Need help with conversation with GP on starting HRT again

[Pinkprescription]

Backstory is I went to a gynae in 2015 and had no hormones at all - so I started on patches. These became difficult to get and I stopped them.
I had the odd period since lockdown and GP prescribed mini pill for contraception. I don't react well with progesterone only (this was my third attempt) and had very poor mood.
I stopped this and had a period of symptoms - night sweats, hot flushes, downstairs discomfort and UTIs. GP re-read letter from gynae and said due to HRT shortages I should go on combined pill in my late 40s.
Combined pill is ok but I have some other health issues and 2 close relatives who are female specialist GPs suggested now would be the time to switch back to HRT but I should try to get the most natural stuff possible - gel for example.
Can anyone give me advise on what I should be asking for? I should have written things down but haven't.
I could get a private consultation but my GP point blank refuses to prescribe anything from private consultants or even NHS consultants who aren't at the local NHS hospital.

Backstory is I went to a gynae in 2015 and had no hormones at all

Hi, @Pinkprescription. Can you say a bit more about what you mean by this? Do you mean you had a blood test and your oestrogen levels were low? What age were you then?

If you are happy to try HRT gel, I can recommend the product that I'm now on called Sandrena gel. There never seems to be a shortage for some reason. If you still have a uterus you'll need a source of progestogen - mirena coil, or other HRT product.

I think all you need to tell your GP is that as per the NICE guidelines, you wish to try HRT gel. Good luck - and make sure they get the dosages right!

Possibly change GP if they are that inflexible! I've been prescribed things by private consultants and GP just adds it to my repeat prescription.

As PP, ask for a trial of HRT. I use oestrogen patches (Everol) and have a mirena coil, plus testosterone.

I love it. I had to have my coil out last week and it was 4 days before I could hey a new one fitted. A horrible few days of bleeding and crying. I hadn't realised how dependant I was on it. The mirena is a miracle if that might work for you.

So basically you want transdermal oestrogen, but I'd advise against the body identical progesterone 'utrogestan' if you are sensitive to progesterone.

There are other types that might work for you.

HRT gel or spray is pretty standard so I doubt you'd have an issue. But you will need a progestogen if you haven't had a hysterectomy. Most surgeries have a GP (or a few) who are particularly into HRT/women's health, so ask reception who that is and book with them.

@AutumnCrow I had such low levels of hormones (all) in my body, no periods at all and was late 30s. I was severely underweight and very stressed hence hrt. He wasn’t sure if I was menopausal or this was a stress response. Put on weight and got periods back occasionally.

@Droolylabradors I would change GP if I could but I’m only entitled to register with one due to postcode and they won’t prescribe cheap bog standard nhs consultant medication as my nhs consultant is a specialist so not local hospital. Drugs have to come through the post and I have to get blood tests and pressure done at hospital. (Cost saving measure as then hospital bears all the cost)

I don’t think my GP allows mirena for progesterone either… they pick and chose what they prescribe.there is a risk I’ll get pregnant as I’m late 40s but it must be tiny.

Hi OP that's extraordinary, these days most GP surgeries push hard on the Mirena.

I am sure there are loads of other people on here who will have a better take on this, but if NICE have agreed certain drugs for menopausal treatment, surely you have a right to request them.

I do blood tests at my local hospital which is brilliant because they have tons of slots from 8am till 5pm so works brilliantly for me around work.

However our GP has a blood pressure monitor in the reception of each building which you can use when you like.

Assume you can't go to a private GP as a one off? Is there another GP at the practice?

@Droolylabradors Thanks for the advice . Sadly my GP practice will not budge on not prescribing anything unless they decide on it or local hospital. I have been to the ICG (used to be CCG) and explained and complained but no GP has to accept any shared care (NHS or private) by prescribing a drug suggested to them by a hospital consultant.#
And no other surgery will take me on. I will be moving house but that could take a year!
I have private GP cover and BUPA with menopause cover but that won't help.

I have private GP cover and BUPA with menopause cover but that won't help.

So are you saying that your GP won't prescribe anything that hasn't been prescribed personally by them?

You can have your HRT prescribed by a private consultant (or a GP) and pay for it at cost. Your repeats will be managed by the private dr.

My HRT prescriptions are private through a consultant.
The cost varies on what you're using, and the quantity, but mine averages out at around £20 a month.

Is this an option for you?

However, your first step must be your GP and they should prescribe gel and Utrogestan if that is what you want.

@JinglingSpringbells - Is that how little it costs per month for the private HRT? I know it varies with what meds are actually prescribed but in my head the cost of HRT would be £50=100 a month which is starting to get unaffordable given I have a lot of complex issues and am paying privately for a lot due to my GP refusing to prescribe my rheumatology meds etc.
I am seeing my GP on Monday - luckily I have the letter and several sets of tests showing I have no (less than 0.1 of) FSH and LH - I think this is probably a pituary problem but they won't investigate). It's why I needed HRT in my 30s and now I'm late 40s I am finding the combined pill a problem.

@Pinkprescription If you're already paying for some meds, you'll know that pharmacies put their mark-up on the drugs, so the cost can vary between pharmacies. Oestrogel (lasting a 32 days on 2 pumps daily) is around £14. Utrogestan is around 40-50p per tablet . It depends how many you use each month, depending on your prescription and if you're stretching cycles longer than 4 weeks, which is allowed off-licence.
I fully understand this is a lot more than an NHS prescription and out of reach for some, but in context, it's less than £1 a day.