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.

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.

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

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).

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.

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.

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.

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

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)

At any age?

But with no oestrogen, no problem?

Yes not a problem without oestrogen

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)

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.

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.

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.