menopause

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Should I start HRT?

Postby Dorothy17 on Sun Mar 19, 2017 2:42 pm

Hi - my GP has recommended HRT. I've just turned 50, my symptoms which I've had for some time now are lack of energy (most noticable/debilitating), feeling low, PMT/mood swings and headaches (although I've always suffered with this around my period), lack of libido, night sweats (although I've had these for years) not day sweats yet! I have the mirena coil and had this fitted in 2013 so will need this replaced before starting HRT. As I have the mirena coil I believe it's not possible to say 100% if I am menopausal/perimenopausal or not? And, ideally I would like to know for sure if I am before taking HRT.

My GP also took various blood tests (at my request) to check for lack of Vit D, siliacs disease, anaemia etc. All came back normal, although the doctor wants to see me to discuss Vit D. next week but I've been told not to worry. So I'm assuming this isn't a big problem.

As an aside, but could be related (please advise?) I've been getting thrush every month around the time of the month for at least a year, possibly longer. (I suffered with thrush all through my pregnancy too - over 10 years ago) so feel I am prone to it. My GP recently put me on a maintenance programme for this - the oral thrush tablet and I've been taking that for a few months. I tried pessaries but thrush kept coming back. The oral pill has kept it at bay for most of the time, but it's not completely gone away. I have still had thrushy symptoms - itchy, discharge a few times during the course of taking the pills. However, on the whole it's improved by taking the oral tablet. I've now stopped the course so that we can see whether it comes back again or not. I'm due to see my GP for a follow up this coming week to discuss.

My thrush, lack of energy, feeling low and mood swings are really getting me down so I do need to do something to sort this out. So, my questions are:-

I am I menopausal for sure?
And, how can I find out whether I am or not before I start HRT?
What are my options? Are they any other options?
Is my thrush related?
I've also heard horror stories about the merina coil and it's side effects - (lack of libido, depression, etc) could this be the cause of my problems? And, not the menopause? Would it be wise to have it removed (I'd need it replaced anyway if going on HRT) and see how I am before going on HRT?

Sorry for all the questions. Hoping you can advise!

Thank you.
Dorothy17
 
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Joined: Sun Mar 19, 2017 1:30 pm

Re: Should I start HRT?

Postby Dr Heather Currie on Mon Mar 20, 2017 4:59 pm

Thank-you for your question.
In women aged over 45, menopause and perimenopause should be diagnosed by symptoms, not by blood tests. So with Mirena which presumably is controlling bleeding, you will not know if your periods have stopped or not, but you can still try HRT.
The main part of HRT is estrogen, since when our ovaries work less well, we become gradually low in estrogen and low and changing level of estrogen is likely to be the cause of these symptoms. If we only took estrogen for the HRT, it could stimulate the womb lining and so we also take progestogen to protect the womb lining. With a Mirena in place, it will release progestogen directly into the womb, protecting the womb lining for 5 years. So, you do not need it replaced before starting HRT and you can take estrogen only either as a daily tablet, a daily gel, or a twice weekly or weekly patch. Mirena is licensed for the progestogen part of HRT for 4 years but it is nationally recommended that it can be used for this purpose for 5 years.
Therefore would seem reasonable to have a trial of estrogen only HRT. If estrogen plus Mirena suits you well and you wish to continue this combination, the Mirena would need to be replaced in 2018.
It is unlikely that the mirena is causing these symptoms, more likely is the changing ovarian function and changing estrogen production.
Finally, sensitivity to thrush can be affected by hormone changes and estrogen replacement, particularly vaginal estrogen, may help by restoring vaginal acidity and hence barrier to infection. There are also some acid restoring vaginal gels which may help.
I hope that this is useful
Best wishes
Heather Currie
www.menoapusematters.co.uk
www.thebms.org.uk
Dr Heather Currie
Associate Specialist Gynaecologist
Dumfries and Galloway Royal Infirmary

http://www.talkhealthpartnership.com/online_clinics/experts/dr_heather_currie.php
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Dr Heather Currie
 
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Re: Should I start HRT?

Postby Dorothy17 on Wed Mar 22, 2017 10:08 am

Dear Dr Currie

Thank you for your reply.

With regards to the Mirena I still have a period - not a bleed but dark brown discharge each month on a pretty regular basis.

Interesting that I won't need to have the mirena replaced until next year and that I can see how the HRT goes with my existing mirena in place which sounds like a good plan.

I will discuss this further with my GP as I have an appointment tomorrow.

Thank you.
Dorothy17
 
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Joined: Sun Mar 19, 2017 1:30 pm

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