In a world where it’s hard to know whether going on HRT is the right thing to do to help with moderate perimenopausal symptoms and the long term brain benefits, not to mention to help stem some muscle and bone less, and GPs are poorly informed, I’m struggling to understand what to do as a result of this article. Thank you for addressing early menopause but I guess my question is, what diagnostics can I use to actually get someone in the medical field to help me decide what the right thing to do for my long term health is as I transition, knowing there are real long term implications to loss of estrogen? The world seems primed to let us all just shrivel up after 50 and it’s so frustrating how hard it is to find a healthcare provider who will go down the rabbit hole. You’ve always been the light at the end of the dark tunnel but I’m struggling with what to do…
Thank you so so much for doing a section on women under 40 with periods and symptoms, Jen. I can’t tell you how much it helps to have this information and just to be seen. I’ve a question I’m hoping you might be able to help with on this. How can you know if menopause occurs before 45 if you are on HRT from 39
using merina coil and oestrogen? Is FSH or another test reliable with HRT to diagnose early menopause?
I had regular periods (always short cycle went from regularly 23 to 21 days but had occasional range of 20-27 days) and completely debilitating and worsening symptoms for 5 years after having a baby. Had tests for everything, all normal. Long story short finally got HRT and effect has been incredible. It literally saved my life and gave me back my quality of life. However, as I understand it I’m not in the “early menopause” or POI categories because I had normal tests and still had periods when starting HRT. But I’m 40 now and if I hit menopause before 45 that’s early that makes a difference : it means I’m increased risk for osteoporosis, cardiovascular disease etc. and should continue HRT until at least 51 (and get a DEXA?)? But how would I know if I reach menopause before 45 since Merina stopped my periods? Are tests reliable with HRT? Thanks so much
thank you for this post! I'm technically post-menopausal now: I hit my period-free anniversary in May 2022, five months after experiencing a semi-random cecal volvulus and emergency surgery (which was thought to be related to my ulcerative colitis but the 37cm chunk that was removed from my intestines was PERFECTLY HEALTHY - f*ck me).
Anyway, my menopause transition went fairly smoothly. I had a small number of night sweats (which were thought to be related to my UC since I was diagnosed at 25), no hot flashes, but I did have random dizziness and nausea fairly frequently for a couple of years, usually in the mornings. I asked my GP at the time (a woman, in case you're wondering) about the dizziness and nausea and she put it down to not eating enough first thing in the morning. I realize now, after some googling, that it was most likely transition symptoms.
Question for you, Dr Gunter: I have a new GP out of the rural medical program in my community and very lucky to have one here in northern British Columbia, with the doctor shortages across BC and Canada. What kind of ongoing vag/cervix/etc checks does one need to have moving forward? The at-home Pap tests are now covered by the government here, which is awesome. I'm wondering what to talk to my new GP about since (post) reproductive health hasn't been a conversation yet?
P.S. I thought I would share this little story: when I hit my one year, period-free mark (and after I recovered from my crazy surgery), I was spending my Sunday mornings jogging around a park in my community. More than once, I left notes on the windshield of an old school van parked outside a Catholic church during Mass, to counter its anti-vax, freedom-shouting, anti-reproductive rights signs plastered all over it. I made sure my messages avoided name-calling, lay out on my opinions about how freedom includes full agency for women and their bodies, made a few references to how I hoped they prayed and sought forgivemess for the damage the church did to the residential school children, and would sign it "the Menopause Manifesto". It was very cathartic and I'm certainly feeling a lot more feisty and social justice-y these days on important topics.
If someone under the age of 45 is on the combined pill and experiencing possible menopausal symptoms what would be your recommendation in this scenario? Thanks so much.
The POI category is not a useful distinction as it is all premature menopause, just various causes, sometimes secondary to surgery or chemotherapy, or needing further evaluation if the cause is not so obvious. I always did at least a CBC, TSH, FT4, FT3 when symptoms appeared menopausal. Anemias are relatively common, and I once picked up an early leukemia (causing severe hot flashes!). I found TSH alone was occasionally misleading.
"...you don’t need a blood test to start therapy if you have symptoms, so a test isn't of help there. .. a blood test can’t reliably predict when your last period will occur..."
PLEASE! Shout that from the rooftops! (I know you're trying...) There's SO much ignorance out there, esp. among professionals who should know better...
I have followed you for quite a while now and I appreciate all of your education and content. (I also love that you are a proud Canadian!) One piece of information caught my attention in this article and I wonder if you could clarify or expand: we know that with “normal” or unremarkable menopause, MHT is not recommended for brain health or heart health, so why or how is it recommended in premature menopause and POI “to reduce the risk of osteoporosis, dementia, and heart disease”? Thank you for all that you do!
I was surprised when my primary care provider ordered a testosterone level. Is there any validity to checking or replacing testosterone in the perimenopausal patient?
I am in Canada, for reference. I am in the transition period, over 45, with very sporadic periods. I am super fortunate in that I don't really have hot flashes or any other symptoms other than joint pain, which is probably more of an arthritis issue rather than a perimenopause issue. My doctor sent me to the lab for hormone testing 6 months ago, and I do have the results via our provincial health app, but have no way of interpreting them unless I go back for another appointment. How does a layperson interpret the results? Should I just go back to my doctor? Or does it even really matter because I'm not having any troubling symptoms?
Great information thank you. I am glad you mention thyroid in this blog. I have read in a few medical journals that women should have a baseline thyroid test done around the age of 35 is this accurate? Also you mentioned in a previous blog that vaginal estrogen (and your chart mentions that vagifem generally will not resolve exterior dryness) does not raise estrogen levels above post menopause, but will that slight increase impact thyroid levels for those of us on a replacement dose? I know from the medical studies that any form of oral estrogen will impact TBG levels and transdermal (gels, sprays and patches) can have an impact as well, will the combination of vaginal estrogen treatment and using a patch when a women requires both impact thyroid (TSH, FT4 levels) to your knowledge? If vaginal will then usng both would increase TSH even higher would it not? I look forward to your response. Thanks
In a world where it’s hard to know whether going on HRT is the right thing to do to help with moderate perimenopausal symptoms and the long term brain benefits, not to mention to help stem some muscle and bone less, and GPs are poorly informed, I’m struggling to understand what to do as a result of this article. Thank you for addressing early menopause but I guess my question is, what diagnostics can I use to actually get someone in the medical field to help me decide what the right thing to do for my long term health is as I transition, knowing there are real long term implications to loss of estrogen? The world seems primed to let us all just shrivel up after 50 and it’s so frustrating how hard it is to find a healthcare provider who will go down the rabbit hole. You’ve always been the light at the end of the dark tunnel but I’m struggling with what to do…
Thank you so so much for doing a section on women under 40 with periods and symptoms, Jen. I can’t tell you how much it helps to have this information and just to be seen. I’ve a question I’m hoping you might be able to help with on this. How can you know if menopause occurs before 45 if you are on HRT from 39
using merina coil and oestrogen? Is FSH or another test reliable with HRT to diagnose early menopause?
I had regular periods (always short cycle went from regularly 23 to 21 days but had occasional range of 20-27 days) and completely debilitating and worsening symptoms for 5 years after having a baby. Had tests for everything, all normal. Long story short finally got HRT and effect has been incredible. It literally saved my life and gave me back my quality of life. However, as I understand it I’m not in the “early menopause” or POI categories because I had normal tests and still had periods when starting HRT. But I’m 40 now and if I hit menopause before 45 that’s early that makes a difference : it means I’m increased risk for osteoporosis, cardiovascular disease etc. and should continue HRT until at least 51 (and get a DEXA?)? But how would I know if I reach menopause before 45 since Merina stopped my periods? Are tests reliable with HRT? Thanks so much
thank you for this post! I'm technically post-menopausal now: I hit my period-free anniversary in May 2022, five months after experiencing a semi-random cecal volvulus and emergency surgery (which was thought to be related to my ulcerative colitis but the 37cm chunk that was removed from my intestines was PERFECTLY HEALTHY - f*ck me).
Anyway, my menopause transition went fairly smoothly. I had a small number of night sweats (which were thought to be related to my UC since I was diagnosed at 25), no hot flashes, but I did have random dizziness and nausea fairly frequently for a couple of years, usually in the mornings. I asked my GP at the time (a woman, in case you're wondering) about the dizziness and nausea and she put it down to not eating enough first thing in the morning. I realize now, after some googling, that it was most likely transition symptoms.
Question for you, Dr Gunter: I have a new GP out of the rural medical program in my community and very lucky to have one here in northern British Columbia, with the doctor shortages across BC and Canada. What kind of ongoing vag/cervix/etc checks does one need to have moving forward? The at-home Pap tests are now covered by the government here, which is awesome. I'm wondering what to talk to my new GP about since (post) reproductive health hasn't been a conversation yet?
P.S. I thought I would share this little story: when I hit my one year, period-free mark (and after I recovered from my crazy surgery), I was spending my Sunday mornings jogging around a park in my community. More than once, I left notes on the windshield of an old school van parked outside a Catholic church during Mass, to counter its anti-vax, freedom-shouting, anti-reproductive rights signs plastered all over it. I made sure my messages avoided name-calling, lay out on my opinions about how freedom includes full agency for women and their bodies, made a few references to how I hoped they prayed and sought forgivemess for the damage the church did to the residential school children, and would sign it "the Menopause Manifesto". It was very cathartic and I'm certainly feeling a lot more feisty and social justice-y these days on important topics.
If someone under the age of 45 is on the combined pill and experiencing possible menopausal symptoms what would be your recommendation in this scenario? Thanks so much.
The POI category is not a useful distinction as it is all premature menopause, just various causes, sometimes secondary to surgery or chemotherapy, or needing further evaluation if the cause is not so obvious. I always did at least a CBC, TSH, FT4, FT3 when symptoms appeared menopausal. Anemias are relatively common, and I once picked up an early leukemia (causing severe hot flashes!). I found TSH alone was occasionally misleading.
"...you don’t need a blood test to start therapy if you have symptoms, so a test isn't of help there. .. a blood test can’t reliably predict when your last period will occur..."
PLEASE! Shout that from the rooftops! (I know you're trying...) There's SO much ignorance out there, esp. among professionals who should know better...
I have followed you for quite a while now and I appreciate all of your education and content. (I also love that you are a proud Canadian!) One piece of information caught my attention in this article and I wonder if you could clarify or expand: we know that with “normal” or unremarkable menopause, MHT is not recommended for brain health or heart health, so why or how is it recommended in premature menopause and POI “to reduce the risk of osteoporosis, dementia, and heart disease”? Thank you for all that you do!
I was surprised when my primary care provider ordered a testosterone level. Is there any validity to checking or replacing testosterone in the perimenopausal patient?
I am in Canada, for reference. I am in the transition period, over 45, with very sporadic periods. I am super fortunate in that I don't really have hot flashes or any other symptoms other than joint pain, which is probably more of an arthritis issue rather than a perimenopause issue. My doctor sent me to the lab for hormone testing 6 months ago, and I do have the results via our provincial health app, but have no way of interpreting them unless I go back for another appointment. How does a layperson interpret the results? Should I just go back to my doctor? Or does it even really matter because I'm not having any troubling symptoms?
Great information thank you. I am glad you mention thyroid in this blog. I have read in a few medical journals that women should have a baseline thyroid test done around the age of 35 is this accurate? Also you mentioned in a previous blog that vaginal estrogen (and your chart mentions that vagifem generally will not resolve exterior dryness) does not raise estrogen levels above post menopause, but will that slight increase impact thyroid levels for those of us on a replacement dose? I know from the medical studies that any form of oral estrogen will impact TBG levels and transdermal (gels, sprays and patches) can have an impact as well, will the combination of vaginal estrogen treatment and using a patch when a women requires both impact thyroid (TSH, FT4 levels) to your knowledge? If vaginal will then usng both would increase TSH even higher would it not? I look forward to your response. Thanks