Can anyone recommend a private doctor for HRT?

[Renter77]

I listened to a podcast episode about body identical hormones (not bio) and I’d really like to go to a clinic and talk to a private doctor who is an expert about menopause about perimenopause and try HRT.

Can anyone recommend anywhere? I was looking at the Newson Clinic after hearing the founder on another podcast, but it gets bad reviews about patient care and how the clinic only cares about money! Not sure how true that is, but the reviews are off putting!

Anyone?

My ds went to the Newsome clinic and thought that they were very good. Had a zoom to start and then went for an in person later on.

That’s good to hear he had a good experience! I was about to contact them when I saw the google reviews. Really put me off.

@Renter77 Most GPs are now prescribing body-identical HRT which is transdermal estrogen (as patch or gel or spray) and micronised progesterone.

You don't need a private dr for this and the Newson clinic will just give you what you can get on the NHS.

You will usually need to pay them for repeat prescriptions unless they contact your GP and they take over the HRT prescribing. And you will pay for the HRT either on a private prescription (up to around £50 a month depending on type and dose) or NHS if your GP takes over it.

Just make an appt with your GP to discuss HRT and say what sort you'd like to try.

Private drs are great when needed (my HRT is private) but the main reason to see a private dr is if you need other gynae help (mine is a consultant gynae - FRCOG) and have some more complicated HRT needs, because they can tweak doses to suit you whereas a GP can't, as the dose would be off-licence.

That’s really helpful, Jingling, thank you! I didn’t know most of this.

The reason I’m keen to explore it privately is that my GP prescribed me antidepressants when I went in with peri symptoms before (my mood being all over the place two weeks before my cycle). I didn’t take the ADs in the end, because I don’t think it’s the right treatment for me.

That has made me want to pay someone to really take a look! But - in fairness - I didn’t tell my GP I wanted to try HRT either. (At that point, I didn’t know it could be a possible solution.)

I am also not sure which hormone I should be taking. Or if it’s the actual right treatment for me. I just want to feel normal all month, rather than normal for only half my life!

I would advise you to go back to your GP. Tell them your symptoms and request HRT.

If they refuse, request a referral to a Gynaecologist.

I was 38 when my symptoms really started to impact my life. I kept going back to the GP who tested my blood and said it was normal. I was referred to a Gynaecologist just before I was 40 who diagnosed peri menopause on symptoms and prescribed HRT.

I have felt so much better since starting HRT.

Be persistent with your GP.

@Renter77 If you are in the peri age range- which is roughly 45+ (sometimes younger) then there are no tests done for peri, just a trial of HRT.

If you are younger, your GP would be right to do blood tests to rule out other diseases.

It's best to read the NICE menopause guidance (2015) online that states very firmly that ADs are not to be used for peri /mood/ psychological issues in women in peri. You can then challenge your GP if they are stubborn!

Go in with a list of your symptoms.
Say you want to try HRT and have read the NICE guidance (take a copy in if you want to.)
Say you want to try HRT and body identical type and say which sort.

Just be pleasant and matter of fact about it.

If they refuse, ask what medical grounds there are for refusing, and say you want an NHS referral to a gynae to discuss it with.

I am also not sure which hormone I should be taking. Or if it’s the actual right treatment for me. I just want to feel normal all month, rather than normal for only half my life!

HRT comes as two hormones- estrogen and a progesterone. The latter is needed to protect your womb lining from growing too thick, so it's taken for half the month (or daily in women post menopause.

If you still want to try a private dr, be aware of the long term costs, unless they write to your GP with their recommendations and your GP takes over the prescribing.

Costs for a first consultation vary but are around £300. Further appts are approx 60% of that and needed usually once or twice a year. Requests for repeat prescriptions are around £35 for the admin, then you pay for the HRT as a private prescription - around £50 a month but it varies on how much you use.

I tried with my GP but nothing improved. I follow Dr Menopause on Instagram.
She has a clinic in London and another up north. However her team do zoom appointments.
I had an initail appointment 3 month ago. Amazing! The appointment lasted well over an hour and she prescribed a cocktail of HRT. She sent a detailed report to my GP who issued the precription.

I'm so much better but still don't feel 100% so I'm having a folow up appointmnet soon

This is the clinic

menopausecare.co.uk/

Tbh I’d just try a GP again and say you would like HRT

I went with Menopause Care too, I had my appointment with Dr Kate Lethaby, prescribed HRT and wrote a lengthy letter to my GP to take over the prescription on the NHS.

With the best will in the world, you are never going to get a 1 hour appointment with anyone in the NHS, GP, specialist etc. So if you really want to go onto depth about your health, then it's worth every penny x

In response to the above, mentioning Menopause Care, all I'd say is GPs do not have to follow other GPs' letters/ recommendations. (Bear in mind that the clinic linked to is all GPs, not consultants.)

If your needs are straightforward, your GP ought to be able to prescribe HRT.

I completely understand the difference in consultations, and that can be comforting and also informative, especially if you have some trouble getting an HRT to suit, or want to stay on it for a long time , and need to discuss the risks with someone more experienced than GPs.

There are some GPs who won't prescribe beyond 60, despite the guidance saying otherwise, but I could name at least 2 top UK consultants (incl mine)who have women in their 80s and 90s on it!

I think that honestly you are better finding a local specialist. There are numerous facebook groups and other menopause groups across the UK - I am in a Scottish group and there is a lot of chat about which specialists are worth paying for. But there's no point me recommending my specialist who sees patients in a private hospital in Glasgow, if you live in Portsmouth.

i received an email today telling us micronised progesterone (body identical progesterone used in HRT, also known as utrogestan) is unavailable. Not sure if this is locally or nationally but there are definitely supply issues with a lot of oestrogen HRT products, and now the progesterone too.

It’s a bloody nightmare as a clinician.

Bear in mind what you might want, and what you can get are not necessarily the same…

Do you know what is causing these supply issues, @Sidge ? Is it demand, Brexit, or both?

I’m not sure @HeraldicBlazoning we don’t get any more info. Many medications are affected, across all areas. I expect it’s a combination of Brexit, Covid, Ukraine, Russia. Big manufacturing issue and delays, compounded by transport/logistics and purchasing.

I’m a clinician not in management or procurement though so I don’t really know.

Peter Greenhouse.

Can't recommend enough.

You received an email @Sidge as a n HRT user, or as a HCP? Pharmacist?

Usually, Besins who produce it are very good at answering emails about supplies.

I've emailed them before to ask about gel.

Yes, I got the usual response that the BMS received and posted, but they also did say they'd try to signpost me to suppliers and that each pharmacy was getting some - it was just flying off the shelves as soon as it landed.

I've got an appointment at our local Nuffield with the doctor Davina recommended in her book, it was a three month wait. Can't recommend as I haven't been yet but am hopeful

@Sidge Are you able to say what your role as a clinician is? It covers so many roles.

The reason for asking is that the BMS update on 22 November, shows Besins saying that Utrogestan is available- no supply issues.

here -
thebms.org.uk/news/british-menopause-society-update-on-hrt-supply/

It would be helpful to know if you have received anything new to update this.

If you are a GP, and have received a heads-up on supplies, that the BMS is unaware of, they need to know, as do women using it.

I’m just a prescribing nurse practitioner, specialising in women’s health. I do a lot of HRT and contraception.

The email we received today was from our locality pharmacist lead clinical advisor bod, I don’t know their source - didn’t have time to read all the attached documentation and alternatives as I was doing a clinic!

Might be different elsewhere. I’m so tired of all the restrictions, I just wish there was consistency in availability.

.

I went to the newson clinic in august and I already feel like the old me, I have been struggling for years, given up with any doctor I had seen in my surgery as I just wasn't listened to. It's been worth the money and the time travelling to and from appointment, got a follow up in a couple of weeks.

Thank you all!

I’m 42, so younger than the age where there are no tests it sounds like (although I’m happy for tests!). I was 41 when the GP gave me ADs. But something has been “off” that’s felt hormonal for a couple of years now, so I think peri might be starting early for me. Which makes sense as my periods started when I was 11!

I’m in London, and willing to travel a few hours - buy yes, Scotland is a bit far!

Since you're in London, if you want a serious specialist, go and see Dr Nick Panay. He's about £450 but he's the best in the business. Private waiting list is 6-8 months though. His NHS list is obviously much longer.

(Note: I've been waiting for my Utrogestan prescription to be filled for 2 weeks now! That's in east London).

@HundredMilesAnHour If it's any help, there is a post on Menopause Matters about Utrogestan. Someone has a reply from Besins to say there was an issue for a short time, but it's been sorted and supplies should be back to normal soon (this week?)

@Sidge

Thanks @JinglingXmasbells yes I saw the post. Just hoping some make it to my pharmacy before I run out.