To be absolutely furious at bloody incompetent GP?

[ItchDrivingMeInsane]

I am menopausal and have had itchy bits for about 6 months now. Tried absolutely everything and despite being on HRT thought I probably need a topical oestrogen gel.

It is driving me insane, I am sore and often bleed down there!

Went to see female GP, was examined and told atrophy present but she wanted me to try a hydrocortisone cream first as it may be dermatitis. I tried to argue a bit and say can you just give me the oestrogen cream to try but she said I’d need a referral to a gynaecologist. I tried to talk about NICE guidelines but she wasn’t having it. She made an appointment for two weeks later to see how steroid cream had worked.

That appointment was rescheduled as I was told she was going to be off sick so I had an appointment with a locum male doctor. I told him the steroid cream had slightly reduced the itching but it was still continuing. Again asked for oestrogen gel but he wanted to examine me again. I refused as said lady doctor had said atrophy was present (really didn’t want to get my bits out again!) at last appointment so surely that should be enough but he said she hadn’t put this in my notes.

He said he’d send a task for another appointment to be booked with her when she came back after sick leave.

That was 2 months ago. I was told that another appointment was not booked and I need to call in to get an appointment on the day on the two days a week that she works. Been trying that for a few weeks but all appointments are gone by the time I get through!

I honestly am fit to lose my shit tomorrow.

AIBU that I should have just been prescribed what my symptoms matched and according to NICE guidelines?

I can't believe your GP hasn't just prescribed it! I had an over the phone appointment with my lady GP and she said any lady over 45 they treat the symptoms of being peri menopausal. My only symptom ( so far) was feeling like I was getting a UTI all the time and being uncomfortable and she didn't hesitate to prescribe the vaginal HRT cream Estriol and omg it has changed my life! How can one little cream be so life changing? I would try and see a different doctor at the practice you shouldn't have to suffer like this. Good luck x

It’s not intimate though. The doctor spends no longer thinking about one patient’s vagina than the next patient’s tonsils!

It is to the patient, particularly one like the OP who has been the victim of SA.

Of course it's intimate. Yes from the GP's perspective it's not and they've seen dozens of women with no clothes on just that week, but for the patient it is. Which is why a decent GP recognises that, offers a chaperone etc etc.

So many of us have stories about what GPs said or did when we presented with menopause symptoms, the general lack of knowledge out there is shocking. Even though I'd had a hysterectomy (which can mean you enter menopause sooner than ordinarily) I was offered two lots of antidepressants and one lot of folic acid (wtf??) before joining the dots myself and asking for HRT, which is what I needed all along.

What the doctor thinks is irrelevant. Its about the patient not the doctor.

Vaginal atrophy is regularly diagnosed from symptoms - a pelvic exam is not an essential, especially in cases where there is history of trauma. Its especially an issue when confronted with an unknown male doctor - at the very least she should have been offered a female HCP for the exam.

The GP who did examine her failed to record the diagnosis in the notes. That's a failure on their part resulting in a CSA survivor being put in the position of intimate exam by unknown man or no treatment.

Whichever way you look at it its poor practice.

If the cream was totally safe you could buy it OTC without needing an online doctor to sign it off.

You can buy Gina OTC. Which is what makes the insistence that the OP has not one but two intimate exams plus a gynae referral especially ridiculous.

Are you a Dr OP? Because diagnosing yourself via google and NICE guidelines isn't always accurate. This could be due to menopause, it could also be for other reasons. By all means ask for a gynae referral, but refusing to be examined and then having a strop because the Dr didn't give you what you wanted isn't ok.

It really shouldn't be this frustrating to obtain HRT full stop. I thought we'd moved on from this years ago.
I'm constantly dismayed when I read threads like this😥

She had always been examined. Nice guidelines say HRT should be prescribed in symptoms only. I have vaginal.atrophy and never been examined, as have lots of women on this thread.

Im guessing you haven't read the Nice guidelines.

YABU. Nice guidelines are guideline and are often misunderstood. If there are a multiple potential causes the GP will go with whichever one they think is right at the time. You’re entitled to ask for a referral and they’re entitled to refuse.

What this comes down to is that if you're a woman with money, you can get exactly what you want by using online services or menopause clinics. If you have no money, it's down to luck whether or not you get appropriate care in a timely manner.

Have you had a good look at your vulva. Please check out LICHEN SCLEROSIS. This can often be misdiagnosed. Do you also have white patches down there, itching and splitting skin which can be sore.

Can you do an e consult? I was getting a lot of UTIs and read that they can be caused by menopause. So I wrote to GP and said what I'd read and was it worth a go due to being late 40s
I got a text back to say she agreed and it's helped loads.
With hrt it def seems to depend on your gp :( I know docs traditionally saw people to prescribe but I think as one has you'd think other would have gone with that and then tried next line of help...topical hrt

You should see a gynaecologist those symptoms n could also be lichen sclerosis which can only be treated with dermovate. You will need a have a skin biopsy to confirm it.

It would make far more sense to try the oestrogen cream first. The biopsy is very invasive, I've seen several woman say the area has never recovered properly after it's done.

Should of let GP exam you. No medical professional is going to diagnose you without an examination.

Again, not true. I don't actually know anyone who was examined prior to getting prescribed oestrogen cream - always given on the basis of description of symptoms.

I thought topical oestrogen was available over the counter now but see it's only one type.

The OP wasn't unreasonable to refuse the male GP examining her - the first GP should have made proper notes.

But this does seem to be yet another example of NHS saying a silly little woman not knowing her own body. Can GPs please just listen to us? And comply with the NICE guidelines.

But this does seem to be yet another example of NHS saying a silly little woman not knowing her own body. Can GPs please just listen to us? And comply with the NICE guidelines.

Now wouldn't that be lovely.

Every menopausal woman has a horror story about what a GP said to her, or refused to prescribe to her, or having to be ridiculously assertive about it, or go armed with information downloaded online, or how someone like Davina McColl or Mariella Frostrup gave better advice than supposedly trained medical professionals.

As the wonderful Jo Brand said: "Did you hear the joke about HRT? Nobody gets it first time".

I had the same with my female GP about 4 years ago. I was in so much pain and like you bleeding. In the end I paid privately to see a gynaecologist who prescribed vagifem, diprobase to wash with and a steroid cream for flare ups. I now get the prescription on the NHS as the gynae wrote to my GP. If you can afford a private appt would be worth it (sorry if you’ve already mentioned this I’ve not RTFT). Otherwise just try and see someone else at your surgery.

Yep! I was prescribed topical oestrogen purely by symptom description

https://www.theindependentpharmacy.co.uk/menopause-hrt

I use this website quite alot, really quick service and lots of medication available. Might be worth a look, more expensive than NHS prescription but the convenience outweighs that IMO.

Hmmn. You've seen two independent GPs - neither of whom agree with you.

There's a possibility their combined 14 years training and career experience makes them a little more knowledgeable on your condition than you deciding what you want or think and matching it to NICE guidance.

It makes no difference to the GPs whether you're prescribed oestrogen or hydrocortisone treatment - unless of course one is not suitable for your condition.

But without any medical training you've decided exactly the treatment you need - despite two GP's not agreeing with you. And refusing to be examined a second time.

Since you didn't even like the advice of the first female GP, why not call every day to try to get an appointment with any female GP and start the consultation from the beginning.

If they want you to try one thing for 2 weeks - try it - but ask to have a follow up appointment put in your consultation notes.

But you know you're not doing yourself any favours by being rude and stroppy and not willing to listen to any medical advice that is given.

An issue with one GP could be an issue with that GP. An issue with two GPs - maybe it's you who are the problem.

Never ever disagree with the GP then? Know your place, middle aged woman, put up with your sore and shrivelled vag which could be easily cured with cream, because the doctor knows best. 🙄

there are some very good, clued up GPs. There are others who might be experts on diabetes or asthma but haven’t the first idea about menopause. When confronted with one of those doctors, the ideal solution would be for the gp to admit their ignorance and refer to a colleague or nurse specialist but that never happens, does it?

a good friend is currently being given the choice of lumpectomy or mastectomy for dcancer. She is being trusted to make the decision. But the op’s GP won’t even work with her to prescribe a very low risk treatment like oestrogen cream???

it’s a bloody disgrace.

My GP prescribed me Ovestin without any exams.

I'd go to a different GP surgery tbh

The GP may have said it looks like it may be VA, rather than it is VA. That would explain her prescribing an alternative treatment in the first instance.

Given OP had already self-diagnosed, she'll have latched onto any mention of VA as being the actual diagnosis rather than it being an actual diagnosis. That supports a VA diagnosis not having been recorded.

That's my theory anyway.