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.

@Shallysally Dr Newson used to (?) have a letter template on her website showing women what to say or write when stuck with an intransigent or unhelpful GP. A lot of GPs took offence (!) so I'm not sure if it's still on the site.

There are quite a few women who have set themselves up with websites on menopause charging women to ask for their 'advice' but they don't have any qualifications.

Fine to offer support, but not to charge for it IMO.

@JinglingHellsBells Well I mean, how dare a mere patient come into surgery and actually know what they need?!

No I agree, I’ve just left the Facebook group as 1, my scrambled brain can’t deal with the myriad of posts all asking different things!
And 2, Jane has just posted re a new course she is running, at a cost.

I understand many women are absolutely desperate for support, and are willing to pay for this, and perhaps I would have booked a session with Jane if my GP hadn’t agreed to prescribe. Each to their own I guess.

@Summerhillsquare, sorry for going off topic on your thread

Not at all, after all knowledge is power and we are all in the same boat. Its just that for some of us, the coastguard appears to have gone off duty!

@shallysally I think if women want support they ought to read info from doctors, not someone copying the info from doctors' websites onto their own website and charging women to 'consult her.

It's really unethical for someone not medically qualified to charge women for consultations and suggest 'treatment' for them.

Exchanging info on forums is one thing- women can take the info or leave it- but actually setting yourself up and charging women for your opinion, when you are not a dr , is not right. Only IMO of course !

@HunkyPunk

Could you have a consultation with a private GP?

I joined the waiting list for Louise Newsomes clinic in July, 3 months minimum wait ,🙄 I am clearly not alone.

@AstonishingMouse

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.

Thank you @astonishingmouse (excellent username!) That is an important point.

I am composing my letter when my distracted brains allows moments of clarity. I might upload it through the NHS app enquiry system rather than practice manager I think, I would like the same GP to read it for continuity of care.

I felt so sad yesterday. I love my work in renewable energy. I have only had my career take off in the last few years, and there will be a promotion opportunity coming up next year. If this goes on, I have no chance of getting it.

@SummerhillsquareThere are other very good meno specialists out there other than Dr Newson. PM me if you ant info.

gp advised to keep my bedroom cool to avoid nightsweats! Strangely enough I'd already tried that! They then wouldn't prescribe hrt without blood test to check thyroid levels which would take months.

I honestly thought I was losing the plot so searched local bmi hospitals for menopause specialists and had an appointment in under a week and a six month prescription within 15 minutes. Was initially annoyed at having to pay so much but has definitely been worth it

I take it BMI are a private hospital chain?

It's a kind offer @jinglinghellsbells but as someone said upthread my case is not complex, it should be simple for the NHS to start treating me. Whilst I am lucky to be able to afford to pay, why should I? The NHS is, incidentally, building up its own costs with unecessary tests and appointments.

Unfortunately it appears to be epidemic, I've given up and booked into a private clinic to see a Menopause specialist GP. It's still a 2 month wait and the Dr is having to put on early morning appointments to cope with the demand. Says it all really.

From an over 45 with raging hot flushes and skin pigmentation changes - who's local GP says it is stress and that I should consider well- being mediation exercises

Just started searching for other private services - this one nearish to me is not taking on more patients due to demand, even though they are quoting very steep prices: www.hormonebalanceclinic.co.uk/treatment-schedule

@Summerhillsquare it in the right ballpark unfortunately. Depends on what you are getting - especially as it is virtual only. Comparison below of another private GP in a major city.

First appointment
45 minutes – £220
Follow up
20 minutes – £90
Smear test
£74.22
Female hormone profile
£65.00

But yes demand is really really high even at those prices. It isn't right that women are being forced out of the NHS, definitely a two tiered system for Menopause treatment.

I'm so sorry for your experience @passmeacoldflannel, women are basically still being written off as hysterical.

Well I wrote a letter to the last GP. Took me a while to collect all my views, and to try and find a polite phrasing, but the jist was why are you ignoring the guidelines?

Sent last week, but I don't anticipate a quick response, I'm sure they are snowed under..

Well it worked! Eventually got another GP appointment and was offered HRT!

Its in tablet form, which doesn't seem very common on here, but I was so relieved I didn't query. GP is anticipating lots of oestrogenic side effects as I've been getting those in the combined pill. Later in she texted me offering a 'top up' mini pill of progesterone as she'd forgotten to mention contraception 🥴 again, I'd never heard of this.

So, lots to consider and I guess I'll be haunting these boards a while yet.

That's good news @Summerhillsquare

However, I wonder if there are any other professionals (earning £100K pa) where their incompetence would be overlooked? (thinking of law, accountancy, finance, etc.) And if they would get away with it?

Your GP ought to know that in 99% of types of HRT the estrogen is totally different to the Pill. It's estradiol. In the Pill it's synthetic.
She can look at the ingredients online! Such lack of knowledge is really unacceptable.

They keep making these mistakes through lack of training/ interest in women's health (which is available through the BMS or other meno specialists) and women are suffering.

Which type were you given?

*estradiol is a body-identical estrogen, the same as our own, so side effects are (logically) non-existent.

Joining the discussion for after my work day - will be back!

(I've had a bit a shocker over HRT lately as well, with two relatively young doctors.)

I too have recently been told by my local HRT clinic at my local hospital that I'm being referred. To whom? For what? Because they don't know what they are doing with my HRT?

hi @JinglingHellsBells I have tried to PM you but the system says I can’t…

Oh dear @jinglinghellsbells, I should have probed more, shouldn't I? She did actually offer me another combined pill with a higher oestrogen dose, which even i spotted was not right. I don't know which type because I havent picked it up yet. She looked up the doe 1000 vs 300mcg in the combined pill. She's one of the practice's women's health specialists! I moved practice for that very reason as the info from previous GPs was woefully poor.

@SpindleWhirl my GP is young too, I'm just grateful to have talked to the same one twice though.

@Oblomov21 that is odd. A previous GP said I should go back to the women's health clinic (where I was treated for PMS, which I now think was peri-menopause in early forties) if I didn't like her advice tat a blood test was essential. At least the new GP agreed that a FSH test WASN'T helpful as I am over 45.

it's all just woeful @Summerhillsquare
The BMS runs training courses (remotely sometimes) on HRT/ meno/ prescribing several times a year. These cost about £100. I find it sad that GPs don't appear to be willing to invest in CPD which is essential in other professions.

This is the list of what you could have

www.menopausematters.co.uk/perimeno.php
It's on a public forum, run by a meno gynae, so now excuse why any GP can't access it and learn.

Thanks that's really helpful. I think she said Ellest. Will see.

I am worrying now about the dose, and balance. Contrary to the research, my PMS only improved with LARC progsterone only, until the second impant I had just caused continual bleeing and I had it out, was gutted at the time. But now that I think of it, the 'time' was early forties, so I wonder if my hormone levels were already changing rapidly.

I'll just have to try and see how I go. I do find it all very vexxing, feeling like a guinea pig though.