What the heck happened during my 6 minute GP appointment?

[largeprintagathachristie]

So, my first foray into seeking help with peri-menopause symptoms went like this. Start to finish in 6 minutes:

Though I'd put "HRT discussion" in the booking process as the reason for the telephone appointment, the GP had no idea it was what the appointment was for. Par for the course, I guess, but relevant as below:

The GP seemed flummoxed that I wanted speak about HRT and said she would "have to refresh her memory" about it. She was clearly out of her depth.

She said HRT "causes" breast cancer.

She said HRT was only relevant if I was having hot flushes.

She said it has very little effect on future health, when I mentioned that as well as controlling peri-menopausal systems I was interested in the protective future health benefits.

Then she said "supposed" I could have HRT but she really wasn't sure what to offer. If I got my blood pressure tested somewhere and texted it through she would prescribe "something."

She said HRT would cause withdrawal bleeds every month. I said, "do you mean when starting HRT?" as I'm aware this often happens in the first months, and she said, no, for the entire time you're on it, like regular periods. Is this correct?

Then the GP she had a very busy clinic and needed to get off the line. She was late calling me, and from start to finish the call was six minutes long.

I had assumed she would cover my existing hormonal condition, polycystic ovaries, for which I take medication, but she never mentioned it and I didn't have a chance to bring it up.

So, I knew GP provision around the per-menopause and menopause varied, but I wouldn't say that went well!

I just don't have any faith at all in that GP. Do I just try again with a different GP from the same practice? Going private seems like a leap as well as £££ but I can see why people do it.

My symptoms, age nearly 50. Muscle and joint pain, fatigue, anxiety, irritability, poor sleep, crying jags. Hot flushes appeared for a quite a few months last year but haven't happened for a while.

Try again with a different GP.
I take it you have looked at menopause matters/ Louise newsome/ nick Panay on line for info.
Your doctor sounds out of date so speaking to another is fine. It is true that if you are still menstruating or in close proximity eg 2 years to periods you are likely to have to have regular bleeds until you are 'through' the menopause that is unless you opt to have a mirena fitted for the progesterone element of HRT. Your GP will probably want your weight/ height and BP.

That is awful. Yes I'd see a different doctor, she sounds clueless, and from experience it's best to say you're having hot flushes.
When I first went to my GP with all the same symptoms as you i was told there was nothing they could do about any of that . Next time I went I was having hot flushes and worse, night sweats/insomnia, was given hrt straight away which resolved 90% of my symptoms within 2 weeks.

thanks @Brainfogisreal

Yes, I might have underplayed my hot flushes.

and thanks @yikesanotherbooboo
I am whizzing through the LouIse Newsome podcasts so felt quite prepared, and also prepared for lack of GP engagement, but still a bit taken aback

Is your gp clinic quite large? You could ring and ask for the Meno specialist? Though they might not have one. A gynae expert might not have been on the meno courses either.

You can read up the NICE guidelines and nhs info too as well as the doctors already given above.

Your gp clearly doesn’t know much about it which happens but I wish they would say that they don’t know and refer you to someone who does

when I got my HRT a couple of years ago I was referred to the resident HRT expert Gp. She was utterly clueless. I learnt everything I needed either from here or menopause matters.

Can I ask what medication you take for PCOS, as I was given the impression by GP that I could only take something when trying to conceive. Thanks - please ignore if you don’t wish to answer.

Good grief. I am (hopefully) still a decade away from this but I naively thought it was so common that GPs would have reasonably in-date information at the front of their brains and rolling off their tongues, and good case experience to call upon if they'd been in practice for more than 5 minutes. Is a GP being clueless about menopause not a bit like bringing in a small child with tonsillitis and them saying erm feck erm never seen it erm some kind of antibiotics, maybe?

My female GP refused HRT on the grounds that it just put off the menopause and it was very difficult to get women off it. She suggested ADs (ADs seem to be the fall back drug now that antibiotics aren't handed out like smarties) or natural remedies. She gave me the NICE leaflet on using natural remedies for menopause which said that they were placebos at best and some were actively harmful. Not much use if you are aware that something is a placebo.

Find another GP or follow Louise Newsome's advice.

6 minutes is very much par for the course these days.

Knowledge about HRT varies hugely, depending on the GP. They are "jack of all trade" doctors so don't necessarily have up to date knowledge on everything.

She should have taken your info/symptoms and offered to call you back though. Have you a follow up appointment?

Christ this gives me the rage! I had a radical hysterectomy a year ago in my 30s and had to explain to my god why the surgeon had prescribed hrt for me... I mean ffs I have no bloody ovaries and I’m in my 30s it’s not fucking rocket science

Clearly I meant to type GP not bloody ‘god’ although I do acknowledge that a fair few of them seem to have some sort of god complex

I am a GP and I agree with OP that the consultation does seem bad. 6 min is way too short to discuss HRT, but keeping in mind we are only allocated 10min per patient, at best 15min. Even then, still not enough time as HRT is a huge topic and follow up is a must. I would suggest you ring up the surgery and ask for a GP that is more familiar with HRT. Plenty of NHS guidelines on HRTs for GPs out there, no excuses to be out of date IMO. There are many types and you should be informed the pros and cons of each. Also you would need basic blood tests as your symptoms could be due to other problems like thyroid. Hope that helps.

Oh gosh, It's just a ridiculous lottery, isn't it.

I was so cross afterwards.

And I'd been optimistic when I saw the GP had a female name, too.

A comment rather than a judgement - I see she gained her primary medical qualification in 1977. In Ireland. Having listened to "The Irish Menopause” Louise Newson podcast recently, I gather menopause training was even poorer, there.

Of course, both those things are likely to be correlation rather than causation, and I’m clearly not young myself, and coincidentally half Irish, so, you know.

I’ve booked another appointment with a different GP in the same practice (though the app has mysteriously cancelled the appointment). I don't know any of the GPs. I moved to the area just before Covid and have never actually been inside the practice, which is pretty stretched, as is common with London practices in the poorer boroughs.

I will try phoning tomorrow to see if I can get a follow up appointment with someone more familiar with HRT.

Thanks, all.

Well done op

A massive generalisation (sorry) but my friends who seem most anti hrt are Irish (live in England though). Possibly mums etc over the years have conveyed that same message as your gp.

I'd pay to see a gynaecologist privately tbh. Yes it's £££ but I wouldn't trust this or any GP. Clues in the name "general". Frustrating though. FWIW I've been using HRT since my mid twenties (not for menopause) and will need to at least until menopause if not beyond. My gynaecologist was an HRT specialist and wouldn't have prescribed it if the risks of cancer outweighed the benefit. If it "caused" cancer it wouldn't be regulated and no one would takeit- you know this to course, I'm just venting.

I had similar with my GP, except she WAS the menopause specialist! Ignored all my symptoms, said if I was having periods then I wasn’t peri menopausal and said the only thing she could give me was anti depressants.

I booked in with the Newsom clinic and am hoping for the best there

@OnlyToWin
Actually, thinking about it, my PCOS meds haven't been looked at for ages so I may be in a medical black hole in that respect. Anyway, my main external symptoms were/are hair loss and acne (not excess hair). I took Dianette for a very long time but at around age 48 came off that and am currently take spironolatone for its anti-androgen effect.

Thanks @largeprintagathachristie that’s the contraceptive pill I used to be on but then they stopped me taking it because I had migraines. Shame because I loved that pill and how much it cleared my acne up.