Carole - Interview 12

Age at interview: 51

Brief Outline: Despite experiencing side-effects with HRT, Carole feels it has helped her overcome anxiety and hot flushes. She believes quality of life is more important than potential risks. Still suffers anxiety and depression but draws support from an online forum.

Background: Carole is a part-time administrator. She is married with no children. She started the menopause at age 48. Ethnic background/nationality' White British.

More about me...

Carole’s menopause experience has been characterised by anxiety and depression which has had a considerable impact on her enjoyment of life and her ability to continue with her job on a full-time basis. Carole traces her problems back to around 2006 when she began to feel slightly depressed, had trouble concentrating at work and felt generally stressed, anxious and unable to cope. This was followed by the onset of hot flushes and night sweats which had a significant effect on her sleep, leaving her feeling very debilitated and tired. Originally prescribed antidepressants by her GP, she decided not to take these and eventually asked another GP to prescribe HRT.

Although the HRT tablets settled the hot flushes and gave Carole more confidence and her ‘old life back’, she experienced an allergic reaction (vomiting and diarrhoea). She subsequently tried HRT patches and a gel which she spread on her upper arms, however, these caused a allergic rash. She believes her reaction to HRT may be due to an allergy to oestrogen. Carole’s GP suggested that she go off HRT for a month to give her body a rest. This, however, saw the return of hot flushes, night sweats and feelings of depression.

Carole has tried St John’s Wort and Femal with limited success. Comparing the cost of these products with HRT, she feels that ‘you could spend a fortune’ on alternative remedies given that long-term use may be necessary to gain full benefit. She has recently started a lower dose HRT in tablet form (Climaval 1mg) which appears to be better tolerated. Despite the problems she has experienced with HRT she believes it has helped her considerably to overcome her anxiety and the hot flushes. She is reluctant to contemplate going off HRT in the future as she believes that quality of life at present is more important than any potential risks later. She is also concerned that if she goes off HRT she will then have to go through menopause with all its symptoms at a later date.

Carole experienced two bladder infections before going on HRT and believes that the menopause has led to a declining interest in sex. Despite the support and reassurance of her husband, she feels that loss of libido and weight gain have made her feel unattractive. Although HRT has helped, vaginal dryness has made intercourse difficult. Despite this, she is reluctant to use lubricants.
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Carole feels isolated as she goes through the menopause and wishes her mother were still alive to comfort and reassure her. Her main support network comes from the Menopause Matters website. She is an active member of the forum, which acts as a source of information and advice, linking her to other women going through the menopause. She posts regular correspondence on the forum which she consults daily.

Carole was interviewed for Healthtalkonline in January 2009.

Carole went back and forth to her GP, trying in vain to find an HRT patch that suited her.

I said, “I am going through the menopause, I’m on HRT and I’m having a bit of trouble settling with the tablets”. I went back to the GP and she said, “Don’t worry Carole,” she said, “we’ll try you on another one”. Excellent I thought, so I tried another one, that was okay for a while but then the nausea came back again. So, bless my lady doctor, she’s got such patience, I went back again and she said, “Well let’s try patches, because they’d be absorbed through the skin rather than through the stomach and the liver”. So I went on Evorel 50, two patches a week on the thighs. Great. Fantastic. Relief. After about six months I started to get a reaction to the patches on my thighs. I would have square patches like that red raw, itching and I was using a different leg each time hoping that that red patch would heal before I got back to that side and I had at the end of about I suppose about another six or seven weeks I looked like a patchwork quilt. It did, it was red raw, it was stinging, it was itchy. I did a bit of research on the internet mainly with the help of Menopause Matters and one of the ladies on there suggested I might try a different patch but I went back to the doctors and she said, “It does sound like you’re allergic to the adhesive, although I was a bit apprehensive about that. But anyway she tried me on a Fem 7 patch. I put one on and it was even worse, it looked like somebody had got a Hoover, put it on suck on my thigh and just bluk, and it was within about one day. So that had to come off. So then I tried the gel which was top half of your arms, once a day and that was alright for about two weeks and then it all flared up again. Doctor said to me, “You’re probably allergic to oestrogen full stop.”

Carole feels 'absolutely shattered' after waking up 5-6 times a night.

We were talking about hot flushes. What effect did that have on your sleep?

Oh, horrendous. I mean it’s like being woken up five, six times a night from a deep sleep and of course then every time you woke up you wanted to spend a penny so you’re taking trips to the toilet as well. And then you’d go back to sleep, or try and get back to sleep once you’d cooled down. It’s just so, excuse the expression, but knackering, absolutely shattered, you’d wake up in the morning and feeling like you’d had a night on the tiles. You’d wake up with a fuzzy head, no energy, everything was an effort you’d, even now, I still get tired but it’s not through night sweats that’s just through the menopause in general, HRT can only do so much, it can’t deal with everything, but it’s just so very very tiring. The night sweats you just don’t want to be woken up at night. If I get six hours sleep it’s rare, but then I catch up at the weekends.

Carole compares her experience with two GPs. She stresses the importance of doctors listening and not making assumptions.

Well I suppose I’ve seen both sides of the coin haven’t I. I’ve had the experience with the first lady doctor who made me feel very stupid and made me feel like I was wasting her time by going and that is not on.

But you just have to have choices and when you’re menopausal and going through the menopause it’s very easy to let your choices go. It’s very easy to be led by doctors and nurses and friends as well who let you down. I just feel that the medical profession needs to have a broader view of things because every woman’s menopause is different and it affects them in a very different way. It takes over their life and it’s there day in day out and it’s a pain in the butt. But it’s going to stay with you for a long time. And it was so refreshing to see this second doctor, I mean she listened, she asked questions, and she advised and she made suggestions and it just gives you hope. Rather than having the door slammed in your face saying one of two things, you’re depressed or it’s the menopause get on with it.

Carole became a frequent contributor to a Menopause Matters web forum, which she found to be a great support and 'invisible friend'.

I think I ‘Googled’ menopause and there was I think the only thing it directed me to was a very clinical description medical terms which I don’t know what they were talking about. And it wasn’t until I found Menopause Matters that I thought let’s have a look at that one and the main front page gives a lot of information about HRT, treatment options, symptoms of the menopause which there are supposed to be at least thirty five and how to get information and various other links. But it was the forum, the members’ forum that really opened my eyes. I think I saw one posting on there from a lady, I think it was the first one I read that hit home and it said something like, “oh I don’t know what to do, I can’t be bothered to do my housework, I haven’t done it for two weeks, my house is a mess and I’m getting so depressed and down about it”. And one of the other members had replied, “sod it, forget about it, it’s still going to be there tomorrow, don’t beat yourself up about it, it’s not the end of the world, just take a step back and look and think about yourself for a day or two and then you’ll feel, because it’s always going to be better in the morning, you’re always going to feel different in the morning”. It’s true. And they’re just people that open up and like I said before it was like me writing it, it was like me talking, saying what they were saying was what I was feeling.

If Mum had been around she might have said “Well, look it sounds like you’re going through the menopause, let’s talk about it” and I didn’t have anybody who could do that so seeing that was just, it was like a big friend, invisible friend, and I have made friends on there, I’m never going to meet them but the two years now that I’ve been with that forum I’ve made good friends. We go through it together, we hold hands, we support each other.

How often do you look at it?

Oh, every day. Every day.

How often would you post a message?

I haven’t done so much since Christmas because of the holiday and as I say I had that cold and that. I think I’ve done over two thousand posts in those two years.

Carole says she's a bit 'old fashioned' and prefers not to use a lubricant despite vaginal dryness.

Vaginal dryness, yes, it’s always well I say it’s always been there, it’s always been a problem and I would definitely say there was one particular HRT which helped better than the others and I can’t remember the name of it. I think it might have been Premarin, I remember saying to my husband “Ohhh HRT’s working” or working better. Yeah it is quite dry.

When you say it’s always been a problem you mean during the menopausal transition?

Yeah, yeah.

And what do you do about it?

Nothing, just persevere.

So you don’t...

We don’t...

...use lubricants or anything like that?

No, we talked about it but I’m a bit old fashioned, a bit naive on things like that. We just keep plodding on and if it hurts too much then we don’t do it. We try again later. And it’s quite funny because it does take sometimes two or three goes in a night, an evening or whenever we do it. Sometimes we have to give up. My husband says, “This just isn’t going to work” and there’ve been a few tears over that but we get by it.

Carole feared she was having a nervous breakdown when she felt weepy and couldn't cope at work and at home.

By the end of the following summer I’d started to notice that I was getting, I wouldn’t say depressed but I was getting quite weepy, I was having trouble concentrating on work.

And I found I just couldn’t cope with things and I started getting a bit tearful. This went on for about another four months towards the end of 2006 and everything got on top of me. I thought I was slightly depressed, then the hot flushes started and they’d been going on for about 3 or 4 months, mainly during the day, not any at night at the time, but then I found I couldn’t concentrate on things, I had no co-ordination, I couldn’t do two things at once. I’d be out in the kitchen thinking I’ve opened the drawer, yes, what am I getting, other times I could do two or three things at once but this was just getting me down.

I think you start to think what the hell’s wrong with me, have I got some disease that, the big C, what is making me like this, am I depressed, am I going to have a nervous breakdown. I thought I was going to have a nervous breakdown until I found the website and I read the forum and I thought Jesus there’s hundreds of women like me, I’m not going bonkers, I’m not going mad, this is quite normal. It’s not abnormal, you’re not mad, you’re not stupid, you’re just going through a stage of your life and you’re not the only one.

Carole's boss suggested she work part-time when her symptoms started to affect her work.

Yeah, where I work there’s only four of us there, one man, his wife and another lady of my age, we’re all about the same age actually, I’m the eldest of them. And yes it’s a small office, it’s not like a big office so if one of you is having a bad day it does rub off on the others. It was a very small sized office as well and my boss said to me, he said, “It’s got to the stage Carole where I’m afraid to ask you, ‘are you alright’, in case you snap at me”. I said, “Oh I’m very sorry about that, I don’t mean to do it, I’m not even aware I’m doing it”. And he said, “I can’t approach you,” he said, “We’re all finding it hard to approach you because you bark at us” and I said, “You know what the problems are. Well I’m stressed in my job, I’m stressed in my job and this is a way of dealing with it. There’s a lot I’ve got to do and I’ve got to do it quickly and I’ve got to do it thoroughly and if it’s not done properly you’re going to ask me why. So I’m sorry if I’m a bit snappy”.

And as I say I was going to leave but then the boss said, “Well, what are you going to do?” he said, “I don’t want to lose you” he said, “You’re a damn good worker”. He said, “This business needs you, you’ve helped me build it up”. I said, “I can’t carry on doing this job”, I said, “What the problems are, I’m going through the menopause, I’m on HRT, I’ve had problems with the job”, and he said, “Well look, can I offer you a part-time job working for us or are you completely fed up with this company?” I said, “No I like working here but I just can’t do that job”. So yes, I mean, working close, I never thought I’d have to go to my manager man and say, “Well sorry I can’t do my job anymore because it’s too stressful and maybe if I wasn’t going through the menopause I probably could do it”.

I mean and going part-time I mean I work Monday, Wednesday and Friday. If I go in on Monday and have a terrible day I haven’t got to go in the next day. Go in Wednesday and have a terrible day, it’s not there everyday, I can take a break from it.

Carole asks partners to be patient and 'ride the storm'.

God bless you all. Because you’re going to need it. You have to be patient. It’s like, if you can think of the woman going through the menopause as a bit like a car, if all the parts don’t work together at the same time it’s not going to go. And when a woman’s going through the menopause not all the parts click at the same time. It’s not personal to you that they’re grumpy, they’re feeling like poo and if they reject you it’s not because they don’t love you. If you can, if you truly love them, support them and just take it. Ride the ride, the storm with them. It’s an awful lot to ask of anybody and it’s a hard thing to do but that’s all you can do. Hold their hand and give them support and just be patient with them.