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.

[quote JinglingHellsBells]@ZaraCarmichaelshighheels Try to answer some of that!

There is a bit of a two-tier system with HRT.

Many medical experts (meno consultants) would give you HRT if you wanted it for a) very mild symptoms or b) to protect your future health.

This is discussed in a podcast with consultant Nick Panay on the Liz Earle Wellbeing website where she asks him just that.

it is highly unlikely that a GP would do the same and would expect you to have real quality of life issues now with peri / post meno symptoms.

IF you had a bone density issue now, HRT is licensed for use in women under 60 as a treatment.

Some women do really well with no HRT so it's not accurate to say you would get osteoporosis, or heart disease without it. If your only symptoms are / were vaginal/bladder etc, they like to try vaginal estrogen first .

However, many women are at risk of osteoporosis without knowing until it's too late.

I wish all women age 55 were given an NHS bone density test and then they could choose the right treatment if needed before it was too late. In fact I think they should swap cervical screening for bone density scans because the number of women dying from osteo complications is hundreds of thousands a year, compared to around 2000 cervical cancer deaths.

So no, HRT is not essential if you have no symptoms, BUT for someone who has a family history of heart disease, or low bone density , or is at risk for other reasons, it's probably worth having that kind of discussion with a medical expert.[/quote]
Exactly this. For me in it a no brainer. Osteroporsis runs in the family.

As I said I think (I'm pretty sure of this!) that a quick email asking them to put into writing the the GP surgery and its GP have a no HRT policy -will result in a phone call consultation and you being offered HRT. Be assertive -if /when a GP phone call is offered -ask to speak to one that is supportive of HRT. A male or female GP SHOULD give the same professional advice.

Locally a girl aged 16 very sensibly went to see a local GP and asked to be put on the pill. He refused and told her to concentrate on her schooling and not boys. The bollocking he got later was unreal. Unfortunately some GPs (partners etc) can be up themselves and it'snot great. Just ask the PM I think this one will be quickly sorted. It pisses me off no end that women are fobbed off with period pain, menopause etc as they are seen as 'women problems' and we should put up and shut up. From the age of 14 I had horrendous period pains absolutely awful a visit to the GP at 16 with my mother -resulted in a flea in my ear by the female GP about how I was making a big song and dance about it. Aged 25 I went to see a male GP about my knee and was clutching a mini hot water bottle down the front of my trousers, he asked what it was and then spent the next 6 weeks pushing through referrals,taking blood samples, scans etc and then the relief of getting proper medication to shorten them and make them lighther. He saved me from 20 years of pain or about 240 weeks of pain or 4 1/2 years of crippling pain. Women should not be silent or ignored for 'women's issues'

@Redshoeblueshoe There is no time limit on how long you can have HRT.

This is clearly stated in the British Menopause Society statements on their website.

Many years ago, there was this 2-5 year 'rule' although it had not science behind it. That's gone now anyway although some GPs still seem to be living in the ark.

You can take it for life if your symptoms are still there - two consultants have said they have 90 yr old women using it.

GPs are just useless for this in the main so do your own homework, read, read, read and then you can tell them the truth! Website of Dr Louise Newson and Liz Earle Wellbeing have great interviews with meno experts.

Thank you very much Jinglinghellsbells very informative, I will certainly look at that podcast, my GP is pretty useless so I think I will go to a private menopause specialist to discuss my options, thank you again, much appreciated.

Thanks Jingling. Both my parents had osteoporosis.

@ZaraCarmichaelshighheels One of the risk factors for osteo is family history. A friend whose Mum had very bad osteo was able to have bone scans on the NHS from her early 50s and referral to a consultant for monitoring as she was losing bone from that age.

You need to ask for a bone density scan now owing to your genes.

@JinglingHellsBells thank you but I think that advice is for @SummerDayWinterEvenings

@ZaraCarmichaelshighheels

You asked this..

Could someone please answer this question which I can’t find an answer for online, if you are peri menopausal or menopausal but have relatively mild symptoms that you can cope with, should you go on HRT anyway to protect your future health? If you do not go on HRT does that mean you will definitely suffer vaginal atrophy, heart and bone problems etc, I really don’t know what to do, my symptoms are mild and I can cope but really don’t want to suffer the issues I have listed, is a ‘natural’ menopause actually dangerous? apologies for my ignorance but I just don’t know what to do for the best

and I replied about the risks of osteoporosis etc - am I going mad or did you not ask for info? :)

@JinglingHellsBells yes that was my original question but if you look back to SummerDaysWinterevening post (she quotes mine) she is the one with osteoporosis in her family not me, so your advice to get a bone scan due to her genes was meant for her and not me, hence I highlighted it in case she missed it.😀

Why do people always say "write to the practice manager" about medical matters/complaints? Genuine question here? The manager is not medically qualified. The complaints go to the doctors to be dealt with. If you are saying write to them to get a response that's fine but some posts (not so much on this thread) seem to give the impression that the manager comes and slaps our wrists and tells us what to do 😂.

Also just for the record. A lot of menopause specialists prescribe outside a drugs licence because they have a lot if experience in that field. They find different methods work. You must remember that GPs are not experts in this field (many could be better, I'm not denying that) but I don't have the luxury of spending my working week purely on HRT ....I might get one patient a fortnight...so I'm not going to be and expert...I'm on it though so understand the benefits.
Some specialist want us to prescribe these drugs out with their licence or prescribe drugs we are not supposed to because they are fairly specialist. If something goes wrong...I am to blame...I'm not allowed to say "the specialist told me to do it" that is not an acceptable defence so I do sometimes refuse if it makes me feel uncertain.

It's great you have come along here @Musicaltheatremum if you are a GP and can give insideinfo.

What is the right way for people to contact the practice if they are not happy?

I don't think for a moment the women here are expecting the manager to make a clinical decision, but given that (as I understand it) most practices are run like businesses, with partners and a manager, are issues like this not brought to 'board' meetings (for want of a better term) when partners (drs) and the practice manager met?

As for you not wanting to take personal responsibility for any drugs recommended by a consultant, are you saying there is a risk they are wrong and the buck would stop with you if there was an unsatisfactory outcome for the patient?
Can you not get round this by asking the patient to sign something saying they would not sue you?

It seems slightly mad, to be honest, that consultants who are highly qualified, recommend a regime and GPs decide they know better and refuse to honour it.

How often in practise is something recommended by a consultant likely to be wrong?

what is wrong are the patients who are being refused the right treatment.

but I don't have the luxury of spending my working week purely on HRT

Why is this an issue?

All that is needed is to invest in a training course with the BMS or attend their annual conference to listen to and learn from the experts.

The variations on HRT are not difficult; it involves a la carte use of estrogen and progesterone, rather than what comes in a box, or extending the estrogen-only part of a cycle, with access to a scan if anything remiss is suspected.

i can only echo Jingling...what the hell....you don't have the luxury of time??

maybe fair enough for a patient presenting again and again and again with something increasingly outwith your remit, but c'mon....50% of a GP's clientele are likely to hit the menopause sooner or later...maybe making some time to go on a course or have a little sneaky peek at a menopause website might stand you in good stead?

and your off licence prescribing excuse is really not an issue here either, as jingling says no one is expecting their GP to prescribe exciting regimes of medications, just the basics.

Jolly good job for you that YOUR GP is more helpful huh?

And...

there are very few off-licence regimes.

One is to extend the estrogen-only part of a cycle if women are intolerant to progesterone.

Another is to suggest Utrogestan is used vaginally (as it is everywhere else other than the UK!)

And in all honesty, having had frequent consultations with a very expert consultant for over 12 years, I can't think of any other off licence variations.

Where GPs struggle sometimes is combining a separate estrogen with a separate progesterone, but if I can get my head round that (and it's all in the pharma prescribing guidance anyway!) and am not paid around an average of £100K a year, surely a GP can?

I also fail to see how a GP can choose to override the advice of a specialist consultant. I know that legally you are not obliged to do what they say, but come on......really?

I didn't know any of the risk-avoiding side of HRT, I thought I wouldn't need it as not having hot flushes etc (so far) I think I need to find out more.
I did ask my GP once about horrendous mood swings and had ADs suggested, as I was only murderously unhappy for a few days out of each month I didn't really want that.

Practice manager is there to register complaints and ensure they get passed to the correct person to answer them as well as arranging input from medical defence teams if needed. As a GP I agree if a gp has refused hrt without reason it should be highlighted to manager. Some private clinic do recommend treatments that are not necessarily appropriate or licensed/suitable so as a GP I wouldn’t prescribe if I wasn’t comfortable.

Some private clinic do recommend treatments that are not necessarily appropriate or licensed/suitable so as a GP I wouldn’t prescribe if I wasn’t comfortable.

Do you mean bio-identical products @Pixie2015? (Please don't confuse with licensed body-identical which are mainstream products.)

These are not prescribed by the majority of consultants (if any in fact) and the BMS has a very strong message on their website denouncing them.

They are only available in private pharmacies on the whole, anyway, so not available from your high st pharmacy.

I don't think any women would expect a GP/NHS to prescribe those- they have to be obtained via the private clinic.

I had in mind treatments that aren’t even oestrogens for issues that may overlap with possible menopause symptoms- anything suitable that was recommended that could be prescribed I would prescribe. Sound a bit cryptic there are some amazing nhs specialist around if GPs are confident to seek advise or support from. Main issue currently is drug availability!

Update:

I have received a reply to my letter from the Practice Manager this morning.

It reads just as @SummerDayWinterEvenings predicted on page 2 "I doubt that you get a reply saying 'Yes our GP and surgery do not and will not prescribe HRT' -more likely an email or a phone calls arranging for you to go back in and 'there seems to be miscommunication -I wasn't saying no to HRT. Just trying to point out and risks and try other things rather than put you on HRT first"

The letter states:

"Dr X states she did not say no but explained to you that there are are things which need to be looked into before HRT could be given....." This is an outright lie.

"Dr X has sent her apologies, as she may not have explained this properly on the telephone."

The most interesting part, I felt was this:

"Dr X is unable to issue a prescription for HRT without the advice of a hospital..." , I think this is probably a good idea but is this standard procedure when the patient doesn't have any diagnosed health issues?

I'd be interested to know if any of you who have been prescribed HRT needed to be seen by a hospital first?

"Dr X is unable to issue a prescription for HRT without the advice of a hospital..." ,

That is complete bollocks.

You need to register if possible with another practice or at least another GP.

Is she really so incompetent she cannot handle HRT?

OR does she not 'believe in it ' so is saying you will have to go to hospital for an appt or she will need to ask a specialist.

It's just delaying tactics hoping you will give up.

The NICE guidance says clearly that HRT is the first line treatment and should be given first, not after other drugs are tried.

I think this is probably a good idea but is this standard procedure when the patient doesn't have any diagnosed health issues?

Of course it's not.

How many women would ever get seen if they were all sent to hospital for HRT?

Beginning to wonder if the dr is even a real one! it's another universe they are in.

Only thing I can think of is the doctor in first year since qualification and can’t prescribe independently - often when people want hrt they have researched it will other times when people not sure I would give info to read - ask to speak with a Senior GP - good luck

Thanks for your replies and confirming what I already thought.

I'm starting to think this is an NHS Scotland thing, I will need to check but I'm not sure that the NICE guidelines apply to Scotland either.

This whole experience has left me feeling dismissed. I never wanted to take HRT, went down the herbal and "ride it out" route, it really took a lot of reading (during my many sleepless nights) to finally come to the decision that I wanted to try HRT and this is how it turned out....what a waste of bloody time.

Same problem OP. GP refused HRT in March. So did senior partner. Both men.

All of these people saying' change your doctor', how is that possible in the middle of this crisis?

I have a telephone consultation next month with a private consultant but I have a horrible feeling she won't be able to prescribe anything without a face to face meeting, tests etc, and it will be money down the drain. I am sick of how women are treated. Would a man with low testosterone leave the surgery without a prescription? Would he be told treatment was too risky, and that it was a natural part of life, and to go do some yoga and eat more legumes? Would he buggery.

@jackdawdawn and @HRTRefusal

This is NOT a Scottish thing.
The website Menopause Matters is run by a Scottish consultant (gynae) and she will answer your questions by email for £30.

The website is very helpful and there is certainly not a difference in English and Scottish prescribing (except some drugs not so easily available.)

You are being fobbed off @HRTRefusal. it's hard to know why- either this GP is young and inexperienced and out of her depth OR she has some personal vendetta against hrt and is behaving unethically, making it harder for you to have it. Neither is right.

@jackdawdawn if your appt is with Dr Newson, she is prescribing by phone and her website says this, as do her Tweets (Twitter.)

When I said change your GP I assumed there was more than one GP in the practice so you could make an appt with another.
OR go through the normal process of registering with another one, either by phone or in person and moving to them. I don't see why this can't happen at the moment- it's an admin process.

@jackdawdawn If you were refused HRT you ought to complain and at least ask why! Refusing treatment for no medical reason is simply not ethical. You ought to have said you have a right to appropriate treatment, you know the tiny risks and you want to try HRT unless they can give you a medical reason to withhold it. They can't argue against that and if they do, you throw the NICE report at them, print it off and discuss.These drs of yours sound like bullies and ought never to behave like that. Don't stand for it.