Please help me wrap my brain around perimenopause

June 14, 2018 11:41 AM

I'd like some help figuring out which perimenopause symptoms or issues I can reasonably expect a doctor to help me with, and which ones I should just expect to put up with until they go away on their own. I am well aware that most of what I'm experiencing is within the realm of normal, but I'm having a hard time knowing whether I should put up with things that are affecting my quality of life.

I'll preface this by saying I'm generally in good physical and mental health, though I am recovering from severe GERD, have moderately painful arthritis managed through physiotherapy and exercise, and have had periods of depression related to infertility and pregnancy loss. I am mostly okay now.

Throughout my life, I've consistently experienced difficulties with menstruation and reproductive health, including severe cramping, very heavy flow, hot flashes at certain points in cycle, fibroids, infertility, and unsuccessful pregnancies (losses at 13 and 20 weeks). I am now in my early mid-40s, no longer trying to get pregnant, and experiencing the beginnings of perimenopause.

Things I think are related to perimenopause/hormones:

• Sudden shortening of cycle length from 26 to 21 days, so I feel like I've got my period all the time
• Very heavy periods and flooding--blood tests revealed I am now anemic and must be on iron supplements
• Bad cramps are back, but now I'm not able to take NSAIDS to manage the pain because of GERD
• Big clots about 1 inch in diameter
• More frequent (but not daily) hot flashes and night sweats
• Insomnia
• I have tingling in my feet that comes and goes--I'll ask my physiotherapist about that today, because it could be related to my arthritis, but I know it can be a symptom of perimenopause.
• I've given up on parenthood and have spent the last couple of years making peace with that, but this reminder that my fertility is really done with is making me a bit emotional again; I'm also grappling with existential questions that are probably common at this time of life for everyone but possibly complicated by knowing I don't/won't have kids or grandkids.

My primary care physician is, frankly, not great. I cannot switch to another doctor because of a doctor shortage. I live in Canada and we need to be under the care of a PCP to be referred to a specialist (ie clinics can't refer).

I have talked with my doctor about my symptoms. His suggestions on managing perimenopause symptoms were taking ibuprofen (I had to remind him of my GERD) or waiting for menopause to take care of it (!!!), at which point I actually asked him if he thought I should suffer through these symptoms for 6-10 years or more. He acknowledged that was a long time. He also said I could take hormones but it wasn't advisable due to side effects. He said there is little that can be done, though he sent me for an ultrasound to make sure the heavy, crampy periods weren't cancer. They discovered reappearance of fibroids and a hemorrhagic cyst that's being monitored.

I asked him for a referral to the gynaecologist. He was reluctant but I was firm and insisted. He warned me there wasn't much they could do for me. I said I wanted to see one anyway.

It's now a 6-12 month wait for me to see the gynaecologist (we have a severe shortage of OB/GYNs here). In that time, I want to figure out what I can reasonably expect help with when I do get in to see them. Which perimenopause symptoms or issues can I reasonably expect the gyne to help me with, and which ones should I just expect to put up with until they go away on their own? Can I manage any of these myself, and if so, how?

posted by hurdy gurdy girl to Health & Fitness (16 answers total)

Response by poster: Oh, I forgot another annoying cluster of symptoms. My hair is dry, out of control, and generally not a nice texture. I feel like it's thinned out but I started out life with a lot of thick hair, so it's kind of hard to tell, and I did have that hair shedding thing after my two pregnancies.

My skin is also dry and my nails are brittle.
posted by hurdy gurdy girl at 12:01 PM on June 14, 2018

I am not in Canada but you might know something about similar limitations in US healthcare.

I have had very similar symptoms to exactly what you describe and decided to pay to have my hormone levels tested - primarily thyroid and progesterone. I used Canary Club for the testing. When my results came back, I made several dietary changes to support my thyroid and started using topical progesterone and magnesium. My cycles have lengthened to 28-29 days and are somewhat lighter and my PMS symptoms have seriously abated. I also had my iodine and vitamin D levels checked and have been supplementing those.

I figured out accidentally that my arthritis symptoms were the result of a dairy allergy and eliminating dairy has eliminated 85-90% of the pain - the remaining 10 - 15% is noticeably triggered by environmental allergies. I have been taking a daily antihistamine for a year and have noticed terrific improvement.

So no, I don’t feel you should have to live with any of this, but I do think you may need to seek testing and treatment on your own while you wait to see a gynecologist.
posted by annathea at 12:11 PM on June 14, 2018 [2 favorites]

the skin/hair/nails thing happened to me as well from severe anemia; my skin was a weird grayish color and small cuts wouldn't heal, my hair was coming out in fistfuls, it was terrible.

i can't speak to perimenopause symptoms specifically, but before my hysterectomy for severely heavy clotty awful painful periods (and a bunch of other things), my gyn and i explored the possibility of a uterine ablation or the insertion of a local hormone releasing IUD. neither one of them turned out to be viable for me personally but they are absolutely things that exist to help with severe menstrual issues, and i'm annoyed by your GP's defeatist attitude on something he doesn't seem to know much about.
posted by poffin boffin at 12:12 PM on June 14, 2018 [6 favorites]

I did some research before going on hormone treatment for menopausal symptoms. The current consensus seems to be that the positive benefits (primarily heart health) is greater than the negative risks (cancer) for women under 60. Also, there is a new formulation of progesterone (somehow encapsulated) that is preferred. I don't have links to all this right now but even the question of risk is more complicated and nuanced than your doctor suggests.
posted by metahawk at 12:28 PM on June 14, 2018 [1 favorite]

I'm sorry you are going through this with such insufficient medical care! so much of this could be alleviated I think. a gyno could help you figure out some options. for example, if this is not a conflict with other medical issues, hormonal birth control can help a lot. I am 50 and peri-meni for about last 2 years. all that time I have been on HBC and I do not have irregular or heavy bleeding, hot flashes or night sweats. my hair and skin are definitely drier but changing products/regime helps a lot with that.

is there any possibility of travel to a place where there is better availability of doctors?
any option of doing phone interview/assessments for the preliminaries at least?
posted by supermedusa at 12:28 PM on June 14, 2018 [1 favorite]

Getting your fibroids treated would help immensely and there are many options for that including a myomectomy or a uterine artery embolization. Does your referral mention fibroids cause that will speed up the process. In addition make sure the GP checked your TSH and T4.
posted by SyraCarol at 12:40 PM on June 14, 2018 [3 favorites]

Definitely treat the fibroids.
posted by Stewriffic at 12:49 PM on June 14, 2018 [2 favorites]

I happen to be one of the people who had a serious side effect from hormone treatment for perimenopause. The hormone was Megace, and the side effect was three brain tumors. The tumors were benign, thank god. I had surgery for two and still live with one. My perimenopause symptoms were truly awful (clots much larger than one inch), and I even went to the ER for severe bleeding once and was told I did the right thing. But please be aware that messing with hormones is no joke.

I have heard of people who had great improvement from giving up animal foods, particularly dairy, but that was not on my radar at the time. If I were dealing with symptoms now, I'd try that first.
posted by FencingGal at 1:20 PM on June 14, 2018 [1 favorite]

Have you had your B12 levels checked?
posted by amtho at 1:25 PM on June 14, 2018 [4 favorites]

Your story could be mine (except I'm not in Canada). After I ended up hospitalized for severe anemia, endometrial ablation was suggested. The gyno was careful to emphasize that the goal was simply to lighten my menstrual flow. I was hoping that a lighter flow would also mean less pain and time taken off for sick leave. But the result vastly exceeded my expectations and I gather that's not so unusual. Although the goal is simply a lesser menstrual flow, a great many women, like me, end up with no more flow at all. Which for me meant no more clotting, no more messy accidents, and no more anemia. Best of all, it didn't just lessen my pain, I no longer had menstrual cramps, nor the period-related bowel issues.

In one fell swoop, all the menstrual-related issues I'd had since my first period were completely gone. And I'm free to live life without scheduling everything around my period. It didn't just improve my physical health, it made me so happy.

In short, do look into an endometrial ablation. There's no guarantee that your outcome would be as spectacularly successful as mine, but any improvement is A Good Thing. Best of luck to you.
posted by Lunaloon at 1:25 PM on June 14, 2018 [4 favorites]

Anemia sucks and with heavy periods you are likely experiencing it. Look into iron supplements or even intravenous iron sucrose (venofer)- it's life changing for some people.
posted by pseudostrabismus at 2:56 PM on June 14, 2018 [2 favorites]

This is of very little help, but as of my 48th birthday, my period is gone. So it’s not necessarily six to 10 years ahead of you. Several of my friends are also done with their periods.

We’re all surprised that it happened so young. But I only had perimenopausal symptoms for a year or so. I always had very light, easy periods, and they got much worse in perimenopause, relatively speaking. So what you’re talking about seems normal.

But not endurable.

Definitely ask your doctor for a full blood panel - that’s just a yearly wellness thing. Vitamin deficiencies, anemia, thyroid - so many things could be off just enough to make you more miserable than necessary.
posted by crankyrogalsky at 3:02 PM on June 14, 2018 [1 favorite]

The fibroids could definitely be causing the heavy flow and cramping. I don't know what you did to treat them the first time. Embolization is repeatable; I'm not sure if they'd do a myomectomy again or go straight to the hysterectomy. They do generally resolve themselves at menopause, but that's a long time to go with really heavy bleeding.
posted by praemunire at 5:02 PM on June 14, 2018

Response by poster: Thanks everyone--some very helpful ideas here. I am recognizing how important it is for me to treat the low iron problem ASAP, as it may relieve some symptoms. Poffin boffin, I didn't know about the connection between hair/skin issues and low iron.

I should have said--the doctor ordered a full panel of bloodwork including thyroid and everything else was normal and good. I should see if he checked my B12 levels. I don't think he checked progesterone or other hormones so I may look into the hormone testing mentioned above.

I had my fibroids removed laparoscopically in 2012, and that definitely helped with heavy flow and cramping until recently. I had D&C/D&E with my pregnancy losses too, and I understand that can reduce cramping and heavy flow problems too. My doctor did mention the fibroids in my referral.

FencingGal, thank you for your cautionary tale. I will definitely keep that in mind when I talk to the gyne.

I can't help but feel frustrated that so many of us have dealt with this without good medical guidance. The lack of research into and knowledge of women's health drives me nuts.
posted by hurdy gurdy girl at 6:10 PM on June 14, 2018 [4 favorites]

Lots of options here. You might benefit a lot from a progesterone-eluting IUD if you don't feel like doing more invasive procedures for the fibroids and bleeding. I'm glad you got your referral to a gynecologist.
posted by The Elusive Architeuthis at 8:39 PM on June 14, 2018

The normal range for ferritin is huge - 12 to 300 ng/mL. Some doctors are ok with having you anywhere in that range, while others prefer women to be closer to 50 or even 80 (which is, some say, around where the hair and nails start looking better). Can you ask what your numbers are? (Some doctors don't like to tell you, I know.)

I also want to say, please keep trying to find a good GP. Many aren't taking patients, but some are... it does take a few weeks of calling offices to find them. (I'd start with sifting through reviews on www.ratemds.com, then finding their details [and any possibly uncomfortable history] on the College of Physicians and Surgeons website (in Ontario, not sure if that's where you are).

I think it's very much worth travelling a bit to see someone if you have to. Better to deal with that inconvenience than see someone more local and have to deal with the attitude you're getting from your GP.

Very sorry you're having to deal with this.
posted by cotton dress sock at 7:59 AM on June 15, 2018