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Menopause

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Original poster

Can the GP refuse to prescribe HRT?

45 replies

thedayismine · 19/02/2018 14:18

My Dsis has been having awful menopause symptoms for a few years now - low energy , hot flushes , aching joints , brain fog ,disrupted sleep etc - we also have osteoporosis in the family.
She saw a GP and was advised it wasn't suitable as she smokes and was overweight.
She has lost some weight but still hasnt been back as she feels she will just be sent away again as she is still overweight and still smoking.
As she says though the symptoms themselves make exercise and other positive action harder as everything is a slog!

Where does she stand - can she insist on giving HRT a go if it's not specifically contraindicated ( and she is aware of the risks ) or is she right in thinking she will be sent away again ?

OP posts:
Original poster
thedayismine · 19/02/2018 14:22

Sorry badly worded OP
I obviously meant HRT wasn't suitable where I say 'it'

OP posts:
retirednow · 19/02/2018 14:25

I was on it for a few years then when I moved my new gp wouldn't prescribe it, she could ask to see another gp. has she had a blood test to cofirm menopause, it's miserable so I hope she gets the help she needs.

Graphista · 19/02/2018 14:26

Yes. There's no "right" to prescribed medication.

Gp is not prescribing because the medication poses a significant risk to your sisters health due to her being overweight and a smoker.

I'm fat myself so understand it may be frustrating but these are both matters she could change.

Exercise makes little difference to weight, it's mainly diet makes the difference.

And the smoking well did she even ask for help quitting?

Also being overweight and a smoker will be exacerbating some of the menopausal symptoms.

Original poster
thedayismine · 19/02/2018 14:27

Thanks for the reply - yes it is miserable ! Am not sure about the blood test but I think so and her periods have stopped so she is pretty certain as to what's caused the symptoms. They just don't seem to be letting up.

OP posts:
Couchpotato3 · 19/02/2018 14:29

What Graphista said.

Original poster
thedayismine · 19/02/2018 14:30

Cross post with you Graphista !
I couldn't find anything in nice guidelines about risks from weight and smoking - will do more reading .

OP posts:
Graphista · 19/02/2018 14:41

Iirc - increased risk of hormone related cancers (which being overweight and a smoker already increases that risk), increased risk of thrombosis which can of course lead to heart attack, stroke, pulmonary embolism.

Btw smoking not good for osteoporosis either.

Emerald13 · 19/02/2018 14:45

No! I don’t think that he can refuse his help to his patient. He has to refer her to a menopause clinic, to another gyn or to an endocrinologist. If he doesn’t know how he can help her, he has the obligation to say it! She has the right to find the treatment that is suitable for her!

Graphista · 19/02/2018 14:49

We don't know that the GP refused all treatment, only hrt. May have prescribed meds for symptoms, advised that diet changes, quitting smoking would help. Which it would even without it meaning the sister more likely to get hrt.

Women who smoke are more likely to enter menopause earlier and to have stronger symptoms.

gamerchick · 19/02/2018 14:51

I think this may be a case of help yourself and then see about medications.

Depends on how much she wants it.

Emerald13 · 19/02/2018 14:54

The only sufficient treatment for the severe menopause symptoms is hrt. If the patient has no contradictions for hrt and is informed about the possible risks can have it! Diet changes and quitting smoking can help her health in general but cannot help with the severe menopausal symptoms and her quality of her life.

Graphista · 19/02/2018 14:59

"If the patient has no contradictions for hrt" but she does

"is informed about the possible risks" they don't have the knowledge a dr has which means they can't really give informed consent which is why it is a prescribed drug and not otc or even pharmacy only. If the dr were to prescribe and a serious risk became reality that dr will be in BIG trouble.

" Diet changes and quitting smoking can help her health in general but cannot help with the severe menopausal symptoms" actually research shows it can, especially if she's a heavy smoker and quits.

LoniceraJaponica · 19/02/2018 14:59

“No! I don’t think that he can refuse his help to his patient.”

Surely he would have a duty of care towards his patient, and if smoking and being overweight increases the risks of serious health issues if she starts on HRT he would be wrong to prescribe it.

Emerald13 · 19/02/2018 15:02

Smoking and overweight are no contradiction for hrt! Definitely hrt can help her lose weight and maybe a motivation to quit smoking. That’s my personal view of course!

InfiniteSheldon · 19/02/2018 15:07

He hasn't refused to offer treatment he has advised 'give up smoking and lose weight'. Excellent advise and should be given more often

Emerald13 · 19/02/2018 15:33

Give up smoking and lose weight isn’t a treatment! It’s a good advice and nothing more! The lady suffers and a doc have the duty to offer something more than a simple advice that everyone knows!

PollyPerky · 19/02/2018 15:44

You can be slim and a non smoker Inifnite and still have menopausal symptoms but yes both will make her symptoms worse.

She does have a right to suitable drugs for any condition Graphista unless the risks outweigh the benefits. GPs have an obligation to explain any added risks.

If she thinks HRT might help, she has a right to it UNLESS she has a medical condition that contraindicates it. Smoking and being overweight aren't in the list. Using transdermal HRT ( not pill types) will not raise her risk of blood clots any more than the risk she already has (by smoking.)

I think there are some rather judgemental comments here Hmm

Yes of course she ought to lose weight and stop smoking. Both carry a higher risk of cancer and all diseases.

Graphista you comment is patronising to women. It is actually very easy for a moderately intelligent person to read all the information online and find out which factors mean HRT is not suitable. eg there is a site for GPs which anyone can find which 'teaches' them about HRT.

There are also books and forums.

GPs are exactly that- general practitioners. Most know very little about HRT.

OP she needs to go back, say that weight and smoking are not reasons to withhold HRT, if she uses transdermal types, and she would like to try it. If he refuses she has to ask for a referral to a menopause clinic (rare as hens' teeth really) or a consultant, as her quality of life is suffering.

PollyPerky · 19/02/2018 15:47

Graphista with respect , you yourself don't know the correct facts on HRT.

There is no added risk of blood clots with HRT above someone's baseline risk if they use transdermal HRT.

user1471451866 · 19/02/2018 16:03

Hi OP I don't think your sister can insist on hrt but might it be worth just speaking to another GP within the practice? I was refused it for other reasons, and in my case I was happy with that decision, but if I hadn't been i would have spoken to one of the other GPs to get their view.

user1471451866 · 19/02/2018 16:08

You mentioned osteoporosis, I was advised to walk just one to two miles a day and drink a glass of milk daily to make a significant difference to bone density. I don't like milk but do try to eat dairy every day.

PollyPerky · 19/02/2018 16:12

A GP or any dr can refuse treatment on medical grounds. If a patient asks for a treatment which is proven to help their condition, the GP has to give a valid medical reason to refuse it. A well informed patient should be able to say that the reasons given are not medically correct. The risk of blood clots is in the NICE guidelines where it says that women who are obese should use transdermal HRT.

Suggesting losing weight and stopping smoking are lifestyle measures, they are not medical treatment per se.

I think it would help the OP's sis in this case if - for her own wellbeing- she agreed to work with her GP on a stop- smoking regime, and also some support to help her lose weight, as part of her own responsibility for her health.

PollyPerky · 19/02/2018 16:15

User with respect that's rubbish advice.

Walking alone does not build bones- not that amount. You need to do resistance exercises especially for osteoporosis - with weights usually. Calcium intake is important but it alone does not change bone density.

If you are at risk of osteoporosis you need to see a specialist and have a DEXA scan.

I know what I'm talking about here- I had severe osteopenia 12 years ago and have reversed it with a LOT of hard work.

user1471451866 · 19/02/2018 16:32

PollyPerky it was my GP who gave me the advice. Fortunately I am not at any particular risk, as far as I know, she just mentioned it as part of the advice she was giving me as someone who can't take hrt but was concerned about the effects of menopause. Happy to be corrected by someone with more experienceSmile

PollyPerky · 19/02/2018 16:49

The reason it's not good advice is that between 1:2 and 1:3 women end up with osteoporosis once they are over 50. If all anyone had to do was walk a mile or so each day (you can usually cover that round the house in a day) and drink a glass of milk, or the equivalent on cereal and in tea/coffee/ cheese/ yoghurt, no one would have osteo!
Walking will help but the research I read said that walking below 4mph didn't have much effect on bones, because what is needed are strength exercises working against resistance as well as enough calcium- not necessarily from dairy - and a whole range of dietary changes.

user1471451866 · 19/02/2018 16:54

Hmm, I do a fair amount of walking and cycling but nothing else. I should maybe look into resistance exercises. I do fall into the over 50 category!
Sorry OP this is about your sister, not me, but maybe PollyPerky's advice would help her too.

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