HRT - sore joints

[Libelula21]

Hi,

I’m 48 and haven’t had a period in 14 months.

Symptoms are not too bad - though have let work get on top off me and am super anxious about that - the worst aspect is sore joints.

I’m unsure about HRT so have ordered some Everol Conti from Superdrug to try out before asking the GP for a prescription.

My question is - is there a type of HRT considered better for sore joints? Or is it very individual from person to person?

I would talk to your gp before taking something "off the shelf", and look at websites such as Women's Health Concern for background information. And perhaps use the Balance app to track your symptoms for a few weeks so you can discuss it with your gp.

@Libelula21 Completely agree with @Pamspeople . I don’t know about the patches you refer to, but you do need to do your research before starting any HRT. Plus the fact that off the shelf treatments will end up more expensive than the new HRT specific pre-paid prescription (which limits your cost over 12 months) but you do need a Dr’s prescription for. Agree that Dr Louise Newsome’s and her balance app is a great place to start for info.

Since entering into the menopause, here’s what I wish I’d known/discovered along the way:
-You need to do the research then pretty much tell the GP what you want. They don’t really lay out any of the options for you and often prescribe the products most available as opposed to the ones which are in short supply but might be more suited to you. Since starting HRT I’ve had issues with obtaining the oestrogen gel and the micronised progesterone tablets. It is a PITA.
-There are two types of HRT - bio identical and non bio identical. You need to decide which is better for you and ask for it.
-HRT takes a long while to get your hormones up to the levels they were before you entered into it
-it isn’t a quick fix for everything. Symptoms like hot flushes and insomnia for me disappeared pretty much instantly but I’ve not lost any of the weight gain. My mood has stabilised significantly though. To answer your question, My joint aches subsided quickly.
-Menopause isn’t’fixable’ any more than you could’ve stopped puberty. you don’t take HRT for 6/12/18/24/36 months and then that’s it (which is what I thought before I started) it’s a long term solution for a permanent change that has taken place within your body.
-The advice as to how to take HRT by the Dr is quite hit and miss - e.g if you don’t know, you shouldn’t take progesterone tablets in the morning, they are sleep inducing…!
-if you have a womb, progesterone is needed to balance the oestrogen content to prevent the chances of womb cancer.
-For me, testosterone has been a game changer in terms of mental acuity.
-you’ll probably have to get your first prescription after a consultation with the menopause clinic in your area. Whilst there are plenty of private practitioners who’ll take your money, they don’t have a special supply of ‘better’ HRT, it is the same products but possibly without the wait and a sense of someone taking more time to listen to you but at significantly higher prescription costs. Everything you need is available on the NHS.

Have a look at Davina McCall’s documentaries on c4 which are also a great starting point. Good luck!

Link to the HRT cert here

https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-hormone-replacement-therapy-prescription-prepayment-certificate-hrt-ppc

I’m unsure about HRT so have ordered some Everol Conti from Superdrug to try out before asking the GP for a prescription.

It's not a good idea to do this.

For a start, you are unsure about HRT so it doesn't make sense to self-prescribe when you know nothing about doses and types. I don't understand why you think that self-prescribing is going to make you more 'sure'.

Can you explain that?

@Netaporter

you’ll probably have to get your first prescription after a consultation with the menopause clinic in your area. Whilst there are plenty of private practitioners who’ll take your money, they don’t have a special supply of ‘better’ HRT, it is the same products but possibly without the wait and a sense of someone taking more time to listen to you but at significantly higher prescription costs. Everything you need is available on the NHS.

There are hardly any menopause clinics in the UK! And they are for women with complex issues that GPs can't handle. The wait can be months.

Also, although private medical care uses (mainly) the same products, the dose can be individually tailored by a consultant (not always a GP working privately.)
There is also a big difference between a private GP and a private consultant.

The prescription costs- yes, a private prescription costs more BUT many people who see a private consultant once (for anything- not just menopause) and have their repeat medication on the NHS. The consultant writes to the GP with their recommendations. Legally, a GP doesn't have to follow those, but most do.

There can be delays or challenges in getting a referral depending on where you are in the UK but don't let that put you off asking.

I originally consulted my GP in early 2022. I had a review after 3 months (increased dose) then further 3 months at which point Gp said not happy to go higher and referred me to clinic - took about 6 months to get seen but I had a choice of clinic location and selected the nhs referral to local private hospital/consultant.

At that appointment I had then been on hrt over 12 months so switched to continuous rather than Evorel Sequi with extra estrogen patch to boost dose.

Just had further follow up - switched regime again to Evorel 100 plus utrogestan and as test showed testosterone levels were low but estrogen ok, I've started Testogel as well.

All of this is NHS provided so no private appointment costs, tests or prescriptions. I was prepared to go through Superdrug or Bupa if it didn't work out but so glad I went through the NHS route and saved myself £00s

My next step is to get GP to take over prescriptions etc on an on-going basis.

@putthehamsterbackinitscage Would you concur though that NHS menopause clinics are for women with serious and complex issues, which a GP can't manage?

For anyone who is wanting to try HRT, their GP is the place to start or, of course, a private dr if that's what they prefer.

It's also rather 'telling' that the NHS in your area also refers patients on to a private consultant presumably because the NHS can't provide the specialist knowledge at their own clinics within a reasonable time frame. They're having to buy private sector time/ drs .

@JinglingSpringbells

I was lucky enough to have a choice of NHS clinic at NHS hospital or the private hospital so I chose private Nhs as it was slightly quicker. And a convenient location. There is about 20-22 week wait on referrals in this area at the moment.

The GP should definitely be the first point of contact for most - with better training and awareness they could probably handle most patients, but obviously there are issues with availability of GP appointments as well as training. The specialist clinics should only be needed for complex cases but at least in my case the GP would not prescribe anything more than a fairly standard dose and would not consider a trial of testosterone. They were good in initial response, prescribing patches as that was my preferred option, but having seen the formulary, actually that was the standard option and not overly costly.

I don't consider myself a complex case. But, based on past experience with asthma and stepping up treatment until I can live as normal, I wasn't prepared to accept that some improvements were all that was possible, especially having read about other options. So, when Gp reached the limit of what they would prescribe I accepted their offer of referral- didn't have to ask.

Where I am the initial consultation has to be done with the local gynae/menopause clinic. Assumed it was the same guidance across the NHS…!

Where are you?
I think that 95% of women get their HRT from their GP.
Only complex cases see a meno consultant at a clinic.

I was the same as you,terrible aching joints I thought I had some dreadful life changing condition 🙄. Anyway prescribed HRT by GP , after a few weeks felt like a new woman.

@JinglingSpringbells home counties…

Just to add - forgot to mention earlier - my GP also tested me for thyroid, ferritin and range of other issues (family history of thyroid) and referred me to rheumatology and sleep clinic to see if she could find other explanations for tiredness, joint/muscle pain etc.

Overall a fairly thorough approach but ultimately no explanations found - all points to menopausal symptoms.

And with benefit of hindsight it had been creeping up for years - the joint/muscle issue have been increasing over say 5 years accompanied by other issues such as lack of confidence, lack of concentration that had been present probably around 8 years - I'm now 54 for context.

Can I ask about the joint pain?

Im nearly 48 and have actually just approached my GP about HRT. First step is bloods. My main issue is sleep and anxiety issues. But I’ve been having pain in one leg for months. It’s hard to pinpoint but I think it’s my hip, but it goes into my knee as well. And weirdly it’s worse in bed, I walk quite a lot and whilst it’s uncomfortable it’s Much worse at night. Even lying on the other side doesn’t help. Now I’m wondering if it’s all connected?

I’d be seeing a physio for an opinion. Knee and hip pain can be connected.
And try some good quality Omega 3 for your joints,

Thank you, I’ll have a look at that.

I would go to your go and ask for tests/referrals as you need them to rule out other possibilities

I saw the practice physio, paid for private physio etc for recurrent tendon/ joint pain but actually hrt has made some improvement and I'm now hoping testosterone will be the missing part of the puzzle.

There is beginning to be at least some acknowledgment that hormones affect us in so many ways.

Keep pushing for answers- don't settle for that's just getting older.

Many replies here, thank you all.

I did have comprehensive bloods done about 18 months ago now, and everything came back ok.

@Tulipvase I did have a strange feeling in my left leg, it almost felt like a ‘dead leg’, but now that you mention it I haven’t had it for a while.

Life / Covid / Peri / emotional eating means I’ve put on loads of weight, which may be putting my joints under strain - but often the worst time is when I’m just out of bed in the morning.

I have done a bit of internet reading, probably not enough. And I did go to my GP - she was sympathetic and wise, but I think her view was that the outcomes of widespread use of HRT were still a bit of an unknown, and that “it may be a small percentage increase in the risk of getting cancer, but it’s 100% if you do get it”. She also spoke about the necessity of accepting ageing - aka “that’s just getting older” as @putthehamsterbackinitscage mentions

The reason I’ve ordered from Superdrug is a) I feel I’ve done enough reading to feel comfortable with that and b) I’m still in two minds about getting a prescription (which is probably a bit silly, I can always just cancel at any time and c) my GP wants me to get my smear test up to date before prescribing, and I just don’t want a test done any more (the last time was awful, and my birth experience was so awful I just don’t go along and consent to things the way I used to.)

The menopause has come on quicker than expected. In some ways I feel so far I’ve got off lightly - no flooding, minimal flashes, minimal brain fog, and I’m appreciating the lack of PMT. The weight gain, joint pain, occasional rages (a really horrible thing to contend with with your the sole parent of a young child 😩) are not great, but what’s really bothering me is the lack of oomph, the lack of libido, the complete evaporation of nurturing feelings (my DS is 6), the feeling like one if my engines has cut out, and I’m just not ready for that.

Sorry for the essay!!

OP I also have been suffering from morning joint pain (46). I’ve been taking HRT (patches) for a few months now but think i need to possibly up my dose as the joint pain has returned.

@Libelula21 as a fellow traumatic birth survivor I hear you. However, before anyone would prescribe me HRT, I had to have full bloods and an internal scan to check the existing thickness of womb lining to ensure suitability and yes, smears had to be up to date. HRT isn’t completely risk free and can cause issues which vary from woman to woman so the belt and braces in preparation by your Dr is for a reason. After some inexplicable bleeding after two years of taking HRT, I had to have another scan where there was a query regarding the womb lining thickness which involved a 2ww referral and a hysteroscopy which was pretty painful but I’d rather be safe than sorry. I also explained to all of the people treating me why I was nervous/uncomfortable with the procedures and they were very understanding.

My childhood and teenage years were pretty shitty because of my mother’s unpredictable moods which were in part caused by menopause. You’re doing a great job recognising you need to address your hormonal imbalance to get back to being a great mum but however difficult, please do get yourself checked and follow the advice given to keep yourself safe.

However, before anyone would prescribe me HRT, I had to have full bloods and an internal scan to check the existing thickness of womb lining to ensure suitability and yes, smears had to be up to date.

In the UK? I'm astounded TBH!
This isn't necessary and women can refuse.
NICE says no blood tests are needed in women over 45.
HRT is prescribed on symptoms alone.
If you were made to have those tests, it's not right- sorry.

The womb lining in peri changes daily, and varies hugely depending on whether someone is ovulating that month or not, or has gone for several months without a period.

@Libelula21 My advice is you see an different GP. If it's within your means, paying for a one-off appt with a specialist might be a good idea if you can't access a sympathetic GP.

You have a 6 year old! It's not acceptable for your GP to talk about 'accepting getting older'.

There is no need to suffer, and GPs are supposed to explain the risks and benefits and allow you to choose.

My consultant says yes, there are some small risks but there are also risks (for some women) in not using HRT.

@JinglingSpringbells yes all NHS. The system here at the time and assume it is unchanged (over 2yrs ago) was quite clear for initial prescription- all consultant led then for the GP to pick up. It was this consultant who advised that there were plenty of private options in the area happy to take my money but it wasn’t necessary as everything was available with them for free. I don’t feel like I’m missing out on something bespoke. tbh I don’t see the issue surrounding the testing. The rationale behind the test requirements were quite clear - bloods ordered at the GP practice to check nothing else was going on (white cell count normal etc.) testosterone levels checked at the same time. Internal scan for the reasons stated above. I don’t love having to have any gynae procedure but I was satisfied with the reasons behind it.

I don’t know if I live in a particularly efficient NHS area but I do know that my GP surgery is exceptionally good at using technology to communicate with patients - test results/ prescription notifications etc are all advised by text which I guess frees up the phones significantly. Appointments generally run to time, especially the nurse-led ones. I’ve even had DM’s from the GP before I’ve even got home to advise next steps after a consultation and although the 8am phone scramble is not ideal, I’ve never not been able to get on the list for the same day. I realise I’m incredibly lucky which is probably why when they advise procedures are required/advisable , I have a lot of trust in them. They do not however take up the Dr’s time converting private prescriptions to NHS ones (my DH found this out recently) which is fair enough I guess.

I appreciate this is your experience but I also think if you asked here you'd find it's almost unique.

I have never ever read or heard of anyone being directed to a menopause clinic for HRT if they have very straightforward needs. This is GP work and I don't understand the rationale behind referrals to a consultant at all. Or being subjected to an internal scan when you had no symptoms of anything amiss.

The 'issue' is that it's a waste of NHS money for something not necessary when women with possibly serious issues are having to wait weeks and weeks for scans.

NICE is very clear on what has to be done or not, in prescribing HRT and your practice isn't working along those lines.

I wonder why GPs aren't providing HRT? That's the real mystery!