How do doctors decide whether you can have HRT or not?

[tartytowers]

I'm 46, and think I have perimeno symptoms, especially anxiety and brain fog, aching, tiredness, etc. I've been diagnosed as having long covid and my long term antidepressant dose was just increased and that was it.

I've read that the last thing you need if you have perimenopause symptoms is antidepressants, but I do find my GP surgery are overall quite dismissive of things. A friend who is my age went to try to get HRT and they said nope, if you still have periods you don't need it, and that was that.

Read, read, read!

There is a lot you can do to inform yourself.
The NICE menopause guidelines are a start (google- they are online.)
Sites like Menopause Matters (not the forum, but the info on HRT) written by a consultant gynae.
Sites like those of Dr Newson.

If you want to try HRT your dr has to give you a very good medical reason why it would be unsafe for you.

There are a few reasons (some cancers, heart disease etc) but you'd know about these I assume already.

There are two main types of HRT- one for women with periods and another for women post menopause (no periods.)

Be polite of course, but assertive, and be prepared to quote NICE which says ADs are not appropriate for peri symptoms.

I was dismissed like this as well. "No we don't give hrt due to cancer risk" and that was that.

I was having all of your symptoms and had a phone call with the doctor. He offered antidepressants but I said I don't think I'm depressed can I go on hrt and he did agree. I didn't have a blood test or anything. I'm on one a day tablets and it's helped me so much been on them 9 months now and wouldn't look back.

My GP tried to say I couldn’t have it because of the cancer risk.

i had to be very diplomatic and rather than tell her that was very outdated advice I told her I knew of the “risk” and I’d like to make an informed choice to take HRT. She said ok.

The challenge with long Covid is that many of the symptoms are non-specific and can be the same as menopause. Anxiety, brain fog, fatigue, aching etc. The difference is that with long Covid you will VERY slowly improve whereas with menopause the symptoms will stay the same or get worse. So if you get worse and/or don't eventually improve, go back to your doctor.

Im 45 and went to GP with bad PMT, brain fog, low mood, memory problems, lethargy … did blood tests which came back as non menopausal.
Yet she was amazing - said she could prescribe the pill, antidepressants or HRT and that the blood tests are notoriously unreliable so it’s more about the symptoms I’m experiencing. Text me lots of information. To be honest, I held off but am tempted to go back again and take HRT as my symptoms are getting worse. My sleep is also being affected now, and my periods are more erratic and heavier but im not getting hot flushes.
So there are some better GPs out there … worth a second opinion.

Mine was actually great even though I’m under 45, had a whole questionnaire on the computer which we went through which gave me a risk score (things like family history of breast cancer, if I’d ever smoked etc). Then gave me various choices and I asked for the one I wanted. Job done.

my GP surgery are overall quite dismissive of things

In last 3 years, what else did you consult them about & what was their response?

Our local GP practice is offering blood tests- not sure why.

Thankfully the one I saw just out me on HRT on the basis of symptoms alone, but I got told it was for minimum time possible. Not sure why because if you expect me to work until I’m 67 I’ll need the hormones to keep going!
I’ve a sneaky suspicion it’s due to cost, since there are no prescription charges in Scotland.

@lljkk well, my daughter was fobbed off about being referred for something and had to get the PCT involved and then the GP decided they could refer her

My DH went repeatedly for months about a very bad back and was fobbed off and told to do stretches. They wouldn't even prescribe painkillers. When he got numbness too they wouldn't refer him and said to 'stretch more', so we had to pay for a private MRI which showed a severely ruptured disc and he was then operated on, on the NHS, within a week, and could have potentially been left with severe nerve damage permanently affecting his bladder and bowel.

Thank you everyone for the replies! I'll fill myself up on NICE guidelines and make an appointment!

I was 42 when I started hrt. I had severe symptoms and regular but lighter periods. Hrt is a life saver for me. I am 46.

Think I’d be finding a new GP.

If I do go, and they say 'Nope, we don't prescribe it here' or that I can't have it due to me still having periods, do I quote NICE guidelines at them, or make a complaint to the practice manager?

Print off the guidelines and take it with you? Ask for them to document on your records that you want to discuss them.

I was fobbed off for years by my GP. I'm the younger side of normal though. I ended up having to go private via the Bupa meno pack. Been prescribed HRT now - cried with relief that I was believed finally!

Nice guidelines state if you're over 45 and have symptoms of peri you can be prescribed HRT with no further tests. If under 45 (like me) it's two FSH tests 6 at least weeks apart and then possibly being prescribed HRT depending on the results.

Ah I hadn’t realised that re blood tests in younger people. I’m old!

They tell you they won't give it to you no matter what because it gives you breast cancer ( no history of this in my family ) That's what my ( young male GP) said when I went through menopause at 48. Nearly 10 years later I have serious joint issues and arthritis which I suspect could have been delayed or averted if I had been "allowed" HRT. I suppose it's too late to start it now...

Just be clear and persistent- the Nice guidelines are clear that a woman’s request is enough of a reason to prescribe and don’t be fobbed off with the cheaper options- insist on patch/gel and progesterone pill which is the the gold standard.

Wikipedia says PCTs stopped existing in 2013.
aren't the commissioning groups called ICS now? And CCG before that.

I imagine even if OP's DH had a referral for his bad back it would have taken 9months+ to get scanned (if in last 2.5 years).

No it is not too late at all

Read Louise Newson's info on menopause dr.

If you start HRT within 10 years it's more beneficial

Oh well, whatever the PCT is called now. She's an adult and did complaining/request herself. Sorry I got the terminology wrong

I have the same problem but I live abroad so NICE guidelines don't really work! It's frustrating.

It's never too late. I know of women (according to my consultant) who asked for it in their 80s and 90s as they still had symptoms.

The max benefit to your heart is within 10 years of your last period.

You can start at 58, 68, 78 as long as you find an educated dr.

It is your RIGHT to have prescribed medication for your health and NICE makes it clear that it is a woman's choice.

Don't accept this type of attitude.

Just insist on trying it to see if it helps you. Keep asking for a different doctor if they refuse. Just keep on. I also think you can order hrt online the one I'm on is called elleste duet it's one tablet a day it's helped me so much