Disappointing menopause appointment

[SpamhappyTootsie]

I follow the threads on here and I thought I was all prepared for an appointment with the Nurse Practitioner this morning (my first).
Had the usual gatekeeping oh you need a smear…..hmm, you haven’t had your bloods done for a while……blood pressure a bit high, buy a monitor to use at home and come back in a week or so
She would not listen to anything I said so now I’m a menopausal sobbing mess at home because I can see my 50s just vanishing in a fog of forgetfulness and joint pain. I’ve already turned down a fantastic job because of my energy levels. I have to choose what social and leisure activities I do because of the joint pain and fatigue.

Give me a kick up the arse, please. I’ve just spent £62 on a blood pressure monitor so I can play along with her stupid game, but I feel like next time I go there will be some other hoop to jump through.
Do I go private? Change GP ? How to combat the White Coat Hypertension because if HRT is riding on some magic number in her office then how will I ever get past that? HRT is proven to lower blood pressure ffs!

@JinglingSpringbells

I just went upstairs to do something and this post instigated me taking my BP

I took it the first time and it was 147/88, waited 2 minutes and took again 136/82 waited another 2 minutes and it was 126/80

the first reading the machine said I had slight hypertension, the second said my reading was normal to high and the third reading was normal.

It shows that just one reading isn't going to be giving a decent overall picture of BP

I've recently been prescribed HRT. The surgery did want me to have blood tests and a smear first (it was overdue). I'm not sure if it's essential or best practice.
But it does mean they have your baseline data for some really important issues that could have a bearing on the symptoms you are having.
I've been reassured that I am free of HPV my BP pressure is normal but I am low on certain vitamins and minerals in my bloods.
The HRT is helping quite a bit but it's not a miracle cure.

It's important that anyone taking their BP does it as advised (info usually with the machine.)

1 Relax for 5-10 mins beforehand. Do not exercise, walk around the house, talk to anyone or do it after just drinking a hot drink (or booze- even worse.)

2 Rest your arm on a table so your arm and the cuff is approx at the same height as your heart.

3 Have the cable in the right position (slightly off centre to your forearm.)

My first post in here. I'm a community pharmacist. All GPs and NPs in England should follow their local medication formulary. Your NP is not giving you the right information. If you Google the name of your local Integrated Care Board or your county and "medication formulary", you should see your medication formulary which would show the HRTs your area allows. Message me if you need help.

@JinglingSpringbells I’m really sorry I missed that, the last thing I want to do is make anyone feel like I’m ignoring or skimming over their advice

@Oblomov23 no, I’m usually very assertive and know what I want before I discuss anything official with anyone, whilst still being open to their professional judgement. I can’t overstate how the birth trauma has impacted me wrt to navigating GP appts where they are more concerned with their smear targets than what I’ve actually gone in for. I will work on deflecting that next time and not feeling backed into a corner about it. I felt like I was fully prepared with all the salient facts ready to give her, including family history of breast cancer.
I did post this morning feeling miserable and asked for a grip, so consider me told.

@ivykaty44 wow, that’s quite some difference in those readings. I’ve just been out for a walk to clear my head and had a cup of coffee, so I’ll chill for a bit and maybe try the BP machine.

@justasking111 yes and yes. I am prepared to do a HPV swab. I am not prepared for a stranger to insert a metal implement into my vagina. That’s non negotiable for me, whatever anyone thinks of my choice not to have a smear.
My diet is good and rarely exceeds 1600 cals a day, yet the weight is piling on. I need to run and hike and do HIIT gain, but I can’t, because joint pain from menopause is crippling me and I need an afternoon nap.

@Beamur I have had blood tests in the past 6 for the joint pain, fatigue etc. I was offered antidepressants and I don’t want them, because it’s not depression. It was perimenopause and it’s now impacting my life so much I want to try HRT.

@tracyalice thank you, I will do that. It may be that my GP only offers an older HRT that does contraindicate elevated BP. At least I’ll know, then and can look elsewhere.

To be honest, OP, I think that's ok.

You could have underactive thyroid and vitamin deficiency which need addressing. When that's corrected you'll be better able to assess whether HRT is helping you when you start it.

I say that because I went feeling awful and had low Vit D, Iron, and thyroxine. No amount of HRT would have solved it if I hadn't addressed that too!

I get your frustration- I haven't managed to feel better yet, despite addressing all the above. I'm trying different HRTs, but can't get the necessary follow up appointments to tweak the dose etc.

It's hugely frustrating. But I'm glad my various other deficiencies are now in hand!

At my surgery it seems to be the NP who did my menopause assessment, over the phone but I had been seen a week earlier by the nurse. She was excellent, we had a really good, fairly lengthy discussion even down to which pharmacies had better stocks. She prescribed a 3 month trial of exactly what I asked for.

I do get that @picklemewalnuts , but I went to the GP in my mid forties expecting underactive thyroid and/or low Vit D and they offered me ADs because the results were fine. Then I went again just before I was 50, same symptoms but worse. My iron was well within range but they offered me iron tablets. When I complained they refused to give me a print out of my results until I asked DH to phone with my permission to discuss it. Turns out he had worked in the same corridor as the Practice Manager in an NHS dept and lo and behold, I was allowed my results print out as long as I promised not to use it as a basis for an official complaint. Then I was offered ADs again.

Is it just that my GPs is a bit shit?

Is it just that my GPs is a bit shit? sounds like it, you can go on the app now and get your results for everything for about the last 25 years anyway

Sounds like it, doesn't it?

Sorry

I'd go private to be honest. I suspect there's more than menopause going on.

Is the British Menopause Society the sort of reputable organisation I need to be looking at? There is a specialist near me who is registered with them. I don’t want to say who as it’s potentially Outing, but there’s a good chance I can get to see them.

Yes, definitely reputable but bear in mind that some of the drs listed there are GPs with meno training and others are at the top of the profession as consultant gynaecologists. I am happy to advise if you want to PM me as I have insight through my work and 'know' some of them (but won't out myself by saying how.)

This one is a meno trained GP with a private clinic at at local(ish) private hospital. If I can register with her practice I could see what the waiting times are and switch to her private offer. I am well within the area for her GP practice.

Has she got any endorsements on her website from happy patients or any reviews online? Does she detail her experience or qualifications in meno? The BMS does many courses all year round on HRT (but it always looks as if very few GPs do them, from some threads here!)

TBH if she is a GP working in the NHS and offering meno support, it may be just as well to register with her practice or call them and ask about appts.

Reviews are good, several mentions of her as a champion for women’s health. Local FB group says the practice is good (small, some phone problems occasionally but nothing major). Looks hopeful. Bound to be better than current practice with no dedicated GP and an unhelpful Nurse Practitioner!

Thanks @JinglingSpringbells and everyone who has answered. I am in a much better place than I was this morning. Might even go and start to get my money’s worth from that bloody BP machine in a minute

Try magnesium supplements. Takes a while to kick in but does wonders for your energy levels

I don't disagree with this at all, but would like to point out that my (very good, holistic, NHS) GP said that if taken long term, rather than just for a few days, you could in extremis end up with too much of it, and it would be a good idea to measure levels before starting on it, and then again during routine bloods once on it. Magnesium can lower blood pressure (too much in some cases), and can interfere with other drugs, along with other mild and serious side effects and complications. Look it up at the Mayo Clinic website, search for magnesium, it's the second entry in the results.

I wouldn't see that Nurse Practitioner again, I'd complain about her attitude and see a GP. I don't think it is ethical to make blood tests conditional on having a smear or even go on about it during the consultation, as it is rarely going to be relevant to the matter in hand (although please do consider getting your smear done as a separate issue) and if they saw anything in your blood tests that would indicate you might warrant further gynae or cancer investigations they would tell you. Or even doing your home BP testing (essential to get done now morning and evening over a week as a PP said) first as this can be done in parallel given that it will take time to get the bloods taken, wait for the results, and then wait for a follow up appt.

Also even if you would like to bring down high blood pressure naturally, via exercise and maybe supplementation, untreated HBP can be dangerous both short term and long term, so it would be a good idea to start on any recommended medication, and bring down the dose with your GP's guidance once you are able to exercise more and/or are supplementing with magnesium. They will usually start you on a low dose and gradually increase it over time, if BP monitoring suggests it is needed, anyway. Defo get your thyroid checked out too, and get a copy of the actual results not just an "okay" which might mean you are borderline for hypothyroidism. Many GPs rely on the figures without really understanding fully what being inside or just outside the reference range can mean on an individual level and what to do next.

I am not medically trained. I do however have all of the problems you listed as well as others and I have been very lucky to have an excellent GP for the last 2.5 years while going through quite a lot of problems, although she has recently left boohoo.

So you would know how bad it was ? So when you do your own you know what to compare it to?

@SpamhappyTootsie I wonder if your thoughts/ideas are not being recognised by the people you deal with as you come across a bit unknowing about some of the aspects of HRT and of even how to take a blood pressure reading. eg you mention going off to have a cup of coffee and taking another BP reading but on the other hand you come across as quite determined but not willing to listen to anything that doesn't agree with your thoughts. Like yourself I have HBP ( have been on meds for 35 years ) and am on HRT. I am aware of the pressure there is in some areas with regard to HRT but I find the best way forward is to demonstrate knowledge and a calm yet proactive approach to the situation eg someone on here linked you to NICE guidelines. Arm yourself with a copy of that.

I wouldn't be drinking coffee before a BP reading

I gave up trying with my Gp and managed to get a next day appointment with Newson clinic who don’t make you jump through hoops. I really hope you get some HRT soon.

What an absolute disgrace.

Yes go private.

Read this first then you know what your asking for

I was told there are only a couple of meno symptoms they take seriously, so it helps to talk a lot about hot flashes whether or not you're having them

Getting home BP readings done sounds like a really sensible suggestion once your clinic BP was noticed to be raised and will only delay things by a few weeks. It would be poor practice on the nurses part to presume that your high clinic reading was or wasn’t white coat syndrome and if your BP really is on the high side it’s important to know so you can monitor it, and also there are some types or HRT (oral oestrogen) that should be avoided.
The nurse might have been thrown by the issues surrounding your smear - the majority of women who are overdue have less serious reasons, this might be something that she can be flexible on once she’s given it some consideration or discussed with a GP. HRT can often cause funny bleeding in the first few months and it’s reassuring if you have an up to date smear if this happens so you’re not worrying about cervical cancer, but I don’t think most prescribers would insist on it.

Also if anyone else is thinking of getting a home blood pressure monitor - there’s really no need to spend £60 - you can get good quality validated ones for a third of that on Amazon.