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GPfor HRT discussion. What can I expect?(6 Posts)
I am probably pretty average as a MP patient exploring HRT; 54 years old, 2 years in full MP, hot flushes that can drench me; very poor sleep; am often itchy; libido shot; no real mood swings, just generally a bit low (whereas, formerly, I could get enthusiastic much more readily - I just can't be bothered right now!), so feeling a bit washed up and that life is just one long hassle!
I wouldn't say I was depressed, but I do feel my life-long, low level (undiagnosed) anxiety has ramped up over the last few years.
Supportive though slightly clueless DH, 2 older teenage DSs.
I am overweight (1.5 to 2 stone, with one of those stones coming on since MP...); eat reasonably well, drink 'within guidelines' , and have recently restarted treadmill power-walking every day, and have been trying to improve my diet more.
I have an active PT HCP job.
I have no medical history of note, or significant FH; good blood pressure results, am on no medications.
I wrote this on an earlier post re: my insomnia, but thought I'd paste it here:
"I am nervous in that I might find myself walking out the surgery door with a 'come back in 6 months if you don't feel better'; clutching a googled, printed off sheet suggesting I 'sleep in a well ventilated room on cotton sheets/drink lots of water/ exercise at least 30 minutes a day/ eat well/ drink moderately' etc etc - like I don't already try and do my best to stay reasonably healthy when faced with little time, a demanding, stressful job, teenagers on the cusp of Life Choices and needing to sleep on my days off in order to cope. And I'd cope better, maybe be more mindful and less stressed and desperate if I wasn't so bloody tired!"
What should I say to the GP (who I barely see so don't know) to 'encourage' them to see that I don't want fobbing off? I read time after time on this forum of women who aren't getting a great service from their GP, and I want to try and pre-empt that.
My group practice GP surgery is a bit hit and miss, they do seem keen on making you prove your medical problem by having to make appointment after appointment for the same thing til they'll refer you on. I can't afford the time to make endless appointments and attend them, resulting in chronic sinusitis leading to saline sprays and me giving up trying to get an ENT referral, but taking up to 2 weeks off work per year with it, in 3 or 4 blocks for about 5 years. Yes I tried 'going back', but because it'd been a year since my last visit, we were back to 'trying saline nasal sprays'..
She may give me choices re type of HRT- where do I research which might be best for me? Should I have to do that?
I know there isn't a single answer, but I guess I'm asking what brand of HRT would someone like myself expect to walk away from the chemist, clutching, in the first instance?
You need to go in and just ask for HRT! Say you can't work and cope with family etc with the severity of your symptoms.
You might want to adjust your lifestyle even more because being overweight and drinking daily are both pretty relevant risk factors for breast cancer, (shown on the chart I've linked to) so if you can reduce both of those, you will have far less a risk once on HRT.
This chart shows risks
As you are overweight you could have a slightly higher risk as a post-meno woman of stroke/ blood clots, so using a patch or gel would be safer than pills.
You may be best using sequential HRT first - having a 'period' once a month. Sequential types have progestogens for half the month only rather than continuous sorts where it's taken daily. The progestogens are the buggers that can cause side effects in some women - PMS, weight gain , mood swings.
By using a sequential type at least for a few months, you can find out if it's the progestogens that give side effects and if necessary change to a different sort.
Some of us are using an 'a la carte' type of HRT mainly prescribed by consultants but GPs can prescribe - it's all NHS stuff. Oestrogel plus micronised progesterone for 10-12 days a month is one such regime and supposedly has lower risks all round.
Have a read of the Menopause Matters site - all HRT stuff is listed under TREATMENTS.
I must admit I'd prefer not to have a 'period' each month! That was one of the only great things about MP!
Was looking at the chart, which is useful. My BMI is 30 on the dot right now, so that's overweight and on the cusp of obese, I see! Are you allowed to swap the little figures around so my 'moderate exercise' offsets my glass of wine??
I wonder if I'm too far into the MP for sequential to be offered? My last 'period' was 25 months ago.
I guess I am shying away from the reams of sometimes contradictory information the internet throws up!
The 'right' GP/specialist would be all over it on my behalf, but I am nervous that I might get one of those who, deep down, sees MP as nothing more than a natural process that one shouldn't interfere with.
Would maybe be a younger woman or bloke, but obviously not always!
I don't think it helps to be ageist about the 'right' kind of dr. It depends on their interests and training.
Re. sequential. I can only share with you what I've been told. Namely that it's though now that oestrogen does not cause cancer. Synthetic progestogens are thought to be the culprit. My regime has always been sequential to keep intake of progesterone to the minimum.
Some women aren't so fussed over this- they'd rather have no periods and accept a slightly higher risk. I'm a lot older than you and am still on sequential. Yo may find 'the average GP' will work on what the books tell them which is continuous for women post meno, which is where seeing a specialist gives more options as they are well, specialists!
it's still however good advice to begin with sequential because that way you can isolate what's not working if you have side effects. You can also work out if you need more oestrogen ( patches come in 37, 50, 75 and 100mcgs) more easily when the issue isn't clouded by daily intake of progestogens.
PP it wasn't 'ageism' I meant, it was more the chance that if they'd never experienced it, it might possibly lead to trivialisation! It's a wimmins' problem, thus potentially worthy of less investigation and treatment.
As an aside, the radiologists I work for are alarmingly more sympathetic and pro-active when dealing with low back pain once they've 'slipped a disc' themselves. With all the professionality in the world, sometimes one can be a bit glib about a medical situation til you've been there yourself!
Can you tell I still fear not being taken seriously?!
Thanks for the information; your info re using sequential to isolate problems is useful. Is the stuff about oestrogen maybe not increasing the risk of endometrial cancer in Menopause Matters?
Can I rudely ask how long you've been on HRT? Have you stopped to see if the symptoms are still there? I gather that's the only way, is that true?
I can only relay what I've read on forums which is that many women are being poo-pood by female drs of a certain age, who say they just have to get on with the menopause. Not all of course- some use HRT themselves and are lovely I'm sure, but I don't think you can be sexist on it.
Will PM you other stuff.
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