Gynaecologist's views on older women AIBU

[disappointedyetagain]

I'm using patches for HRT. They're not working very well and my GPs all seem to think the only other option is a pill version. I've tried this and although it worked well to start with, it made me very unwell emotionally. I already take the max of a well-known anti-depressant plus a low-does of an older version for pain I get with a chronic disabling condition I have.

Despite sweats that literally wash over me, I can no longer shower daily as the moment I hit the water, the patches slide off. I've tried different brands but my stretch marks cause little gaps that leave water seep between the skin and patch.

I finally got referred to a gynae and after a year-long wait, saw one yesterday. There are no menopause clinics in my area (only one in the country and that's out of my LHB). I can't afford to go private.

What a waste of time. I explained why the patches weren't working (falling off), she asked why I didn't put them on my arms. It says not to on the leaflet, so I told her.

Told her the problem with the pills, and then explained my medical history means I shouldn't have been prescribed them in the first place.

I asked her to prescribe the gel as I thought it might be my only other option but my GPs haven't heard of it. I then had to spell it for her to look it up in the BNF. She couldn't understand why I wanted the gel as it's the same ingredient as the patches. I repeated the problem I was having with the patches falling off.

She concluded that she'd be writing to my GP recommending anti-depressants and beta blockers (I also said I can't take them as I'm asthmatic).

She then asked how long I've been menopausal (2 years) and said that I only had another 2 years before it finished! I'm sitting there wishing for a crystal ball like she has, whilst wondering if she'd cope with another 700 nights of lost sleep due to menopausal night sweats.

I told her that my sister suffered through her menopause for over 10 years and that I knew women who were still taking HRT at 60.

Then she got vitriolic and practically spat at me that those older women only took it "to make them feel younger and look better so they could attract younger men".

WTAF?!

WIBU to complain about this doctor?

Is it me? Why am I getting doors slammed in my face for wanting a solution to the awful flushes and sweats that keep me awake? My condition is hard enough to live without dealing with something making it even more difficult.

I'm a long-term poster who's name-changed for this post as it's outing. I'd really like some sensible input and advice about this.

[WorldofTofuness]

Someone more qualified in this area than me will no doubt be along to explain, but--If the problem with the gel is that it is oestrogen-only, why not a formulation that contains the necessary progesterone too, for women with uteruses (uteri?)?

Unless there is something I have massively overlooked that makes gel inherently a delivery method suitable more for hysterectomised women, it seems like a combined gel would be an obvious step.

[quince2figs]

Hope things improve, OP. Please can I reiterate that it sounds unlikely that any patches will suit if skin is quite uneven. Any areas which don’t have stretch marks, eg: bottom?
Please can I reiterate NOT to attempt dressings/tape etc on top, as this will still not enable the oestrogen to be absorbed. You certainly need the gel. Please insist on being referred on the NHS to one of the registered menopause specialists on the BMS website.

[disappointedyetagain]

Thanks, everyone for your help and support.

I will see one of the GPs next week if I can get in. I'm not sure if I want to officially complain (though I know I should as that doctor's tone and opinion were unacceptable), but I will tell my GP what was said.

It should be interesting to see what that doctor has written to the GP!

I'm annoyed as almost all the GPs at my surgery are female, yet there isn't one that takes a particular interest in female problems. More annoyed that every time I've bothered to print out info, none have even glanced at it.

I showered this morning and the water is running behind the patch where it's come unstuck over a stretch mark - I'm covered with them due to pregnancy and fast growth spurts which left me with them on my thighs and bottom, too. Everywhere below the waist has this problem so the gel would be an obvious solution.

I'm so frustrated I honestly feel like banging my head against the wall. If I was male I'm pretty bloody sure I wouldn't be treated like this.

Thanks again for all the support and info.

[KatyMac]

Thanks Theswaggyotter - I'm sorry I'm in surgical menopause and having real problems getting information from my GP surgery (the consultant won't even engage)

[Theswaggyotter]

Yes not a problem without oestrogen

[KatyMac]

At any age?

But with no oestrogen, no problem?

[Theswaggyotter]

katy oestrogen on its own can lead to thickening of lining of womb and if this continues may lead to cancer of lining of womb (endometrium)

[KatyMac]

WHy/how does progesterone protect your womb? (no ovaries womb still there)

[Ribeebie]

I agree with previous PPs here. There is an oestrogen gel available, we prescribe Sandrena locally.

It is an oestrogen only preparation though so if you have not had a hysterectomy you must use progesterone as well (mirena coil or tablets). This protects your womb.

I am not aware of any cost/formulary prescribing restrictions on the gel, and it is much much safer than oral route as it has a much much lower risk of blood clots.

Is there a GP at your surgery who specialises in women's health? I would try to see them and request this specifically. Most menopause and HRT treatment is actually managed by GPs rather gynaecologists, but if there is no GP at your surgery with a special interest in this, and you are not getting anywhere then definitely request a second opinion from gynae.

[Esspee]

I would like to correct a statement on implants made by an earlier contributor. Implants CAN be given to women who have, and those who do not have a womb. If you have a womb you will need progesterone also. If you have had a hysterectomy then the oestrogen implant is all you need. Some ladies also get a testosterone implant to help with libido.

[Esspee]

So sorry you are having this problem OP. I have been getting oestrogen implants for the last 29 years and they work beautifully. Twice a year a tiny pellet of oestrogen is implanted under my skin and for the other 363 days I forget all about the menopause.
I have tried gel and patches but hated both. (Have allergic reaction to the adhesive on the patches). Won't take pills because of the high doses needed due to the oral medication having to pass through the liver. The gel was messy and took ages to dry. Implants have been wonderful. I will be on them until I die. (Almost 70 so hopefully a few more years to go)
You need to Google NICE guidelines for the menopause. This document is the government's standard of excellence for medical professionals in the UK. It is perfectly readable by the layman and once you have studied it you can refer to it when you visit your doctor. A friend actually printed it out and put it on her doctor's desk after I suggested she read it. Ask them why they are not following best practice. Stand your ground and ask to be referred to another doctor of you are not satisfied.
I do hope you get satisfaction.

[agedknees]

Can you put opsite over the patches when you shower

Ex gynae nurse and post menopausal woman. And it does get better, honestly.

(Opsite is a waterproof dressing. You can get it at the pharmacy).

[Dodie66]

Can I ask what happens when you leave off hrt? I have a friend who was on it for years and the gp said she couldn’t stay on it any longer and all her symptoms returned. The GP told her that she had to go through the symptoms at some time

[AnoukSpirit]

From your last update it does sound like you saw a junior doctor.

Sadly, I have learnt that often the only way to receive humane, decent care is to complain and be the pushy person our culture teaches us not to be.

I would complain. How you were treated was unacceptable and unprofessional.

If you're not comfortable complaining for yourself, consider complaining for all the other women she will also treat this way and who may blame themselves. If nobody feels able to complain, nothing will stop her continuing to behave like this.

[PrincessLuna]

Patches drove me mad. I tried everything and never got them to stick for any length of time. Now have the gel (and Mirena) and is amazing to finally have it all sorted. So definitely worth pushing for the gel... good luck getting it sorted.

[Theswaggyotter]

Definitely need progesterone if you are having the gel and have a uterus. It’s not safe to prescribe otherwise.
No excuse for that doctor to speak to you like that and I think it’s worth flagging it up
Women’s health matters are often downplayed by doctors and menopause is underestimated in terms of how severe symptoms can be. I hope you can get something sorted out.
Did you say you couldn’t have the mirena coil? It would be great alongside oestrogen gel if you could have it if not then the pessaries would be the next best option

[quince2figs]

Hi OP, I’m a consultant gynaecologist and specialise in the menopause.
To confirm what some prev posters have advised:

You are absolutely entitled to have the gel prescribed, but it MUST be used in conjunction with a progestogen (oral or Mirena) to prevent the womb lining becoming abnormally thickened or pre-cancerous.

Problems with patches sticking is common; it’s worth trying a different brand as adhesives vary. Don’t bother trying dressings on top etc, as the oestrogen still won’t absorb.

For vaginal symptoms, you can use topical oestrogen (pessaries, cream or a ring) which is pretty much risk free. This won’t help hot flushes and mood changes though, and won’t have the other health benefits. It’s commonly used in addition to topical or oral HRT.

Everyone is advised to use transdermal (patch or gel) oestrogen HRT to reduce clotting risks; if you are immobile, it’s vital that you avoid oral oestrogen.
Sounds as if your cardiac and osteoporosis family history are extremely strong indications for HRT regardless of symptoms.

HRT use can be lifelong if you are fully informed of the (small) risks.
There is no defined duration of symptoms.

The doctor you saw acted extremely unprofessionally and sounds to have almost no knowledge of menopause and it’s management. I really hope she was not a consultant; she may well have been a junior doctor or a non-menopause specialist - unfortunately there is a huge shortage of specialists and sometimes poorly informed GPs end up referring women to almost as poorly informed gynaecologists (or at least outdated in their knowledge).

You are entirely entitled to a second NHS opinion, even if that is out of area. Please use the following:
www.menopausematters.co.uk for excellent advice which I think you’ve found already
thebms.org.uk/ for recent national guidelines confirming all the above - with advice for GPs!
www.womens-health-concern.org Is the patient arm of the BMS website and includes a register of UK specialists, just a few in Wales.

I would suggest going back to your GP with written info from these websites, asking for a second opinion if necessary. I would also suggest if GP refusing to prescribe gel, then consider submitting a written complaint/summary asking GP to clarify in writing why they are withholding a standard drug.

Good luck - it’s all so much more work and effort than it should be, for something that will affect most women. FWIW, I struggle to get repeats of an extremely standard HRT from my own GP, that I have been using with no problems for over 2 years....

[kikashi]

Is she a GP specialist? My son was referred to dermatology . We were told we would see a consultant but we actually see a GP specialist . The same was true at the MIgraine clinic. Seems to be standard NHS for clinics in our area now if you are classed as a "routine" case.

So sorry you are going through all this.

[Serialweightwatcher]

Disgusting what she said - assume she's younger and hasn't experienced any symptoms. Have you thought of the Ladycare magnet (attaches to underwear) - some swear by it. I think I felt a little better but was always attaching myself to teaspoon on the worktop - maybe worth a try to see if it helps at all:

www.ladycare-uk.com/shop/menopause-relief/ladycare/

[tolerable]

i dont know anything..cant restrict it to just being about menopause.i landed ,co of my lack of paying attention on an article earlier- so-on off chance its worth a shot praps,here it is...(if not,can i just say,good luck in getting through this/better soon.x megsmenopause.com/2018/06/07/apple-cider-vinegar/

[Fozzleyplum]

This is a bit of an odd suggestion, but you could try covering the patches with gaffer tape, as it is very sticky and waterproof. I used it to get rid of DS's warts on his hands (something yo do with the glue, apparently), and it stayed on through handwashing etc.

[Bluelady]

I can't believe your GP hasn't heard of the gel. I had EstroGel 15 years ago. My uterus is intact. I'd recommend you go back and refuse to take no for an answer. The beauty of it is you can regulate the amount to get it just right for you.

[TurkeyBear]

@Agedfanjo you can request to change GP and move to another surgery? Why haven't you yet? You're not tied to them.

[Gigglebrain]

Hrtft, sorry, but have you tried Wellsprings hormone cream. It’s very good.

[TurkeyBear]

OP request some Tegaderm+ dressing covers with your scripts from the GP. They're totally watertight and will cover your patch until you decide to remove them.