GP attitudes to HRT.

[CallistoSol]

I'm new to HRT, having just been prescribed progesterone 14 days on and 14 days off and oestrogen gel (forget the names). It has been life changing and I am feeling better in so many ways.

My GP was fab, from filling out the online form to picking up my prescription was only 7 days including a weekend. In that time I had a telephone consultation and went in for a blood pressure test. All incredibly positive.

I realise how lucky I am, but why is there so much pushback from other GP's? Why is HRT not prescribed as standard to women who are struggling with symptoms? Is it just another element of the patriarchy? Do GP's have a vested interest in not prescribing HRT? It seems so bizarre.

Meant to put womens health specialist in every practice.

@CallistoSol

I can't imagine the workload of the average GP, and having to 'know everything' must be exhausting and stressful. Maybe GPs should be able to specialise more within a practice so that there would be a womens health specialist.

I'm really wondering about vested interests in menopause treatment because denying women HRT seems so embedded in the system. Or maybe it is just because older women don't matter so who cares anyway

But there is nothing to stop any GP attending a course as part of their CPD. I have paid for and attended all kinds of courses in my working life (not connected with my current role) as CPD.

The BMS runs day courses right across the UK, costing around £120 or so, and has an annual conference over 2-3 days. This is where the top meno drs in the UK speak, and GPs can learn a huge amount.

Many are just professionally incompetent re. menopause and prescribe incorrectly. Okay some are good but judging from posts here they are few and far between.

So the answer for women who are being prevented accessing the correct medication would be education so that know their rights, and the confidence to challenge their GP. And/or change to a different practice. I do think there is a lot of passivity in the UK public when it comes to authority figures.

@CallistoSol

So the answer for women who are being prevented accessing the correct medication would be education so that know their rights, and the confidence to challenge their GP. And/or change to a different practice. I do think there is a lot of passivity in the UK public when it comes to authority figures.

Yes, any or all of those.

No one says all GPs are poor, but they are no more 'qualified' than loads of other professionals who have higher education and Masters or PhDs and whose professional training is more extensive.

What is so bad is that so many GPs are not working within the NICE menopause guidelines and appear to be working with 20 years old research/ guidance on menopause.

Would other professionals like lawyers, dentists, psychologists, and a whole lot of other professionals be 'allowed' to carry on practising if they didn't update their expertise through CPD?

A lot of women are being treated as if they are idiots, and refused hrt for subjective reasons, or given the wrong treatment.

My experience has been exactly the opposite with GPs (my practice doesn't really have ak lead GP, just on paper) suggesting hrt every time I mentioned issues related to the menopause even after I tried 3 different ones, all making me feel worse.

I have a fab GP who is really knowledgeable about the latest research in all matters meno, BUT she was the third gp in the practice that I saw, the first got all flustered and said it wasn't his area and the second told me HRT would give me breast cancer and tried to prescribe antidepressants, he got quite annoyed when I said I wasn't depressed.
The lack of knowledge is quite concerning, if I hadn't of insisted on seeing another doctor I would be a hot sweaty suicidal mess not ideal when I've got a severely disabled child to take care of.

It's no secret amongst consultants and menopause specialists that many GPs are not performing well in this area of medicine.
Many experts run free courses for GPs or HCP and of course there is paid for CPD available - now online so no excuse.

No GP can be forced to invest in training- though maybe they ought to be.

They reckon it's going to take 10 years or more for GPs to get up to speed in enough numbers that all women will get the right treatment.

It's really not good enough considering women make up half of their patients. The lack of myth busting education about menopause, HRT and associated health is really shocking tbh.

@Shehasadiamondinthesky

I had a job getting mine even though the menopause gave me a breakdown. Female GP said she didn't have time to go through all the HRT thing??? Its not like I talk the hind leg off the donkey in the surgery I just had a few short questions about it. Finally got it and it was life changing, who wants to be a fat, sweaty ragey mess? I'm angry that we can't get testosterone prescribed here for loss of libido like they do in the states, I'd be quite happy to buy it privately but it isn't allowed I've tried. So its ok for me to totally lose my libido and for my marriage to collapse then? My friends who take it in the states say it's also life changing. I really feel the medical establishment don't give a shit about womens issues sometimes.

I have testosterone as part of my HRT. I use a private specialist.

One of my friends who is a GP took one of the courses (and more) as described by Jingling up thread. She described it as “eye-opening” and has been inspired to learn more with the aim of becoming a specialist. I know for a fact that my knowledge of HRT options was greater than hers before she started this journey.

Also many suggest antidepressants not because of depression but because many help with anxiety.

It's not lack of knowledge to suggest it when a woman tells her GP that her worse or only symptom is anxiety. Some antidepressants also help with hot flushes for some women.

@dontdisturbmenow

Also many suggest antidepressants not because of depression but because many help with anxiety.

It's not lack of knowledge to suggest it when a woman tells her GP that her worse or only symptom is anxiety. Some antidepressants also help with hot flushes for some women.

It is lack of knowledge though because experts would say that both anxiety and depression that occur for the first time- or become worse- in peri menopausal women are a symptom of peri menopause.

NICE says clearly that ADs are not be offered as 1st line treatment for psychological symptoms, in women who are in peri menopause.

I think that some GPs are still quite suspicious of prescribing HRT due to the associated risks, but the situation is improving. My GP referred me to a specialist clinic where I was able to have an in depth consultation and discussion regarding my options. It’s pretty difficult to cover everything in the meagre 10 minutes a GP has with each patient.

I think there has been an attitude in the past that women should just put up with their symptoms as it’s just part of getting older, which of course is true. However, more women are working in demanding careers and menopause symptoms can be extremely debilitating and can be so bad in some cases it’s impossible to carry on working. There’s also the problem that some women sail through menopause where others feel like they’ve been run over by a truck and symptoms can go on for a long time in some cases.

It is simply lack of training for many GPs as the marvellous Jingling explains. A larger surgery will have one or two GPs who have been on the extra courses and it will make a huge difference if patients ask specifically to see them.

Benefits of hrt far outweigh negatives for most - it protects heart health, bone health and mental health

And regarding symptoms, just because you think you don’t have symptoms, doesn’t mean the damage isn’t being done. Heart, bones, brain are all at sub optimal function at best, becoming damaged at worst.