Anyone with medical knowledge about HRT around? Not sure if GP is fobbing me off.

[menopausalminnie1]

My GP has told me that I don't need HRT. I'm not sure whether she is right, or if she's fobbing me off to save money.

I am 55. I still have periods, albeit erratic. I have no issues with low mood, but I am very achy, especially in my lower back, which impacts how long I can walk for. Just had a long holiday with lots of walking, which was agony quite frankly.

I've read that HRT can cause cancer, so it's best to avoid it, if you can manage without. But other things I've read contradict this and even say that all women should take it for bone health etc.

Any experts out there who can advise me please?

oh mate it doesn't cause cancer. And v good for bones.

Recent BBC article about the NICE guidance on hrt: https://www.bbc.co.uk/news/articles/c20npvvxr59o

They don't cause cancer but they do increase a risk of breast cancer and cardiovascular diseases. If you are predisposed (i.e. have family history), you may want to weigh risks and benefits.
Whether you need HRT or not will depend on your bloods. I wouldn't personally have it just for pain unless there is no safer analgesia option which works. It's not my direct area of expertise but I do work with a lot of peri-menopausal women as part of a different specialism and it is becoming easier to request HRTs than it ever was. Did your GP justify her clinical reasoning in any way when you saw her about HRT?

I doubt HRT will help with your back ache. Has your GP suggested anything to investigate what's causing your pain?

I think there are other things to check first eg your vitamin D level. There is a small possible increase risk of breast cancer with HRT. There are other medicines you can take instead for bone health if you have risks that can HRT is not ideal for you.

This is an interesting link OP https://www.chelwest.nhs.uk/professionals/gp-hrt-advice-guidance

It's a postcode lottery unfortunately and many GPs do not have sufficient knowledge to discuss the options so they should refer you to someone in the practice who does. Can you go and see another doctor in the practice?

Think HRT is protective against heart disease in some cases.

www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women/hormone-replacement-therapy

Thanks everyone. I will read those articles. My mum had breast cancer but it was secondary to lung cancer. I don’t think my GP know this though!

She just said if you can avoid HRT it’s best to.

Joint pain can be a sign of menopause - or of other things. If I had no concerns about anything else I'd think a 3 month trial of HRT, without changing anything else, would be perfectly reasonable.

Is she the GP in the practice with an interest in HRT? There is usually at least one!

oh I've just seen this.

I would say that if you can avoid GPs with this attitude, it's best to 😀

Sorry about your Mum - one primary breast cancer (if genuinely a metastasis that doesn't count) in a first degree relative diagnosed over 40 doesn't put your risk above population risk. This is useful to work through if you want to work out whether you have an elevated risk. Go from section 1.3 on page 50.

https://www.nice.org.uk/guidance/cg164/resources/familial-breast-cancer-classification-care-and-managing-breast-cancer-and-related-risks-in-people-with-a-family-history-of-breast-cancer-pdf-35109691767493

You know why OP because menopause is an elective that GPs do not have to take. So a lot of them know eff all about it.

Go back, see a different one if you can. And go armed, watch the Davina documentary, go with your other symptoms and be pushy.

Unless she has a very specific reason to advise you of this - eg due to medical history - it is complete and total bollocks to say that it is best to avoid HRT if you can. There is some evidence that the very very small increased chance of breast cancer would be a possible problem for someone who is already high risk but even that I believe is being mitigated today by the fact that the hormones we're taking are more natural.

Joint pain, and by association back pain, can absolutely be a sign of peri-menopause. There are about 100 other symptoms too and guidleines are that for a woman over 45 experiencing any symptoms, HRT is the de-facto first treatment, with no requirement for further tests.

I would be surprised if you don't have other symptoms. Erratic periods are often a problem not so much from a routine point of view, but increased flooding/longer periods is a pretty common one as a result of peri, for example.

Yes, I've not heard of menopause associated with back pain. Getting older - definitely associated with it.

When GP's give advice such as this, it always makes me wonder if their advice would be to avoid insulin (or equivalent) to someone with diabetes.

HRT for peri and post menopausal women is to replace essential hormones lost at a particular time in our lives. Why medics would say such a thing is baffling and outdated given the recent NICE guidelines quoted in a previous post.

Yes. Very old fashioned advice. Give it a try for 3 months and see if it improves any of your symptoms. Print off NICE guidance and take to GP.

Have you had recent bloods done, OP?

If you are on Facebook there are some super groups with medical professionals on who know their stuff.
I find this one particularly good, it was started by Davina -but there are others.

https://www.facebook.com/groups/339468798172619

I'm not an expert but was in a similar situation. I woke in pain every night for over a year with a stiff, sore lower back, struggled to roll over in bed etc and was told similar by my GP. Referred to (useless) pain clinic and prescribed naproxen, tramadol, gabapentin etc. Multiple requests to speak with someone in the surgery about menopause options, appointments were made and cancelled without explanation by the surgery. A GP in her 30s told me the menopause is natural. This must almost fill the bingo card?

Eventually spoke to a locum who seemed nonplussed by the situation and referred to a menopause clinic and as soon as I was on HRT I immediately started sleeping through the night.

To be clear it didn't 'fix' my back but I suspect it was a mixture of peri sore joints and poor sleep, both greatly improved on patches.

At the very least they should admit their ignorance if they don't know much about it rather than making it up. Can you see a different GP and to be referred?

At 55 surely I’m not still in Peri?

This GP I’ve seen is the appointed Menopause GP for my surgery, btw!

You're only in menopause when you haven't had a period for a year.

I'd say that's shocking but...

Have you had a bone density scan?