Three Drs at practice refuse to prescribe HRT

[Therewere5inthebed]

Sorry for the disordered post, so miserable and anxious.
I'm 44, had peri symptoms since 2002, DM was through meno and out the other side by 41.
I have really been struggling with physical symptoms for the last yr, have had citilopram prescribed for this however this does absolutely nothing about the physical symptoms.
My periods are all over the place and I flood for two days and am then done.

I have ridiculous brain fog and loose my temper very quickly when I've always been a calm person.

I am so tired all the time, can fall asleep anywhere but wake up at 3 every morning without fail.
Despite this the worst thing is muscle stiffness and pain. It's so debilitating.

I had a total knee replacement a yr ago and I have put on weight since being unable to exercise for the last few years but I am dieting and have lost 3/4 stone since the end of April.

Three GP's have refused me HRT due to the risk of DVT and strokes, I've requested patches but I've repeatedly been told that the risks are still there however the hormones are given.
I've quoted NICE guidelines until I'm blue in the face but all I'm met with is resistance.
I've been in again today and been refused again and I feel like sitting here sobbing as I can't continue like this.

I understand the risks, I've done so much research but if I'm not so stiff and sore or tired it would be so much easier to loose the weight. I can barely walk when I get out of bed.

Sorry for the rant but have no idea where to go from here..

Citolopram for the mental symptoms not physical.
(I'm 5ft6 and weigh 95kg but they do not take into account the fact that I have well toned muscles (that are rigid at the moment)

I feel for you, I have been taking HRT for around 11 years after a radical hysterectomy. My GP does give me the warnings etc but I have low BP, low cholesterol and not overweight, so at low risk of heart issues (hopefully). I am happy to take any other risks which HRT may bring as things were just dreadful before I started to take it.

Are the GPs offering any advice as to how you deal with all the symptoms? Is there another practice you could move to?

Hi 5inthebed, no wonder you are feeling anxious & miserable with all of those symptoms, that's just not fair at all
Congratulations on losing weight, that is one heck of an achievement in your situation!
Looking at everything you describe, are you certain that the perimenopause is the cause?
Fatigue & insomnia, pain, anxiety & disrupted menstrual cycles can all be due to other conditions - fibromyalgia springs to mind (because I have it & our symptoms match).
Perhaps you could return to your GP & discuss your situation from a non-meno angle?

Your BMI must be well over 40, being honest is it really all muscle? I'm a GP and to be honest, with he spiralling cost of litigation insurance (currently costs over 20% of my income) I practice much more defensively than I used to. I'd suggest you ask for a referral to a gynaecologist with a particular interest in menopause.

Great username Five I bet they're a handful.
I too have low BP, I'm still relatively physically fit considered my weight, less so than I was previously but my knee problems put paid to that for a while, my cholesterol has never been checked so I have no idea but I do eat healthily, just more than I should now that I'm less active.

I've been with the practice since I had born and they have always been good until recently when 'my' Dr retired so I feel some sort of misplaced loyalty I suppose.
The other practices locally really aren't that great.

I know the risks but feel like the risks of not having it are higher.

Sorry, they've offered to up my dose of Citolopram but it won't bloody help the physical symptoms.

wicker My BMI is 34 according to my Dr and My Fitness Pal/Garmin etc. And yes, I am very muscled and still pretty toned as I've not sat on my backside throughout any of it, I have a fairly physically demanding job and we are a very active family.

I think a referral may be my only option if they'll give me one.

Launderetta I did wonder about Fibromyalgia at one point but with my family history I do think Peri-meno is much more likely.

Have a look at Wellspring website x

Sorry my mistake. A referral is perfectly reasonable to ask for.

That's ok Wicker I panicked there for a moment!
I'm going to call and ask for a referral in the morning as I'm really at the end of my tether. It feels like a catch 22 situation, I hurt so am struggling to exercise as much as I did previously but if I exercise the weight will come off faster and i'll be able to have HRT..

(I realise you know this OP as you have a PHD in the guidelines by now) But I read it that if under 51, risks are not increased even if overweight because the hormones are what your body would be producing anyway? I have a similar BMI and have been prescribed an oestrogen gel.

Poor you OP . Can you put in a complaint that they are not NICE concordant in their treatment?

Wow, perimenop since age 29.

I said that to my GP today about the reduced risk due to my age Safe but she categorically refused to acknowledge this as have the 3 previous GP's that I've seen.

I don't really want to go down the official complaint route unless I have no other option but I do feel as though they are pushing me in that direction.
I will call in the morning and request a referral in the hope that it will either mobilise them to listen to my concerns or actually refer me to a Consultant Gyne. Either way it will make them realise that I'm not prepared to let this go any more.

The other thing is that, re-reading your OP, is it 100% clear that you are going through the menopause? You can't be perimenopausal from 29 to 44, you either have premature ovarian failure or you don't. Have you had an FSH blood test? If the flooding is new then that in itself needs investigating.

So sorry, was all het up as I posted earlier, the yr symptoms started was 2012 not 2002! I think I'd either be out the other side or well and truly dispairing if it had been from 2002!
I really must proof read my posts. Everything else is spot on though! Apologies.

Being really blunt you must lose weight or you will have more mobility issues but you know this.
You could try swimming or cycling where you body weight is supported so your joints won't suffer.

You have 3 options:

Find another GP practice
Self refer to a gynae. Not sure where you live but there are plenty top gynaes in LOndon who would see you without a GP referral.
Ask your GP for a referral to an NHS gynae. But they may not do this for you.

As far as I know being overweight is not a risk factor for HRT, and transdermal doesn't raise your risk above what it is already.

I'd love to know what your GPs say if you have taken in the NICE guidelines and quoted them chapter and verse.

You either have to push harder with them, or walk away and find a dr who is going to treat you.

I have lost 3/4 of a stone since the end of April and am continuing to loose, I had a really tough time with the knee replacement, mentally just as much as physically and stopped exercising due to the pain, I was super fit previously (3 peaks challenge etc) and not being able to exercise hit me really hard. I'm determined to get back to a good level of fitness and I currently walk on average 5 miles a day during the week and more at weekends.
My DH is fit to Iron Man levels, DD's run and cycle and I suddenly felt on the scrap heap.

So you are losing around 2 lbs a week on average since end April? That's good. If you walk 5 miles a day that's amazing! That alone should shift weight if you are also eating less.

You need another GP or a private /NHS gynae for your hormones, Your GPs are rubbish.

That's right Polly I need to get to 12 stone to be st my optimum fit weight (a size 12 for me)
That's what's upsetting me, I'm not sitting on my backside and expecting them to dish out drugs to solve the problem, I'm doing my bit too and will continue to despite the joint and muscle pain. I just want it to be easier and when I know that HRT will ease the symptoms it's so frustrating that they won't let me have it.

Can you go private? I self referred to consultant at private hospital. £270 first appointment and then £190 subsequent appointments. Best decision I could make - although my credit card isn't looking good.

As above ^^.

Some are even less than that (mine is and it's Harley St.) You may only need a review once every 9-12 months if all is ok.

PollyPerky - that's not on !! I'm out in suburbia and pay more than Harley Street!!!

:) Doesn't surprise me.There's not a lot in it, but mine is less and has a wider range of fees.

Consider a formal complaint. The GPs are operating outside NICE guidance and your weight should not be an issue. If you're active VTE risk is not huge and as long as you are aware of symptoms then it shouldn't prevent treatment - unless you carry additional risks.

Actually, consider GMC referral or complaint to CCG as they are making judgements about your care that are not evidence based. It sounds as if they are jumping on the 'being overweight is the root cause of all ills' bandwagon and discriminating against you because of their own prejudices. Just because you are a bit overweight does not mean you should have lesser quality of care.
Or it could be about their budgets, ask them outright.