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.

Holdingonbarely

The issue with that approach is that in some areas something may be in NICE guidelines but not local formulary. You can argue for it, but if it isn't on the formulary then you would have to go through whatever local policy is for prescribing "off-formulary". Incidentally, going privately does not always circumvent this process- if a private specialist prescribes something not on formulary, it still cannot be prescribed. The specialist can provide a private prescription (or the GP can) or the GP can refer to an NHS specialist to ask for second opinion (may or may not need to be seen)- depending on cost of what is recommended you may also have to go through a shared care/other agreement for prescription of non-formulary medication. Admittedly, not necessarily applicable to OPs case.

The reality is, like it or not, that with funding as it is the NHS is simply not able to provide every treatment for every condition- I am not advocating that as a sensible position but it is the one that we find ourselves in.

Jacks11 I took Elleste Duet and it made me very, very anxious - to the point that I was very unwell with it.

The GP who gave me 3 weeks of diazepam took me off it and told me I shouldn't have been taking them as I'm very immobile and at risk of DVT. My mum had also had a DVT after a long-haul flight many years ago.

I'd had advice from Menopausematters forum members before going as I still have a womb. Apparently, many women have the gel prescribed alongside the Mirena coil, but that had the same effect on me as the Elleste tablets. Those that don't have Mirena use Utrogestan tablets or pessaries to take with the gel.

I took all the printed info along to the appointment. She brushed it off saying I shouldn't believe everything I read on the internet.

I really, really want to complain but don't know where to start. Also, I don't want to be labelled a nuisance patient - I'm borderline there already!

Am I barking up the wrong tree by thinking maybe the gynae I saw isn't a gynae?

Reason I ask is that she said she'd had a chat with the consultant I was booked in to see originally. I assumed she was just one of the doctors running the clinics but alarm bells started ringing when she asked me about placing the patches above the waist when it says on the leaflets not to due to increased breast cancer risk.

Then she asked me to spell oestrogel...

Try sticking a Tegaderm dressing over the top to see if it will make it stay on. They are see through film dressings - come in various sizes, a massive one may be needed to really stop you sweating the patch off.

I'm reluctant to post, as I get very annoyed at people posting when they haven't RTFT... I haven't, because I'm a bit pissed and simultaneously watching Strictly!

I am menopausal following a complete hysterectomy 2.5 yrs ago for endometriosis, with Zoladex (hideous devil stuff) for 6 months prior to the op. I've been on Oestrogel since my op, and I wouldn't be without it. It's a bit of a faff to apply, and I briefly asked to try the patches instead... they were hideously uncomfortable and impractical. Originally I was on 2 pumps of the gel (half the max dose) and I was still feeling shit (though not getting full hot flushes etc), and my lovely (female) GP told me to go on to the full dose. I did, and wouldn't have it any other way. It's mildly inconvenient because you have to rub the gel in and wait for it to dry (I put it on my thighs, then use my arms to spread it all over my legs). It's just a bit of an annoyance to wait for it to dry before you get into bed, but really, it's a minor thing...Try the gel!!!

They won’t give her the gel!!!!!

Don't put Cavilon on under the patch-it's a silicon barrier spray

OP

In that case topical oestrogen is the best way to reduce the pro-thrombotic effects of oestrogen whilst still using HRT. But you would absolutely have to have a progestogen.

Utrogestan or medroxyprogesterone (provera) are commonly used as the adjunctive progestogen. However, if you've had issues with the progestogens in both combined HRT and mirena, I would have concerns that you would have the same issue with any form progestogen taken orally. Equally, I think you run the risk of similar problems with the pessaries. But I suppose it's trial and error.

Sorry for the hijack disappointed

Jacks11 may I ask for help here?

Tegaderm problaly would work over the patches (although it seems utterly ridiculous that you've not been offered the gel). Someone suggested it earlier and it really is worth looking into

Individual tegaderm dressings are really pricey, the rolls are much more economical www.amazon.co.uk/gp/aw/d/B00KTD93JC/ref=mp_s_a_1_7_a_it?ref=plSrch&keywords=tegaderm+roll&dpPl=1&dpID=41crUYvsbHL&tag=mumsnetforum-21&ie=UTF8&qid=1541277946&sr=8-7

It’s possible you saw a junior doctor and not a consultant. Junior doctors can be doctors training in gynaecology or to be GPs. Most clinics are a consultant and several juniors, for any specialty, so you don’t always see the consultant.

A bit off topic but if you've got heart issues in the family you can ask to be referred to a cardiologist to check for any underlying hereditary conditions I'd have thought? Might put your mind at rest there.
YANBU because the gynae sounds insensitive and off

Cavilon is a barrier so your skin won't absorb the drug properly if you use that. We use cavilon in hospitals and nursing homes on peoples buttocks to prevents bodily fluids attacking the skin and causing sores. It's not an adhesive!

Have you tried any herbal remedies like black cohosh (sp.?) as it was recommended to me.

Having been through several medical menopauses due to treatment for endometriosis then I understand how bloody awful it is.

I was given livial HRT to ease me through.

How often do you change the patch? I'm not familiar with them, sorry.

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.

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

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

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.

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.

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/

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/

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.

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....

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

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.