Dr refusing me HRT - frustrated

[willitbe]

I have just come back from my GP, who I usually get on very well with. I said I felt I needed HRT, she wants me to go on mini-pill as HRT "not recommended".

I am 47, but periods started going haywire three years ago, initially getting closer together (even as close as two weeks) I was checked out at the gynae clinic and as all well was offered the coil as option for controlling / getting rid of bleeding.

When I have been on progesterone supplements before it made my moods worse. And my main problem at the moment is PMT being worse and going on for longer now that my cycles have stretched to 5/6 weekly.

I am clearly peri-menopausal, and my reading on the topic is that before age 50 HRT is no longer considered the issue it was. Am I wrong?

There is no other GP I can go to, so I don't know what to do now. She took bloods today to check my iron and thyroid levels. I have to go back to decide what to do. What do I do?

As far as I know, GPs are not allowed to refuse treatment based on non-medical reasons (eg their own feelings or prejudices.)

You need to go back and be prepared to be more assertive.

Ask why it is 'not recommended' for a start. Unless you have risk factors then there ought to be no reason why not.

The Chief Medical officer recently made a statement about patients being more pro-active and 'demanding' the right treatment- he says we should be more outspoken ( but politely.)

However, it depends what you feel HRT will do for you. It may help your moods but if you take the sequential type that gives you a bleed, you may suffer PMT symptoms as you do with a normal cycle- this can vary with the type of progestogens used.

HRT should control your erratic periods BUT may take a few months to kick in to override your own natural cycles- you might get spotting in between.

As yet it sounds as if you are not getting hot flushes, sweats , vaginal and bladder problems that may come later. (Lovely!) So she may well argue that irregular periods and mood swings don't warrant HRT. If you feel they do then challenge that.

You are right that HRT before the age of the normal meno (51) does not carry any risks.

If you don't get any joy, google menopause clinics in your area or if you can afford it, see a gynae privately for treatment.

Also- think about joining the forum on www.menopausematters.co.uk for even more support!

I am getting the vaginal and bladder issues in the last 2 or 3 years, I was referred to physio for learning to do the kegal exercises properly, over a year ago due to leaking. Getting a few episodes of cystitis that I have never had before. I have also had a few episodes of (undiagnosed by doctor) what I thought was thrush, now I think it was just dryness. But I am not getting hot flushes or sweats fortunately.

She was suggesting an anti depressant for the low mood/mood swings, and I am really not thinking this is the way to go.

I did mention about the vaginal soreness to her, all she offered to do was examine me, I declined that too.

The not recommended comment was regarding breast cancer risk.

I know my mood swings are linked with my cycle, even irratic as it is. I have always had mild PMT, but it now feels much worse with a longer run-in time. So I thought HRT would be the solution, but perhaps not. I am not sure myself what is the best option.

Until you get any joy out of your HCP, have you tried a vaginal moisturiser?

(I have some, but it's sat in the cupboard for several months now and I've never dared try it!)

This is a rather basic article, but puts some of the risks vs benefits into perspective.
www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372?pg=1

I am so with your GP for you!
The comment about cancer is so ill informed it's laughable. How old is she? she clearly knows nothing about menopause.
Go to the menopause matters site and find the page that shows the scales- risks and benefits of HRT by age.This is the menu on the left under HRT.

For women under 60 the benefits outweigh the risks. You could also print this off and also show her the latest comments from the British Menopause Society on how HRT should be used for symptoms.

You need vaginal oestrogen for your bladder and vaginal symptoms- this is not absorbed and will not cause cancer. Ask for Vagifem or Ovestin.

PLEASE do not put up with this dreadful GP not knowing what she is on about.

Ask for HRT and try it- not sure where you live but the menopause matters site has a link at the top to clinics across the UK if your GP persists in being hopelessly out of date.

Risks

BMS statement

Print off and show dr- it says the choice about HRT is the woman's

I asked for a referral to the meno clinic at the Chelsea &Westminster after similar nonsense from my GP. The team at the C&W had no issues with giving me HRT and have been brilliant. If you're in London or the SE ask for a referral there or if not to your nearest big teaching hospital's meno clinic. Don't be fobbed off

Thank you for all your help. Fortunately on Christmas eve my GP rang saying that my blood tests had shown low progesterone, so was writing a prescription for HRT for me, as long as I understood the risks.

I have not yet started as I am waiting til my next period starts (hoping in the next week), then will begin. I have been prescribed Novofem, which according to menopausematters website is intended for 6 months after last period, but I looked it up as it appears it is the same drug as Elleste duet, which does not have the same requirement, so I am assuming it will be fine!

I am hoping it helps soon. Thank you again for all your help and pointing me in the right direction.

Do you think that might be low oestrogen? They don't normally check progesterone.

Novofem- I'm a bit confused because according to the MM site it's shown as being one of the options for peri menopause.

Novofem

There aren't any preps for 6 months after a lst period- the ones for post meno are for women who have not had a period for 1 year ( or over age 54 sometimes.)

Hope you get on okay!

Just wanted to update on my situation here and this thread is as good as any! I came off HRT last July on the advice of my new GP ( when I returned to live in the UK) who was reluctant to prescribe it for me..... What followed was 6 months of sheer hell - what was the worst? The feeling of being microwaved all day?? The aches and pains in my hips, knees, ankles and legs in general - in particular in the mornings which would wake me up ? The tossing and turning all night due to pains in hips and other? The low emotional feeling all the time ? The headaches? Lack of focus? The bloating that I suffered on my legs and skin in general? The itchiness of my skin with the occasional feeling that my skin was shedding itself? The feeling of despair when a doctor asks you if you think that the pains in your legs are maybe due to exercise? WTF ! I was tested for everything and anything which related to any kind of bone condition( oust, arthritis, rheumatism) and all came back clear. FINALLY the doctor said he would refer me to a menopause clinic on the NHS - what was the wait time???? 18 weeks! Just too long for me...

So I made an appointment with a private doctor who put me straight back on HRT - the cost 160 Pounds. 4 months of HRT on a private prescription cost me 48 Pounds ( Just giving these costs in case they are of use to someone). WITHIN TWO WEEKS my aches and pains had gone, the microwave effect had gone, my focus was back and I slept through the night - it was the old me! I have started a nutrition and exercise plan to lose the weight that I put on during those 6 months when I had no focus.

Thanks to pink frocks who answered some of my posts previously.

Lucky ladies who sail through all this with a couple of evening oil of primrose or a dose of agnus casta...but for many that isn't the case.

The only sensible thing my GP said to me was that we do live in a "what if" culture currently and this often prevents us from taking some form of action.

When life is miserable on a daily basis from the minute you open your eyes and you dread going to bed at night because you know what is coming you need to do something.

Just because something is " natural" doesn't mean you have to suffer....

Good luck everyone!

So glad you are sorted- sounds good!

How did you find a private doctor?
My GP wants me to stop using Ovestin cream as I have been using it for 2 years, told him, in a polite way that I thought he was not up to
date on current guidelines and I was prepared to take the risk!
Pleased you are sorted, will you be able to get future prescriptions on the NHS?

It's my understanding that you can only get the prescriptions on the NHS if your consultant writes to the GP saying 'Do this' and they are happy to issue them. It then becomes more complicated because you have to have a review at least once a year- I have them every 6 months- so the question then would be who does the review- the private consultant or the GP who is issuing the prescription on their advice?

I've paid for mine for over 6 years and TBH the cost of a private prescription is hardly any more than the £8 for the NHS ones- sometimes it can be cheaper as you pay for the product not a set charge.

You can easily find private drs- look at any local or national private hospital and so a search under the consultants for the condition / body area. ( eg gynae.) Many have their own websites so you can click on those and find out their areas of specialism and interests. Other publications like the Tatlers Top 250 Doctors online ( voted for by other drs) is also an information source.

Sorry for answering out of turn perhaps and hope the PP doesn't object!

My doctor is talking to female colleagues for their advice, as he did admitt that his territory was testicles and prostates!
If he says no, I will go down the private route, can't put up with VA!

pinkfrocks thanks for info

well, unless you have a sex change that might be your best bet!
Though it's a bit much that just because he is male he doesn't know how to help 50% of the population. I wonder if female drs know nothing about willies and balls? Just imagine the outcry if they said they didn't.

when I first had problems I saw the older lady GP thinking she might be knowledgable. She was useless, told me it was not possible to get VA while still getting periods and kept insisting I had thrush even when tests were negative.
I do hope he is talking to the 2 younger women Gp's!

I am seeing my GP next week. I think I want HRT. Perhaps you can help me! I've seen GP before, but my blood tests didn't say definitely Peri.
I've had night sweats (awful).
I've not had a period in over 270 days.
I've gained over 2 stone in those 270 days.
I have joint aches.
I am slightly anxious.
I am quite miserable.
Will HRT help all of the above - especially the weight gain?

HRT is not a cure for weight gain :) You have to stop eating as much as you perhaps did in your 20s, 30s and 40s. I eat about half of what i used to in order to maintain my weight. You also need to up the exercise- a goo brisk 45 minute walk every day would be a good start.

You have not had a period for almost 10 months? If that goes to 365 days ( a year) then you are post menopause ( if you are under 50)- if you are still in your 40s then they say wait a bit longer before assuming your periods are over.

But yes, HRT would help everything else!

Blood tests are useless- your hormones are all over the place in peri. Drs who know their stuff will go by symptoms not blood tests. Just go along and ask to try HRT and be assertive- but polite.

Hi
I have an appointment tomorrow with GP
My symptoms...night sweats for last 4 years, really bad some nights.
Boob pain, feels like I am constantly pregnant with swollen sore boobs.
Joint aches, especially in my hips, to the point if me having to take neurofen to get through the day.
Periods are laughably irregular, but usually it seems every 16-21 days. They are not heavy but just lots of hideous lining stuff.
I do have bleeding at other times, just a bit if break through. No real pain, just feel grumpy & oh so tired with it. (Am 48)
Do you think the GP will give me something....fingers crossed

It's up to you to ask .
If you go in and say 'these are my symptoms, I'd like to try HRT' then they would be unreasonable to say no. Back up your case if needed with info from Menopause Matters website or the British Menopause Society website.

After a long ordeal when my friend died, the GP prescribed me Propanalol for heart palpitations, Ferrous sulphate for iron deficiency and vitamin D as I was lacking it, my GP showed compassion for my loss and bad health, we came up with many options and even offered me HRT as I am screaming Menopausal, I declined at the time as I was only used to taking 2 Levothyroxine tablets and now I was taking 5 tablets in the morning. I went back several months later for my blood results and he told me to stop the Propanalol and Ferrous sulphate to see how I go on and true enough when I returned the other day everything was back to normal. I asked him why I was sleeping for 12 hours and still felt tired, i've gained weight, lost my appetite and am getting mood and snappy, he said I may need to go on HRT but he is not prepared to prescribe it to me as he has to do investigations first, when I asked what they were he could not give me an answer apart from he is willing to take a urine sample and prescribe me anti depressants, which when I looked up the side affects are the same as what I'm feeling now, drowsy, dizzy, nausea, lack of appetite and weight gain. Would it be appropriate to complain to my surgery manager?

I don't really understand why you think he is out of order? You have an under active thyroid? (Correct us if that's wrong.) So weight gain and tiredness are symptoms of that. Does your dr want to be sure your drugs for thyroid are correct before prescribing HRT? What meno symptoms do you have now? How are your periods? How old are you?
I agree he should have offered an explanation of why he was offering tests. But if he already offered HRT a while ago, he doesn't seem to be refusing it now. Is he? Or is he saying he needs to do tests first to rule out other things?

Do you think it's poor communication because you could have pushed him a bit more on why the tests were needed .

If you want to stay with the practice and that GP it could make things more difficult. The easier route would be a different GP at the same practice. Is this possible? Or, change the practice.

, he said I may need to go on HRT but he is not prepared to prescribe it to me as he has to do investigations first, when I asked what they were he could not give me an answer apart from he is willing to take a urine sample and prescribe me anti depressants,

You just need another appt to go over this. Ask him what the tests are for. No one can do tests without being honest over what they want to look for.

A urine sample is no good for a hormone profile anyway- so you need to query that. ADs are not the answer for meno anyway if you can use HRT.

Go back and have another chat?