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Ask a Menopause Nurse | Diane Porterfield-Bourne

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  • Djdros52Djdros52 Posts: 29 ✭✭

    Hi there, I 52 and stopped my period at 49. I get hot flashes that seam to start at the back of my head down my neck through my legs and burn my feet. Then I turn around and get chill's to the bone and my head feels like it has water in it, andy ears ring constantly. Any idea what I am dealing with. Additionally, my heart beats real fast. Am I normal or should I seek medical attention?

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Djdros52

    Thank you for writing in. You have said your periods stopped when you were 49, was that due to tablets or the coil or just stop naturally? If this is the case you are over a year without a period so are post menopausal.

    Any symptoms you have or are worried about must be discussed with your GP. They know your health better than anyone and are your first port of call. Some of the symptoms you are describing could be menopause related but your GP will discuss this. We all go through the menopause but we can have other health conditions too.

    Please let us know what your GP advises.

    Best wishes

    Diane Porterfield Bourne.

  • sunny123sunny123 Posts: 5

    Hi Diane,


    Just wondering if you can help me.

    I was on hrt pumps 1 pump a day but stopped on day 10 as I felt drugged walking around totally spaced out. I didn't take any progesterone as I hadn't got to day 14.

    Since I stopped the hrt, I have had 3 periods in 6 weeks, 2 weeks apart, for 6 days at a time. Will this stop, why is it happening. Su h a nightmare tbh. I don't seem to be ovulating at all.


    Thank you

  • Evening Diane

    I was wondering can HRT give rise to anxiety? I was in my 3rd/4th Month of HRT and I seemed to turn weird!! I got such anxiety which caused me to have OCD . Could the HRT have contributed to this?

    Hope you can help

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @sunny123

    Good morning.

    Thank you for your question.

    Firstly 1 pump of oestrogen gel per day is a very small dose... We are all different and react to medications differently. Have you only just started HRT?

    Feeling ' drugged' is not a symptom I have heard women say. Did you call your GP to discuss this?

    Progesterones can sometimes make women feel a bit sleepy but not many and it often passes quickly, but you didn't take any?

    Were you taking any other prescribed or over the counter medications?

    I would suggest talking to your GP, to ensure there are not other issues to why you were feeling this way.

    I would doubt your periods/bleeding are related to this taking such a small dose of Oestrogen for such a short time but you must run this past your GP. They will give you advice and reassurance.

    Please keep in touch and let us know how you get on.

    Best wishes

    Diane Porterfield Bourne.

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @AnnieBycraft09

    Thank you for writing into Live Better With Menopause.

    When we first start taking hormones, our bodies have to adjust from not a lot and levels start to increase. This MAY give rise to some anxiety but it isn't something women often say. Anxiety is a common symptoms of low Oestrogen so when your levels increase they relieve symptoms of menopause.

    What type of HRT are you taking? Are you taking it exactly how it has been prescribed?

    Have you ever experienced these feelings before?

    Can you relate them to anything else going on in your life? Anxiety amongst most people has increased, so it maybe a contributing factor.

    Please discuss this with your GP. The better forms of HRT are Oestrogen in a patch or gel and progesterone in a coil or capsule.

    If you would like to talk more about HRT please write in to me.

    Please let me know how you get on with your GP and keep in touch.

    Best wishes

    Diane Porterfield Bourne.

  • ElaEla Posts: 1

    I'm looking for advise about HRT I am taking. It’s Utrogestan 1 capsule daily and Sandrena 1mg gel daily. I’m post menopausal last period over 4 years ago. I keep bleeding every 4 weeks, painful breasts etc. I’ve had internal scan; womb thickness was 9mm which apparently is too thick. Consultant said she would recommend a biopsy because of the bleeding. I was a bit shocked and didn’t ask her if I should keep taking the HRT, so, I stopped taking it. I’ve only been taking it for about 4 months.

  • Natj1Natj1 Posts: 1

    Hi,

    Im 49 and haven’t had a period for about 6 months. My night sweats are preventing me sleeping. My Dr advises against HRT as my mum and her sister have both had breast cancer. I’ve tried Sage leaf/Menopace and Evening Primrose, but no success. Recently my dr prescribed an anti depressant as she said this could help, but no relief. She is now writing to the breast clinic for advise, but I’m desperate for a nights sleep. As reluctant as I am to take HRT, I really can’t continue not sleeping.

    Thanks in advance,

    Natalie

  • BoroBoro Posts: 1

     Dear Diane 

    I will summarise as best I can.

    The Past 

    Early 2017 (almost 51) Felt v depressed despite being on sertraline 200mg since I lost my Dad in 2013(was well within 3 months and stayed well 2013-early 2017) Dr put me on mitrazpaine and apriprozale and then to a psychiatrist who put me on venlafaxine 300mg. In between all this I had a blood test which they told me showed I was post-menopausal. (139 pmol)I went on Premarin but nothing changed and was thought of as "treatment resistant" that is until I changed hrt and at 3mg elleste solo (I have the Mirena coil currently 3rd one inserted 2019) I was totally well. I started to get bad migraines so was taken off the tablet and put on 2 pumps of gel initially slunk back into a deep depression despite still being on venlafaxine. Finally on 4 pumps of gel I was well again came off the anti-depressant June 2018 and stayed well till December 2019. I even ran Menopause cafes to support others. I had reduced to 3 pumps of gel over this time and was still well. However I had been on oestradose not the usual UK estrogel for the 2 months prior to December 2019. I fell ill again possibly just a coincidence the oestradose. 

    Jan 2019 blood tests showed oestradiol at 357 which should be a good result but it didn’t work for me. They put me on sertraline around February increasing up to the maximum 200mg. Then switched to patches another blood test showed 105 still depressed. Increased to evorel patch 2 x 50 (twice week)and eventually 3 getting up to 4 pumps of gel. Also added in tostran one pump a day. Finally I feel well again back to feeling like me the clinic said to have another test as a well person and the oestradiol showed 800. I said should I stay on this level of hrt and they said yes to stabilise. So I did and then started feeling dreadful again and sent me for another blood test which showed this: 

    08-Jul-2020

                  Serum testosterone       7.4 nmol/L         0.4 - 1.2 nmol/L

                  Comment: (ABR186) - Raised

                  Serum oestradiol level

                  Comment: (ABR186) - High - to discuss with menopause clinic and adjust dose

                  Serum oestradiol level   2149 pmol/L      - pmol/L

                  Comment: Reference Ranges Follicular 77 - 922 Luteal 77 - 1145 Post Menopausal <103 

    The menopause clinic told me to come off hrt for about 4 days and then restart again. I did and got up to 2 patches again and 1 pump of gel . 

    They asked me to check bloods again

    30 July Serum testosterone         9.5 nmol/L         0.4 - 1.2 nmol/L

                  Comment: (ABR186) - High at 9.5

                  Serum oestradiol level

                  Comment: (AME186) - Normal

                  Serum oestradiol level   581 pmol/L        - pmol/L

                  Comment: Reference Ranges Follicular 77 - 922 Luteal 77 - 1145 Post Menopausal <103 

    Told me just to use tostran 2 days a week and to build up the oestrogen again. As I obviously need to be higher. I am currently on 2 patches 50 evorel and 2 pumps of gel. Also 200mg sertraline. The menopause lady said she will telephone me in October told her I was still struggling and she said she is a gp and has seen good results with patients on Lithium. I looked it up and would try anything but it looks scary and I don’t have physchosis or bipolar I just feel hormonally depressed sad and flat. My doctor is away and referred me to a mental health team my appt is 7 September. 

    Sorry it’s a long email Diane I cry as I write it. I am struggling so much to the point of not wanting to be here but I don’t want to kill me just this feeling. I run, I go to my job but I am just going through the motions and pretending and life is so hard. 

    Please can you help me you are my last resort. I just want someone to say I will be well again. Do you know of any other anti depressants that may work along with the hrt or should I just come off everything.  It is such a balancing act to get the oestrogen to the right level for me. My dr is away and they said best to chat to her as she knows me but not much about menopause.  Is Tibolone a good one?

    Thank you so much


    Julie Salmon

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Ela

    Thank you for writing in about vaginal bleeding when you are post menopausal.

    After your periods have ended for a year...you are post menopausal and should not have any vaginal bleeding except if you start of HRT. You can bleed up to 6 month when you start taking it but always follow the guidance from your GP and in doubt please discuss with them.

    I would ask your GP or call your gynae secretary and ask them that exact question. Do they know you take HRT? I would have thought if they wanted you to stop your HRT they would have said but do ask your GP.

    Will you let us know how you get on?

    Best wishes

    Diane Porterfield Bourne.

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Natj1

    Hello and thank you for your comments.

    Many doctors fear HRT and breast cancer...and I obviously understand your fear too.

    Can I ask how old your mom and sister were when they were diagnosed? This is very important.

    If they were younger and as you have a sister and mom with breast cancer they will wait until you have been seen in the breast clinic.

    Evening Primrose has shown effective in breast tenderness during menopause but I have not read anything else about its effectiveness. I can't comment on herbal supplements.

    Taking HRT is a discussion you must have with your breast clinic ( as your GP has referred you). Or call the GP...

    It is about quality of life V risks and if they think your risks are higher it is still your decision. You MAY have a higher risk of getting breast cancer but you may not...

    1: 8 women in the UK get breast cancer who take HRT and 1: 8 women will get breast cancer who don't take HRT... you see what I mean? Please ask lots of questions when you see the breast clinic. If you want to DM me I can help you focus on the questions.

    But at the end of the day, even if they thought you had a greater risk of getting breast cancer it does not mean you will actually get it... Like I said it is about quality of life V risks.

    Please keep in touch and I am here if I can help in any way.

    Best wishes

    Diane Porterfield Bourne.

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Boro

    Thank you for getting in touch.

    There is a lot going on....I would discuss all this back at the menopause clinic. Do not leave this until October...


    Your history is complex and I am sorry I can offer a certain level of guidance. It is your GP and menopause clinic who you need to talk too..

    I have advised and supported women with menopause and most women once their levels are reached and they get on the right HRT regimes feel better. Some women need more Oestrogen than others but this is what your Menopause clinic and GP will discuss with you.

    You said you are feeling low, I therefore strongly advise you discuss how you are feeling with health professionals, 111, family and friends. Its vital you have everyones support.

    I wish you luck.

    Best wishes

    Diane Porterfield Bourne.

  • MazzleMazzle Posts: 6

    HiDiane,


    I am due to have a phone consultation today with the menopause GP, they haven't stipulated a time as the GP is in with other patients. Anyway, this is my second appointment in approx 10 months, the first was because I have had my marina coil in for 5 years, she said it was ok to keep it for longer. I expressed symptoms of menopause mainly, mood, achy bones, dryness, lack of sleep, lack of interest in sex fogginess and poor memory, anxiety. She advised that I was probably going through the menopause but that she would do a blood test in Nov at my 52nd birthday.

    Todays consultation comes on the back of fogginess, anxiety, no interest at all in sex, achy bones, night sweats, vaginal dryness, frustrations, sadness, anxiety. I am off work due to the anxiety and stress although the majority of which is work related. Now there has been talk of HRT but I need to know more. I would love to start enjoying sex again with my hubby and I would like to minimise all the other symptoms I am experiencing

    What would your recommendations be and why? Are there vegan HRT meds?

  • Blanka_CBlanka_C Posts: 406 Community Admin

    @Mazzle

    Hi there,

    Thank you for your question! Diane will be in touch soon with an answer for you, but in the meantime I just wanted to let you know that we have an FREE online event coming up tomorrow at 5pm BST. It's a live Q&A with Diane and we'll be discussing HRT! You'll have the opportunity to listen in and ask questions.

    Feel free to join in if you'd like, here's some more information on how to join (it's via Zoom):

    Hope to see you there!

    Best wishes,

    Blanka

    Community Associate @ LBW


  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Mazzle thank you for your message. You tell the story of so many women...

    How long have you been having these symptoms? When you say they talked about HRT has your GP advised it or suggested you read more on it? Are you going back to talk about your menopause and possible treatments?

    Blood tests to diagnose menopause are not required if you are over 45. If they want to check other things like cholesterol or thyroid then that's different.

    Did they prescribe vaginal Oestrogen for your vaginal dryness?

    I prescribe HRT and understand how it works in the body. I do advocate HRT but not every women wants to take it and that is their choice. However I hear time and time again myths, and strange things women take and buy over the counter for menopause that have absolutely no proof it will help.

    HRT improves mood, fatigue, flushes, sleep, libido and improves your long term health too.

    As a health professional I advise women on treatments for menopause that are hormonal and non hormonal. What I do advise is based on research and best practice within the UK.

    Please listen in tomorrow and I hope to clarify some of your concerns. If I don't cover everything, please write back in or PM me on here to talk in more detail.

    Best wishes

    Diane Porterfield Bourne.

  • MazzleMazzle Posts: 6

    Thanks for getting back to me.

    I did mention that my understanding of NICE guidelines is that I don't need a blood test due to my age and symptoms. she said she wanted one as when I last had oneNov 2019 result FSH 106 I had the Merina coil in at the time. I am having a blood test next Fri still with the marina coil in?? Im confused. She said she has had experience of removing the coil and periods coming back and she didn't want this to happen in my case. I am 51, 52 I Nov.

    I have absolutely 0 libido and its impacting on my marriage having only been married for 6 years so anything that can help would be appreciated. Right now sex is the last thing on my mind, well to be honest its only on my mind as I don't have the urge and I know the negative impact this is having on my hubby and our marriage. I did used to enjoy an active and healthy sex life pre menopause.

    The only other thing is that my preference for consideration to HRT is that its plant based, not derived from animal..


    I have had no prescriptions as yet for anything - not sure if oestrogen is plant based..

    what do you recommend?

    Thanks, Maz

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Mazzle

    Thank you for updating me. You are right the NICE guidelines indicate that women over 45 with menopausal symptoms can be diagnosed with the need for blood test. I always question, what information does your GP seek to gain by repeating an FSH? Will they start you on HRT regardless?

    The Mirena coil is a great way of getting progesterone as part of your HRT, I advocate this and other types of progesterone. You don't need to have your coil removed unless there is a specific health reason why they want it out?

    HRT that I and your GP prescribe is "regulated bio identical", it is based on plants. The only tablet oestrogen that based on mare's urine is rarely prescribed. I would have to contact the pharmaceutical companies to ask about any products coming from animals, as with any other over the counter or prescribed medication. The oestrogen tablet based on mare's urine is the only 1 I can say for definite. I think the rest are suitable for vegetarian but I'm not 100%. You could ask your pharmacist too.

    As for your libido, your GP needs to support your with this. HRT is the gold standard and other hormones.

    Please let me know how you get on with your GP, please listen to the talk tonight, I think it will help you.

    Best wishes

    Diane Porterfield Bourne.

  • TrogTrog Posts: 1

    Hello

    I had a period in Feb 2019 and it was the first one for 10 months. I then had one in Nov 2019 but since then nothing. On 3 separate occasions since November 19 I have had a pinkish discharge for a couple of days, thought I was going to have a period but nothing happened. I know that if you have any spotting or pink discharge after the menopause you should see your GP but I don't want to waste their time if it is normal. Should I wait until November for the year without a period to pass and then go and see GP if it happens again. I am 51 and had breast cancer (triple negative) in 2005 so I am not taking any HRT. Thank you

  • MazzleMazzle Posts: 6

    Hey up Diane,

    I was in on the webinar tonight but I had failed to see your response above so I continued to pose the same questions sorry for any confusion.

    I found the webinar useful for the short time available.

    I'm keen to sort my libido because if home isn't sorted then I can't expect everything else to work effectively including work ( a little like Maslows hierarchy)

    All these words banded about, progesterone, testosterone..what do they do ?do they work in partnership with oestrogen? and if so why? and for what?..

    Oh my days, it's a minefield.

    Im thankful for advocates/ambassadors like yourself, honestly it makes this very difficult time much more bearable


    thank you :)

  • PoppyfieldPoppyfield Posts: 1

    Hi there, I wondered what your thoughts are on whether Doctors are led by Pharmaceutical companies to pescribe certain HRT products (my concern is am I getting the correct one or the one most promoted) and secondly will I go through similar symptoms that I had before I started taking HRT when I stop taking it. I've been dealing with challenging symptoms for the past three years and started HRT two weeks ago and it's transformed my life. I'm back to me!

  • dawn75dawn75 Posts: 1

    hi im 45 just had a hystrectomy with ovaries removed and gone in to surgical menopause . not suffering to bad but is having very bad heart palpations and what i can only explain as a funny head where it feels like someone is squeezing my head and i feel funny like i am going to black out then it goes .it only last a couple of seconds .i have just started estrogel and using 3 pumps wondering if to go up to 4 . i am just a bit conserned as i have not read anywhere about this feeling in my head which is assoiciated with menopause

    many thanks

    dawn

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Mazzle

    Good morning.

    I hope you understood a bit more about the menopause. It is a vast subject and obviously I can only skim a few areas in 30 mins.

    Hormones- they are our Oestrogen, Progesterone and Testosterone. We have good levels of them but they fall during menopause. The lack of Oestrogen is the most significant. HRT improves many of our menopause symptoms; this includes low libido. Most women who take maximum Oestrogen will find there libido returning but some don't. This is when you can have testosterone too. We actually produce a fair bit of it and during menopause it can hit the floor. Replacing this important hormone is very important.

    Your GP/health provider if started you on HRT ( oestrogen and progesterone) and after increasing found no significant difference in your libido can do blood tests for testosterone levels too. If this is low, testosterone replacement therapy can be given. It is safe and many women feel much better on it.

    I hope this helps. I hope you can talk to your GP/Health provider and if HRT is what you want/suitable you can be prescribed it.

    Please keep in touch and let us know how yo get on.

    Best wishes

    Diane Porterfield Bourne.

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Trog Thank you for writing in to Live Better with Menopause.

    You are right, that vaginal bleeding after you are post menopausal ( and not taking HRT) needs to be reported to your GP. Once you have gone a year with no period then yes you are post menopausal. If after that year you did have a bleed or vaginal loss yes you must see your GP and be investigated.

    If you have any concerns please discuss this with your GP.

    I hope I have helped answer your concerns. If I can advise again please write to me.

    Best wishes

    Diane Porterfield Bourne.

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Poppyfield

    Thank you for your question. As health practitioners we do not get led by pharmaceutical companies on what to prescribe. Drugs are prescribed on safety, availability, suitability and cost.

    Cost is always an important factor, as if there are choices that the same type of drug, action, safety is cheaper than another we do have to think about cost but not above what I have already said.

    The right HRT for you should be based on your risk factors and the type you want. For example I suggest a few types of progesterone. A very effective long term one is the coil, it is cheap, lasts years and very good but some women can't have this or don't want it. It is about discussing what your want and what is safe for you.

    Many women ask will I get symptoms back when I stop HRT. The answer is we are all different, there is a good chance you may but we really don't know. My question is why would you stop HRT? If there is a legitimate health reason, or you decide to stop then of course. But HRT can be taken as long as the benefit of taking it outweighs your risks. Many women continue taking it into their 70's, 80's.

    It is a personal choice and one you would make with your health provider. However you said you are feeling better after 2 weeks! And that is how you should feel.

    If I can answer any more questions please write in.

    Best wishes

    Diane Porterfield Bourne.

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @dawn75

    Good morning. Thank you for your message. When did you have your hysterectomy? I am pleased you have been started on HRT. If is very important to protect your heart and bones as well as improving the physical and psychological effects of low hormones...

    Younger women often need more hormones than older women.

    I am unable to advise on your symptoms as you need to take to your GP. However palpitations can be common in menopause and head pains but until you discuss this with your GP you will not know for sure.

    I never advocate increasing prescribed medications unless the person prescribing wants you too. Please talk to your GP. Let us know what they say.

    Best wishes

    Diane Porterfield Bourne.

  • MazzleMazzle Posts: 6

    Hi Diane,


    thanks ever so much for your response and detailed experience. I am at the beginning of my journey with my GP and I do feel like its a long road ahead..

    Can I just ask? how do you know what stage of menopause youre in? what determines it? I have heard the words peri, post etc..

    Regards, M

  • Djdros52Djdros52 Posts: 29 ✭✭

    Hi Diane,

    Thanks for your response to my post. I stopped my cycle at 49 naturally. I recently was put on steroids and antibiotics for sinus. This is probably the problem with my head. The do have an appointment with the heart doctor on Sept 2 and I will update you with results. I'm hopeful that all is well. I am contacting my GP again also as I just had my pap test and mamogram in may. All was well but she did mention to me about taking antidepressing med's but if I not depressed, I don't want to take that. Thanks again

    Djdros52

  • Djdros52Djdros52 Posts: 29 ✭✭

    Hi Dawn 75,

    I just wanted to let you know that I have been going through the same feeling in my head. It feels like my scalp is being ripped from my head at times and like you describe that someone is squeezing my head. Feels like you are going to pass out. I have sinus infection quite regularly so my medical Dr is treating me with anthisamines allergy tablet after he had me take a steroid and antibiotics. I hope this clears it. I hope you can get to the bottom of your symptoms as well. I will let you know my outcome.

    Djdros52

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Mazzle

    Hi there.

    You are right there are stages of menopause.

    Peri means before.... this is the time leading up to the first day of your very last period. This may last for some years.

    Menopause, the day your begin the menopause is the first day of your very last period. Once you have completed a year have " Completed the menopause"

    Post means after....When you haven't had a period for a year you are then post menopausal.

    Of course you can have the "symptoms" all the way through and they can continue for many years.

    Its important to write down your cycle, so you know where you are. You might not even remember when you last had a period but it makes a difference when I prescribe HRT.

    I hope this helps.

    Best wishes

    Diane Porterfield Bourne.

  • MenopauseorjustmeMenopauseorjustme Posts: 431 Menopause Nurse Practitioner

    @Djdros52

    Thank you for giving me more information.

    Many women tell me their GP suggests/prescribes anti depressants when they have told their GP they are not depressed.

    Did you see my Webinar I did on Wednesday? If you can't find it @Blanka_C could you find the link please?

    Here I talked about NICE guidelines on menopause and it states that anti depressants are not advised for low mood in menopause. If you are feeling low during the menopause HRT should be offered first. If your GP however believes you have underlying depression/anxiety for completely other reasons, then this maybe why they were suggested. But low mood during menopause is very common and HRT can be extremely effective. If you do not want or can have HRT then anti depressants, counselling may certainly help.

    Do let me know how you get on.

    Best wishes

    Diane Porterfield Bourne.

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