Really good article in The Mail on Drs lack of knowledge on HRT

[QueenoftheNights]

Why GPs refuse women HRT

Thanks - that's interesting reading.

Not all of them, when I first went to the doctors he noted my age and quoted the NICE recommendations which had come out a few weeks before. We had a grown up discussion and I decided not to take HRT. This article seems to assume that most women want or need HRT.

I personally would like to see more research into what's going on in the body during menopause as they know so little, and would like alternatives to HRT as I know from colleagues and friends, it isn't a magic bullet.

The article throws light on the fact that more women do want or need HRT but are not being given it due to drs being out of touch with new guidelines. Of course there are exceptions and some women do get what they want , though seeing a GP if someone doesn't want any prescribed medication is a waste of everyone's time.

There is plenty of scientific research into what happens in the menopause. There are books by consultants on it, research papers on Google Scholar, reports in the BMJ (online), research in depth by the IMS (international menopause society) and research done by UK consultants such as Nick Panay which are linked to on his own website.

This feature in the Mail was a result of the IMS conference held last week in Vancouver, where some of the world's best drs and meno experts lined up so it's not something to dismiss.

it isn't a magic bullet

It is for lots of women , me included. 11 years on it and feel great.

Every year I get called into the surgery to undergo my yearly pleading to keep my HRT. I sit there and get patronised by this man, who tells me lies about the treatment... I might get that article printed out and take it with me next time.

Very interesting article. Shame its in the Mail. I have been refused, offered AD's which I phoned tis GP back and told him I didn't want, and told to take the test again pre and post period, which my other GP had previously done, but the trouble is I haven't actually had a period since.

I might go back and take a firm line. I've had enough of such poor service.

before I do, I must read up of the NICE guidelines, so I'm prepared. What are the arguments AGAINST the downsides of HRT so that I'm prepared?

Don't worry about having loads of knowledge about the downsides. The GP has to inform you that there is a small risk of breast cancer with some types of HRT but these are less than the risks of BC with 2 drinks a day, being overweight, inactive or smoking. THEIR responsibility is to pass this info on and then they are supposed to leave the final decision to you unless you have pre existing medical issues that increase your risks. So all you need say is you understand the risks and you want to try HRT (if you do.) This is in the NICE guidelines anyway- having an equal discussion and you making the call.

I don't think having periods in your 60s and putting up with side effects, especially from the progesterone is a magic bullet for menopause, doubt if many would describe it thus.

Odd to think that seeing a GP and not getting medication is a waste of time, suggest watching 'The Doctor who gave up drugs'. Medication is not always the answer to every health issue.

There is plenty of research, but still no clear understanding of why we have hot flushes for example.

I don't think having periods in your 60s and putting up with side effects, especially from the progesterone is a magic bullet for menopause, doubt if many would describe it thus.

With respect, it's a personal choice ParisUSM. My dr has made it very clear indeed that there are risks of not using HRT as well as risks using it. For me, looking at my health as a whole having a good night's sleep and feeling well are far more important than a period every now and then.

It's clear that some women are anti HRT for whatever reason and that is their choice too.

I think you ought to bear in mind that no woman takes HRT lightly, in the same way that no woman has a termination lightly. (The two topics seem to bring out the worst in women criticising other women.)
Everyone using HRT is doing so after a lot of careful thought and, in my case, discussion with an expert on menopause and the whole range of treatments for it (HRT and other things.)

If it's not for you that is fine. But the link I left was for women who are having issues because GPs lack the correct training. I don't see why it is now yet another thread about whether to use it or not .

I am making the point that it isn't a magic bullet for anyone, there are symptoms, there are risks, there are inconveniences. I think it does no one any favours to pretend otherwise. My wish would be for alternatives to hrt as I do not believe it can be the only way to deal with symptoms. The article seemed to me to be saying that a minority of women took hrt because their gps stopped them, when obviously that is very simplistic.

Think bringing terminations into this is poor taste.

You are stating the obvious that there are risks and benefits and inconveniences. Women know that. To keep going on about it is patronising and unhelpful.

The point of the article was to show how women are being denied a choice by drs who are mis-informed.

I think that denying women a choice on anything that affects their health ( and saying it's not for you so other women should avoid it, or think only of the risks) is in poor taste actually and very dictatorial.

Didn't say any of that, as anyone reading this thread will see.

My wish would be for alternatives to hrt as I do not believe it can be the only way to deal with symptoms.

It depends what you mean by symptoms? There are the unpleasant, but sometimes temporary symptoms of the menopause viz hot flushes, night sweats, mood swings for example, and there are also the longer term potentially adverse health consequences of being oestrogen deficient for 30-40 years post-menopause - which may or may not give rish to obvious menopausal symptoms eg osteoporosis, cardio-vascular disease etc. There is also vaginal atrophy or GSM as it is now called - which does cause symptoms when it occurs.

In addition to this some of the so-called temporary symptoms can last for 15 years or more in some women - and who wants to do the experiment on themselves to see if you are one of them or not.

The point is - those who decide to treat their unpleasant symptoms with HRT ( and are able to medically) may well be also protecting their future health - QueenoftheNights mentioned the large amount of research being carried out by the academic menopause societies amongst others.

I don't think having periods in your 60s and putting up with side effects, especially from the progesterone is a magic bullet for menopause, doubt if many would describe it thus.

Yay - I'm one of those - like Queen - I've been on HRT for 11 years, I'm 65 and YES I STILL HAVE A BLEED shock horror. Luckily (and partly through my own efforts) I am fit and well and enjoy life - never looked back after starting HRT in late peri-menopause. I would say it is a magic bullet for me!!! Will carry on taking it provided no adverse health condition comes along to bit me and I keep muself as healthy and fit as I can to minimise the chances of that happening.

By the way - yes I saw the programme about that doctor and drugs and I quite agree - but taking bio=body-identical HRT is not the same as taking drugs - it does what is says on the tin - replaces deficient hormones - you don't have to take any synthetic ones.

There are alternatives to HRT that work for flushes and sweats particularly - and are very helpful for those women who cannot take HRT - but these are drugs - mainly some anti-depressants and some blood-pressure medications. I would on;ly want to take these if I was medically unable to take HRT.

Btw haven't read the article

I have been unfortunate to have developed the most awful VA in the peri stage, struggled to get treatment for two years, I couldn’t sleep because of the burning and during the day it was uncomfortable to sit and walk or do any exercise, I wouldn’t wish the condition on my own worst enemy.
I did tell one male GP to imagine he had sunburnt testicles as that’s what my undercarriage felt like!
I shall continue taking HRT and will accept any risks as there is certainly no non HRT cream or pill that works for VA.

Thank you Queen for sharing!
I absolutely agree with the article. If men had meno they wouldn’t suffer for sure!
Taking hrt is an individual choice after all. We can get informed and make the best decision for us.

I don't think having periods in your 60s and putting up with side effects, especially from the progesterone is a magic bullet for menopause

To reassure anyone reading....

Sequential types are a choice. I could swap to a continuous type tomorrow with one of a number of progestogens incl the Mirena.
Most women do choose bleed-free HRT.

Some of us choose sequential in our 60s ( so?!) for a number of reasons to do with breast safety and fewer side effects. And not everyone has side effects from progesterone / progestogens. There are many types to choose from.

If we were unhappy with our choice, we'd stop or swap!

I found that article depressing. This is exactly the experience I had (blood test at the age of 49, the offer of antidepressants and 'it's a natural process' from the gp). I have a slightly higher than normal risk of bc so it really is important to me exactly how that is affected by hrt and how those risks might be balanced (eg more frequent ultrasound bc screening) in an appropriate way.

With so much ignorance on the anti-hrt side, I don't want to pursue treatment by someone who doesn't understand it; equally I don't fancy having the potential risks downplayed by someone who thinks women should just take it. It's really hard to know who to trust, opinions are polarised and I can't help but think everyone has something to gain. I don't want someone half-arsing it to maintain their position, I want treatment based on evidence ffs.

Also 'Women are clearly more sensible than some people think' - wtf?

After my frustrating gp appointment I wrote to the Britsh Menopause Society and for my £10 contribution got what seems like a copy-and-paste reply (which a pedant might have noticed was full of typos ), ignoring the specifics of my query: 'Peri-menopause can be a difficult time and symptoms that arise may be difficult to identify as being due to hormonal changes' blah blah. 'At the same time, as women, we have to be open to the infuence of other factors, such as stress, tiredness, depression and try to address these too.'

So 'as a woman' I will be 'open to the influence' of 'stress' and take to my fainting couch until I die it passes. So much fucking bullshit, so little time.

Oh and please feel free to pm me if you have any recommendations. I'm on my third day of brain-blistering fatigue which I suspect is peri-related and I really want to get on top of it.

I'm so cross that we're expected to be satisfied with a head-pat ('natural') when it suits them, and pseudo-science ('stress' and blood tests) when the head-pat doesn't do it. Why is there no protocol??

Sorry you feel as you do.

I don't think any of the drs in that feature have a vested interest. The two who are quoted are open about the fact they use HRT themselves.

I don't think opinions are polarised really. A good dr will give you the facts and let you decide but you also have a personal responsibility ( I think) to do your own research - there are masses of papers online as well as papers from the BMS/IMS.
If you choose HRT they will give you the safest type which is tailored to your needs.

My personal meno experience was that I was never going to use HRT, having had easy pregnancies, no intervention or pain killers for my two deliveries, and no peri symptoms till 51. However, I did discover I had low bone density ( despite no risk factors) so sought the advice of an eminent gynae who had a specific interest in bone health.

I began to really trust their take on the whole meno thing- very balanced, happy to discuss, treated me an equal etc.

In the end when insomnia and flushes made work really hard for me I decided to try HRT . I was given a tailored regime (I don't mean 'bio identicals') taking into account my own risks/ benefits/ lifestyle.

In theory I have a slightly higher risk of BC having had my first child in my 30s, but I hope I am mitigating this by lifestyle choices which reduce baseline risk.

I have done an online BC risk test and my risk is something like 0.3 above the risk for women my age which is down to a later pregnancy.

To reply to your post @thefirstmrsdewinter having a dr you trust is key. Mine tells me there are some risks using HRT (but very small ) but equally there are risks NOT using HRT. Each women makes that choice herself considering her quality of life, what's going on in her life ( ie work, elderly parents, teenagers, whatever) at the time.
No one considers the other risks in life that we all take all the time: statistically, you have more chance of being injured or dying on the road than using HRT- but do we stop driving cars?

Sorry you feel as you do. Maybe we've got our wires crossed - ? I'm not disagreeing with you. With respect, it's not about my feelings, I'm saying I've had the same experiences as women in the article. Provision is inadequate. Is your specialist private?

Personal research can be helpful, but I am not a scientist and really that's what medicine is for, to professionally assess risk vs benefit and put it in a treatment package. If you take the NICE recommendations as the current protocol, why are doctors largely not following it or not even aware of it?

I agree 100% that you need a doctor you trust.

Maybe we did!
I agree with what you say. In terms of research, all I'd say is that the wheels of the NHS grind very slowly. The NICE guidelines are not almost 3 years old ( and STILL many GPs haven't read them) but obviously they only used data available before 2015.
In the past 3 years there will have been new research coming out (studies that were ongoing) or a review of old data etc.

I don't know why GPs are not reading or adhering to the guidelines. Unless they have an interest in menopause I guess they just don't bother; it's not mandatory to read the guidelines. I do know that across the UK, the BMS is doing its best to get GPs to its training days on meno and there is an annual conference (in a couple of weeks) which aims to do the same.

The difference is that most GPs work from the set menu (ie this packet of pills, that packet of pills, IF they even prescribe HRT anyway.) Whereas consultants (who are able to prescribe regimes that are 'off licence as well) have a more a la carte approach; this type /dose of estrogen and this type of progestogen. Most GPs aren't aware of these variations (some are, but not all.)

The other issue sadly is that too many women accept poor treatment. They don't argue their case, but walk away from drs who say they can't have HRT so the situation never changes.

yes, my dr is private. He used to mix NHS and private but now it's only private. I have roughly 2 appts a year and it's worth every penny.

I absolutely agree with you Queen. I also think that we have, as women, responsibility too.
We are in denial! We deny menopause, we prefer to suffer in silence. We don’t seek for the suitable therapy for us and we are not get informed.
The majority of gyns simply don’t know a lot and they don’t have specific education on menopause.
Sometimes I feel that I know more than my gyn, although he is a very caring and trustworthy one! :)