Appt with NHS Meno consultant in 3 days & dont' know what to ask / say???

[54isanopendoor]

My GP eventually agreed to put me on HRT 15m ago.
I'm 54 & was still menstruating each month but was very peri symptoms.
I was given Evorel Sequii conti. patches.
It helped for about 6m but then effectiveness reduced.
I was told that I couldnt have a higher dose.
I was given progeserone pessaries (100mcg) & estradot transdermal (75mcg)

I have not started this yet. I've had a horrible year & was 'waiting for the right time' (stupid, in hindsight as peri symptoms back with a vengeance) but
My Mother died of Ovarian cancer & I am waiting to hear back from Genetic counselling to see if I am increased risk or not so I sort of 'froze' ?

My GP (unbeknownst to me) referred me to a Meno consultant on the NHS.
The video appointment is in 3 days.
I feel I should cancel it as I've not started the 2nd type of HRT so I'm a 'fraud'.
But I'd also feel guilty as they might not be able to re-allocate it at short notice / I might not get another chance.

What would you do in the circs please?

I'd probably attend and talk about how things are, the cancer history and why I haven't taken the new stuff.

can I query the progesterone pessaries.

what are they?

Micronised progesterone - Utrogestan- is the usual progesterone to use with estrogen-only patches/tablets/ gel but it's not licensed for vaginal use in the UK but many women do use it that way with a consultant's advice (or they just use it that way and don't mention it to the GP.)

Are you using Provera or Cyclogest?

Or is it Utrogestan but your GP has said use the capsules vaginally?

If it's Utrogestan they are not pessaries- they are oral capsules, also used as pessaries if needed.

Sorry for all the questions but it's an important distinction, basically to understand where your gp is coming from!

Sorry to hear about your Mum. Do you have a date by which your genetic risk will come through?

There is no established link between HRT and ovarian cancer, although some studies show a minute added risk.

What you should have - either on the NHS or privately - is an annual pelvic scan of your ovaries to give you peace of mind.

(I see a private meno consultant and have private scans every 12-18 months, a bit like women have smear tests- like a MOT.)

Back to your question- it's your choice of course but I wonder what you will get out of the appt?

Many drs in menopause clinics are 'just' Gps with a little extra training but they won't be able to tell you about your genetic risk, or help you decide what to do.

If you want more info about OC, the charity Ovacome is a great source of info.

Hi @JinglingXmasbells
My appt has been re-arranged to the 19th (I got a voicemail)
so still time to reply to your very helpful post (thank you)

The prescription is:
Estradot 75mcg
Lutigest 100mg vaginal pessaries

I'm keen to use something to avoid bone density loss (I had bariatric surgery so my calcuim is supplemented but orally which I don't ingest very well now)
apart from that I just have horrible peri symptoms (mostly insomnia, brain fog, anxiety & hot flushes) & haemorrhoids (for completeness)

@JinglingXmasbells sorry, forgot: no I've no date by which they will come back to me re genetic risk. My Mum died in May. Her initial ovarian cancer had been missed until it was everywhere & she had an awful death. My GP was reluctant to pass me to the genetic service & they seemed disinterested but said they'd 'try' to reach my Mother's records but as I'm in Scotland & she lived in England they said they 'didn't hold out much hope' so I'm not holding my breath.

I'm intrigued why your GP has given you Lutigest and wonder if they have some 'reason' to do that rather than Utrogestan?

Lutigest isn't licensed as HRT treatment. It's a fertility drug (and so is Utrogestan when used in large doses.)

Do you know why?

In some ways your GP may be 'enlightened' but if they wanted to go the vaginal route they could still have prescribed Utrogestan, which isn't actually licensed for vaginal use (in the UK- in Europe it's been used that way for years) but most specialists prescribe it that way.

I'm sorry to hear about your Mum. Sadly, late diagnosis of OC is often the case. I think you ought to push for annual pelvic scans (or even pay, privately if that's an option) but the link with HRT is very tenuous (I think that stats are something like 1 possible extra case in 10,000) and most drs wouldn't consider it an issue.

Ah- you are in Scotland. In some regions of Scotland, Utrogestan is not licensed for use. Don't ask me why , but it isn't. You could I assume pay for it on a private prescription.

@JinglingXmasbells

THANK YOU for replying so promptly, it is very kind of you x

I am not keen to take any fertility drugs (I had extensive IVF 20 years ago & over responded - OHSS& I have always wondered about later OC rates for those whose ovaries were subjected to such abnormal amounts of chemicals...)

The vaginal route is probably because I don't absorb through my stomach now.
I wonder if it is worth keeping my appointment - saying that I have delayed starting the meds as awaiting feedback from Genetic counselling - & asking if I can be given Utrogestan instead?

I'm keen not to 'waste' the opportunity to speak to a Consultant -
(my GP said: 'oh, I sailed through the menopause, if you struggle you could speak to the chemist' for 2 years until she agreed to prescribe HRT)
but I'm still not sure whether it would annoy them more for me to re-arrange it now, or whether to 'use' it now & poss need a further appt to see how I get on?

I don't know if you are still reading @JinglingXmasbells but in case you are, I kept my appointment with the HRT consultant.

As I had a period since coming off 6m of HRT the Consultant said she'd prefer if I stayed on Everel Sequii Conti (same dose) but 'could go up to a patch & a half'.
OR I could have a mirena coil fitted & take an oral oestrogen. I pointed out that I don't absorb well orally any more (& I had troubles with a coil years ago) so she said I could take a patch & progesterone pessaries but they a unlicensed & 'won't give enough proctection' (though she did say they had a lower breast risk). She was dismissive about any risks from IVF or my Mother's ovarian cancer.

So it was left that she will write to my GP & 'I can choose which route I want'.

I am not sure I feel any clearer tbh.

I'm confused too @54isanopendoor !

Is the consultant talking about Utrogestan or is this not available in Scotland? I know it's not in some areas.

Or is she talking about Lutigest?

My understanding is that Utrogestan and Lutigest are the same in terms of their drug content but the latter is not licensed as HRT.

That's why I queried why your GP was suggesting it.

Certainly, Utrogestan is an acceptable form of progesterone.

You might like to read the info here, which is from the best NHS meno clinic in the UK. They take referrals from all over the UK (not sure about Scotland) and the clinic deals with complex meno issues for women with complex needs. It's headed up by Nick Panay who is an eminent menopause consultant/ gynaecologist/researcher, and he will have provided info on the leaflet I've linked to.

It's for GPs to help train them.

Obviously, Utrogestan can't be ineffective or it would not be on the list.

www.chelwest.nhs.uk/professionals/gp-advice-and-troubleshooting-guide-for-hrt-in-primary-care

Can't you have a higher dose patch and Utrogestan? Or the combined patch?