Just had my annual " why don't you come off HRT " lecture from my GP - how to handle this ?

[VivaMiltonKeynes]

Yesterday I had a phone call from my GP doctor and it is the usual "lecture " that you seem to get at this practice every year .
For background I was on HRT for 4 years then came off at my previous NHS doctor's request . It was horrible - total resumption of the symptoms I had - feeling as if living in a sauna, aches and pains in hips , inability to sleep . I therefore went privately to a menopause specialist also an NHS Consultant in Contraception and Reproductive Health who put me back on HRT and referred me back to the NHS . I came off in 2015 when I had a total hysterectomy and the aftermath was even worse . The Gynae consultant said there was no reason I could not go back on and now on Oestrogel . I feel great on this .I only take one pump a day. Joined this GP surgery a year ago and had the lecture on joining then this review yesterday - she wants me to come off it . She referred to a greater increase of likelihood of stroke . She asked me what my "plan" was and I said to her that my private specialist had said there is no need to come off ever . She seemed to go very quiet at times and seemed unsure of how to handle someone saying they didn't want to . In the end I agreed to take one pump every other day and she is going to call back in 3 months and see how I am getting on . I am pissed off with myself that I even agreed to this . After the call I reviewed the NICE and NHS guidelines and they specifically say there is NO or little increased risk if you are using the gel . I know all about the positive benefits. Firstly I don't think this is fair - that women have to be subjected to this whereas a man can be prescribed Viagra for years and never be questioned on it .Secondly how do I tackle this with this GP ? Just tell her I want to stay on and refer to the guidelines ? Sorry this is so long but trying to cover all details. Thanks for any input.

In a similar situation, been on HRT for over a a year after horrific symptoms, saw a private GP who put me straight on HRT, tried to get my prescription changed to an NHS prescription and GP wants to take me off HRT and then monitor me for 2-3 months to see if I really need HRT or not.

I'm going to have to continue with private GP and private prescriptions.

I've had situations like this where I end up kicking myself for going along with something I wasn't happy with.

What I've found helps is to call back or write a letter, I would say that I felt put on the spot and under pressure by them earlier and having thought about it further and doing my research I have decided to keep going with my current treatment.
I feel more in control that way as I call back with my facts and knowing I won't budge on it.

@AvoidingRealHumans

I've had situations like this where I end up kicking myself for going along with something I wasn't happy with.

What I've found helps is to call back or write a letter, I would say that I felt put on the spot and under pressure by them earlier and having thought about it further and doing my research I have decided to keep going with my current treatment.
I feel more in control that way as I call back with my facts and knowing I won't budge on it.

This is a good idea . These phone calls are far from ideal in getting your point across.

Current thinking is that oestrogen is beneficial for cardiovascular health as long as BP is good and no other contraindications. I suspect your GPs might be a bit old school.

www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/menopause-and-heart-disease

Sadly she is a young female GP .

You just show them the NICE guidelines- pinned above- or do a search for the same topic - look at the British Menopause Society website and they have a list of 'consensus statements' on the menu and it all says the same- basically that there is no limit on the length of time you can use hrt and can use it for life if you want to.

Nick Panay ( top UK meno gynae) has videos saying he has patients in their 90s on it, as does my own meno specialist.

GPs know next to nothing on meno and HRT .

She is incredibly ill-informed for any GP!

1 Transdermal hrt foes not increase risk of strokes. That is in ALL the guidance on HRT. Surely she's read the basics?

2 Estrogen only HRT is safe. Women using it have LESS breast cancer than all women in the population who are NOT using HRT!

She needs a training course.

I tried to manage my symptoms with herbal stuff from well known health shop and it worked for a while then stopped working so I went to see my gp and asked about hrt. My appointment was with a male doctor who said I had 2 choices either to go on hrt or just cope. I replied that I had been trying the “just cope “method and now I needed help. He said he would prefer not to prescribe hrt. I said in a slightly light hearted way there speaks a man who has never had these debilitating symptoms . His reply was rather bizarrely yes but a man who had a mother that went through the menopause. Needless to say that didn’t work for me and I left the surgery with the prescription
and have not looked back since

I reiterate - your gp is a twit on this subject.

Thanks everyone . This has encouraged me to stand my ground.

Shocking how women are just fobbed off - and it's clearly not always by men!!

I am 46 and suffering now with symptoms but am on the mini pill so not sure how to progress. My mum is 68 and has been on HRT for many years. She looks and feels amazing and is always recommending it!! She had the same nonsense at her GP surgery (also from a very young female GP, disappointly) so she ended up paying for a private consulation with a menopause consultant at at specialist womens health clinic and now gets the prescription from there instead. It's awful that you have to go that route, but at least it's an option.

The private specialist can write to your GP and ask you to be put on it on NHS but yes you then get all this shit .

I have been on HRT for 14 years after a total hysterectomy. I have moved from tablets to patches as I do (well I did) three long haul flights per year (NZ to UK).

I maintain that life is too short to worry about the side effects when the benefits are so good and will not be stopping HRT any time soon.

Stand your ground OP and good luck

Take your original dose of a pump a day in the meantime!

I am doing so and did write a letter to the doctor and handed it in. Again thanks all.

Well done, you!!!

Would you believe that my surgery refused again to dispense my Oestrogel ? Said I had to have a review so via the e consult I advised them that I had had one , felt pressurised at the time and had written them a letter saying I wanted to continue . Get a phone call again this evening - a different doctor who was asking me why i wanted to stay on it and was I aware of the risks ? I repeated to them the info in my letter and she kept on asking about do you check your breasts, have you had a mammogram, do you know the negative effects on your heart etc etc etc ...... I actually told her that I was unhappy being quizzed like this (esp when she obviously knew nothing about my situation ) after the last recent time . Anyway they have written a script for me . I bet men don't get quizzed like this with Viagra or transgender women . It makes me so cross .

Menopause knowledge within GP surgeries is woeful. There is a fantastic online resource here www.menopausedoctor.co.uk Dr Louise Newson is on a mission to educate women and general practice doctors as there is so much out of date information and myths out there that is damaging to women.

Using HRT long term is not a risk. In fact it protects against heart disease, osteoporosis, type 2 diabetes and some cancers.

You are only REPLACING the hormones you have lost, not asking for extras! The sooner you start HRT the better.

Keep fighting your corner OP!

I had this issue. My GP was determined I should come off HRT as I'd been on it for more than 10 years. He refused to prescribe more than a month at a time. Every month he would lecture me using the same arguments you were given. After six months of this I gave up and now get an annual private prescription from a menopause specialist. It costs me about £120 a year plus an annual zoom review but it's worth it.

How infuriating. I plan to stay on HRT until I die. Stand your ground

I would complain to the Practice Manager quoting NICE guidelines and copies of anything in writing from specialists.

It could be the issue is that you've been seen privately and some GPs are absolutely ridiculous now in terms of agreeing to anything recommended through a private consultant, regardless of what it is.

I had an issue with my surgery a few years ago when private Gynae wanted me to have a course of treatment prior to full hysterectomy and GP tried to get out of giving it to me even though if I'd seen the Gynae on the NHS the treatment would have been the same and could only be given through my GP.

I complained, and it was sorted pretty quickly.

If you don't get anywhere by writing, can you change GP? Despite my previous issues, in terms of HRT mine are all very pro to the extent they have helped me identify the best one for me despite it costing more than the generic so they aren't all as clueless.

I repeated to them the info in my letter and she kept on asking about do you check your breasts, have you had a mammogram, do you know the negative effects on your heart etc etc etc ...

Clearly they are out of date with all research and NICE guidance.

HRT is shown to reduce heart disease by 50% in women who use it within 10 years of their last period.

NICE and BMS guidance is an annual review (at least), awareness and discussion of risks, then the woman makes her choice.

New guidance from the General Medical Council came into effect 09/11/20 about decision making for doctors AND patients. There are 7 principles. Hopefully 🤞🏼 this is the link about it www.instagram.com/p/CHXFajdAUQ0/?igshid=1kkdf4ca5nbm6
Good luck

That is shocking OP.
I thought from previous threads and advice on here HRT was good forevermore.
I said I'd try to avoid it as my DM came off it at 65 forcibly and she became very depressed dealing with hot flashes too she never got back to herself.
I was sure I'd try it if it's life long but apparently it is not now.
Can you ask to speak to another GP go armed with facts?

@JinglingHellsBells
Estrogen only HRT is safe. Women using it have LESS breast cancer than all women in the population who are NOT using HRT!

This is not accurate. Women using estrogen only HRT are more likely to develop breast cancer than women using no HRT.

The Lancet results also mean: (a) of 70 women taking estrogen plus intermit- tent progestogen, we would expect 5 rather than 4 cases of breast cancer; (b) of 200 women taking estrogen only, we would expect 14 rather than 13 cases.

thebms.org.uk/wp-content/uploads/2020/01/HRT-and-breast-cancer-risk-should-women-be-worried.pdf