Nick Panay & HRT

[HundredMilesAnHour]

Has anyone seen Nick Panay for HRT, either privately or at Chelsea & Westminster's menopause clinic?

He was recommended to me by a private menopause GP but my NHS GP won't refer me out of area, even though Chelsea & Westminster accept referrals from NHS GPs anywhere in England.

So I've finally bitten the bullet and joined his private waiting list. It isn't covered by my health insurance so this will be expensive. But I am struggling so much with menopause symptoms that I desperately need some help. In particular, the insomnia and brain fog are increasingly putting my job at risk. (I work in a high pressure role and can't afford to be off my best game).

As background, I'm high risk for breast cancer due to family history. I'm under care of a breast clinic at one of the big London hospitals and they say that the safest form of HRT will increase my breast cancer risk by 2-5% and don't recommend it given that I've just spent 5 years on Tamoxifen to try and reduce my risk.

Just wondered if anyone had any experience of Nick either privately or on the NHS?

I don't understand why your GP won't refer you as surely it doesn't cost them anything?

There is a referral form for them on the C&W meno clinic website.

Why won't the refer you?

You can listen to and see him on Youtube videos. One of the most recent was last August where Diane Danzebrink interviewed him.

He is also on Liz Earle's Wellbeing site as a podcast - it's an hour long and he talks on all kinds of HRT issues.

He is one of the best and my own meno consultant knows him and speaks highly of him.

It is certainly worth a consultation although I understand it's a 6 month wait even for a private appt.

Do you have the BRAC gene?

The other expert is Prof Michael Baum (google him too) but I'm not sure if he is retired now. He was a breast expert who was often used by women with high risk like you.

Good luck.

Just checked- if you google Nick Panay and Youtube, loads comes up and the most recent one is top of the search.

I don't understand why your GP won't refer you as surely it doesn't cost them anything?

Fucks know why. They say they need permission from their Chief Executive as they're not allowed, blah blah. Infuriating. This is the same GP surgery who refused to contact my breast cancer clinic to ask a question about if a certain type of HRT might be suitable. Their excuse was "the breast clinic will just say no". Which proved to be total bs as my private GP contacted them and the breast oncologist sent back a very detailed, thought through response.

Classic example of menopausal women not getting the support they're entitled to. I haven't given up the fight but I'm just recovering from Covid and struggling somewhat and there are only so many battles I can fight at the same time. Once I feel better, I'll be back on their case again though.

Do you have the BRAC gene?

I can't be tested unfortunately. My mother and aunt both died at a young age from breast cancer but this was before gene testing was readily available.

I understand it's a 6 month wait even for a private appt.

My private GP thought it was 12 months even for private but today they gave me an appt with him in Feb next year so that was a pleasant surprise! Now I just need to scrimp and save to afford him.

I was referred to him on the NHS (have a history of breast cancer and had a full hysterectomy) but ended up with a different member of his team after about six months waiting (who was amazing). So I also paid to see him privately. There was a four month wait. To be honest, whilst he is clearly incredibly clever and up to date on everything he doesn’t have a good bedside manner. I had some initial bloods taken and had to chase for results. The results were emailed to me with no analysis - I’ve had to request a follow up and a month later still haven’t heard anything. I’ve spent around £700 so far and not got anything out of it so far.
If you can get referred to an NHS meno clinic then I’d go that route.

That doesn't sound great @Martinisarebetterdirty. Sounds expensive and frustrating. I watched a view YouTube videos of Nick Panay last night and I can see what you mean re lacking bedside manner.

I actually just got a referral letter today to Barts menopause clinic on the NHS. I went online to book an appt (as instructed by the letter) and there are no appts available grrr. So not sure what good a referral letter is other than my GP fobbing me off. Big sigh.

It does feel expensive but like you I want to be cautious around the breast cancer aspect. I have to say Chelsea and Westminster NHS were fantastic, but again the follow up appointment is six months away and I fully expect it to be longer and to be bumped nearer the time.
Wishing you all the best of luck - I understand Louise Newsome’s clinic has a shorter waiting list and is a bit less expensive if that helps.

@Martinisarebetterdirty

It does feel expensive but like you I want to be cautious around the breast cancer aspect. I have to say Chelsea and Westminster NHS were fantastic, but again the follow up appointment is six months away and I fully expect it to be longer and to be bumped nearer the time. Wishing you all the best of luck - I understand Louise Newsome’s clinic has a shorter waiting list and is a bit less expensive if that helps.

Actually, that's a good point about Louise Newson. I know her clinic does video appts as well but I was a bit fixated on wanting to see someone face-to-face. Maybe I should reconsider if the private treatment with Nick Panay isn't "all that". It's a lot of money to be disappointed with.

I saw Nick Panay before he became so famous when I was living in Hammersmith and Fulham so he was the gynae I was referred to on the NHS (probably 15/20 years ago).

He nothing short of saved my life. I had horrific PMT - really dreadful - with awful physical symptoms. He listened to me, dealt with everything - he was the first doctor who actually believed me. I cried after my first appointment I was so relieved.

He made me realise I could deal with it and it wasn't in my head as the GPs kept alleging. My career had been suffering and I went from strength to strength after I saw him. I was an unusual case so took part in some other research he was doing. I am still eternally grateful to him decades later!

Hope you get your referral soon! I actually got on with him on a personal level v well.

@StrongArm that's really great to hear, thank you so much!!

@HundredMilesAnHour

I don't understand why your GP won't refer you as surely it doesn't cost them anything?

Fucks know why. They say they need permission from their Chief Executive as they're not allowed, blah blah. Infuriating. This is the same GP surgery who refused to contact my breast cancer clinic to ask a question about if a certain type of HRT might be suitable. Their excuse was "the breast clinic will just say no". Which proved to be total bs as my private GP contacted them and the breast oncologist sent back a very detailed, thought through response.

Classic example of menopausal women not getting the support they're entitled to. I haven't given up the fight but I'm just recovering from Covid and struggling somewhat and there are only so many battles I can fight at the same time. Once I feel better, I'll be back on their case again though.

Do you have the BRAC gene?

I can't be tested unfortunately. My mother and aunt both died at a young age from breast cancer but this was before gene testing was readily available.

I understand it's a 6 month wait even for a private appt.

My private GP thought it was 12 months even for private but today they gave me an appt with him in Feb next year so that was a pleasant surprise! Now I just need to scrimp and save to afford him.

I would write and complain to their practice manager OP.

@HundredMilesAnHour How would you make a judgement on bedside manner from a Youtube video? This is a genuine question, not being confrontational!

I have spoken to NP professionally, for work, not for myself, and found him fine.

I would write and complain to their practice manager OP.

This hadn't occurred to me (so thank you @PeriChristmas) and I might well do this. If only for the women who come after me. I'm aware that I'm lucky enough to have some private medical cover as well as a decent salary so this gives me other options. But plenty of women don't. Especially women attending my GP practice as it's one of the poorest areas in London.

[quote JinglingHellsBells]@HundredMilesAnHour How would you make a judgement on bedside manner from a Youtube video? This is a genuine question, not being confrontational!

I have spoken to NP professionally, for work, not for myself, and found him fine.[/quote]
I just wrote a reply to this explaining that between Covid brain fog and menopause brain fog, I really am a liability at the moment and anything I say / do should be taken with a pinch of salt. I'm a 100 times more grumpy than usual and have significant memory issues. Seriously. It's quite scary actually (I'm not normally like this). I then provided how incompetent I am right now by thinking I'd posted but my reply disappeared (so I assume I hit the wrong key, duh). So please don't anyone trust my judgement right now. Covid brain fog or menopausal brain fog, how the hell do I tell the difference?!

But, to answer the original question, he just seemed to lack warmth and charm. Not essential of course but I guess at almost £400 a pop, I'd maybe expect those attributes. Ultimately, as long as he knows his stuff, it really doesn't matter. Maybe he has them anyway, it just wasn't apparent in what I watched.

I made the initial comment about his bedside manner - for me he lacked warmth and I found it felt as though he wanted to get through the appointment quickly. That is not to cast any aspersions on his technical or medical ability which I’m sure are second to none. I do have a lot of experience of speaking to doctors about things that could be potentially embarrassing too (breast cancer, IVF, potential cancer of the uterus) so it wasn’t that. Maybe he was having an off day or was under the weather himself. Or maybe we didn’t click, generally you do get some small talk to warm you up and there wasn’t any at all.
Just to reiterate - I am sure he is expert and one of the best to see, I just didn’t expect to find him difficult to talk to.

A friend chatted to Nick Panay at a social event ( I was with her) and he was friendly, intelligent and answered endless HRT questions with no sign of impatience. I'd go to him if I needed specialist menopause help.

By far the most amazing helpful understanding specialist in this field is Professor Ann Macgregor at Barts. I believe she is also available privately. Not too sure how long the wait is now.
Mr Panay is at C an W via a long nhs wait but on the whole i have experienced a frustrating really poorly run clinic whilst Mr Panay may be well respected and ok the clinic itself is at best - very poor I have health complexities and have seen mr Panay once due to my insistence the menopause clinic is predominantly run by a nurse on a Thursday only - having been referred to the clinic i spoke to mr Panay very very briefly and never saw him again i only ever saw the nurse until I insisted - as I wanted to raise concerns with him about the really poor lack of support within the clinic - unfortunately there are only 2 menopause clinics that offer HRT inplants, and sadly my experience at curl an Westminster hasn’t been very positive - be prepared for extremely long waits despite a 20 minute rushed allocated timed appointnent the clinic never ever runs on time with waits of 1 hour 40 minutes and 2 hours!!!!
If you can get referred to Professor Ann Macgregor her clinic at Barts is far better run with much better support. Much busier but far less chaotic than chelsea and westminster

This is an oldish thread but wanted to add my endorsement of what Mants said about Chelsea and Westminster meno clinic - it's an appallingly run place, inefficient to the point of being potentially harmful, and with some people whose temperaments leave a alot to be desired - especially for anyone feeling menopausally wobbly. Panay himself I managed to see a few times after encountering problems and complaining multiple times and while at first I found him fine, quite empathetic and easy to talk to, he then became increasingly terse and abrupt and to my mind whatever your techinical/scientific skills, you cannot be a good doctor if your communication skills are that poor - of course it's natural for doctors to like or dislike patients on a human level but to show it is unprofessional. Anyway he's left now so probably even less reason to go to Chelsea & Westminster.

I saw NP at the start of my treatment and he was fantastic. I then saw his team for all of the follow ups. They were all good and the nurse who is often taking appointments is really good at her job. However at one point the treatment wasn’t working and an appointment was made for me to see NP again and I found him very very uninterested.

I'm the OP for this thread and just to update. I was on the private waiting list for NP but was really struggling. I also have long Covid (and had primary hyperparathyroidism unless I was operated on) so impossible to tell how much of my brain fog and fatigue is that and how much is menopause but it was so bad that I was on long term sick leave from work (causing new problems with no income!). My GP referred me to Barts menopause clinic but they wanted to wait until my long Covid settled down (long story) due to the non-specific symptoms I was struggling with. In the end I went back to my GP surgery and basically threw a hissy fit and demanded HRT now (regardless of my breast cancer risk) as my symptoms were debilitating and I needed help. I was given an appt with my former GP (she retired but she apparently does some sneaky part time work for my surgery which they seem to keep on a need to know basis - she's wonderful and I was gutted when she retired) and she prescribed me HRT after seeing an email from my breast cancer specialist at Barts saying that it was worth me taking the risk as I was struggling so much.

So I've been on HRT (gel & Utrogestan) for 3 months and it's helped hugely!! I have my annual mammogram in March so fingers crossed that will be clear and a follow-up with Barts menopause clinic in August (9 month wait for an appt!). So I never say Nick Panay. Probably saved me a fortune - and quite possibly a lot of disappointment reading the experience of the last few posters.

That's interesting stopsnowing as it reflects my experience of Nick Panay quite drastically changing his demeanor for the worse when the treatment hadn't worked.

HundredMiles, I'm glad you managed to find a way forward and hope all goes well, current thinking is that HRT can be safely taken in most cases by women with breast cancer risk. I'm in London so might try St Barts though the long wait is a bit scary, also UCLH has a meno clinic but I can't find any feedback on it.

My experience of Chelsea and Westminster clinic, was one of initial positivity to begin with. I'm a breast cancer survivor and was referred by my GP. I was prescribed gel and utrogestan.

Then that stopped working. So patches were prescribed. Then I had endless bleeding whilst on the patches. At this point, C&W lost interest. Appointments were hit and miss, no clear advice, no follow up calls, no to a coil, no to any other hrt other than gel or patch.

I'm now under Liverpool women's hospital and find the service much better.

I think the clinic might have been good, once upon a time. Not any more.

Glad you found a good alternative Runaround, clearly there's been a severe decline at C & W.

further to my previous message and up to date experience the decline has not got any better with the HRT/menopause clinic at C & W.
Contacting PALS and making a formal complaint has made no difference the involvement of the Gynaecology Service Manager has still made no difference to the chaotic appointment system the service and the overall clinic is an absolute disgrace - that seems justified with ‘lack of resources’ as being a tried and tested response.
This lack of resources makes no difference to the dont care service the dusmissive attitude of the staff and cavalier attitude of the consultant.
I think the fact that the gynaecology department at C & W share one email address with a completely different department and is not checked regularly speaks volumes !!!!!!!

@Mants001 totally agree with you. The ' service' is shocking, given that is in London. I travelled from Cheshire in 2019 for my appointment. Then waited 2.5 hours in a hot crowd waiting room for a 15 min appointment!

Further appointments were sporadic and lasted roughly 5 minutes. Just a horrendous way to run things.

There are far better clinics around the county.