GP has told me they don't prescribe HRT

[HRTRefusal]

I've been following this board and reading about HRT for over a year, trying to decide whether to take it or not. My symptoms have been getting worse and I decided I had to try because I'm fed up feeling like this, it's affecting my quality of life.

I had a GP call back this morning only to be told "we don't prescribe HRT because of the risks" I was offered anti depressants for anxiety/low mood, something else to help with my sleep issues and she could also give me something else that would help with sweats (I'd told her I have that under control with Red Clover). I have other symptoms but these are the ones she offered treatment for.

It was a real blow because it has taken me so long to decide I want to try HRT and I feel I was fobbed off tbh.

I'm in Scotland so I don't know if there are different approaches to menopause treatment here, I'd love to hear from anyone else who's GP doesn't prescribe HRT and whether you take anti depressants and sleep issue medication or whether you changed GP. I don't know where to go from here.

WHAT?! Surely it's up to you to decide the risks for yourself. I don't have experience of this as my GP prescribed HRT whilst explaining the risks but I would seriously consider changing doctors or seeing a menopause specialist. Anti depressants do not replace the hormones that your body is no longer producing. It's that simple.

Also please bear in mind it can take a while to find the right HRT for you. I am 18mnths in and on my third type and only now do I feel that I've got it right. So you really do need an understanding GP.

Good luck.

Find another GP, or google menopause specialists in Scotland?

Gp here. If correct that's unacceptable. Letter to the practice manager in the first instance, politely querying if the Dr was right.

I am shocked they don’t offer it but just thought I would tell you my recent experience. I have had hormone treatment for endo which put me in full on menopause. The hot sweats were so full on that in the end I broke down on the phone to my doctor. I’d been recommended fluoxetine several times by my consultant but I kept telling her I wasn’t depressed, she advised they will help with flushes. In the end out of desperation I tried them and within two days my flushes were practically gone. There are a few other things that could have been responsible but ultimately they sorted the flushes.

Depending on what symptoms you are finding the hardest it may be something you wish to consider. Being totally honest I have stopped taking them due to my hormone treatment finishing and it not working out for me.

I’d be complaining to the Practice Manager!

Refer to the NICE guidelines and that dismissing women’s health like this is unacceptable.

There’s a really useful section in the Invisible Women book about how women are treated as having a mental health condition when it’s actually physical so the wrong thing is being treated.

Find another GP and complain to the GP association in your country - or to the NHS if they are NHS funded.

HRT is less harmful than antidepressants. But I too was put on antidepressants instead of HRT - I changed GP and now am with someone who specialises in menopause.

They cannot refuse to treat you and if they do, you need to complain loudly to the right patient organisations.

Never heard anything so ridiculous.

NICE guidelines- top of this page- say ADs are not treatment for menopause.

I’m not sure if the NICE guidelines are used in Scotland, is there an equivalent for up here?

If the GP doesn’t prescribe surely you should be able to get a referral to somewhere that does? My practice nurse recently went on a course about it as there is a lot of frightening and confusing information out there, and said if I wanted it to go to the GP who’d prescribe it.
I don’t because of relatives and breast cancer so I chose acupuncture to balance me instead.
But you should have the choice surely. And if you do get to a specialist will they prescribe it or send you to the GP with a note suggesting he prescribe it and then he says no so you’re back to square one?
It may be time to change practice if you really want HRT.

Find another doctor

They are being paid about £150 a year just for you being registered with their practice so I would be removing that from them straight away. Find a new GP. And menopause doesn't just cause hot sweats. Vaginal atrophy is a real thing and it is painful and distressing. Find a new GP and then write to them. I bet they prescribe for men who are experiencing distressing effects of aging eg catheters for enlarged prostate and urinary incontinence.

OP I don’t know where in Scotland you are based but every health board has a prescribing formulary.This is usually available online and states which drugs should be used for each condition. There is most definitely a section on peri/menopause. Screen shot it and send it to your practice.
Here’s NHS Highland’s
tam.nhsh.scot/home/formularies-and-the-pink-one/obstetrics-and-gynaecology/hormone-replacement-therapy-hrt/for-women-with-an-intact-uterus/

Not sure if it is relevant but florexitine killed my sex drive dead and it took years to return - I'd be reluctant to go down that route if a sex life is important to you.

Dundee has a Menopause Clinic...I ended up with a referral there because they had a huge appointments issue in Tayside a while back I needed a new mirena for OUTRAGEOUS menopausal periods and got on a local list and the one at Dundee at the same time

After having the coil done locally I said I'd cancel the appt, but the family planning doctor said to keep it and discuss options, which I did, and it stood me in good stead because when I did go back to my surgery with dreadful flushes/insomnia/bone pain and the previously helpful GP got difficult and tried to gaslight me about available options so I asked to be referred back to Dundee.

The clinic had advised to carry on with the mirena with the option of gel as a supplement if required..they did lean quite heavily on the option of ADs but really....I do not see how that is helpful to add in something like that to treat something entirely due to a hormone deficiency. They wrote back to my GP outlining this.

Once my GP saw that she did a complete 180 and started wittering about costs to the practice vs costs to the Meno Clinic...and said "OF COURSE you must have the gel if that's what they said"

Anyway..TL:DR ...make a fuss and don't be fobbed off, there are other options than your GP.

Thanks everyone for your replies, I'm still reading through them.

I think I do need to contact the Practice Manager, the way she said we don't prescribe it because of the risks makes it sound like a blanket ban so I'd like to find out.

@Wuybb That is shocking! So if a locum can prescribe patches then it's a clear practice choice not to. I had heard or read somewhere that Scottish Drs don't prescribe but I thought it was a particular HRT gel, not all HRT.

If the GP doesn’t prescribe surely you should be able to get a referral to somewhere that does? - I can ask this in the letter to the practice manager, thanks, I wouldn't have thought of a referral.

@Allnamesaregone ..thanks for the tip about the formulary

HRT details are under Endocrine System if anyone cannot find it ...well they are on the tayside one.

They are just trying to save money

'They are just trying to save money'

not true. Not prescribing doesn't save the practice money.

This still isn't acceptable.

They are being paid about £150 a year just for you being registered with their practice

£80 - £120 actually. For which they have to see you whenever you are ill or believe yourself to be ill. Do try to find similar care for your pet for the same money for a year, I think you'll struggle.

@HRTRefusal The doctor who runs the website Menopause Matters is a consultant in Dumfries. HRT is most certainly available in Scotland. You can also contact her by email for advice via the site, for £30.

www.menopausematters.co.uk/contact-the-doctor.php

However, you do need to challenge your own GP first.

Why would they be trying to save money?

HRT is dirt cheap.

I pay for it myself as it's a private prescription and per month it works out at no more than the NHS prescription charge. (Though in Scotland no one pays, do they?)

I understood that NICE had updated their guidelines on risk, according to their website it states:

NICE looked at the risks of the following conditions in women taking HRT compared with women of menopausal age in the general population. Your GP should explain that the risks of the conditions described below vary from one woman to another and depend on many risk factors. In cases where HRT is said to increase risk this usually means a very small increase in most women.

I would be going back to the GP/Practice Manager and asking them to explain what the risks are to you (over 60 for example) and asking what criteria was made for their decision.

However, aside from getting an answer I would still see a specialist. I had HRT from the GP for over a year but recently saw a private consultant and was prescribed something different. The cost was about £200 for the consult and the prescriptions worked out the same. I am not sure GP's are as clued up as the specialist clinics and I would spend that to get the optimal treatment for me.

I'm in Scotland, also not had any joy whatsoever in getting anything taken seriously, also refused HRT as it was too early (I have finally started getting wobbly periods, hooray) and also put on Fluoxetine for hot flushes.

It does work to control those, but as another poster said, the lack of sex drive is dismal and the one time I came off it for 6 months (tapering slowly) my brain turned to mush.

I seriously think that any doctor prescribing it for hot flushes needs to take a good long journey into quality of life for perimenopausal women. I cannot say that long-term, having no sex drive is better than hot flushes. It was never mentioned though.

Email the GP PM and copy to this link
www.nhs.uk/conditions/hormone-replacement-therapy-hrt/

Explain you had an appointment with Dr X on Y date. After careful consideration and lots of research that you had contacted your GP to look at starting HRT. But your GP had categorically told you that the surgery and GP does not prescirbe any HRT "because of the risks". Ask them to confirm this is the GP's policy and the Doctor Surgery's Policy and that no one else treated at the surgery is allowed or has been allowed to be prescribed HRT. State you were offered antidepressants but were told you were specifically refused HRT and wanted a detailed discussion about it.Say you want to confirm the GP's policy and surgery's policy.Also ask if this is in line with NICE guidelines and state the NICE quote "Your healthcare professionals should talk with you about menopause. They should explain any tests, treatments or support you should be offered so that you can decide together what is best for you. Your family or carer can be involved in helping to make decisions, but only if you agree." -as in where is the 'decide together' bit? Providing HRT is suitable for you. Are there any extra risk factors for you? OP. For example if you had liver disease HRT would not be appropriate. Here is a list of conditions which might mean HRT is not suitable -but I'd expect it to be discussed with you. www.nhs.uk/conditions/hormone-replacement-therapy-hrt/
www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT Also worth pointing out NICE says - about Hot flushes and night sweats -Hot flushes and night sweats are common in menopause. If you are finding them a problem you should be offered HRT after discussing the benefits and risks with your GP.

If you have a womb you should be offered HRT that contains oestrogen and progestogen. This is because oestrogen‑only HRT can be harmful to the lining of the womb. If you don't have a womb you should be offered oestrogen-only HRT.

Note the word SHOULD be offered HRT for Night Sweats after a discussion of the benefits and risks!

I guarantee you will have a reply with 2-4 days asking you to talk to your GP. That's bollocks quite frankly. Although I'm a doctor - slightly different scenario as my own GP is also a personal friend -and we had a mass conversation about what type of HRT -not if I should be on it. I tried patches but was allergic to the adhesive -so I'm on Femoston. But -none of the 4 females GP I know who are very good friends -would dream of not discussing it properly. If you had a patient come and see you are say I have only have this symptom: Vaginal dryness but nothing else -the suggestion might be an oestrogen cream and not HRT. But never ever should the discussion be shut down.

@nibdedibble It's a joke.

Anti Ds do not give bone or heart protection.

Given that 1:2 women end up with osteoporosis and may die from the complications in old age (far more than die for any cancer) GPs need to wake up.

Also, in Scotland with the climate, people are more at risk from lack of Vitamin D, which is essential for bones , and which is also why many more Scots have MS as that is linked to low levels of sunlight.

There is no joined up thinking, is there?

@Allnamesaregone Thanks for the link, I'm in Glasgow, I will search for a similar page