Getting nowhere with GP...partial hysterectomy, osteoporosis & depression

[Whitehorsegirl]

I am 51 and I want to HRT to deal with hot flushes, tiredness, creaky joints, anxiety/hopelessness, not feeling like myself anymore. I had a partial hysterectomy about 5 years ago so kept functioning ovaries but I recently started feeling like I really needed to do something. I also have osteoporosis so I thought HRT would help protect my bones too alongside exercise/calcium. I did some blood tests first to make sure there were no other health issues causing the symptoms.

I have had two appointments this week with two different GPs and getting nowhere fast...

The first one prescribed something which is not available anywhere.

The second today prescribed a cream but when I got home and read the leaflet I realised she prescribed something totally useless as it is only meant to deal with vaginal dryness only and will have no effect on my actual symptoms...she also wrongly told me that patches did not exist for oestrogen only which is clearly wrong. This is just driving mad.

• Does anyone here has experience of what the best HRT is for women who had partial hysterectomy and what they should be prescribing me?
• Can anyone give me advice on dealing with this useless practice? I have just made a complaint and the practice manager will apparently ring me back.

I was thinking of going private but I am worried about the cost of repeat prescription, do you need to pay every time you would need a prescription renewed?

I am in London and any advice would be much appreciated.

what rubbish treatment!

If you have osteoporosis, are you being monitored by a specialist? (You ought to have seen one, at least.) How long ago were you diagnosed?

What treatment are you on for it? Are you on any drugs and how severe is it?

Reason for asking is that they could be the ones to prescribe HRT with the repeats taken on by your GP.

HRT is licensed for osteoporosis in women under 60.

What did you first GP prescribe? I'm assuming it's estrogen gel. If it's not available (it will be, once the supply issues are sorted out), the alternatives are at the discretion of the pharmacist. Did you take your prescription in and ask for the best alterative? It would be a different gel or spray OR if that's all gone, an estrogen-only patch.

@JinglingHellsBells

The first GP prescribed Sandrena 1mg gel

I tried various pharmacies, including a large Boots pharmacy, and could not get it. One of the pharmacist then scribbled on a piece of paper that all they had in stock was Evra patch and Ovestin cream.

The silly second GP prescribed Ovestin cream only telling me it would get the oestrogen all around my body and deal with all the symptoms.I specifically questioned her on this point to make sure it was not just a cream for vaginal atrophy. Then I got home and read the leaflet and realised she did not have a clue...

I saw a specialist for the osteoporosis but at the time he suggested that calcium and exercise should be used first and that I did not really need drugs then discharged me.

I really despair at doctors in this country at the moment...

Why not go back to the GP and ask for a new prescription for your HRT?
If they are prescribing gel, the pharmacists now have the authority to offer a substitute. That could be an estrogen only patch (did you mean Evorel? Or Estradot, or an estrogen only tablet - to be changed back to transdermal when available.)

I find it hard to accept that if you had a diagnosis of osteoporosis, you were not given drug treatment or at least a follow-up in a year or two. Do you have a record of your T-score (your bone density score)? Your GP will have this.

Why were you referred? Were you breaking bones or family history?

You should be given a DEXA scan every 3 years at least and ideally every 2 years if you already have osteoporosis.

Go back to your GP and insist you are scanned to see how your bones are now!

My blood is boiling at your GPs' ignorance.

Educate yourself with this and perhaps go back to your GP, or ask around and change practice:

balance-menopause.com/uploads/2021/10/Easy-HRT-prescribing-guide-NHMS.pdf

The publisher of this guide is an expert who had to take her clinic private as she wasn't getting enough traction with the NHS.

www.newsonhealth.co.uk/

Have a look in the Resources section too. www.newsonhealth.co.uk/resources/

I am very lucky with my NHS GP practice, they seem very good with Menopause and HRT.

But a friend did have a consultation directly with Newson Health, then took her prescription back to the NHS successfully.

Would you be willing to tell us the reason for the hysterectomy as this is important in advising on HRT preparation.

if your GP isn’t confident in HRT prescribing then they should refer you to a menopause specialist. Perhaps you could ask for this?

in answer to your question another alternative to Sandrena gel is Lenzetto spray.

Would you be willing to tell us the reason for the hysterectomy as this is important in advising on HRT preparation.

It's very simple to prescribe for women who have no womb. It doesn't matter what the hysterectomy was for (usually.)They only need estrogen. Most women find they get side effects from the progesterone, so estrogen-only is really simple.

The trend now is to offer transdermal, but for someone young like the OP (ie under 60) tablets are acceptable too.

I'm interested in why @Whitehorsegirl were referred and diagnosed with osteoporosis.

Your 'treatment' seems crazy to put it mildly!

Do you have actual osteoporosis or was it osteopenia which is low bone density but not as bad as osteoporosis?

There is now new evidence that taking calcium unless someone is deficient, (and that isn't the same as having low bone density) is harmful to the arteries and also it doesn't necessarily help bone density either. It's better to get your 700-1000mgs of calcium from food.

Please start making a lot of noise over all of this and get referred for an update on your bones and ask for HRT anyway.

I went private because I had cervical cancer many years ago and had a radical hysterectomy. I had a feeling I wouldn’t get very far with a GP in terms of getting them to agree to prescribe.

I paid £250 for an initial hour appointment and my prescriptions have been £10 a month. The specialist I saw did say I could get repeat prescriptions through my GP so you should be able to do that.

Thanks everyone for the replies.

The partial hysterectomy was done due to adenomyosis and heavy bleeding (not cancer) that nothing else had been able to control. I also had endometriosis.

I did go back to the GP (this morning) only to be prescribed a useless alternative which is why I am so angry. She did not seem to have a clue about what to offer.

The pharmacists I spoke to after I was given the first prescription (the Sandrena gel sachets) did not try to offer an alternative, just said I needed a new prescription...Again I might try another pharmacy in a different part of town.

I had a diagnosis of osteopenia in my spine and osteoporosis in one hip. To be honest I read such awful stuff about the drugs prescribed for osteoporosis that I wasn't keen but the specialist did not prescribe anything. I have never broken anything apart from the tip of one finger that got caught in a door...

Anyway I am getting fed up of going back and forth with this surgery so will get a different GP but that means more delays and I should not have to put up with such uselessness for something like HRT which should be fairly usual for them to address.

I will ask for a referral to a menopause clinic.

@JinglingHellsBells

the reason for the hysterectomy is very important. Women with endometriosis have endometrial tissue outside of the uterus and therefore giving unopposed oestrogen puts them at risk of developing cancer of the remaining endometrial tissue and so they really should also receive progesterone.

The rule about pharmacists being able to swap your Sandrena prescription for something that is available is very new, can you take the prescription back and ask the head pharmacist directly about this.
If you havent still got it ring the doctors and request a fresh prescription and tell them that even if the sandrena isn’t in the pharmacist can now swap it for something else

@RolaColaLola Not always. It depends. Also, the OP has her ovaries. These would have kept on producing estrogen for a while anyway after her womb was removed. So any endo tissue would still have been stimulated. There's little point removing the womb only if there is endo, as the endo tissue can be anywhere in the body.

Yes I was going to try other pharmacies tomorrow to see whether a decent pharmacist could actually just use the initial prescription for the gel sachet and give an alternative.

and yes when I was researching HRT for women who had partial hysterectomy today I did come across something about needing progesterone if you still have a cervix as I do. Maybe the best thing is to get a referral for a menopause clinic/specialist to discuss this but I assume it will take time to happen and I am exhausted all the time at the moment...

Or maybe I should just pay for a private consultation and then try to get the GP to renew the prescription given. Has anyone manage to do that? and if you did and are in London please don't hesitate to DM any advice on what private specialist/clinic to go to.

I am so concerned about how my health is at the moment that I want to do all I can to try to improve it.

@RolaColaLola I am guessing that the OP's GP knows about this and therefore she thought estrogen only was ok.

I agree with your comment however, that if it was endo, it needs further thought.

@Whitehorsegirl Glad to see you here giving a bit more info.

I misunderstood as a partial hysterectomy can mean all the uterus removed but the ovaries kept.

Your GP could refer you to the NHS Chelsea and WEstminster Meno clinic (all the booking info is online for GPs to read.) They used to say there was a max of a 6-week wait. Not sure what it is now.

Yes, you can see a private consultant and they can write to your GP and suggest the GP continues to prescribe whatever they recommend.

But what about the osteoporosis? How was that diagnosed and are you not able to insist on a referral to a rheumatologist?

I’m a pharmacist, bit of misinformation going on here I’m afraid. Pharmacists have only been given the ability to give an alternative on certain hrt, not sandrena gel sachets. However the pharmacy I was working in today could get sandrena, which was a Rowland’s, so if there’s one near you try there. If you can’t, get your gp to prescribe you oestrogel, as pharmacists can give you an alternative for that if they can’t get hold of it. With regards to osteopenia, you can buy calcium/vit d tabs over the counter, such as adcal d3.

@Berlioz23 Adcal and other calcium tablets are not a treatment for osteoporosis or osteopenia. (I have had monitoring through experts for my own low bone density for many years.) Women with osteoporosis are only given these is they are elderly with a poor diet, and / or low in calcium following a blood test.
There is also new evidence that on the whole, they are harmful- was in the press last week with some drs saying they ought not to be available.

6 weeks would not be too bad if that means the right HRT/a thorough consultation. I will try to ask for a referral for that clinic or similar as part of my complaint.

I did have a Dexa scan and I saw a consultant after that who decided not to prescribe meds. There is also the complication that some of these osteoporosis meds can affect the jaw bones and I have had an operation/reconstruction on my jaw to straighten it so again it is a bit of a complicated issue in my case.

I will also ask for a new scan but again the HRT would help with protecting my bones if I understand correctly.

I really appreciate everyone's feedback!!

Sandrena gel is substitute for Oestrogel.
I think the GP knew Oestrogel was out of stock in many places, so plumped for Sandrena (which is now also out of stock sometimes!)

So yes, ask for Oestrogel, then you have the option of Sandrena, a spray, or an estrogen patch.

Thank you @Berlioz23 for the clarification. Will try the prescription again tomorrow to see if someone has the sachets in stock and then will ask for referral to look at HRT longer term.

@Whitehorsegirl Jaw necrosis, as it's called, is rare but if your consultant through that the usual drugs for osteo were unsuitable, they ought to have suggested estrogen.

Maybe you don't want to say why, but how did you come to be assessed for bone loss anyway?

You really need to know your T-score. (I have my bones scanned every 2 years.)

The dose of estrogen you need for osteo is linked to your bone density. Some low dose HRT is not enough.

@JinglingHellsBells umm.. not a treatment, no but as the op is unable to take bisphosphonates and at 51 she still has many decades of life left. Also as the op hasn’t mentioned her calcium levels we can’t rule that out. The jury is still out on the effectiveness and safety, but the latest studies look at higher levels of calcium than the one I suggested (adcal d3), especially if just taking the recommended otc dose. I went through POF at 23 and my endocrinologist still recommends calcium and vit d tablets, having read the evidence myself I can’t disagree with him.

@Berlioz23 You might find this interesting.

Calcium pills may cause heart damagel

Sorry it's the Mail but it was in other more reputable sources too- but often behind a paywall.

@Berlioz23 The treatment for women under 60 (especially) with osteoporosis, is HRT. Bisphosphonates are for older women. Sorry to bang on but I have a lot of personal experience of this (treatment of osteopenia as well as writing about it professionally.)

British Menopause Society statement on this.

Prevention and treatment of osteoporosis in women

Summary

The British Menopause Society Council aims to aid health professionals to inform and advise women about post reproductive health. Osteoporosis affects 1 in 3 women. This guidance regarding oestrogen and non oestrogen based treatments for osteoporosis responds to the controversies about the benefits and risks of individual agents. Treatment choice should be based on up to date evidence based information and targeted to individual women’s needs.

Summary practice points

HRT reduces the risk of both spine and hip as well as other osteoporotic fractures.

Oestrogen remains the treatment of choice for osteoporosis prevention in menopausal women, and especially in those with premature ovarian insufficiency.

Bisphosphonates are effective for treatment of established osteoporosis, reducing both spine and hip fractures.

Bisphosphonates have a very long skeletal retention time and hence should be used with caution in younger postmenopausal women (e.g. those aged below 65 years).

Denosumab is an effective treatment for reducing spine and hip fractures in osteoporotic women.

Denosumab should be avoided in women with increased susceptibility to infections.

There may be an increased risk of fractures after denosumab discontinuation.
Provision of adequate dietary or supplemental calcium and vitamin D is a part of osteoporosis management

The effects of calcium and vitamin D supplements alone on fracture reduction however, are contradictory and may depend on the study population

@JinglingHellsBells I won’t derail the thread any further, I’ll PM you.