What checks would you say a GP should be doing on you when you are on HRT ?

[MrsMaizel]

I was prescribed HRT by my surgeon in 2015 after I had a hysterectomy and asked for it . Since then there has been nothing from my GP other than the annual "chat " about " when are we coming off this ?" which I do not intend to do . Are there any checks that doctors should do ? I do have mammograms in line with my age . I ask this because initially I went on to HRT privately and she did several blood tests before prescribing in 2014. Thanks .

BP and weight off the top of my head

Following.
Thank you for this thread. My follow up is due and I’m interested to hear what it should concern.

Just had a look at the NICE guidelines and saw this:

Do not recommend the use of bioidentical hormone replacement therapy.

I'm a bit confused ...isn't this the type of HRT people on this board advocate?

Height, weight, BP before each prescription. Usually 6 monthly.

Annual review to take into account risk factors - age, family history of breast cancer, smoking, BMI etc.

@MrsMaizel

I was prescribed HRT by my surgeon in 2015 after I had a hysterectomy and asked for it . Since then there has been nothing from my GP other than the annual "chat " about " when are we coming off this ?" which I do not intend to do . Are there any checks that doctors should do ? I do have mammograms in line with my age . I ask this because initially I went on to HRT privately and she did several blood tests before prescribing in 2014. Thanks .

@MrsMaizel The guidance is an annual review.

This is to discuss risks v benefits and type of hrt especially for women aged 60+ (who should change to transdermal types.)

You should have a BP check but you can do this at home. HRT rarely raises BP but if you have high BP anyway, transdermal better.
Weight is not done- it's not relevant. @CoffeeRunner

There is no age limit on HRT.

Estrogen-only as you are on is very safe and reduces breast cancer risk to less than the base population of women not using HRT.

No other things- family history is not discussed - it's done before you are given it, if relevant and rarely is .

@HmmmmmmInteresting

Just had a look at the NICE guidelines and saw this:

Do not recommend the use of bioidentical hormone replacement therapy.

I'm a bit confused ...isn't this the type of HRT people on this board advocate?

Start another thread- this isn't on topic?

Also, look at the videos by the BMS - thread on this forum.

Annual blood pressure and BMI along with general review to assess effectiveness and side effects and to check if you have any new medical conditions which could impact treatment e.g. migraines. If you're deemed at higher risk of cardiovascular disease they may also do bloods to check your lipids so they can calculate your QRISK score, if it indicates a higher risk of stroke then they may want to change you to a patch or gel if you're currently taking tablets.

Oh and they should also be checking that you're up to date with mammograms and smear tests.

Mammograms and smear tests are optional - not compulsory and therefore there is no need to be "up to date" with them.

None at my surgery, never been mentioned.

Thanks everyone . Mammograms up to date and no need for smear as have not cervix now. Yes I monitor BP myself as on meds for that . It's not normal for them to check hormone levels then at any stage ?

@MrsMaizel The only check is your BP.

I've used HRT long term (privately) and the only check is BP. Never weight.

I think perhaps some posters are mixing up checks on the oral contraceptive Pill (which used to include weight checks?).

Obviously, the risks around HRT and health include discussing healthy lifestyle, but no one weighs you.

Blood tests are not done. It's not really possible to get accurate hormone levels when taking hormones.

[quote JinglingHellsBells]@MrsMaizel The only check is your BP.

I've used HRT long term (privately) and the only check is BP. Never weight.

I think perhaps some posters are mixing up checks on the oral contraceptive Pill (which used to include weight checks?).

Obviously, the risks around HRT and health include discussing healthy lifestyle, but no one weighs you.

Blood tests are not done. It's not really possible to get accurate hormone levels when taking hormones.[/quote]
Would they not do them to see if you are taking enough of your HRT though and eg to see what testosterone level is ? I'm looking at going to a private clinic and they want test for Oestradiol, Testosterone and SHBG.

I have twice-yearly full blood screen (private specialist, bio-identical) I like it and it’s interesting. Haven’t been able to have F2F during pandemic but would normally have BP too. However I’ve had regular BP as part of vaccine trial so I know that’s ok.
I have my mammogram and smear tests on recall schedule. My weight is well controlled and BMI 20. I’ve also recently had a pelvic ultrasound (nothing to do with HRT).
There’s no more to know 🤷‍♀️

@MrsMaizel The way they judge if HRT is working is whether your symptoms have improved and you feel ok.

Tests for hormones are known to be unreliable at best and can vary owing to the time of day and all sorts.

If someone isnt getting any benefit from their HRT then the way to deal with that is to increase the dose, try a different route, ( pill to transdermal for example), different progestogen, etc.

Testosterone is only given to some women for tiredness, libido, etc and only once estrogen has been established at a good working level.
Not many women use it.

You might find the videos on the BMS site useful. (Linked to in a post about 6 threads down.) There is one on bio-identical HRT and the dr speaking discusses the differences with it and body identical HRT.

Also @MrsMaizel be wary of clinics that say you need all these tests and charge a ££££ for them. My dr said he could offer tests that cost £thousands, but they wouldn't be of any real use at all.

Why would they check your hormones? They are replacing them. If you feel fine then you are at the right dose

I’m happy with my choices thanks @JinglingHellsBells

[quote JinglingHellsBells]@MrsMaizel The way they judge if HRT is working is whether your symptoms have improved and you feel ok.

Tests for hormones are known to be unreliable at best and can vary owing to the time of day and all sorts.

If someone isnt getting any benefit from their HRT then the way to deal with that is to increase the dose, try a different route, ( pill to transdermal for example), different progestogen, etc.

Testosterone is only given to some women for tiredness, libido, etc and only once estrogen has been established at a good working level.
Not many women use it.

You might find the videos on the BMS site useful. (Linked to in a post about 6 threads down.) There is one on bio-identical HRT and the dr speaking discusses the differences with it and body identical HRT.[/quote]
Thanks , Yes have looked at a couple.