Reluctant to prescribe HRT

[shadyzadie]

I'm 45 and for the last 6 months my periods have gone from a 28 day cycle to 45-48 day cycles and for the last 2 months I've been getting hot flushes throughout the night which are really impacting my sleep. I'm presuming I'm in peri-menopause and I want to start HRT as I'm really struggling with the lack of sleep, don't want to have to endure this like my mum did etc.

I've just got off the phone from my GP (they're taking non-emergency calls) and he's saying firstly I need blood tests to establish it is peri-menopause, as I've only recently turned 45 and he wants to rule out any other causes like thyroid. He's also saying that even if the bloods indicate peri there's 'other things' they can give me to help with the hot flushes other than HRT, and that he'd be reluctant to prescribe me HRT as I'm relatively young and can't be on it forever because of 'the risks'.

Is this right? From what I read on the NHS site if I'm symptomatic and 45+ then HRT is the go to.

I went through similar but I'm a few years on from you. I believe hormone levels have to fall below a certain level before they will prescribe. I was also quite young when my perimenopause started - 42/43. Doc told me they don't like to leave you on HRT for longer than 10 years due to increased risk of some cancers.

My doc strongly recommend Mirena & a progesterone poll. I didn't get it in the end, but maybe you're GP wants to try other hormonal birth control?

You'll definitely need a blood test & physical exam before any of this.

Hope you get sorted out. I had rotten symptoms before I started HRT. Insomnia, hot flushes, anxiety & low mood. It's really unpleasant.

Thanks for your reply N0tfinished. That's good to know. I just don't want to be fobbed off and was worried the 'other' options might be ADs, which I really don't want to do. My blood pressure is good, so I'd happily go back on the pill if that's an option!

The NICE guidelines are HRT prescribed at any time you are symptomatic

And there's no increased risk of cancer, that's outdated

I started at 47 and just took the nice guidelines with me as the doctor was seriously outdated. She argued and I told her she wasn't up to date - I had peri symptoms so was beyond fucking about.

My symptoms disappeared in 5 days

Your dr is wrong on so many accounts- sounds like he's old school and not updated himself.

-No blood tests for meno after age 45.
-No limit on time on HRT- you can use it for life. This is made clear in the British Menopause Society statement where it says dr must not place limits on years on HRT.
-NICE says that HRT is the first line therapy for peri meno, certainly not ADs or meds for high BP (these are for women who cannot use HRT for medical reasons.)

Thanks everyone, my experience was 4 years ago, things must have changed. Glad I can take HRT for life. Menopause was hell for me.

Thanks everyone. I'll have a follow up call once the blood tests are back so I'll make sure I've got the NICE guidelines to hand for that.

You need a different gp. Yours, like so many, is absolutely clueless about peri-menopause.

Thyroid problems do feel like some menopausal.symptoms, ie joint psin, brain fog, anxiety, tiredness. I had a thyroid problem (hypo) not a perimenopause problem. Also very low on vit d. Many problems cured by.vit d.and thyroxine, diet and exercise. Please dont assume it is just HRT that is the solution. Your gp is right to do proper blood tests for all sorts of.factors.

Except, @Nettleskeins that following the NICE guidance, blood tests are not necessary for women aged 45 and over who have irregular periods and hot flushes etc. (A thyroid test is fine of course but testing FSH and estrogen levels is not done as they are inaccurate.)

The NICE guidelines were published in 2015, they are out of date. . A meta analysis in 2019 showed combined HRT usage is linked with increased breast cancer risk if taken for over a year, and the risks persist after you stop taking it. It's on the NHS website.

The NICE guidelines and the research you mention @Quincesorbet are completely different and don't affect women's choices or prescribing. The NICE guidelines don't affect diagnosis or whether women use HRT or not.

The analysis you mentioned has been questioned by many scientists and menopause experts, who believe it to be flawed. It didn't actually show anything new, by the way, as it relies on very out of date studies from over 20 years ago (WHI and Million Women) then collated them.

Try red clover capsules for the flushes (Holland & Barrett sell them). It helps some women.

I think GPs are reluctant to prescribe HRT because of the risks.

I went for a well woman check first. Also, my GP thought my fatigue, lack of motivation and bouts of insomnia could be due to depression. I told her that I am not depressed and I eventually had HRT patches prescribed.

No, he’s a shit GP. There are minimal risks whereas the risks for osteoporosis, losing teeth, hair and prolapse are far worse.

The younger you are, the more you should be on hrt because of the heart and bone risks. At least, that’s what my premature menopause consultants have both told me. I started perimenopause on my late 30s.

Thank you for all of your comments. I had my bloods taken last Monday (to check hormones and thyroid function). I rang today to check the results (via the receptionist) and they've all come back as 'satisfactory'. I've got a telephone consultation booked with a different GP to properly discuss the results on Friday.

I found a sleeve of my old contraceptive pill last week (came off it 3 years ago, not for health reasons). It's a low dosage combined pill so, in a possibly foolhardy experiment, I thought I'd take it and see what happens. This was after the blood tests, obviously! 7 data in and since day 3 no night sweats for the first time in 3 months. So yes, I'll definitely be pushing for some kind of hormone therapy on Friday.

@shadyzadie Please remind your GP that the reason NICE says no blood tests is because they are unreliable!

You could have another test next week and it might show you are right into peri or even (my own experience! ) post meno (when I wasn't.) Have to add the blood test was done NOT for meno but an overall wellbeing test with a gynae for other reasons who simply laughed when it said 'post meno' and said it would be another example to tell his post-grad students that tests are unreliable.

You have 2 classic symptoms:

Irregular cycles
Hot flushes

Disgraceful your GP has wasted valuable NHS resources doing blood tests.

Can you not see a different GP at the same practice?

What the hell is wrong with GPs?

From the first days of the NHS, they have been willing to fling all manner of anti depressants, sedatives, uppers, anything at 40 something women to get them to belt up about what were and are plainly menopausal symptoms. Now there is an effective treatment, which is safe for most women, and they won't prescribe it! If your thyroid and bloods are fine, you should insist on at least trying HRT. No lasting harm done surely, if it doesn't help.

Blood hormone tests are meaningless as fluctuating hormones are the essence of perimenopause esp. after 45 - you would need to take blood over a full cycle, and possibly two, to get a clear picture.

It's a disgrace isn't it @jackdawdawn?

My Mum's late friend suffered from her 'nerves' from 50 onwards and was put on ADs and sleeping tablets till she died at 80 from a heart attack. All she probably needed was HRT and it might have even protected her heart as well.

Similar scenario for so many women of her generation and it's tragic it's still going on.

It reminds me of the treatment dished out in One Flew over the Cuckoo's Nest; give women drugs to shut them up and dampen their emotions, so they won't bother the doctor, when it's completely incorrect treatment for most.

Oh those 'nerves'! I read once that in the first decade of the NHS, there were more scripts for barbiturates than antibiotics. Then they moved onto Valium, Librium...and it's still going on. I worked in an office about twelve yrs ago, mainly female, and about three-quarters of those women were on Prozac and Seroxat! Seems to be such a casual attitude to prescribing brain-altering drugs. I am sorry about your mum's friend suffering unnecessarily. Sleeping tablets were routinely given to women when I was a child - everyone knew someone who was on them.

You need hrt for your health protection and for symptoms relief. I started hrt at 41 and I am 2 years on it. At first I was in panic because of risks but I am more relaxed now. Take care! :)

Thanks again for everyone's advice and encouragement. I've just got off the phone with a different GP and they were absolutely lovely. Up to date with the guidelines and happy to start me on cyclical HRT. Result!

Good news Shady!

Goodness.That is good news, but at the same time it is disturbing that there are so many variations in diagnosing menopause and prescribing HRT within the NHS. And within the same practice! Aren't they all supposed to be trained together, and be on the same page on these issues?

I would speak to the manager of your GP practice, Shady, and let them know of your experience - it might improve things for other patients.

@jackdawdawn The sad and shocking fact is that there is NO training in menopause for GPs other than 1 lecture at medical school. Unless they choose to go on courses run by the British Menopause Society, they learn very little and tend to react to media headlines about risks without knowing the full story (on HRT.)

There is a petition going around #makemenopausematter which is asking for all GPs to be trained. Their lack of training is driving meno consultants mad- they are fighting this battle daily as are women.