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Cynthia - Interview 16

Age at interview: 54
Brief Outline: Cynthia expected an easy passage through the menopause. Severe hot flushes however have had a significant impact on her well-being. She has tried a range of alternative therapies and herbal products, but is now finding relief by taking a low dose HRT.
Background: Cynthia is a part-time administrator. She is married with two adult sons. She started the menopause at age 48 and had her last period at 51. Ethnic background/nationality' White British.

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When Cynthia’s periods first became erratic, she welcomed the onset of the menopause. After all, she had no reason to expect anything other than a smooth transition, having had ‘a very easy time all my life with my hormones’. She did not appreciate however, that ‘ferocious’ hot flushes day and night would have such a debilitating effect on her life, nor that the following years would see her try a range of prescription and alternative treatments with varying degrees of success.

Cynthia describes her hot flushes vividly as being ‘like someone walked up, opened a little trap door, put a hot coal in, shut the door and it radiated from inside’. Consulting her GP, Cynthia was offered ‘HRT or nothing’. Her doctor’s ‘casual dismissive attitude’ and unwillingness to take her preferences into account led her to seek help from a registered herbalist who prescribed a herbal tincture. Much to her relief, within a fortnight the hot flushes had stopped. Unfortunately, within seven months they returned with a vengeance.

Feeling desperate, Cynthia embarked on a series of alternative therapies and herbal remedies, including Chinese and Western acupuncture, natural progesterone cream (which she bought on the Internet), soy isoflavones, dong quai, and a magna pulse magnet worn in her underwear. All, however, were ineffective, ‘a waste of money and very expensive’. Cynthia’s hot flushes continued unabated.

Returning to her GP Cynthia asked to be put on clonidine (a blood pressure lowering medication which at smaller doses can help minimise hot flushes). While her daytime flushes decreased, however, they continued at night. After several months she asked her GP for HRT. As she had finished her periods two years before, Cynthia was prescribed a ‘no bleed’ HRT (Kliovance). However, side effects, including bleeding and headaches, led Cynthia to change to another low dose HRT (Premique) which has worked well for the past year. However, knowing that her GP will only supply HRT until she turns 55, Cynthia is gradually weaning herself off by not taking the full dose. She feels that by keeping a supply to take later, she will maintain some control over her treatment.

Cynthia strongly recommends the internet as a source of information for women going through the menopause. She has found the Menopause Matters website particularly helpful in giving advice and providing a forum for women to share their experiences.

Cynthia was interviewed for Healthtalkonline in February 2009.

 

Cynthia resents having had to give up alcohol because it triggers hot flushes

Cynthia resents having had to give up alcohol because it triggers hot flushes

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And at its worst how many were you getting in a day?

On the hour every hour and if I drank alcohol they were even fiercer. I did learn I could not drink. I had to stop completely. One millimetre of Southern Comfort particularly watered down with a tin of Seven Up would still be enough for me to be hot flushing. I noticed if I had, oh, what are those round things that you get at Christmas with meat in them? Pastry. Ah, mince pies. Now you see that’s a menopause thing. That happens to me all the time. What’s the name of that? I’m playing like ‘Give us a Clue’. Mince pie with a little bit of brandy in that would be enough. I would be hotter for about twenty minutes after I’d feel it sort of radiate from inside. So I was teetotal and I’m still teetotal. I still resent the fact. It’s not worth it and curry can set me off as well yeah, some Chinese food.

 

Cynthia managed her severe night sweats using a ‘little hot flush kit’ she kept beside her bed

Cynthia managed her severe night sweats using a ‘little hot flush kit’ she kept beside her bed

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In the early days, I had to get up physically on the hour every hour. It woke me without fail and I had to get out of bed, go into the other room, had a big fan, stand in front of it until I cooled down and then I went back to bed. You do get used to doing that and you do sleep in between. As I got better at managing them I think, I identified that I couldn’t drink anything and I couldn’t eat curry or Chinese food I got so that I had my little hot flush kit beside the bed. I had a towel and gel pack, sports injury gel pack that had been frozen inside of a pillow case. And I’ve got dozens, dozens and dozens, and I’ve still got them in a little basket of those little hand fans like you’d have on holiday.

And I had that beside the bed so when I woke with a hot flush starting, I’d grab the towel and slip that underneath me, the gel pack behind my neck and the little fan resting on my chest and I’d just lie there like a sack of potatoes until it passed. And then I’d chuck it all off and go back to sleep until the next one. And I did sleep. I did get used to being tired but I did sleep in between each hot flush. But they were on the hour.

 

Cynthia’s friends at work ‘fill in the blanks’ for each other when they can’t remember things

Cynthia’s friends at work ‘fill in the blanks’ for each other when they can’t remember things

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The forgetfulness isn’t helpful but I’m not sure that that’s necessarily menopausal. I think that’s partly an age thing and words. As I’ve just said, using the wrong words and forgetting words but because now I’ve worked with these people for quite a few years and we are all having the same problems we fill in the blanks for each other without missing a beat. And post-it notes come in really handy. They’re stuck all over the place at work.

 

Cynthia fears her symptoms will return when her GP ‘cuts off her supply’ of HRT after 5 years

Cynthia fears her symptoms will return when her GP ‘cuts off her supply’ of HRT after 5 years

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He doesn’t know yet but from the time I went on it I’ve been weaning off it, so going on was my weaning off programme. I take a full tablet every other day and the days in between I take half and in another month or so I’m going to cut that back a little bit more because I don’t really like being on it. When I very first went to see him in 2004 or whatever, he said, “You can have HRT.” And wanted me to have HRT, “For five years or until you’re 55.” Well, as I was nearly 50, five years and I did say, “What then?” And he went. So he said, “It might just get you over the hump of the worst of the menopause.” And I think now that demonstrates a total lack of understanding because if your own hormones are misfiring you’re making less progesterone and less oestrogen and you’ve got all these symptoms. What does he think is going to happen when you’ve had your five years of taking an artificial substitute and then you withdraw it? The same thing is going to happen. So what then? And if it’s nothing well, what’s the point in going on it, so I’m weaning off. I’m keeping a little stash of all these half pills and when he cuts off my supply, which is likely to be this September, a) he’s going to have a fight on his hands, b) I might go private and get it that way or c) I’ll take my little stash that I’ve got in the cupboard without his knowledge. But that’s it really.

 

Cynthia’s doctor offered her fluoxetine (Prozac) to help her hot flushes but she didn’t want an...

Cynthia’s doctor offered her fluoxetine (Prozac) to help her hot flushes but she didn’t want an...

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It was clear I was not having an easy ride with the menopause. Mine wasn’t going to take the standard oh well, up to two years. Mine was dragging on so I went back to the doctor. This time I found him a bit more receptive to other suggestions but that was because I sat down in the surgery and burst into tears. And I had read about clonidine being used for hot flushes and so he did agree that I could try that or he offered me Prozac. Now I was a bit surprised. I know that on certain doses some antidepressants are supposed to be able to help the menopause but I don’t really think it’s appropriate to have women going on Prozac when they’re not clinically depressed. I’m not sure there’s been enough research there for them to be so quick.

 

And I said, well, I’d try the clonidine but I wasn’t interested in the Prozac. I tried that low dose rising one tablet a week until I was up to the maximum of six and it did help during the day. From about 7.30 in the morning until about 4.30 I didn’t have any hot flushes. And then from 4.30 in the evening until right through the night I was back to having them on the hour every hour. So I’ve no idea. I think other things must come into play not just oestrogen and progesterone. There must be I don’t know chemicals or hormones that you make in the day or at night. There must be something else in there. Otherwise why would I every late afternoon and evening and night have flushes and then they’d stop in the morning. That was really weird but. So I did stay on that for about five months but it didn’t get any better in the evenings and I just had had enough. So back I went and said, “I’m now desperate. I’ll go on HRT.”

 

Cynthia bought a progesterone cream over the internet after her doctor refused to prescribe it...

Cynthia bought a progesterone cream over the internet after her doctor refused to prescribe it...

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So I moved on and had done some research about natural progesterone cream. So I was following a Doctor Lee’s theories. I don’t know if anybody has mentioned that but it’s about the imbalance between oestrogen and progesterone as opposed to being short of one and a little bit of the other so I think your adrenal glands take over producing oestrogen but you’ve got no progesterone so if you put some progesterone cream on that can help.

So I went back to the GP because I knew there is such a thing as progesterone cream but I think it’s very strong and they use it for infertile women. But I know somebody that gets it and breaks it up, cuts up the capsule, whatever it is and just rubs some on her skin. But my doctor wasn’t having any of that. “No, that’s not what it’s for and you’re not having it and there’s no valid research to show that progesterone cream on its own will help anyway.” So he wouldn’t give me that and away I came empty handed again. So I bought it on the internet. You can get it in Guernsey or Jersey.

 

Cynthia was disappointed her GP could not offer as much support as her herbalist

Cynthia was disappointed her GP could not offer as much support as her herbalist

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I think I’ve harped on more than enough of my disappointment with the GP’s casual attitude. I don’t think there’s much more you can say about that. I think that there’s lots of training that could be done there for things to be, for women to not come out feeling like, “Well, I’m on my own with this then.” The person that you turn to that should help you the most is your GP I think and when they don’t I think that’s quite sad. I still feel a bit choked, when I think about when I very first went there how needy you are. But when you are able to suppress all of that they need to be able to look underneath and see that there is this desperate woman sitting there that might look all composed and everything but actually isn’t and you come out feeling desperate. I don’t feel that I should have, I wish my GP had treated me with the same level of attention and respect and caring that my herbalist did. And I know that you could say, “Yeah, but you were paying him.” I was paying him twenty five pounds. I pay more than that in my national insurance. NHS is not free, you are paying for it and I think it’s a shame that my GP didn’t offer me the same level of support that my herbalist offered me.

Is the GP the right person? Are they equipped to deal with it?

No, I think actually if they can’t deal with you, if they can’t devote the right level of time maybe they should refer you. Maybe there should be more menopause clinics so you go there specifically to have help.

 

Cynthia talks about the pros and cons of websites she’s used to find out about the menopause

Cynthia talks about the pros and cons of websites she’s used to find out about the menopause

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The internet and I couldn’t recommend enough that people do their own research. Go on to internet sites. Particularly Menopause Matters because it does have a GP running that and so their information is accurate. You can get loads of advice just by joining in forums from other women who’ve been there, done that and I pass on a lot of the things that I’ve learnt.

So you mentioned the Menopause Matters forum?

Excellent.

Were there any others that you used?

iVillage.

That you could recommend?

iVillage has a menopause section on there. Each part of that site’s got all different things, motherhood and bereavement and all sorts and part of it is perimenopause and menopause site. But she doesn’t normally offer information. It’s the women participating that do that. She directs you to other websites where you can get stuff, information or products.

Do you see any negatives about forums?

Yeah, people can have very definite views on things.

And I think there’s some misinformation that’s given. Sometimes you get the Daily Mail have a site as well and there is someone on there who’s an American who keeps talking to people about the types of HRT, oestrogen and progesterone that they can get, compounds from the compound pharmacies, compound pharmacies I think they’re called, where they make the stuff up specifically for you. Well, that’s all very well if you’re in America. You can’t get it over here and so you keep hitting your head against a brick wall there. I keep going on and saying, “No, this is not America. There’s a clue in the site dailymail.co.uk. We can’t get what you can get so there’s no point in recommending that stuff.”

 

Cynthia says she ‘got off lightly’ with few emotional symptoms

Cynthia says she ‘got off lightly’ with few emotional symptoms

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Some women talk about mood swings and anxiety and loss of confidence. Did you experience anything like that?

Not really. Mood swings but then I’m not sure I’ve always been a little bit had a short fuse so it’s difficult to tell whether it’s just me as a normal short fused person or whether I was. I didn’t feel, I didn’t have tearful times. I didn’t have real highs and lows. I think I got off light with a lot of other symptoms. People have panic attacks and anxiety and I don’t really think that I had any of that. Palpitations, people have said they get. I’ve not my own. I’ve said the only thing really on my list was hot flushes and if I could have not had those I’d have said well, I sailed through the menopause.

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