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?

UPDATE.

Had a call with a second doctor for a second opinion. She has said I don't have to wait until August for the blood test, but can have one in two weeks. We went round in circles with me arguing @JinglingHellsBells statements and her saying that HRT has side effects and they need to measure my hormone levels to check that the levels are low and therefore need Replacing. I have to wait two more weeks for my "brain to reset".

She offered me antidepressants to treat the night sweats and hot flushes (which are no longer major symptoms since removing caffeine from my diet).

Progress I guess, but yet another phone call that ended in tears of frustration.

She kept saying that HRT has side effects, I pointed out that the perimenopause has fucking side effects too. She said that many women go on HRT and still have the symptoms, so not to expect any improvement even if I go on HRT.

@JinglingHellsBells thank you for your kind offer, will PM now.

@Paperreceipt

UPDATE.

Had a call with a second doctor for a second opinion. She has said I don't have to wait until August for the blood test, but can have one in two weeks. We went round in circles with me arguing @JinglingHellsBells statements and her saying that HRT has side effects and they need to measure my hormone levels to check that the levels are low and therefore need Replacing. I have to wait two more weeks for my "brain to reset".

She offered me antidepressants to treat the night sweats and hot flushes (which are no longer major symptoms since removing caffeine from my diet).

Progress I guess, but yet another phone call that ended in tears of frustration.

She kept saying that HRT has side effects, I pointed out that the perimenopause has fucking side effects too. She said that many women go on HRT and still have the symptoms, so not to expect any improvement even if I go on HRT.

That’s because their doctors haven’t gone through the process of trying a range of HRT products and doses to find the one that works. She really doesn’t know that much, does she?

For some women it does take two or three tweaks. I had to change my oestrogen gel dose from two to three pumps.

I have a mirena for the progesterone element, which works really well. That would seem to be a neat fix for your contraceptive requirement.

UPDATE AGAIN

So, following the second opinion, the doctor's surgery never rung to book me in for the blood tests. I rung them, finally managed to speak to someone (in the wrong dept) who managed to get a message to my surgery. The second doctor rung me today and said she had changed her mind and I had to wait three months for the blood tests and they won't treat me with HRT in the meantime. Neither will she refer me to the nearest menopause clinic until they have the blood tests.

I think I give up now.

@Paperreceipt

UPDATE AGAIN

So, following the second opinion, the doctor's surgery never rung to book me in for the blood tests. I rung them, finally managed to speak to someone (in the wrong dept) who managed to get a message to my surgery. The second doctor rung me today and said she had changed her mind and I had to wait three months for the blood tests and they won't treat me with HRT in the meantime. Neither will she refer me to the nearest menopause clinic until they have the blood tests.

I think I give up now.

I would write to the practice manager. Make a formal letter and quote NICE etc and demand proper treatment. This is a nonsense.

Do not give up. Contact your MP and say you are being refused treatment.

Thank you your patience, but there is no quote I can give that states they should give me HRT.

I will sleep on this and follow your advice if I can summon the energy. It just brings me to tears of frustration. I’m worried that I’ve had three years of this, and I’m concerned about the increased risk of dementia, osteoporosis etc. not to mention dangers of weight gain.

(I overhauled my diet last year, and I do feel in particular that cutting out caffeine and sugar helped with the night sweats and insomnia. But the weight gain around my middle has stuck).

@Paperreceipt Going right back to your very first question.

In theory women under 45 are supposed to have a blood test to rule out other health issues that may mimic peri meno.

However, as the Pill will mask the results- ie no FSH levels etc- it's not wroth doing them unless you stop the Pill first.

If this is unacceptable for contraception reasons, your GP ought to be sensible and offer you HRT.

However, as I've already said, you'd need to discuss contraception again in the context of using hrt as on its own it's not effective birth control unless it includes the mini pill (and that's not as effective as the CCP.)

Some younger women swap to the CCP called Qlaira which is very similar to HRT ( a more natural type of estrogen.) This might be your first step.

Your other option is to try the Mirena coil which acts as part of hrt and also as a good contraceptive.

Can you consider either of these and discuss with GP?

If not, the options are to move to another practice or another GP in your practice, or pay for a private appt with a meno gynae.

This rigmarole has pretty much used up the three months they require me to wait, so I reckon I can book in for my blood tests soon!

If it comes back as the menopause they say they will refer me to the nearest menopause clinic and I will be able to chat with someone knowledgeable about contraception etc.

But I will probably still write a letter of concern, especially about being offered antidepressants.

I didn't realise you had already stopped taking the Pill. In that case, you can have your blood tests soon BUT please don't reply on them. Many women have normal results as they only catch your hormones on one day (and make sure you have the right tests, on the right days, on 2 cycles, not just one test on a random day.)

reply- = rely

Hi, I am new to all this and hopefully you can offer me some advice. I am in my mid 40s and just found out I am going through the menopause 😔. I have been prescribed a gel and vaginal capsules. To be honest, I was expecting an oral pill. is this form of HRT common? Any advice would be appreciated. Thank you 😊

I don’t know what I was thinking earlier, I’m weeks away from their deadline.

Am going to treat myself to a cafe, take my laptop and write the comms you suggested Jingle.

This is awful. Can you change Dr's surgeries?

Hi, I am new to all this and hopefully you can offer me some advice. I am in my mid 40s and have just found out that I am going through the menopause 😔. I have been prescribed a gel and vaginal capsules. To be honest, I was expecting an oral pill. Is this form of HRT common? Any advice would be greatly appreciated. Thank you 😊

It's a shame @DonLewis as I'm the third generation at that surgery, but the old doctors are long gone and it's all been 'privatised'. I'm definitely going to look in to it.

@Cannnotstopeatingsweet you will get a better response starting your own thread. At the moment it's like you're butting in to a conversation that's already taking place about someone else's concerns

@Cannnotstopeatingsweet

Hi, I am new to all this and hopefully you can offer me some advice. I am in my mid 40s and have just found out that I am going through the menopause 😔. I have been prescribed a gel and vaginal capsules. To be honest, I was expecting an oral pill. Is this form of HRT common? Any advice would be greatly appreciated. Thank you 😊

Hi @Cannnotstopeatingsweet yes, very common. The safest forms of HRT are those that are body identical and appplied transdermally - absorbed through the skin -rather than orally as this bypasses the liver and has less side effects than pills.

I'm guessing you've been given Oestrogel or Sandrena gel? Regarding the vaginal capsules if you have a womb then this would be utrogestan which is a body identical micronised progesterone which is used to keep the womb lining thin. If you don't have a womb then perhaps you've been given vagifem pessaries for vaginal dryness?

There's some information on HRT options here: d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/491/HRT-Types%20and%20doses%20v21-02.pdf

HTH

Another update

I didn't give up. I made a complaint to the surgery. They didn't respond. I made a complaint to the ombudsman. They should have responded by yesterday (but didn't).

However, I did receive a call from the senior doctor at the surgery. She was apologetic and didn't understand why I'd got the response I had from her colleagues. She is referring me to the menopause clinic and believes that they will start me on HRT straight away. I am going in for blood tests also, not just for hormone levels but (once again) for diabetes etc. I think she mentioned leukaemia, but who knows.

Interestingly, I mentioned about not relying on the hormone levels as I'd seen a graph in one of Dr Newsom's CPD lectures about how they fluctuate (@JinglingHellsBells refers to this just a few posts ago). She replied that "to be honest, once they're high, they remain high" and I don't know enough to respond to that.

I have a couple of other difficulties in my life at the moment and am struggling. It is encouraging to read other people's posts about HRT meaning they have more energy. I just want to feel myself again.