Head first into Menopause

28th March 2024

I started HRT at the end of March this year nearly two months post endometriosis excision surgery and total hysterectomy (including removal of my ovaries). 

It was something I knew I’d need to do at 40. I wanted to ensure I protected my heart, bones and brain health and that I’d be able to live a long and healthy life. I was mindful that without my ovaries I’d be launched into surgical menopause fairly quickly. The first two weeks I focused on managing post surgery pain and recovery. 

I remember waiting for the symptoms to hit me out of the blue thick and fast. I had already had peri menopause symptoms a year or two before and maybe even sooner, if I think about it. My egg reserve was low after my first laparoscopy for endometriosis. It was something that I’d known for 6 years or so. 

Initially, I had a few symptoms but couldn’t work out which ones were post surgery and which ones were from the terrible kidney infection I had from the ureter stents. To be honest I was so exhausted from constant sickness and the symptoms the kidney infection gave me that I just focused on getting through each day one at a time.

After a week or so, those symptoms got worse and worse. I was told I shouldn’t start HRT for 6 months by my initial surgeon who also told me he was not a hormone expert. Pre surgery I went to see the menopause nurse who runs a clinic at my GPs clinic. She was so lovely, she listened and explained what we could do post surgery. She explained the difficulties of obtaining testosterone on the NHS but gave me some great tips and books to go and read. 

I was keen to look into testosterone as for women before the average age of natural menopause testosterone is the first hormone to fall off a cliff post surgical menopause. It is wrongly branded a 'male hormone', in fact women produce testosterone in their ovaries. they produce 3 x the amount of testosterone than they do oestrogen. It is a critical hormone for a number of functions including: bone strength, cardiovascular health, cognitive performance, improving mood related symptoms, anxiety, sleep, improved energy, brain function including memory and concentration.

Post surgery I booked an appointment with a menopause specialist that I’d been recommended after my surgery. I had very little faith in the things my surgeon was saying to me and got quite upset whilst in hospital being in the position of menopause at 40 with absolutely no support as to what happens next. I saw the menopause consultant a month after surgery. The main reason I decided to do this was due to endometriosis. I was told I had to be careful about HRT due to endometriosis growing back. 

This scared me as after such major surgeries the last thing anyone wants is for the disease to grow back…

However, I don’t believe there is enough evidence to suggest that anything out there will “stop” the growth of endometriosis. I would like to think that I’ll have a few more years with lower pain and reduced symptoms. It’s difficult that with no cure there is no end point (even with a total hysterectomy). 

The specialist was really lovely, he put me at ease instantly. It was refreshing to see a specialist with a sense of humour, clear knowledge and experience. It felt like he was with me on this journey. 

He said he wouldn’t start me on anything yet, as I was still recovering from surgery.  We discussed a plan, and decided on bloods he wanted to check. He prescribed me some HRT. I went back to my GP to get the prescription but under strict instructions to not take it until we had discussed the results at my follow up.

The second time I went to see him we combined a 6 week post operative check with the bloods results. My bloods were taken at 4 weeks but my menopause symptoms had got much worse. He suggested it could be where the brain is a little confused and still thinks that my ovaries are still there. It supplements hormones with the FSH. However, when it realises that the ovaries are no longer there the hormones take a further steep drop off of the cliff… leaving me in a state of hormone deficit. 

The idea would be to top those up - but slowly and carefully. He said I could start the Oestrogel and Utrogestan (progesterone) at night to prevent regrowth of endometriosis. 

I collected my additional prescription for testosterone. We said we would wait to see how I get on with the Oestrogel and progesterone first and then when we have our follow up in a month or so we can decide when I can add this to my regime.

I started the HRT that night (he had suggested both to be taken at night). I struggled a bit with the gel as one pump was a lot and I needed to do two. It said in the instructions not to rub it in which meant it was taking ages to dry. I was cold waiting for it to dry and still on antibiotics for my Kidney infection at the time. I just felt pretty rough all round. 

I knew it would take a while to kick in but was pleased to be starting it. Over the next few days I kept getting nauseous and sick after having my breakfast. I had finished my antibiotics so I didn’t think it was that.  

My hot flushes were getting more and more unbearable and lasted longer. I started to get an agitated anxious feeling throughout my body. It would take a trigger and then last most of the day. One weekend 10 days into HRT I was an absolute state. I’d never felt the physiological signs of anxiety before. I would worry and get anxious when things were happening that were stressful but it would be more thinking and less physical symptoms. It made me empathise with people who suffered in this way, as until you experience it, it really is hard to explain.

One night I was getting upset about the gel not drying and remember having a little meltdown thinking “It’s so unfair that I have to do this and that I even had to have a total hysterectomy so young”. I appreciate people have had them younger but it was just that feeling in the moment. I was inconsolable, tears just kept running down my face. 

A few days later, I read that Dr Laura Newson recommends that you can apply the gel like a moisturiser so there is a bit of rub involved! Phew! I was coating my inner thighs and they took 30+ mins to dry. I swapped to this method the next night. 

I noticed that I was sleeping a bit better and didn’t have as many hot sweats in the night. However, the HRT seemed to wear off early the next day and I was noticing the anxiety, hot flushes and itchy skin starting after lunch each day. 

I put in a follow up call with my consultant to discuss next steps and to let him know that I was really struggling. I had tried to wait as long as possible to keep the cost down but I was unable to function on the day to day. I was so thankful I didn’t have to work whilst I recovered from surgery, dealing with recovery and being launched into full menopause is A LOT! 

I had kept a diary since I had started HRT so had a good track record of the times I’d taken the hormones and the symptoms I was experiencing each day. This made the call easier, along with my most recent blood test to show my oestrogen levels. I wanted to rule out the option of my body not absorbing the oestrogen.

My symptom list on one day looked like this: 

• Heartburn

• Knee joints sore

• Nausea in morning whilst eating or trying to brush teeth. 

• Head better in morning not so woozy and a little more together cognitively. 

• Brain kept glitching as day went on. 

• Sharp pain in rib (right) can’t eat much feel uncomfortable. 

• Anxious feeling around 3:30pm again full body tingling, tightness in chest and flutters

• Head woozy

• Feeling warm and then freezing. 

• Face extremely dry and dry eczema under lip on chin. Never had this before - itchy and sore

• Frustrated this evening. 

• Exhaustion high levels 

• Knees sore and tender this morning when coming down the stairs. 

• Low appetite 

My consultant agreed that my oestrogen looked low and that some of the symptoms could be related to low oestrogen. He set out a plan to increase my oestrogen levels - using gel morning and night, reduce my progesterone (I was being sick every morning), add vaginal oestrogen at night and introduce testosterone. He wants to talk to me in two weeks and for a repeat of my hormone bloods to be completed in 6 weeks time. 

Menopause has been a bit of a rollercoaster so far, full of ups, downs, scary turns and then some better days and glimmers in each day. Today is one of the days where I’ve given myself grace and went back to bed to rest this afternoon. It’s 10 weeks post surgery, I need to take my time, bowel and bladder surgery and a total hysterectomy is a major operation. I need to listen to my body and rest when I need to. 

I’ll keep you posted on my menopause ride! 

LBH x