HRT

[Runtoyou]

I feel quite irritated after having a telephone conversation with a doctor at my surgery so would be interested in your views, experiences etc.

I have been taking Elleste Duet HRT for thirteen months now. I feel really well on it. I'm 48. Prior to taking it I tried natural remedies for the menopause, later progressing to vagifem oestrogen gel. However eventually neither stopped the night sweats and insomnia which left me exhausted and barely able to function. HRT has made me feel much better. I'm aware that there are risks in taking it, but I weighed everything up and decided quality of life was very important to me.

Anyway finally getting to the point; I get HRT on prescription but it's not on repeat so when I run out I have to talk to a doctor to get more. I usually get asked health questions such as 'Do you check your breasts?' (I do and gave a yearly mammogram), told I may need a blood pressure check and asked about side effects. All perfectly reasonable health questions even though I feel I'm having to jump through hoops. Tonight the male doctor I spoke to asked if I had thought about weaning off it. WTF?! Why does he feel the need to ask this? I explained I had no good reason for weaning off. As well as pointing out how well I feel, I also told him that a recent bone scan had revealed some bone thinning on my lower spine. So Surely a. Dry good reason to stay on it.

Sorry this is so long but why is it so difficult to talk to a GP with proper knowledge of HRT? Sadly the lovely GP that originally offered it to me has recently retired.

I had endometriosis so I was already seeing a gynae consultant. Loads of obviously menopausal symptoms from around 41 or 2 looking back but GP didn't initially take me seriously because of my age. Finally accepted I was menopausal at 47 when my FSH level went over 80 and I still didn't have a period.
Went on HRT but GP wouldn't prescribe it because of my history so had to wait until my consultant follow up appointment. Felt better within days! Consultant is brilliant, treats me like the informed adult I am, and says I can stay on it for as long as I want. GP happy as they aren't responsible for the decision...

Sure there were some recent guidelines saying that long term use not particularly an issue and may be beneficial, might be worth printing it off if you can find it. Wonder if it's a cost thing?

Yes, sadly, GPs dont spend that much time studying menopause when training and a lot fail to keep up with current thinking, studies and recommendations, hence the number of women who get put on anti depressants instead of HRT.

Can you see another GP in your practice?

Mine won't give it on repeats either. My always low blood pressure is checked every 3 months and I usually have to plead my case for more. A poster here called polly is very knowledgeable and has links to NICE guidelines advising that there's really a need to stop if you don't want to.

If you have been on HRT since 47 that is quite young . The advice of NICE is to continue to age 52 - average age of menopause. After that it's up to you as long as your GP advises you of risks and you understand them. The risk / benefit profile is more benefits than risks up to age 60 at least.

The risks don't start till 50+ anyway as up till then you are simply replacing what should be there naturally at 47 /48.

Women on HRT are supposed to have check ups annually at least. Check ups mean your BP and asking questions about your overall health. NHS mammograms are every 3 years and not more often even if on HRT (though you can pay for more privately which I do.)

I see a top gynae privately. I have reviews every 6 -9 months usually. I've used HRT for 8 years.

Your GP is talking rubbish so stick to your guns and see someone else if necessary.

Thanks I definitely think cost might be a factor ... Perhaps some doctors view HRT as a luxury?
Unfortunately it was a phone call from a doctor I didn't know at the surgery. For prescriptions not on repeat it's the norm to get a phone call and you can't always choose who you speak to.

I didn't think being on HRT long term was a problem either. Will have to do more reading ..

I honestly don't think how cost can be an issue. You can see the RR price of all HRT on the website Menopause Matters under Treatments/ HRT/ Preparations. Most HRT is cheaper than the £8+ you pay for a prescription. It's not as if it's costing the NHS £100 a month!

My care is private and I pay for my HRT on a private prescription. It costs me around £12 a month and that includes gel which is roughly £10 including the dispensing mark up for the pharmacy.

You need to read the NICE guidelines. They are easily found online.
The main point is that menopause care should be mutually agreed between woman and dr. There is also NO limit on how long HRT is used; it's down to individual risk and choice. As you have low bone density you ought to be on HRT at least to early 50s and maybe longer.

PollyPerky thanks for your replies. I do consider myself to be fairly up to date with regards to HRT which is why the doctor I spoke to annoyed me. I made an informed choice to start HRT last year after struggling for a while. I started menopause fairly early due to the removal of one of my ovaries and I wasn't expecting it all to happen as quickly as it did.

My DM got breast cancer in her fifties and at the time HRT was blamed for it so when she recovered she stopped taking it. Obviously due to this I wanted to see if I could manage without it. It was only when an older doctor at my surgery suggested it that I started to view it differently. I have yearly mammograms due to my family history.

Sorry about your mum Run. I'm also sorry you are having this battle with the drs. Having annual mammos is a good idea. I wonder if you have discussed the different types of progestogens with your Dr and were advised that some types of HRT are considered safer, re breast cancer?
If you haven't already read it, there is a good blog on the Home page of Menopause Matters by Dr Currie who is chairman of the British Menopause Society (and a consultant gynae.) Her take on HRT and cancer is that HRT may in some women promote the growth of an existing tiny tumour but doesn't cause BC . My consultant has said the same to me.
If you continue to have to battle, maybe you could think about going outside the NHS and seeing someone privately? I'm always a bit surprised that more women don't do this. Fortunately at the moment I can afford this but I'd rather pay for good medical care than buy a holiday if it was a choice between the two.

I have Pmed you. However Mumsnet had a fit and have sent it 5 or 6 times.

PollyPerky I had this issue. I contacted my local NHS Meno Consultant who bollocked my GP. My GP still continued with out dated info. I am an ex HCP so I went to GMC Register found my GPs Responsible Officer who is a Medical Director at NHS England. He intervened and.my GP is being investigated. It may affect his GMC Registration. It was taken very, very seriously as the GP advice is dangerous and outside NICE guidelines. If enough of us do this we may change things. My story is identical to OPs. OP messaged you.

I think many / most people would not know who to contact or what to do unless they were some kind of HCP who knew the system.

But anyone can take along the copy of the NICE guidelines- or read them off their phone or iPad in a consultation with their dr- and ask why they are ignoring current advice.

The main point of the Nice guidelines is that meno treatment is a partnership with dr and patient being equally invested and knowledgeable. So women do need to be more assertive and not allow out of date GPs get away with poor treatment.

Problem is my GP told me the NICE guidelines changed nothing! That.does not always work. Happy to help anyone find the correct people to complain to re HRT and their GP.

I've heard people here say that their GPs wriggle out of the NICE guidelines by saying they are 'suggested'' ie meaning they don't have to take any notice!

NICE does use words like 'Consider' rather than 'You must...' to GPs.

Or, Gps say they are 'just guidelines' again- meaning they are not mandatory.

However as I found the GP Responsible Officer who recalibrated/approves their registration with the GMC takes a different view.and investigates them for dangerous practice. FTW

How would women find the NHS Meno Consultant? Do you mean one who is in hospitals or someone who is in admin? Did you need an appointment? I think you did well, but would women who are not ex HCP know what to do?

There are women who come onto this forum and argue against HRT poo-pooing the NICE guidelines as well, saying they are 'Guidelines' and therefore not mandatory. Of course GPs can't be forced to prescribe HRT but my understanding is they have to give sound medical reasons not to if women ask for it- and by 'medical reasons' I don't mean 'we only give it for hot flushes, not blah blah...'

I am meaning DOCTOR Menopause Consultant. Menopause Matters web site.has the list of NHS Hospital Clinics. GMC Register will tell you your GPs Responsible Officer. If a GP is giving advice outside of NICE guidelines it is potentially dangerous hence their Responsible Officer is very interested and will act.

My feeling is enough women took this action it could massively improve HRT prescribing.

The problem though is that NHS meno clinics are not spread around the UK; there are many areas that have none.

If women can't get help on the NHS it's worth paying for a private consultation then the consultant will usually write to the GP to continue the prescription, and maybe also go down the route your consultant did because the majority of consultants combine NHS and private work.

Very true however worth contacting your nearest Meno Consultant to ask if they will update your GP. Could advice re going private too.