HRT Advice

[Applejack87]

Hi , I’ve been menopausal for a couple of years now , I’m keen to take HRT I have done some research & would like something as body identical as possible so was thinking estrogen gel & progesterone, I am on blood pressure tablets .
The last time I spoke to my Dr she advised having my routine mammogram and coming back to her but she did say Gp’s aren’t really trained in HRT
My mammogram was fine so I’m wondering should I ask for a referral to the menopause clinic ? Is there a back log due to covid and what sort of questions should I ask regarding hrt
Any advice please ?

Anyone have advice please ?

Mine was prescribed by my GP, no referral needed.

Sounds like you need to make another GP appt to discuss next steps.

Hi, I’ve just started HRT and my GP was happy to prescribe. She did ask my for a blood pressure reading first. And I need to repeat in 6 weeks.

I’m 40 and in early menopause and my HRT (oestrogel and utrogestan) is prescribed via my GP - however I did go privately to Newson Health clinic (remote consultation) as I wanted their opinion and they recommended which items I needed and then my Gp took over the prescription.

Thankyou for your replies , I’m worried that my GP will give me the same thing that she gives to all her patients for menopause
I pretty much have read up on HRT but am nervous about starting it I’m just hope it works for me

I was prescribed tablets at first even though I’m on thyroxine and there is evidence that it affects thyroxine absorption and shouldn’t be prescribed in that form. GP said it wouldn’t affect it .

When I realised that was probably why I was TATT again I asked for patches as I’d read that it was difficult to get the gel. I found them a bit of a PITA with them falling off and the black outlines all over my legs! They were often out of stock too.

I psyched myself and asked for oestrogen and utrogestan (gold standard treatment apparently) today after doing a bit of research, GP said I could try going back on the tablets if I didn’t like the patches but space them out from my thyroxine (not like I hadn’t been doing that before) even after I’d specifically asked for the gel! I just said that these items are prescribed on the NHS so was there a reason he didn’t want to give them to me? He got a bit flustered and said no, no it’s fine and prescribed them!

So I’d advise being quite forthright in saying what you want .

Sorry oestrogel not oestrogen (although that’s what it is!). Bloody autocorrect.

I phoned my Dr today & was told there’s nobody trained or familiar with HRT , I don’t want to be fobbed off with any hrt so I guess I’ll have to try abc go down the private route

@Applejack87

I phoned my Dr today & was told there’s nobody trained or familiar with HRT , I don’t want to be fobbed off with any hrt so I guess I’ll have to try abc go down the private route

How is it possible that drs don't know about hrt....hope you get some joy op

That's appalling - maybe complain to your local NHS trust?
Surely all GPs should be able to access information on menopause & HRT, or be able to refer you to someone within the NHS?

My GP told me to go privately as they aren’t trained to do anything other than prescribe HRT in tablet form! If you watch the you tube video of Dr Louise Newson talking about menopause - it’s about an hour long, but so so informative, it all becomes clear. She talks about the advantage of gels/patches over tablets, she talks about the breast cancer risks, it’s like having an hours consultation with her - I’ll try to post the link here, I can’t recommend it enough. She also talks about going to see your Dr armed with a completed chart that you can download from her website, which basically proves that you need HRT and not anti depressants, as apparently a blood test isn’t always accurate due to hormonal fluctuations.

Thankyou Rina66 that’s so helpful , the Newson clinic is £250 for a consultation I can’t justify it and there a wait .
I really would like to speak to someone that is a specialist who can listen to my needs and prescribe HRT to hopefully suit me , going to the GP and been given a HRT tablet really isn’t good enough . I have managed to find a HRT clinic in my area yes it’s expensive but I’ve spoken to the Dr on the phone she was lovely & listened to me , I’ve also told her that I don’t want a private prescription, she said it’s not a problem she can send a prescription to my GP .I’m hoping to book an appointment next week .

I did exactly the same as you @applejack87, booked in to a private clinic in Harley Street - £355 for the first consultation over the phone then a follow up 8 weeks later at £255, the meds have totalled around £250 so far and we’re still adjusting, so more consultations and drug costs to come. I’ve viewed it as investing in my future, the money isn’t worth having in the bank if I couldn’t enjoy it, so even if it ends up costing me £2k over the course of a year, I’d rather that that than a holiday, I barely wanted to leave the house let alone the country, so it was an easy decision. It’s all sorts of wrong that women are forced to do this, but desperate times require desperate measures. I do hope that times will change and our daughters will be more fortunate than us, the NHS could save millions by treating menopausal women properly with estrogen, rather than leaving them at the mercy of a joyless sleepless life on unnecessary anti depressants followed by heart disease, osteoporosis and dementia.

That’s a lot of money Rina66, but I’d do the same GP’s really need to get trained in menopause there are a lot of women suffering who can’t afford private advice .
I have yet to book my appointment but can anyone advice me as to what will happen at the consultation & which questions I should ask please ?

@Applejack87 Maybe just ask your GP for what you want to try? Could you do that?

Many women are using Oestrogel and Utrogestan. You can get both via your GP on the NHS. There is no need to see a specialist unless you have another other more complicated issues.

If your GP isn't trained, then it's fine for you to ask for what you want.
It's not a case of being fobbed off. Tell her you have read up about it and you want to try whatever type you want.

@Rina66 That's not completely true about what GPs can prescribe. Some do go on training courses and many are now available online via the BMS.

Women themselves need to be more proactive. Just ask for what you want! There are thousands of women on HRT using patches or gel, from their GPs. The guidance on how much to use is on the patient leaflets and there are lots of women on forums who can share their experiences too.

I did ask for what I wanted @JinglingHellsBells, I’d read books, listened to podcasts, watched videos and then I explained to my Doctor all that I learned and what I wanted (in the 5 minute appointment, I didn’t draw breath!) It’s well documented that estrogen in patch or gel form, which bypasses the liver, together with ultrogestan, because it’s bio identical and gentler, are the way forward - however one size does not fit all in terms of dosage. My Doctor said she was not a specialist, that ‘form’ of HRT needs to be tailored and she was unable to do that for me - she told me the wait for NHS specialists was over a year and then told me to go privately, get the dosage correct and then, but only then, would she prescribe what my private consultant and I had found to work for me. She was only prepared to prescribe tablet form of HRT, which I have since found out via the private consultant, given my very high cholesterol levels, should never have been given to me! If I could, of course I would have gone through the NHS, that’s where I started, but the system with regards to menopause is broken, we are not a priority, many GP’s do not understand it and consequently we are moved on to specialist menopause clinics which are few and far between, so the wait times are too long. Ultimately women get so desperate and dissolutioned that, like me, they pay.

That's a pretty dire experience @Rina66

There are 1000s of women on that type of HRT all obtained via their GP. (They discuss it on the Menopause Matters forum.)

however one size does not fit all in terms of dosage. My Doctor said she was not a specialist, that ‘form’ of HRT needs to be tailored and she was unable to do that for me - she told me the wait for NHS specialists was over a year and then told me to go privately, get the dosage correct

What she said above is incorrect as I'm sure you know, now you use that sort.

The starting dose is listed on the leaflet. It's 2 pumps. The advice is to increase gradually if this doesn't relieve symptoms. It doesn't need tailoring any more than tablets or patches, where the guidance is to use the dose for 3 months, then review.

It's really awful that GPs like her can't deal with something very basic and neither are they willing to invest a small sum of money either from their practice funds or their own pocket for CPD. There are many courses held regularly by the BMS ( and it costs around £100) and other menopause consultants.

Just coincidentally, @Rina66 the BMS menopause training course for GPs popped up on my Twitter feed tonight. There are 2 Zoom sessions over the next 2 weeks, for GPs and other HCP, where they learn about prescribing. Cost is £110. It's CPD with credits.

I guess some GPs just aren't interested :(

hi, my dr prescribed tablets as I still have periods (although erratic). She said I couldn't be prescribed other forms of HRT if I still had bleeds. I haven't read this anywhere else - does anyone else know whether this is true?

Also, I still haven't been able to start the HRT as I haven't had a period for over 40 days and I have to wait for the next cycle to start before I can start taking them.

I'm feeling a bit lost to be honest. Any advice?

I was still having regular periods, my Doctor just said start the Femoston tablets today, it doesn’t matter, you’re not ovulating in your 50’s, your hormones are all over the place anyway!
From what I can gather, the gel is great if you’re still having a cycle as you can adjust it daily to suit your requirements - your estrogen drops after ovulating, so you might find you’d need more from mid cycle onwards. So in short, yes you can definitely use the gel whilst still having periods and if your periods are irregular I wouldn’t think you can wait for your next period to start the HRT, it might not happen? Unless your young enough to still get pregnant, maybe your Dr is wanting you to have a period to confirm that?
@JinglingHellsBells is very knowledgeable, hopefully she can help you or maybe post on the menopause matters site? Some of the posters on there are very well informed.
So sorry that your Dr is as misinformed as mine and that you’re having to try to work it out for yourself.

@Frumpypigskin

hi, my dr prescribed tablets as I still have periods (although erratic). She said I couldn't be prescribed other forms of HRT if I still had bleeds. I haven't read this anywhere else - does anyone else know whether this is true?

Also, I still haven't been able to start the HRT as I haven't had a period for over 40 days and I have to wait for the next cycle to start before I can start taking them.

I'm feeling a bit lost to be honest. Any advice?

@Frumpypigskin If you are having periods, you can use any type of HRT' pills, patches or gel.

There are 2 types of HRT

1 women have have periods
2 women who have not had a period for 12+ months

In both 1 and 2 , you can use pills, patches or gel.

Women who don't have periods use a type which has 2 hormones every day.
Women with periods use a type that follows a normal cycle: estrogen daily and progestins for 12 days per month. You will have a withdrawal bleed after the end of the pack.

Find another GP?
Their ignorance is shocking. A simple google will tell them!

You can start your pack anytime. Eventually, it will reset your natural cycle into a regular monthly cycle.

From what I can gather, the gel is great if you’re still having a cycle as you can adjust it daily to suit your requirements - your estrogen drops after ovulating, so you might find you’d need more from mid cycle onwards.

@Rina66 Are you starting with gel? Have you been advised how to use it?

Please don't chop and change with the dose daily. That's not how it's done.
(I've used gel for over 12 years, which also shows how out of date your GP is!)

The way to use it to start with 2 pumps (or some women use 1 pump only to see how that feels.)

If 2 pumps control symptoms (and you need to wait up to 3 months to see), that's great.

If not, then increase to 3 and stay on that for a few weeks.

Please don't try to mimic a fertile cycle by swapping doses all the time. That is likely to make symptoms worse and might cause breakthrough bleeding. Your body needs a constant dose in the blood stream.

I’m using patches now, prescribed privately, they’ve been increased as I was started on the lowest dose, hence why the costs keep on rising, I’m having consultations every 8 weeks to adjust my dosage.
Sorry, I thought the gels could be increased/decreased @JinglingHellsBells after having watched the amazing hour long Dr Newsom you tube video, I must have misunderstood.

After seeing various gps in my surgery who waved away the notion of using hrt ( I'm 46 and still having periods but definitely peri) and instead directed me to a consultant for surgical options who was frankly bemused I phoned back and saw a lovely locum doctor who had no hesitation in prescribing hrt. I pick up my script this afternoon. I suggest you keep trying new Dr's, locums, until you find one who will. After over a year of BS I couldn't believe how easy it was with this one and wept with relief.