Going Private And Telling GP.

[SebastianFlytesTrousers]

Although my GP is lovely, I feel we really haven't got anywhere with sorting out the mess that happened since I came off my estrogen only HRT implant in September 2022 with an alternative HRT. This past week for me has seen me reach the lowest point I have ever known as I'm really struggling with low mood, low motivation, anxiety (so much so that I now think that i'm actually depressed), aching joints and muscles plus all the other woes of estrogen depletion (I had my ovaries removed so my menopause is surgical).

I have an appointment with my GP on Wednesday and i've now chosen and booked a private menopause consultant. I will be telling my GP this, plus I want to discuss the possibility that I think because of the protracted struggle with low doses/the wrong types of HRT and continuing awful symptoms over the last year plus that I think I'm now clinically depressed and might need an antidepressant as well.

I know it's probably low self esteem due to the lack of hormones, but I am worrying excessively about how to get all of this across to her and how she'll react. If any of you have gone private, did your GP agree to continue with the Hrt prescribed privately if you requested them to rather than continuing to have to pay privately? I'm not bothered financially having to pay for private prescriptions but it would certainly be easier if I could just order repeats from my GP if they would agree to take over prescribing.

You need to ask your private gp to send a letter to your gp , explaining his/her findings, and for the nhs to continue with the treatment. It’s up to the nhs doctor to decide whether they agree with the devesion, and therefore to continue the treatment.

In my surgery, you woukd have had at least one private prescription before they would convert it to an nhs prescription. I think this was to check it worked and the right course of action.

In this day and age,it’s not unusual for patients to see private doctors, especially in specialist areas such as the menopause, adhd etc, and then return to the nhs gp, so I shouldn’t worry about this.

Your GP won’t be bothered at all that you see someone privately.

They are under no obligation to continue prescribing though, but most are happy to do so depending on the regimen suggested.

Bear in mind that in some areas (such as mine) a private menopause specialist may prescribe something we can’t offer on the NHS such as testosterone or very high dose oestrogen (just as examples).

Thank you. I am looking for the private specialist to prescribe testosterone too as my GP isn't confident about doing so. I know myself what regime I need but my GP is a very (over) cautious prescriber unless guided by a Consultant. I'm keeping my fingers crossed that once estrablished on the correct HRT, she'll feel OK with continuing to prescribe it.🤞

out of interest @SebastianFlytesTrousers what regimes have you tried that haven’t worked? X

Why do you even need to tell them? I wouldn't. They'll be too busy to give you a second thought I'm afraid.

Can I suggest something else @SebastianFlytesTrousers

That you cancel the appt withy our GP.

There is no need to tell them why you want a private consultation, if you find the idea difficult.

If you wanted to 'make a complaint' or an explanation at some point, that's different.

The usual practice when seeing a consultant privately is that they write to the GP (this is a courtesy and medical arrangement they all have) with the outcome of your consultation (including any meds prescribed.)

Bear in mind that if you have symptoms or want to change a dose etc, you'd be going back to the private consultant, not your GP.

I've never used a GP for menopause and went straight into HRT with a private consultant gynae I was already seeing for something else (hormone related). My prescriptions are private and in my experience it's always been very quick to get a repeat prescription - I phone and it arrives a day or two later.

Also, bear in mind that your private consultant may want to do reviews . Legally all meds are reviewed annually, but sometimes when you start something new, it's reviewed at 3 or 6 months.

If you hand over the prescribing to your GP, would they be doing the review, or asking you to have the review with the consultant?

This is the same as going to the cheese counter at the supermarket and saying "you don't have the type of cheese I want for my diet, I'm going to go to the deli across the road."

They won't give a shit and you're one less customer to serve.

If the GP is any good and hears feedback like yours regularly, they may do some menopause training as part of their CPD, especially if you go back to them with the info that your private consultant tells them and it differs from the GPs advice/knowledge.

GPs are the buffet table of doctors; they're supposed to have something to offer everyone, but they can't have in depth knowledge of everything.

And most of them accept this.

Thank you for all the thoughful replies. Just to clarify - i'm going to see the GP to discuss the crippling depression i've developed over rhe last few months which I believe is over and above any menopause mood issues i'm having and has been caused by struggling with the severe symptoms I have had since my implant was withdrawn by the NHS menopause clinic.

My decision to go private is as a direct result of the clinic failing to liaise with my GP to ensure that I had been given an adequate alternative HRT and my GP being very nervous about making HRT updosing decisions by herself. I think it's the depression and crippling lack of confidence I've now developed (that's partly hormonal) that's making it difficult to approach this appointment. I should have been clearer in my original post but my head is not working properly right now, so apologies.

Can I just add, that although you may want a higher dose of hrt and or tester one, the private gp may not feel it’s suitable for you, and so may not prescribe it. They may feel the current dose of hrt is adequate, or want to monitor you on that for three months before making any changes. I don’t want you to go alone requesting xyz, and expecting to get it.

Thank you. My GP gave me 1mg Elleste Solo and i'm in surgical menopause (total hysterectomy plus bilateral oophorectomy). She wouldn't prescribe anything else. I am also a chronic migraineur so this is contraindicated for me. I'm not looking for a high dose just a dose and type that works for me that I can tolerate without having to phone my Neurology nurse because I thought I was having a stroke from the migraine the oral hrt caused, even though it is a low dose.

I've also chosen the private provider carefully, choosing to go with someone hopefully knoedgeable and not just the 'more estrogen, add testosterone' type. Fingers crossed!

Oestrogen in HRT is not contraindicated in migraine sufferers. It is something to be cautious with as it may increase migraine frequency but not a complete contraindication.

Out of interest, what regimen do you think you need?

Transdermal isn't but oral estrogen most certainly is with migraine with aura, which mine are. My Neurologist who sees me for migraine has already flagged this and we've discussed that transdermal is OK. This is also why I was formerly on estrogen subdermal implants under the NHS menopause clinic as they keep levels more stable. Fluctuations in estrogen are very problematic for migraine sufferers.

It isn’t totally contraindicated even with aura but guidance is to use transdermal.

So again, what regimen do you think you need?

Go to a private GP find something that works get the GP to write a letter to your GP. Meanwhile ask your GP to refer you to a specialist. It is clear you need medication via a specialist. A GP is a general practitioner not a specialist they are the gateway to other services.

Yes I did this.

My GP was more than happy to prescribe on the recommendation of the private GP/specialist with a few caveats. They wanted reassurance that the private GP was a properly-trained doctor registered with the GMC and not a shaman or "wellness practitioner" or whatever. And would not prescribe anything recommended "off-label".

Yes, that's what I said. I know it isn't contraindicated but it HAS to be transdermal. I would be looking for a patch starting dose of 50mcg and titrating if remaining symptoms dictate and adding in testosterone gel at some point as my testosterone is very low due to no ovaries and it helps me significantly with muscle and joint pain. I know what I need - I just can't get it from this GP practice and other than the HRT issue, I like them for everything else so don't wish to change practice.

@Rocksonabeach I've jotted off an email to my health board complaints department today as I am still officially under the NHS complex menopause clinic here but don't have a return appointment until May, and historicaly, the appointments keep getting cancelled with one particular Consultant. I know there are other Consultants available who I could see there so have asked if I might have a sooner appointment with one of those since I have been waiting to be seen since my implant ran out in September 2022.

I feel this is a move in the right direction and feel like I've been more assertive - I think not having anywhere to go with this other than to the private sector has been what has driven my slump into depression tbh.

Ok so 1mg Elleste is largely similar to a 50 mcg patch.

It might be that she can’t prescribe testosterone. We’re not allowed to either which sucks. Can only be initiated by secondary care and they will only accept referrals into Menopause Clinic for very tight criteria (and the wait time is hideous).

Hopefully your private consultant can help, they should certainly be able to prescribe testosterone. If you can get it, there have been shortages…. It’s all so unsatisfactory.

Crossposted.

I thought that 50mcgs was more like 1.5 mgs estrogen? (It's supposed to be a medium dose the same as 2 pumps of gel.)
And a 37mcg patch was like a 1mgs tablet?

Maybe that's not right?

The issue with tablets is that a lot is lost in digestion, so it's very hard to compare tablets with transdermal products.

Also, with tablets there are only two doses- a 1mg or a 2mg.

With patches (or, better still, gel) there is a lot more variation.

@JinglingSpringbells thats exactly it. The dosing is hard to equate between transdermal and oral preparations. So much is ‘lost’ in the first pass.

I understand that 1mg is very roughly “equivalent” to 50mcgs and is mid range dosing. 2mg is top range. There’s no low or middle ground or easy adjustment. Another reason to start with transdermal IMO, so much easier to tweak dosing.

It's very cofusing as the BMS state in their HRT equivalent dosages chart that 1mg oral estradiol is equivalent to a 25mcg patch, although I have indeed seen other sources that state 50mcg.

I am still an active patient at the NHS menopause clinic and they prescribe testosterone fairly routinely to women who have had BSO. Ditto as you say, the private prescriber. But yes - the trouble is actually getting the blinking stuff nowadays.

Your GP won’t bat an eyelid. People go private for menopause issues all the time because the NHS clinics move at a snail’s pace. Just be upfront about it and say you want things stabilised properly.

When I was stuck in the same stop–start cycle with HRT, I also booked a private GP appointment (mine was at Linbury Doctors). My NHS GP didn’t react in any odd way, they just added it to my notes and carried on prescribing what was agreed.