Menopause woes

January 3, 2024 3:04 PM

I believe I'm going through menopause. My doctor and gyno are unsatisfactory. I would appreciate some advice from people who have gone through this crap already because I have no idea at this point if I should persist with these people or start over from the beginning - executive dysfunction has swamped me. Details and wall of text inside.

Before we start, you are not my doctors or medical professionals or whatevers. I get it.

So, I'm 51 and experiencing what I believe to be menopausal symptoms (night sweats, hot flashes etc). I also suffer from heavy periods which are contributing to anemia and these have changed slightly over the last few years (shorter but more violent). My (male) doctor is handwavy when confronted with any of this and I finally got him to refer me to a local gynecologist.

I had my first consult with her just before Christmas, and brought in my last pelvic scan (2018) that showed ovarian cysts - I've known about these since at least 2014 and previous scans have shown no changes to date. She conducted a pap smear, said that I was too young to be going through menopause, didn't give me a chance to explain symptoms, and basically threw a prescription for a Mirena at me, with a muttered aside of "Oh, I'll probably take a biopsy wen I put this in." No other scans or blood tests or what have you were ordered. All of this took about 10 minutes with no chances for questions.

So here I am. Do I try to push back with her? Appointments with her take about 4 weeks to book and aren't cheap, and while I do have one booked for the 30th its supposedly for the Mirena. Do I just go ahead with a Mirena and possible biopsy (I'm assuming uterine - she didn't actually say) and try for more information then? Or do I make an appointment with a GP that I trust that I haven't seen in 4 years that is more than an hours travel away in the hope that she at least listen to me?

Help me come up with a game plan here - at this point I can't tell how much of this is my own anxiety getting in the way and how much might be an actual problem. Suggestions, advice and personal anecdotes are welcome.

posted by ninazer0 to Health & Fitness (33 answers total)

This is utter bullshit. The average age of menopause in the US is 51, but "early menopause" isn't even a consideration unless you're under 45, which means you're solidly in the normal timing.

I see you're in Australia. Do you have anything akin to Planned Parenthood there, where you can go for gyno care? You might want to read the Menopause Manifesto, which will fill you in on facts, myths and what kind of good care you should be getting. But other than that, I'd say yes please start with a doctor you trust.
posted by BlahLaLa at 3:13 PM on January 3 [21 favorites]

Can you clarify, are you looking for specific symptom relief, or are you looking for "confirmation" of menopause? (Or something else I missed, I can't quite distinguish your question)
posted by tristeza at 3:13 PM on January 3

Seconding BlahLaLa's reading suggestion, and adding Heather Corinna's What Fresh Hell Is This? It may help with understanding what's happening, and will give you some vocabulary to use with your GYN. (Who treated you terribly. If this were me, I would cancel the appointment on the 30th, reschedule something for February or March, and spend the time reading up on peri-menopause/menopause. The casual "biopsy too" is a little alarming. I guess I'd say arm yourself with information and THEN decide if you want to proceed with this particular doctor.)
posted by MonkeyToes at 3:34 PM on January 3 [5 favorites]

I think pushing back with her with something like I went home and looked up the Mirena iud. I'm looking for something to help with hot flashes but it doesn't seem Mirena well help with that. Is there another form of medication you can perscribe to help with hot flashes?"

This is subtle walk around way and not the direct way, but it's generally how I approach things when I'm leading a doctor to where I want them to be.

Basically not saying is menopause but telling her it's menapause.
posted by AlexiaSky at 3:36 PM on January 3 [1 favorite]

Response by poster: tristeza: Fair point - I sort of missed that there wasn't a distinct question. So, I want to stop or at least reduce my horrible periods. I want to know why they're changing and rule out the scarier reasons if possible. I would like to treat the menopausal symptoms that I'm having and regain some quality of life.
posted by ninazer0 at 3:38 PM on January 3

I mean, I’d seek other opinions. I’m 40 and solidly in perimenopause; symptoms started at 37. My doc and gyno were both like “let us know if your symptoms are interfering with stuff,” which they are, but I am both a) stoic and b) unable to tolerate hormones. But they didn’t bat an eyelash when I started describing my symptoms and said “congratulations! This is your life for up to the next 10 years!” I was like thanks I hate it.

Apologies because I have little knowledge of healthcare outside the US, but if you have an opportunity to speak to another/other professionals I would.
posted by sara is disenchanted at 3:48 PM on January 3 [1 favorite]

Technically this is perimenopause. Menopause is what you call it when you have not menstruated for at least 12 months. But you are definitely not too young, that is bullshit! Sounds like you need a second opinion (and a hug).
posted by Coaticass at 4:04 PM on January 3 [6 favorites]

I would probably not return to that doctor. I was in perimenopause in my mid-40s with night sweats, hot flashes and heavy periods. My first symptom was the change to my periods. Sorry to say that's part of the deal. I think I hit menopause at 49. My doctor said that if I could just know that's what it is and make it through it, that's the best course in her opinion. I can't speak to anything that really helps, aside from very light pajamas and a cold bedroom. I'd talk to another doctor if possible, someone who is a better listener.
posted by hellochula at 4:11 PM on January 3

So, I want to stop or at least reduce my horrible periods. I want to know why they're changing and rule out the scarier reasons if possible.

I think more conversation is warranted but I had a biopsy and Mirena for super scary, long (20+ days), go through a super tampon in 40 minutes periods in my mid-40s and the Mirena, for me, was a miracle cure.

I don’t think it will help with the other symptoms, but I don’t think it’s completely off base either.
posted by warriorqueen at 4:16 PM on January 3 [6 favorites]

Heavy periods are not normal, and if you are anemic, the heavy periods should be your new doc's first concern. I waited years before going on hormones because according to my old doc, "just wait for menopause and then you will be fine!" I was 48 at the time. I didn't get relief until 52, when I started taking progesterone.

Don't be me. Get an ultrasound and get a biopsy to rule out fibroids or endometriosis or something that can be helped with surgery. And then demand a hormone replacement option that works for you!
posted by Arctostaphylos at 4:17 PM on January 3 [2 favorites]

FFS. I'm sorry you've had such a shitty experience with such a hopeless doctor - you deserve better.

Honestly, I would absolutely go back to the doctor you haven't seen for four years. It's worth two hours of travel to be in the hands of someone you trust, rather than this woman, who sounds like she knows less than nothing about menopause. I mean that literally - if a doctor thinks 51 is too early for menopause, they not only know nothing, they are relying on actively wrong, damaging information to make treatment decisions. It's maddening how bad many doctors' menopause education is, but this is beyond even the average incompetence and misinformation.

If your old doc seems more competent, she might be able to recommend someone closer to you that she knows to be on the ball, which would save you travelling long term.

I had a coil put in a few years back as a supposed solution to very heavy periods, with no scan done beforehand. Turned out the heavy periods were because I had a huge fibroid, and that was the cause of the bleeding. The consultant who finally took the fibroid out was gobsmacked that anybody had even managed to get a coil in there with the size of the fibroid. Oh, and the coil made the bleeding way worse, was agony, and started coming out in no time at all, but not until I'd been through what I think were something like labour pains, as my uterus tried to expel it. Would not recommend.

In the UK, I believe it's possible to ask your GP to refer you to the local menopause service, but it doesn't seem to be widely advertised, it's the kind of info that middle aged women pass between themselves as one of those vital nuggets essential to our wellbeing that the medical system omits to tell us. I've no idea if there would be an equivalent in Australia, but just mention it in case.

There's a list here of doctors in NSW who are members of the Australasian Menopause Society. I don't know enough about the Australian medical system to know if any of those would be useful or affordable, but in case it helps.
posted by penguin pie at 4:17 PM on January 3 [6 favorites]

I used to cuddle an ice pack. It was glorious cold comfort.

But yeah, you’re the right age. I’m 48 and totally done with menopause and not one person batted an eye over it. Heavy bleeding, I discovered, is shockingly common and doctors like to recommend Mirena because it works for a lot of people, and its effectiveness means it’s likely you can fast forward to a solution without a lot of other tests. I had a positive experience with Mirena, fortunately.

I think the question is, how urgent are you feeling about the anemia? In my case, mine was bad enough to require transfusions, so I didn’t have time to research providers and I kind of had to take the first provider who could see me, which wasn’t ideal. If you’re in a position where your anemia is mild (a simple blood test) and you’re feeling okay, you might pursue the luxury of a second opinion.
posted by mochapickle at 4:27 PM on January 3 [1 favorite]

This is really weird. The only thing I can say is that you might want to start saying "perimenopause." Menopause is when your period has stopped for at least a year. Perimenopause is when you still might have irregular periods.

What's super weird to me is that either of your doctors could test your levels of FSH, follicle stimulating hormone. That's what my doctor did when I started having what I realized were hot flashes. Then she prescribed me HRT, hormone replacement therapy, and I went from a dozen or more hot flashes a week to almost none. I want you to be able to find a competent doctor who will have these conversations with you.

I'd say book with the old GP.
posted by bluedaisy at 4:35 PM on January 3 [3 favorites]

Can you get a different gynaecologist? I would not go to one who told me that 51 is too young for menopause because that is wrong.
posted by Badmichelle at 5:01 PM on January 3 [11 favorites]

Australia has an amazing resource: Jean Hailes for Women's Health. From their 'about': "Jean Hailes for Women's Health is a national not-for-profit organisation dedicated to improving women's health across Australia through every life stage."

The website is great, very up to date and contemporary. If nothing else, it can provide with real evidence-based information and not the weird gaslighting you are getting from the irresponsible and ill-informed gyne you are seeing.

If the location in your profile is correct, message me and I can share contact info for my GP and clinic - I've seen several women there and all have been stellar.
posted by lulu68 at 5:12 PM on January 3 [5 favorites]

your gyn is flat wrong.

I had perimenopausal flooding: it's a thing. It's not necessarily a sign anything terrible is going on, but it's worth seeing a GYN who actually knows something about perimenopause.

Find someone you trust. You may end up with a Mirena, but get a better doctor first.
posted by suelac at 5:26 PM on January 3 [1 favorite]

DO NOT DO NOT DO NOT get any kind of biopsy without a) a better reason and b) adequate pain control up to an including general anesthesia. It sounds like that doctor is going to do it with nothing as part of IUD insertion. RUN AWAY from this barbarian! Google people who’ve had biopsies without anesthesia, I beg you.
posted by Violet Hour at 10:21 PM on January 3 [5 favorites]

Also, in the USA there are multiple online providers who specialize in menopause symptoms. If something like that is available in Australia, use it—the vast majority of other doctors, even gyns or menopause specialists, are useless
posted by Violet Hour at 10:23 PM on January 3 [2 favorites]

You definitely need a new gynaecologist, and by the sounds of it a new GP.

I’m 50 and now in menopause (which is not particularly early), and perimenopause began long before.

I can relate to the increased anxiety and had a massive decrease in executive functioning (turns out I had ADHD and had been masking all my life, who knew!). I could often not get a full sentence out correctly, kept misspeaking, and had trouble coming up with the correct nouns (‘chair’, ‘table’ etc.) I had various other symptoms too, to the point where my GP referred me to a specialist menopause clinic (I’m not in Australia).

I am now on HRT and within 10 weeks most of the cognitive issues had resolved, along with most of the physical symptoms. (For various reasons HRT is not suitable for everyone, but it is now a standard first line treatment where I live.) You don’t have to suffer, and you definitely need health care providers who have up-to-date knowledge.
posted by rubbish bin night at 1:43 AM on January 4 [3 favorites]

just wanted to agree with folks that you are going through all this in a pretty normal timeframe, 51 is not at al too young. If it helps at all, I have had a lot of the issues people are discussing here, and now as I'm about to turn 54 they are getting much better. slowly, but definitely improving, which is a relief. Omg the mixing up of nouns? wtf is that? We named it menopause scattergories.
posted by 5_13_23_42_69_666 at 2:29 AM on January 4 [3 favorites]

You've already got a lot of great advice above, but I just wanted to stress that you don't have to put up with menopause symptoms, and you don't have to put up with dismissive, ignorant doctors who aren't doing their job properly. Unfortunately many of them, including gynecologists, understand very little about menopause and haven't kept up with the latest research on treatments, so I would recommend seeing a menopause specialist. That will save you a lot of time, hassle and suffering in the long run. Penguin pie provided a great resource with the list of doctors in NSW who are members of the Australasian Menopause Society. I found my current (fantastic!) menopause doc by checking the list of practitioners on the American Menopause Society website.

Good luck and I hope you find a solution soon!
posted by mydonkeybenjamin at 4:45 AM on January 4 [1 favorite]

So there are also bloodwork tests that can be done that can show what your hormone levels are and where you might stand in the process of menopause. I'm 49 and just had a hysterectomy to remove my uterus and fallopian tubes because I had a rapidly growing fibroid that was no longer managed by an IUD. I was having two to three week long periods with excessive bleeding that was causing anemia and massive pain. My gyno was very, very emphatic that not only was this not normal or part of menopause, but not something I should have to live with. You'll want to have your doctor do an vaginal ultrasound to see the status of the cysts and make sure there's nothing else going on like a fibroid or some other cyst.

When my bloodwork was done, my numbers showed I was still well within the range for fertility and not in a phase of menopause. While I was waiting on the hysterectomy, they did give me a low dosage of HRT to stop the bleeding or bring it back to a manageable level, which was helpful because I was going through a ton of pads everyday.

I know hysterectomy sounds extreme, but I am 5 weeks post-op and I will say it's been fairly easy to recover from and not having to deal with a period again feels magical.
posted by teleri025 at 8:18 AM on January 4 [1 favorite]

oh for pete's sake. 51 is the average age for peri/menopause!!

if you actually want the mirena, you can go ahead with that appointment, but i wouldn't expect much more from this doctor. i know it absolutely sucks, but i would try to find a new gyn, because if she thinks you're too young to be in perimenopause, i wouldn't count on her to know much of anything about the issue.

there are many things that could help you with your symptoms, and a good doctor will walk you thru them. you may also be interested in reading some of the books i mentioned here. if you're "new" to perimenopause, you might find some insights from one or more of them.
posted by misanthropicsarah at 9:01 AM on January 4

I 47 and started having some very very heavy periods. My gyn did an ultrasound, endometrial biopsy, and then a uterine ablation with a more complete biopsy. Due to a history of hormone sensitive cancer I am not a good candidate for birth control or HRT. She also wrote a script for Lysteda which makes your periods lighter. It’s not a long term solution but helped while we were figuring things out.

I’m telling you so you get a sense of how an attentive gyn would approach this.
posted by jeoc at 11:16 AM on January 4

Nthing that the doc you saw is full of shit, she should be ashamed of herself. How old is she, I'll guess she is a lot younger than you. I hope you find someone better. I went through menopause at 47, more than 25 years ago. I have the sense that we've learned a lot more about it since then, but maybe not enough.
posted by mareli at 1:29 PM on January 4 [1 favorite]

Response by poster: I guess my issue was less "menopause - what is it?" and more "is this gas-lighting or no?"

I have cancelled my appointment with that gynecologist and have booked to see the trusted doctor as soon as she returns from Christmas holidays. It's a three hour round trip with hell parking, but better that than a 30 minute trip and total indifference.

Thank you - every one of you. Between the hormonal bullshit, the doctors bullshit, and the regular everyday bullshit, my brain had just completely blue-screened. None of my friends - close or otherwise - are going through this and my mother passed away in 2020 so there was no-one I felt I could ask. Once again the Hive Mind has my back. Love you guys!
posted by ninazer0 at 2:39 PM on January 4 [11 favorites]

As a person who was fully menopausal before age 45, I want to share a few other things that might be useful to know about:

1. HRT is a risk factor for cancer, so those of you who go that route, be sure to read that link so you can be informed about your options and risks.
2. Certain herbs can reduce the intensity/frequency of hot flashes/night sweats for some people.
3. A low dose of Paxil can also reduce hot flashes for some. Bonus: helps anxiety too!
4. Endometrial ablation sounds scary but is 100% effective at eliminating heavy bleeding (and preventing pregnancy). Bonus: eliminates the risk of endometrial cancer!

Sorry to add more complexity to your situation by bringing up cancer, but too few people know about the risk, which increases the longer you take hormone therapy.

Best of luck to you in navigating this terrain.
posted by acridrabbit at 2:57 PM on January 4

I'd actually say there's a lot of misinformation about cancer risk and HRT because a generation of women were scared off of it because of misunderstanding of the large women's health initiative. Avrum Bluming and Carol Tavris wrote a book called Estrogen Matters, and you can hear them on the Peter Attia podcast here.

"Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women’s Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease and neurodegenerative disease, and osteoporosis, to name a few."
posted by bluedaisy at 3:15 PM on January 4 [2 favorites]

Yes to Heather Corinna's What Fresh Hell is This? and also -- when you talk to another provider, which you should because these ones are terrible -- consider including the executive dysfunction symptoms in your list. Because my exec dysfunction is out of control and it's very clearly linked to increasingly-wonky cycle; yours might be doing the same thing.
posted by librarina at 4:19 PM on January 4 [1 favorite]

Family Planning NSW (and in other states) may be of use - they do the full life cycle of sexual and reproductive health. Their help line is also good resource.
posted by MT at 12:11 PM on January 5 [1 favorite]

I had horrendously heavy periods for the last couple of years before they finally stopped for (what appears to be) good. Many women say that "flooding" isn't uncommon in perimenopause, although medically you obviously want to be sure everything is OK (a pelvic ultrasound is usually recommended). I don't think there is anything wrong with the Mirena plan at all, but I think there's a lot wrong with how this doc's (lack of) bedside manner is making you feel.

I think you should definitely seek out another gynecologist if at all possible, you need to feel listened to and understood, not hand-waved away, and you need someone who you won't feel uncomfortable going to if you're worried about something. If you can't easily change doctors, then I'd try to reframe how you're thinking about your doctor interactions and see them as medical-only, and look for the other kinds of support you need elsewhere. Menopause can be pretty rough, and there are some excellent support groups on Facebook and Reddit.

Menopause has a host of unpleasant things that go along with it, but I can tell you as someone who seems to be coming out the other side of it (finally), that it really does get better. During the worst of it one day I'd be bursting into tears waiting to get my tea at the drive-thru, the next day the hormones would say "we're ANGRY today!" and I'd be swearing under my breath at everyone (and sometimes not so under my breath), I couldn't remember anything, my brain would short-circuit in the middle of a conversation, I'd have panic attacks, it was beyond disconcerting. It's like puberty only worse, it feels like you don't know your body and mind at all anymore, and you don't recognize yourself in how you react to things. My poor husband.

This too shall pass, you will come out the other side and feel like yourself again. But you need medical professionals with compassion and understanding to help you through it. It is also always OK, if you're feeling brave, to say to a medical professional that you are uncomfortable with the way they're interacting with you and that you don't feel heard. They're people too and most are in that profession because they genuinely do want to help people and sometimes a gentle reminder of that can be helpful to both parties.

If you can get Estroven where you are (or even just unbranded black cohosh root) it can help a LOT with symptoms (I was taking it twice a day at my gyno's suggestion when my hot flashes were unbearable and I was unwilling to take HRT).

You can do this.
posted by biscotti at 6:43 AM on January 6

Response by poster: I'm wary about taking supplements now - on the advice of a nurse friend, I started taking a simple astragalus supplement and the brain fog and sleep issues just vanished nearly overnight. Unfortunately I also had mid-cycle bleeding so stopped taking it. The next period after that experiment was absolute Armageddon, so until I can get some handle on whats going on chemically in my body, I ain't taking nothin. But yeah - this was one of the reasons I wanted blood tests etc done. Not that I got a chance to explain to that gyno. Anyways, onwards and upwards!
posted by ninazer0 at 3:12 PM on January 6

Response by poster: Ugh. Ashwagandha, not astragalus.
posted by ninazer0 at 2:32 PM on January 7 [1 favorite]