Terrible anxiety - do I need to see someone?

[SecondaryBurnzzz]

Hi there,
I am using Elleste Duo at the moment and usually find them pretty good (half progesterone and half oestrogen). For the last 3 weeks I have been suffering from terrible anxiety and panic attacks. I normally feel a bit 'highly strung' and aggravated when I take the progesterone tablets, but never this bad. Apart from being under lockdown, my life isn't that stressful at the moment, so no reason why I should be so out of sorts.
I asked my GP if there was anyway I could have my dosage tweaked and she said that I'd need to see a specialist for that. I do have private health insurance but it doesn't cover menopause. So would I have to pay to see a private consultant, or is there something similar available on the NHS. I am in London.
My GP has prescribed me anti-depressants to help in the short term, but I would really like to just get my HRT fine tuned.
Any advice or recommendations would be gratefully received.

Your GP could offer you a different type of HRT- doesn't have to be Elleste. There are numerous types including gel + utrogestan, gel+ Mirena, estrogen -only patch + Utrogestan, Femoston (tablet but different type of progesterone to Elleste.)

Most Gps would be au fait with trying different types first before suggesting a specialist.

Anti depressants don't work for hormonal anxiety- some of the top meno specialists are on record as saying this and NICE guidance is to sort out the type of HRT NOT give anti-Ds.

A private appt with a consultant won't be covered by insurance and will cost around £250.

NHS clinics are a possibility but you will probably have to wait months and if the can't suggest anything other than what your GP could give you.

If you choose a specialist make sure they have an interest and background is dealing with menopause as not all gynaecologists 'do' menopause- they all have their favourite interests.

thank you @JinglingHellsBells. It was a phone consultation with my GP and not a great line, and I don't think it was an area of interest for her actually. She was wavering between anti-d's and sleeping tablets so I thought at least anti-d's would be useful generally. I thought that a specialist would be able to fine-tune my prescription a bit more based on blood tests and to be honest £250 would be a small price to pay to feel human and in control again!

Your GP could just change your HRT for a different one, I was suicidal on the progestogen part. I was never good in hormonal contraception either.
Now I have oestrogel and utrogestan and I am all fine.

You need referring to this lot

www.imperial.nhs.uk/our-services/fertility-and-reproductive-medicine/menopause

I’ve had an appointment with Newson health last week - they’re GPs who specialise in the menopause. Louise Newson is their main specialist - she’s on all sorts of TV programmes and You Tube talking about menopause. I paid £250 for a remote consultation, it was worth every penny. They can issue prescriptions etc. If you google Newson Health it will come up.

Thanks CrotchetyQuaver and Bagelandbrie you're both right, I may need to throw money at this. Crochety your post makes me very hopeful, and my work are allied with Imperial. I wonder if they'll give me a discount!
Bagel did you need to have a blood test or did they prescribe based on the information you gave.

I have emailed a specialist nurse through Women's Health Concern, part of the British Menopause Society. I'll see if she has some suggestions too.

Dr Newson is fine @SecondaryBurnzzz. I 'know' her as I'm in the media and have been in contact with her on meno stuff.

You do not need a blood test. This is because your hormones will be all over the place and as you are on HRT it's not going to show your natural levels anyway.

No one needs blood tests for HRT, only sometimes to show if you have any other condition.

My consultant, who I've been with for ages, is offering online consultations, but would I think expect women to see them in person at some stage once it's possible (London area.)

I can tell you now that Louise Newson will offer you estrogen gel and Utrogestan as this is considered one of the best combos.

Your GP could prescribe that if you asked.

The only difference with a private consultant is they have the ability to prescribe outside of the licensed regimes, as they take responsibility, so sometimes this can include lengthening the estrogen-only part of the cycle, reducing the progesterone part, etc.

As the previous poster has written you don’t generally need blood tests for anything HRT related, however for me personally I did have some as I have a lot of complex medical conditions and I am young - 30s, the NICE clinical guidelines state that anyone wanting to start HRT who is under 40 should have baseline bloods done. Newson suggested I do this and was able to book these through my own Gp and then send the results back to them.

I am on oestrogel and Utrogestan. It’s all good so far.

One thing to consider @SecondaryBurnzzz is that Dr Newson doesn't offer tablet form of HRT- this is on her videos and also the info on her website. That's because tablets are 'old fashioned' and have more risks of blood clots, albeit tiny.

She would offer you patches or gel, as I said in previous posts.

Thanks JinglingHellsBells. I don’t really mind how I take them as long as they stop me feeling so crappy. I’ve read good reports of small doses of testosterone but I don’t think it’s licensed here.

Watching with interest as I too, considered an appointment with Dr Newson but if she is prescribing very little other an oestrogel and Utrogestan, there seems little point - I could get this via the GP? Do the doses vary?

Hi @user48675 maybe start your own thread on this - you'll be bound to get more traffic.

@user48675 The dose is standard although a specialist may advise slight tweaking under medical supervision if it warrants it. These tend to be specialists not bound by NHS licensing practise, who can make an informed decision which most non-specialist GPs can't or aren't allowed to.

Estrogel is 2-4 pumps per day.

Utrogestan is either 100 a day, or 200 x 12 days per month, depending on continuous or sequential regimes.

Yes your GP can give you those, although many GPs don't seem au fait with it (they are getting better) as it's two separate items and sometimes that's out of their understanding.

The other issue is of it doesn't suit, it's a case of 'what next' and sometimes again, a GP doesn't have enough knowledge of different combinations of types of HRT available.