How to persuade GP to prescribe HRT

[Dreamgirl1111]

I am 56 and have suffered all the usual menopausal drawbacks. Have also been diagnosed with Osteopenia and given Adcal to strengthen bones.
I made several requests to my GP , but was politely refused HRT.
What do I need to do to persuade her to prescribe?

Ask her why she wont prescribe. There could be a valid reason.
if not then see a different doctor

There is no reason, nothing to do with me. She just said that they would not normally prescribe it. But reading her all you ladies are taking it. I suspect that this is just the Postcode Lottery, or the NHS trying to save money.

HRT is prescribed for osteopenia.
Calcium alone- Adcal- is not enough.

Out of interest what led to the diagnosis of osteopenia- did you have a fracture?

You have a right to treatment- if she won't prescribe for osteopenia then you ought to ask for it for menopausal symptoms and then it will still help your bones.

You also have a right to a 2nd opinion so ask for a referral to a gynae if she still refuses. But she has to give you a reason why she won't prescribe- she cannot refuse saying they would not normally prescribe- that is nonsense and very poor practise.

My mother suffered from it, she was a hunchback in her late seventies. I asked for a scan a few years ago soon after my periods stopped and was diagnosed. Three years after the first scan, the condition was getting worse. The GP only increased the Adcal to two a day.
Your reply gives me some hope. I have an appointment tomorrow.

Please please please get some proper treatment for your osteopenia.
Here is a link from the NOS which you might like to discuss with your dr

www.nos.org.uk/document.doc?id=823

Could you see a different GP? Or move to a different practice?

HRT is not normally prescribed for osteopenia maybe you are mixing it up with osteoporosis .
Clinical responsibility for a prescription sits with the HCP not a consultant advising. It would be an inappropriate referral and still the GP could decline to prescribe.

However ideally should be a joint decision with you being aware of risks and benefits and that at some point you will most likely have to experience the symptoms of menopause. I am not a fan of prescribing it, will suggest alternatives if appropriate and prescribe if it is right for a particular lady.

Emphasise the effect it is having on your quality of life at present, acknowledge the risks, agree to the follow ups monitor BP. Is there another dr in the surgery

Explain If you work the impact the sleep disturbance has on ability to function. If it is affecting your mood the effect on your relationships with others etc. good luck.

I have a close friend age 56 with osteopenia- her mother has severe osteoporosis- and once her DEXA scan showed low bone density she was referred to both a gynaecologist and a rheumatologist . HRT is licensed and recommended for women under the age of 60 who have osteoporosis or very bad osteopenia- depends on the T-score- along with menopausal symptoms.

She has been prescribed Raloxifene - to prevent osteoporosis.
Initially she was prescribed HRT for menopausal symptoms/ osteopenia but it affected her fibroid.

Bugs Are you a GP because you say you 'are not a fan of prescribing it'?

I'm sorry to disagree with your opinion if you are, but the latest research and recommendations of the British Menopause Society are that HRT does not have a cut-off point, so women can take it for life if the benefits outweigh the risks. I have to say that I do not agree that you seem to not want to give HRT to a patient when it is a treatment that is available and gives quality of life for many women. Unless there are medical reasons why a woman can't use it, then it's her choice not the drs.

OP

Do you know what your T-score is? How much bone have you lost recently?
I'd really recommend you look at the NOS website and maybe start doing bone building exercises as well as making sure you have a good diet and avoid things that are bad for bones ( alcohol and fizzy drinks for example.)

You can increase bone density quite a lot by doing weights and very brisk walking. Exercise takes a long time to have any impact- you'll need another scan in 2-3 years. But you need to do something because prevention is better than dealing with full osteoporosis- and drugs for it such as bisphosphonates have side effects too which can be unpleasant. There is controversy over how well they work because they stop bone turnover, which means no new bone is made, but the old bone stays as it was. some drs think this is bad because it means the bones are comprised of old bone which can break just like thin bones!

I'd just reiterate that imo you need a referral to a consultant who is able to advise on options beyond the knowledge of most GPs.