@sunshine080
I agree- a trial of HRT sounds in order. You could try one last go at your GP - but if that does not work then would really recommend private. I could not do my job without HRT.
When you do speak to your GP you may need to change your approach. Be factual and polite and make sure your talk about your hot flushes/night sweats as your first symptoms (not anxiety/brain fog etc) as HRT is licensed for hot flushes. If you say "I feel awful,anxious, brain fog, moody, achy, and occasionally the odd sweat", the GP (who only has 10 minutes) has determined from the first few your priority....and you can kind of understand why they may go towards anxiety treatment.
State (politely) what you want. "I am over 45, I have symptoms of perimenopause, I would like to trial HRT. My symptoms are nightsweats...b.c.d.e...."
Take the NICE guidelines with https://www.nice.org.uk/guidance/ng23
Take the a list of symptoms with you - there are various ones - https://balance-menopause.com/uploads/2021/10/Perimenopause-and-HRT-Feb-22.pdf or https://www.themenopausecharity.org/2021/10/21/symptoms-list/ what every you take have hot flushes/period issues as the ones at the top of your list so you discuss those first
Below is a cut/paste from a Peri group I am in - admins put it together due to the frustration a lot of people were having getting HRT from their GP. It is long, but worth a read. I have put in bold particularly useful parts. Please have a look.
From Facebook Group:
Lots of posts about people have issues with the GP, getting angry at the GP, getting worried about speaking to the GP or confused about how to talk to their GP recently. I’ve posted versions of this in replies but given the posts today about GPs, a general post seemed a good idea.
- “I think I’m peri / menopausal, should I bother talking to my GP? There’s lots of other women seeking help / I guess I’ll just struggle on till there’s no HRT shortages” This is silly. Sorry not sorry. There is no prize for “struggling” and there’s evidence to suggest women who start HRT earlier do better. There are always going to be people seeing the GP and it really doesn’t matter if some of those people are also seeking help for menopause. There is not a quota for how many women can get help for menopause per day! As for shortages - there are always some shortages and while it’s a bad thing, most women are able to get their HRT after a bit of phoning round and potentially travelling further than they should have to. If you’re waiting until there’s no shortages or risk of shortages, you’re gonna be waiting a long time. So call your GP! And when you make the appointment, and the receptionist asks what it’s for, make sure you say “I believe I am peri / menopausal and want to trial HRT”. Lay the groundwork early.
- The appointment
First things first. Younger GPs are not necessarily better or worse than older ones, female GPs are not guaranteed to “understand” just because they too have a uterus. So unless you’ve got personal experience of a GP, don’t assume. If you have the option of speaking to a receptionist to make an appointment, you could always ask to speak to “someone with a special interest in menopause” but not all surgeries will have someone.
Second, prepare your information. The frightening (in one way) and awesome (in another way) about peri-menopause and menopause is you get to (or need to!) do your research and take control.
We’re used to going to the doctors and being seen in a paternalistic fashion- being told what to take and how long to take it for. Few of us are going to argue for a different antibiotic, we are nice polite ladies and take what we are told, saying thank you doctor on the way out.
Peri / Meno / HRT is different. You are expected to have some ideas about what to take. If you haven’t, you will end up with what the GP thinks is best for you based on their preferences which may or may not be the same as yours. For instance, GPs where I am love the coil, and would give that to every woman if they could. It doesn’t suit me though, so if id just asked for HRT, that’s what I’d have got.
Download the “balance” menopausal app onto your phone and fill in the symptoms checker. *The biggest mistake people make is going to the GP and crying about feeling sad. Some GPs will consider HRT at that point but most will (understandably) equate crying woman with depression. And if you’ve not fully explained other symptoms a handful of anti depressants is hardly unsurprising.
If you fill in the report on the balance app it’ll generate a PDF you can email or email and print off which puts your symptoms in doctor speak. For instance, night sweats are vasomotor dysfunction. You need to take this to the GP with you so print it off.*
Next go to Google and find the NICE menopause guidance. This is the GP “rule book” on how you should be treated. Read it several times and highlight bits if you want - print it out, take it with you but KNOW what it says.
Next, work out what HRT you want. Forget about shortages. There are always shortages near enough. At the moment it’s gel, next year it’ll be patches or even spray. Work out what you WANT. You will need something to give you oestrogen and something to give you progesterone.
If you want the BEST (most modern) option go with transdermal oestrogen (patches, gel, spray) and Utrogestan progesterone tablets. You can consider the coil and patches for progesterone but these are synthetic progesterone (progestin) and some people don’t manage them as well. You MAY be offered a single daily “combined oral HRT” tablet. You can only take these for five years and they carry a slightly higher clotting risk. So you’d need to change again at 55 - just get the new stuff to start with.
So now:
You have your report
You have your NICE guidelines
You know what you want
On appointment day, scrap any combative attitude you have. No “getting ready to do battle” or “preparing for a fight”. Your attitude will affect your behaviour and that will affect the GPs attitude and behaviour. Look at it from the GPs side. They probably don’t know you from Eve, and in stomps a bolshy woman with a face like thunder. Of course it shouldn’t make a difference but it does. Be confident and self assured, cos you’ve done your homework. Remember too that your GP has ten minutes. GPs are trained to talk abs question in a masculine fashion. Woman chit chat, dance round the subject and hint at things obliquely. It’s what we do as part of society. We don’t ask clearly and simply for what we want. This is fine when you’re chatting to a shop assistant but not when you’re explaining symptoms to a GP.
Example: a male approach would be “I’d like to trial HRT because I believe I’m peri-menopausal and my quality of life is suffering as a result”. A female approach (and I’m talking from experience) “I feel really weird and sometimes I cry and I don’t know why and I’m anxious about things like the other day I was in the shop and I just felt really worried and I’d only gone for some bread but there was so much and I just couldn’t choose and then I knew I’d gone for something else but I couldn’t remember what so I had to call my husband. And at night I just can’t sleep and sometimes I get really hot and go all red but no one else is hot and I’m not wearing a jumper so it’s not that and I wake up in the middle of the night and I’m all sweaty, I used to get that when my husband cuddled up to me but it’s not that, I don’t want him cuddling up to me and it’s a shame cos we used to have a really good sex life but I’m just not interested now but it’s probably a good thing cos it’s all sore down there you know anyway…”
See the difference? It may seem rude to speak in a masculine fashion but it’s really not and it’s just for now. Your GP will appreciate you being direct because your appointment is only short. But you’ve got your lovely balance app checklist, so this is going to be easy!
*“Hello, I believe I am peri-menopausal and would like HRT. I have tracked my symptoms on the Green Climeratic Scale (hand over the report from the app), and I have read the NICE guidelines. I have a copy of the NICE guidelines if you would like them. (Offer to hand them over). (If you’re 45 or over you can say: I am aware I should be offered HRT based on my symptoms as I am over 45.)
I am happy to have blood tests to rule out other conditions but would like to trial HRT for three months now. Having done my research, the formulation I want is (whatever HRT you want). Then sit back and say nothing with a polite smile.*
If they offer blood tests that’s not a bad thing (iron, vitamins can cause issues) and say you are happy to have them for OTHER concerns but (if you’re over 45) point to the guidelines and say “the NICE guidelines for menopause treatment at my age state diagnosis is on symptoms as blood tests are unreliable. If you are refusing to follow NICE guidelines for my treatment, I would like that added to my medical records along with your justification so I can make a formal complaint”. Don’t be emotional, just polite.
That should work nicely.
- If they say no
This isn’t the end of the world and don’t take it personally! Ask for them to document why they are refusing to allow you to trial it and ask for the reasons to be added to your medical records. Ask for them to provide you with a copy of that entry and explain you want a second opinion and you’d like that arranged now please. Just be calm and polite. Then repeat this process with the second doctor.
- If “the blood tests are normal”
This is only an issue if you are under 45. 45 or over you can remind them that it says they should treat based on symptoms in the NICE guidelines.
Blood tests should be carried out on two specific dates in your cycle to have any chance of being accurate. If you’re told your blood tests are normal based on one test, explain that you’re aware there should be two tests carried out, but even then it is unreliable. Explain that “even thought my blood tests say I am not menopausal, my symptoms suggest i am, and I would like to trial HRT in the form of (your choice) for three months please”.
If you’ve got an agreement to trial HRT, make sure you use the balance app to track your symptoms so you can show what has changed.
And Finally:
GPs aren’t all perfect but they’re not all dreadful. They’re GENERAL practioners and yes of course they should know everything about the menopause, but we also expect them to know about cancers and strange rashes and weird ear issues and dodgy toes and funny lumps and why your pee smells funny and why the baby won’t stop crying and god knows what else. We need to take control and research ourselves. The info is out there, and brain fog isn’t a reason not to do it. If the Balance Menopause site is too hard, watch the Davina McCall programmes. Use the search bar here - it really does work. Or post your own question. But don’t let fear put you off.