Should I be offered HRT without blood tests?

[Paperreceipt]

I’m 41 and have had symptoms since I was 38. I’ve tried to get help but either been offered antidepressants or told I’m too young for the peri menopause or it’s just part of aging. I’ve made all sorts of lifestyle changes including quitting my stressful job/career.

The main barrier is that I have a monthly period, but that’s because I’m on the pill. The doctor explained that I’d need blood tests to confirm perimenopause but that means months off the pill first. I declined, as I’m petrified of falling pregnant. A year or so later my live do has completely disappeared, so that’s less of an issue now but I feel too desperate to wait another few months.

Recently I’ve been reading guidance that HRT should be offered in response to symptoms and blood tests are “not normally required”.

Can anyone advise? Do I have any right to HRT now?

The NICE guidance pinned at the top of this forum gives everything you need to know. :)
Diagnosis- blood tests not necessary in women over 45.
At your age they just need to be sure it's nothing else BUT what I always say is if it looks like a duck, sounds like a duck and walks like a duck....
some drs would reach straight for HRT for you.

Blood tests would be hard as you are using the Pill.
Can you see another GP? Many young women your age are given the Pill Qlaira which has enough natural estrogen in it to be like HRT but with the bonus of contraception.

Thank you @JinglingHellsBells. I have gone back to the doctor quoting the NICE guidelines but she refuses. (I mean, I've literally just got off the call with her, in tears. It's an online service my surgery has outsourced to, and I was hoping for a different doctor). When I quote the NICE guidance her response seems quite reasonable. She says it's hormone replacement therapy and she will not prescribe it until she has the blood tests showing that my levels need replacing.

But that's four months from finishing the pill. I feel desperate. I'm going out of my mind. I spend most days having to pretend I'm ok when in fact I have no energy, no purpose and death would feel like a relief.

Could you write to her? Or ask for a face to face appt?
List all your peri meno symptoms?
Tell her that you are not willing to risk pregnancy by coming off the Pill?
Print off info about Qlaira (google it re. similar to hrt for younger women)

or see another GP at the practice
or pay to see a private meno specialist.

It’s a video call, outsourced by my GP’s practice. I will try to get a face to face but it’s almost impossible.

I listed my symptoms showing the Menopause Doctor website’s questionnaire, but that came across like “something I found on the Internet”.

She mentioned I could go private, but I gave my job up in December and things are tight.

There’s a menopause clinic here which she won’t refer me to until she has the evidence to do so. To be fair, she was a bit more gentle this time around.

I’m going to research Qlaira later, thank you for responding @JinglingHellsBells it was all feeling a bit hopeless.

Sorry to hear this. I was prescribed HRT at 41 without blood tests - I went through the Newson Clinic but have since spoken to my GP who seems fine with continuing the prescription once my current supply runs out. I've been having symptoms since my 30s and already have Osteoporosis that the NHS hasn't bothered to treat. I still have periods but not on the pill. Only a few weeks into HRT but already feeling better.

I'm afraid I don't know what to suggest, but from what I've read, blood tests aren't very helpful. Can you try a different GP?

I tried to get second opinion today, but it was the same doctor. I’ve specified a different doctor and have a call on Monday.

I’m not sure what I can say to convince them when they have the expertise.

What are you on? The drug mentioned above does sound like a good option for me.

I think you need to hold firm here and threaten to make a complaint, because they aren't complying with NICE guidelines.

@Paperreceipt The thing is they don't have the expertise - not when it comes to the menopause. Did you see the programme Davina did on C4 this week?

I'm on oestrogen patches and progesterone tablets. Anyone know how to work out when to take them days 15-28 when your cycles are irregular?

I'm not sure that the NICE guidelines are completely clear for a 41 year old:

If menopausal symptoms are affecting your day-to-day life you should see your GP. Your GP should be able to tell if you are in perimenopause or menopause based on your age, symptoms and how often you have periods, so you are unlikely to need tests

You may be offered a blood test but only if: you are between 40 and 45 and have menopausal symptoms, including changes in your menstrual cycle (how often you have periods)

What do you think?

You arelooking at the patient info.

The NICE guidance for GPs is pinned at the top of this forum.

If you click on it and on the side bar you should see 'Diagnosing'.

Look at Section 1.2 and in particular the bullet point of 1.2.4

It says consider using an FSH test in women between 40-45.

The whole thing is not black and white. As you have many symptoms, your GP ought to use a 'suck it and see' approach whereby if it works...that's the issue.

It's hardly heroin! Honestly some GPs. If after 3 months, you felt like a new woman- great! If not, they could investigate a bit more.

The thing is, you wouldn't get this nonsense from meno specialists. They tend to be far more relaxed about the whole thing as they are better informed anyway and more confident in their approach.

Can you afford £250-£300 for an appt?

This is why I’m waiting a few months until I’m 45. But I appreciate you don’t want to wait 4 years.

Could you have a non hormonal coil fitted, come off the pill and have the blood test?

There is no point doing blood tests if you are on the pill.

HRT for peri menopause is NOT just about replacing missing hormones. It’s more complicated than that. Otherwise there would only be progesterone in HRT rather than oestrogen. (Natural progesterone cream is great btw)

I’ve come off the pill so I’m ready for the blood tests. I’ve zero libido and I just want to give HRT a try.

Thanks Jingle, I’ll look at that again, in the right places. Yes, I could stretch to that if necessary. I’ll see what the second doctor says next week.

@JinglingHellsBells The whole thing is not black and white. As you have many symptoms, your GP ought to use a 'suck it and see' approach whereby if it works...that's the issue.

I can’t find a quote that states that. The document you directed me to is the one I have quoted I believe.

@CovidSmart

There is no point doing blood tests if you are on the pill.

HRT for peri menopause is NOT just about replacing missing hormones. It’s more complicated than that. Otherwise there would only be progesterone in HRT rather than oestrogen. (Natural progesterone cream is great btw)

Peri symptoms and menopause symptoms are caused by a loss of estrogen. That's the basis for all HRT.

Progesterone is only given to protect the womb lining from overgrowth and potential cancerous changes.

In the US in the past, HRT was often estrogen-only but it was found that within a year, 20% of women had hyperplasia on it and that's why progesterone is used as well.

[quote Paperreceipt]**@JinglingHellsBells* The whole thing is not black and white. As you have many symptoms, your GP ought to use a 'suck it and see' approach whereby if it works...that's the issue.*

I can’t find a quote that states that. The document you directed me to is the one I have quoted I believe.[/quote]
@Paperreceipt Ok I will copy and paste for you.

LINK at the top of this forum

www.nice.org.uk/guidance/ng23

2nd subheading Recommendations

In Recommendations go to 2nd bullet point

of perimenopause and menopause

This is what is says

1.2 Diagnosis of perimenopause and menopause

1.2.1Diagnose the following without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms:

-perimenopause based on vasomotor symptoms and irregular periods

-menopause in women who have not had a period for at least 12 months and are not using hormonal contraception

-menopause based on symptoms in women without a uterus.

1.2.2Take into account that it can be difficult to diagnose menopause in women who are taking hormonal treatments, for example for the treatment of heavy periods.

1.2.3Do not use the following laboratory and imaging tests to diagnose perimenopause or menopause in women aged over 45 years:

anti-Müllerian hormone

inhibin A

inhibin B

oestradiol

antral follicle count

ovarian volume.

1.2.4Do not use a serum follicle-stimulating hormone (FSH) test to diagnose menopause in women using combined oestrogen and progestogen contraception or high-dose progestogen.

1.2.5Consider using a FSH test to diagnose menopause only* [BOLD type mine for your information]

in women aged 40 to 45 years with menopausal symptoms, including a change in their menstrual cycle

in women aged under 40 years in whom menopause is suspected (see also recommendations on diagnosing and managing premature ovarian insufficiency).

1.2.5 Says consider using an FSH test. It is not mandatory which is the line your GP is giving you.

I don't know which symptoms you have and as you say, you can't count irregular periods as you are using the Pill. It is not essential to have an FSH test.
To ask you to stop your preferred method of contraception to do a test is a little unreasonable.

HOWEVER you can't take the Pill and use HRT together, so you will need to re-think that.

Yep, a couple of years ago a male doctor said he would not treat me for perimenopause without blood tests, and couldn’t do the blood tests without me coming off the pill. I preferred to stay on the pill for contraceptive reasons.

Thank you for the cut-and-paste. It’s exactly what I quoted to the doctor. As it’s not specific enough, she still argued that she wanted to do blood tests.

HOWEVER you can't take the Pill and use HRT together, so you will need to re-think that.
I thought there was a progesterone pill that could be taken with a form of HRT.

This makes me think I need to go private. I need someone who knows more than I can figure out, to advise me

Consider using a FSH test to diagnose menopause only in women aged 40 to 45 years with menopausal symptoms, including a change in their menstrual cycle

Her argument is that I’m in this age range for which a blood test should be a consideration.

I started my menopause at under 40 and a blood test confirmed this . Women can have an early menopause. I'd go back to your Dr armed with information to show them and suggest they do their own homework to educate themselves .

Yes @Rainbow321 my question/hope is do I have a right to start HRT without waiting months for the blood tests?

@Paperreceipt
I thought there was a progesterone pill that could be taken with a form of HRT

Utrogestan is micronised progesterone but it's not used for birth control - it's actually used to enhance fertility in larger doses.

My meno consultant says that a certain dose of the mini pill can be used alongside estrogen as part of HRT. You would need advice as to whether this acts as birth control- I think it does but obviously it's the POP not the combined pill and it's unlikely your GP would know what dose to give you as HRT.

If you do go onto HRT you would need to come off the CCP.

Many women use the Mirena coil as contraception/ progestogen part of HRT and add in a type of estrogen (for HRT)

Or there is Qlaira which I mentioned.

If you go privately, PM me the location and dr you might go to see as I know many of the experts.

@Paperreceipt

Consider using a FSH test to diagnose menopause only in women aged 40 to 45 years with menopausal symptoms, including a change in their menstrual cycle

Her argument is that I’m in this age range for which a blood test should be a consideration.

The only consideration is to rule out other illnesses which may be giving the same symptoms.

They can short-circuit that process by giving you HRT to try.