Just saw my gp re perimenopause

[arousingcheer]

Don't know why I'm posting. For commiserations? Maybe so someone can help me gauge how good/not good my gp is based on today's appointment? The outcome is not bad and I'm not here to run anyone down, I think I used to be pretty confident in my last gp and I'm not sure how I feel about this one.

I discussed my blood test results with the new gp this morning. Apparently if you get mood swings they prefer to treat you with antidepressants because they're 'safer than hrt'. I said I understood that to be in contravention of the NICE guidelines and as they are 'just guidelines' it doesn't matter, they do it anyway.

Not super encouraging.

I had questioned the need for blood testing as I am 49 (those pesky NICE guidelines again) and gp said it wouldn't effect treatment but - surprise! - she said today that according to the tests I still have hormones circulating so it doesn't look like I'm close to menopause yet, which means she is reluctant to give me hrt. She says they only use hrt to treat hot flushes - ? We then did the dance of 'go away, do some reading and come back when it gets worse' vs 'oh thanks but I have done a lot of reading and I am here because it is worse' etc etc with which I'm sure we're all familiar.

To be fair she then said if I feel it is a problem that needs addressing immediately I can just ring her and she'll do a scrip for me, no need to wait six weeks for an appt etc which is good. I requested patches vs tablets (why do they go straight to tablets?) which is also fine with her. So in light of that I agreed to go away and see how I go for a few months.

There was a vague whiff of the menace of chemical intervention though, yk, 'But you might get through it all just fine without the need for drugs' (after having said they use antidepressants). 'It is a natural process which can be managed with diet and exercise.' If I suggested I was going to try diet and exercise in preference to drugs for anything else I can't see the gp giving it the thumbs up. There was some hand-wringing about having to keep a close eye on my blood pressure on hrt - ? - but how to explain why I can't remember when they last took my bp and I'm on enough thyroid meds to suppress my tsh and no one is interested in my bp now - ?

I was pleased to find I am 'not anaemic' until I asked what the results were (18). That's lower than when I was taking no iron supplements at all (before my periods got so heavy). So now I know I need to bump that up a lot.

I’ve no idea.... it’s a minefield. No 2 women report the same!

I think I’m through it mostly. Not been to a gp

Diet/exercise seems to have worked for me.... I think

I agree diet and exercise have worked for me apart from feeling hot. Exercise seems to balance out the hormones somehow

The thing is my diet is great and I'm getting enough exercise, my weight is in check etc so while I'm sure improvements can be made even to already good things I feel I'm doing pretty well.

It's just that diet, exercise and antidepressants were her only suggestions. I've sorted out the first two and am not interested in the last one. Why are they so pro-antidepressants and so anti-hrt?

You need to see another GP or get yourself off to a private menopause specialist.

The argument that the NICE guidelines are just 'guidelines' and aren't enforceable is really not on. NICE published this report for the very reason shown by your experience- to get GPs away from dismissing menopause and offering ADs.

Why would mind altering drugs be safer than estrogen? She is clearly very badly informed because ALL the evidence shows that HRT taken for 5 years anyway has health promoting benefits and long term use has other benefits.

NICE also says that the choice over using HRT is a JOINT decision by the woman and her Dr. A dr is not supposed to impose their opinion unless they can show you are at a high risk for use of HRT.

It may be hard for you to do, but I'd ask her what the risks are with use of HRT for up to 5 years. The advice on Menopause Matters is that risks outweigh benefits in women up to the age of 60 then risk v benefits are equal up to age 70. (this is consultant -led research.)

menopausematters.co.uk/balance.php

Thanks Polly. You and I discussed this before my appt so I was more well-informed and prepared than I would have been otherwise. She was deffo not in favour and treated it a bit like an endurance test, like if you can grit your teeth, take your antidepressants and do without HRT you'll be better off.

I will probably end up seeing someone privately, which you and I also discussed.

Whenever my husband goes to the gp he comes home with a funny anecdote (his gp told him BMI is nonsense and 'If you're obese then I must be obese too!' ) and useful advice, meds or a referral. I'm sent home to 'come back if it gets worse' as though actually seeing the gp is such a doddle I've done it for a laugh. Tut there's me just nipping in at the first sign of trouble taking the very first available appt six weeks later.

I wonder what she would have said if you'd said: 'I've read about the risks and benefits of HRT, including the NICE report, and would like to try it. I don't appear to have any medical history that means i can't use it'.

The comment about only using HRT for hot flushes is ridiculous.

Sadly, most GPs are completely out of touch about HRT. They seem to put it in the same box as crack cocaine.
Either go back or see someone else.

That is more or less what I did say and when she said something about tablets I asked why they'd be tablets and not patches. She did offer to leave a scrip for me for when I want it. It's more that now I don't feel it's worth being treated by someone who 1) doesn't like prescribing hrt so 2) isn't likely to be good at working with it. I don't feel like hers are a safe pair of hands iyswim. Why wangle a scrip off someone who doesn't want you to have it and then trust them to support you through any troubleshooting?

I have previous history with letting them take charge of my thyroid meds when they clearly don't know much about it and ended up undermedicated.

The danger is she will want you off it asap- say 2-5 years and no flexibility.
The two top meno consultants in London BTW have told me they have patients in their 90s on HRT.

A friend of mine keeps going to the GP to ask for HRT. She gets everything, but. And every time she goes back, it is about a 6 week wait to see that particular doctor (part-time).

I don't understand that!
TBH if a GP refuses HRT they need to be asked why- what medical grounds. They cannot refuse a licensed treatment out of prejudice or 'belief'. If they insist on refusing, ask for a referral to a gynaecologist who will give a 2nd opinion. I doubt the GP would refer, because it would show them up as useless, but it's worth calling their bluff.
This whole thing of GPs refusing HRT is simply a disgrace.

They don't refuse - it is an exercise in goal post moving.

It is hard to pin them down - especially if you have to wait 6 weeks to do it.

OMG. Your GP clearly hasn't read any medical or scientific literature in at least a decade. I took the pill for over a decade for awful quality of life affecting peri-menopausal symptoms. I recently (at 54) just switched directly to HRT (without needing any blood hormone checks). It's pretty much the same thing, just a slightly lower dose (and slightly different distribution of hormones). Most importantly the patches (which you actually use in combination with a pill) are better than the pills because they lower the rate of certain issues like cancer and stroke (I think those are the two...but don't have time to double check). The NICE guidelines are very very clear and in fact what I armed myself with when I went into my OBGYN's office here in the USA. (I didn't need them because he was extremely well informed himself and added "if it quacks like a duck and walks like a duck....I don't need blood tests to tell me you are menopausal" - guess a British doctor wouldn't be quite so informal)

Can you ask for a referral to an OBGYN/Hormone specialist? I got one in my early 40's from my London GP because I was having such awful peri-menopausal symptoms.

I don't know what you mean by 'goal post moving'. The simple way is to say' I want to try HRT'. If they refuse, you ask why. If it's not a good reason you say - again- you want to try HRT as in the NICE guidelines, you are aware of risks and benefits etc.

If they refuse, you say politely 'Are you refusing to give me HRT?' And ask why.

I'm sorry but if a GP wants to play God, I'd move to another GP or pay to see someone privately and be done with it!

arousingcheer, what kind of symptoms do you have?

My GP was very sympathetic when I saw her 2 years ago for peri menopause symptoms - dreadful PMS, low stress resilience and sleep problems. She offered both antidepressants and HRT, but initially I said no to both. When I eventually caved in and asked for HRT, she gave me the mini pill! I have been on it I think a year now, and I am better, but I don't think it's because of the mini pill.

I saw her a few times, and essentially she said that it's very hard to do much about menopause, as it is experienced so differently from woman to woman.

I have tried a lot of herbs and supplements on my own, but not much luck. I have done yoga, counselling and read numerous books (the best one was Sarah Gottfried's The Hormone Cure, you should get it). I now swim 2-3 times a week and finish with a sauna and magnesium cream after my whower, it really sorts me out, I can handle anythings after such a session! I am finally getting somewhere with supplements now, I saw a kinesiologist who put me on vitamin B6, which really helped my PMS and bacne, first month on a high dose, now a low maintenance dose. Next step - as I still have very bad sleep before my period - is a Chinese acupuncturist.

misscph1973 my symptoms are mainly heavy periods and trouble sleeping (both the opposite of what I'm usually like). For a while I've had a funny appetite too. I realised I wasn't eating until the afternoon because I just felt a bit queasy. I've become oddly squeamish and fussy about textures and smells of food, which I think goes back to feeling vaguely queasy a lot of the time. Again, this is not my usual way, I've never had issues with appetite.

I have problems with adrenaline too. I have hypothyroidism and a gp told me I was on too much thyroid medicine which was making me produce too much adrenaline (I'm not sure this is strictly the case as I get dreadful anxiety when my thyroid levels are too low, and my last two t3 tests have been well within range). When people talk about mood swings I guess that's how I can relate to it. I can't really discuss difficult things without feeling like my head will explode. I don't have a lot of patience. Also seeing more episodes of random anxiety/palpitations where I feel like I have adrenaline coursing through me (though not as extreme as a panic attack).

Friends have told me to try black cohosh but I know nothing about it.

Have you had your vitamin d levels checked. Vitamin D deficiency can adversely affect sleep and appetite. The rest of it sounds like hormones. The mini-pill is absolutely helpful with peri-menopause.

If you can afford it I would do some research and go to an experienced specialist. Having had various problems after an early menopause my doctor decided I should now cease hrt as I had reached the normal age. After the return of my symtoms with additions, I decided to get a specialist opinion and now use hormone gels which are great. Hope you feel better soon.

SofiaAmes thanks for reminding me, I do have vit d fingerprick tests I do periodically because it was so low one year (10) and difficult to get into the normal range, but the last time I sent it in it was rejected and I haven't done another since. I can't remember having symptoms other than sore hands and they seem fine now (I got a fair bit of sun this summer and hoped it would be enough) but I should test and start supplementing again.

Cheers all, thanks for the comments.

arousingcheer, without being an expert, of course, I can see why you think the symptoms are peri meno pause related. Sleep, appetite, low resilience with life's more difficult subjects - at a certain age these things are all of a sudden harder to deal with, and the background is often a mix of hormones imbalance and deficiencies. I really do think you should find a kinesiologist, they can test for exactly that. In my experience your GP is not going to be of any help, it's just not something they have much knowledge of from their education, and unfortunately it doesn't seem to be a very high priority for the NHS, even though it affects potentially half the population at age 40-50!

Do you take magnesium? Very relaxing, could help. Better You magnesium cream is really good after a bath.

misscph1973 I used to use mag oil every day and for a while I took tablets. In truth I didn't notice any difference using it vs not using it. Apologies, kinesiology is a bit woo for me, but I will probably consult a private specialist.

OK, fair enough with kinesiologist;)

Perhaps the GP can at least refer or recommend a private specialist?

Lol, I think her recommendation might not be worth much but I do have someone in mind who comes highly recommended so may do that instead.

Things are not so bad that they demand immediate attention (maybe?) so I thought I'd see what the gp had to say so I know what to expect down the road. I don't want everything to slide incrementally until I'm miserable so I'm exploring my options.

On the positive side I used to suffer terribly with depression and that seems to be largely a thing of the past so I'm in a better position to deal with this than I was. It's knowing when the symptoms become unacceptable that is the challenge.

If you have depression, definitely go back on the Vitamin D. Forget about pricking your finger. You are almost certainly deficient and it's really unlikely that you are overdosing. 5000iu a day is what the Vitamin D Council recommends for adults.