How do you insist they stick to the NICE guidelines? Blood tests

[Summerhillsquare]

So I was diagnosed as likely perimenopausal in May, by the first GP I spoke to regarding worsening PMS. He put me on the combined pill, ordered blood tests, and I started reading up, and have done the work menopause awareness course.

Since then my symptoms (all the classics) have worsened, and 3 subsequent GPs have said I'm too young or using the wrong contraception and have ordered more blood tests. The first one showed post menopausal levels of FSH, but obviously now no tests available. I am over the age the NICE guidelines say that tests are unecessary... Have challenged repeatedly but no HRT til more tests and so we are at stalemate.

Of course I have been offered anti depressants of all shades at every appointment, even by the nurse! Oh and herbal remedies...

I hesitate to make a formal complaint in a pandemic but I'm at my wit's end. I can't sleep or work.

I think more formal complaints might be needed before women start getting decent advice instead of incentivised anti depressants. I am sorry you are having this experience. What happens when you discuss the guidelines with them and ask why they are diverging?

The first doc who disagreed told me that the guidelines didn't apply to me because I was using contraception, and if I didn't like it I could go back to the PMS clinic (tried, couldn't). So I agreed to the FSH test, just because I thought it would get me another GP appointment (a long time on the phone each day is required here to at least try and get one). The second said I was far too young, and that the blood tests were inconclusive so I'd have to have more. The third, today, said it would 'normalise' the diagnosis, even though the first test in fact showed post menopausal levels. When I said I didn't understand what that meant, she moved the discussion back to anti anxiety drugs. I wish I'd refused the tests but then I'd still have been refused treatment I guess.

How old are you @Summerhillsquare
If you are over 45 with symptoms, your GPs are being ridiculous.

Either confront them again or make a formal complaint to the practice manager, copy and pasting NICE in your letter.

Blood tests are not necessary and HRT is given on the basis of symptoms.

Honestly, it's easier to get methadone than HRT from some GPs

Nightmare

Yes I am over 45 and have raised this at each appointment. Politely, even so the second gp took offence. She said I could go back to the PMS clinic, who, when they event answered the phone, wouldn't accept me. Yesterday I asked outright to try hrt now rather than anti anxiety drugs, and she said 'we could, but I'm not going to'!

@Summerhillsquare I think you need to be more 'forensic' in your responses!

NICE says HRT and meno treatment is a 'joint discussion' not drs playing God.

You need to ask what medical reasons she has for withholding hrt. Ask if you have any contraindications.
Say that you are 'allowed' to have HRT on symptoms unless she can find anything in your medical history which means you are at risk from it.
Say that the choice is yours, and her role is to discuss the risks and benefits.

I know this is not an easy conversation to have but it is all in the NICE guidance.

No contraindications, we discussed that.

I will get back in the system asap.

without being arsey with them, I think you might want to ask if any GPs in the practice prescribe hrt as 3 have already refused you and offered other treatment.

I'd ask why they feel it's not 'appropriate' for you and have suggested drugs (ADs) that are not recommended.

It really ought not be a battle to get prescribed medication when you need it.

It endemic. A female GP told me she won't prescribe HRT unless a woman clearly can't hold on to their sanity.

That's right. A female GP thinks being borderline clinically insane is the only circumstance to prescribe HRT.

Keep going OP. It really shouldn't be this hard.

The NICE guidelines absolutely do apply to you. If you had a vitamin D deficiency, the GP would willingly write you a prescription for a supplement.
That is exactly what HRT is, a supplement of hormones to replace what our bodies are lacking due to menopause.

I’ve joined the Jane Pangbourne’s menopause group on Facebook. There are some straight forward guides on there, also Jane offers bookable sessions with her, produces a report that you can take to your GP so they can then prescribe based on Jane’s recommendations.

Also, the Davina McCall programme is really good and informative, worth a watch.

Good luck!

Thank you @Terryscombover for your support, and @jinglinghellsbells for your good advice.

Just shocking the way women are treated. Men wouldn't last 5 minutes in this state.

I watched Davina's program @Shallysally, it was informative and warm I thought. I just can't imagine presenting the doc with a recommendation from a web page though, given how badly one of them reacted to my polite questions re the NICE guidelines!

I talked this over with BF, who works in healthcare, trying to figure out why they do it. He said either the drug is really expensive, or they don't believe you 😔

My gp is online now. I wrote all my symptoms and requested a call back. Going on my symptoms and at the call she said "lets get this sorted". I was so relieved and I had my hrt the next day.

Its incredibly upsetting that some women have to fight to get hrt when it makes such a huge difference to the quality of their life.

Sorry I wasn’t clear, you book a session with Jane, it costs but apparently is worth it. I haven’t needed to do that so far.
She e mails the report to you, and you can have this to refer to during the appointment with your GP. So for example, your symptoms are x, y and z. You are concerned about osteoporosis, heart disease. You have considered the risk factors, and are aware that you are at less risk of developing breast cancer from HRT than someone who is overweight/drinks more than the recommended limits each week.

And you have considered that actually, the great protective factors that HRT offers is what you need.

State that you have considered the risk factors, and need a better quality of life now over the possibility of developing cancer/DVT. (Transdermal route minimise risk of clots.)

Be calm, and consistent. If GP still refuses, ask for a referral to your nearest menopause clinic.

@Summerhillsquare

I talked this over with BF, who works in healthcare, trying to figure out why they do it. He said either the drug is really expensive, or they don't believe you 😔

HRT is dirt cheap. I pay for mine (private prescription) and even with the dispensing fee it costs no more than an NHS prescription for a month.

@Shallysally Who is Jane? :)

GPs are not obliged to take any notice at all of anyone. They usually follow guidance from consultants.

Also, there are very few menopause clinics around. They are for women with very complex meno issues beyond the remit of a GP- that doesn't seem to be @Summerhillsquare!

Okay @Shallysally I've looked at Jane's website.

She would have no credibility with a GP (sorry). She's not qualified other than being an affiliate of the BMS ( which anyone can be if they pay a sub.)

The info she gives is freely available online (Dr Louise Newson's site has fact sheets).

There is also enough info (dare I say it?) on this forum for women to compose a 'speech' when seeing their GPs.

Could you have a consultation with a private GP?

If you can afford it go private.
I had to in the end as my GP was rude and dismissive and told me I was (JUST!) depressed. I had been having very erratic periods and she just said you cant be menopausal if you are still having periods.
Got bloods done and all hormone levels were zero! Private Dr prescribed it on the spot. I feel like a new woman. It was the London Hormone Clinic I highly recommend them.

I find it mind boggling that so many GPs behave like this still!

What is so sickening is that menopause consultants do NOT treat women like this!

You'd expect GPs to follow the expertise and advice of specialists but oh no, they are still 20 years behind in their thinking.

@JinglingHellsBells Jane is a menopause and HRT educator, she runs Menopausal Not Mad.
She works alongside a doctor, and runs a facegroup group. I was directed to the group from a poster on here.

And yes, I agree that GP’s are not obliged to take notice of anyone else when assessing and prescribing, but given the apparent lack of knowledge around the menopause and HRT, I feel it’s important that women inform themselves so they are able to have a balanced discussion with their GP.

I only mentioned the menopause clinics as I’ve spoken with women, not on here, who have been referred there because their GP has been so reluctant/cautious to prescribe them HRT.

@JinglingHellsBells

“Okay @Shallysally I've looked at Jane's website.

She would have no credibility with a GP (sorry). She's not qualified other than being an affiliate of the BMS ( which anyone can be if they pay a sub.)

The info she gives is freely available online (Dr Louise Newson's site has fact sheets).

There is also enough info (dare I say it?) on this forum for women to compose a 'speech' when seeing their GPs.“

Sorry cross posted.

Fair enough. I’ve not actually had a consultation with her as I’ve informed myself with the info on here so don’t have personal experience

I work in healthcare.
Absolutely do complain, you have had poor care.
Complaints are extremely useful for driving change, your complaint may result in improved care for other women.

After a lot of chasing around, I emailed the practice manager, attaching the NICE guidelines, and explained as politely as I could that I felt dismissed and according to the research, my health was being put at risk by my not being treated properly as it says in the guidelines.

This apparently lit a fire under someone, as my next appointment I had a different GP going through all the tests I'd had over the previous 5 years, showed me the results on the screen and discuss them with me. It turned out in my case that I'd been misdiagnosed, but then I was on the track for getting the treatment I needed which made a massive difference in my life.