems to be that continuing the POP with HRT is not licensed but could be an acceptable form of protection and could be prescribed.  If I indeed I need protection? This is where I'm so confused.

Does anyone have any experience of any of this please? I'm finding it very hard to get any clarity - and while I play the waiting game, I continue with the horrendous sleep disturbance (I'm trying Maca but so far to no avail). What does make more sense is the collection of symptoms I've had over the past 2 years.. frequent UTIs, inexplicable bladder pressure, headaches, tiredness.  I put some of this down to post covid recovery (I had it in 2021).  I didn't even consider menopause because my Drs weren't willing to really discuss it with me.

Any help anyone could provide would be VERY much appreciated!!!

Thank you!!

Lou

[Dotty]

Hi you can take the POP for contraception, alongside the hrt. You will need to take oestrogen and a progesterone as your hrt. So you can use Oestrogel and Utrogestan as the hrt for example and carry on with the POP for contraception xxx

[Taz2]

Hi Lulu. Sorry for this brief welcome but about to go out.  I agree with Dotty. https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20200202115555524548

Taz x 

[CLKD]

I had cold flushes when taking 'tamoxifen' and again a few years later as I went into peri.. 

Browse round. Join in. 

[Lulu_A]

Hi all,

Thank you to those who answered my previous post!  Just a quick update.

After booking a call with my own Dr which never happened, I finally spoke to a very helpful Livi Dr yesterday.  The beauty of the Livi system is that you can email EVERYTHING you want to say ahead of your booked appointment time, the Dr has time to read it, digest it, review the links you provide and think about it before calling you.   I included the GPNotebook link on taking POP with HRT.  I didn't mind my calling being 20 minutes late because he read and took seriously what I'd submitted.

This very empathetic Dr agreed that with my medical and family history there seemed no reason for me not to continue on Noriday POP whilst also prescribing Elleste Duet (sequential HRT pills). I'm starting on a 1mg dose and he thinks that whilst I may get some breakthrough bleeding that should settle within 3 months.  This makes me very happy and very hopeful!  I'm not expecting a magic bullet but it does at least provide an opportunity to try to get rid of the sweats, shivers, aches, emotional wobbles, night-time tingling feet!

Just goes to show that it pays to do research and present it in a way that it can be absorbed. I wouldn't have had this opportunity with a 5 minute call with my own surgery.

Thanks,

Lou

[Cocobra]

Hi Lulu,

my bit of experience re. contraceptive pill vis-a-vis HRT: when I had similar FSH levels to you (and I was 44 at the time, now 50), my GP in the UK wanted me to go on HRT while my gynaecologist in Italy wanted me to go on the pill first, before going on HRT later. I cannot recall why she suggested this, which I realise is not helpful, but she thought it'd be best given that I could have got pregnant still. She also thought the pill may alleviate the symptoms (I too had terrible hot/cold flushes). In the end I did not go down that route and started HRT soon after.

All best