Feel like my Dr is safekeeping HRT

[Appalonia]

Last week I finally decided to ask for HRT. Had a phone consultation with my Dr, described my symptoms, and she seemed more concerned that they could be caused by the fact I have an underactive thyroid ( which I take Levothyroxine for). She said she didn't want to ' over medicate ' me. So she's said I have to have a blood test and then see her in person. I understand she needs to do due diligence, but I have this bad feeling that she'll just try and pin my symptoms on the thyroid issue and refuse me HRT.

Has anyone else had this happen to them? I'm not a medical expert, but having listened to a lot of podcasts about the protective effects of HRT, and feeling generally rubbish ( not sleeping, low energy, depression, no libido, no sex drive etc ), I feel that I owe it to myself to at least try to find out whether HRT would help.

How old are you? If 45+ print out the NICE guidelines and very strongly request HRT.

• Meant to write GATEKEEPING! Not safekeeping...

I think given you have a condition that could potentially cause similar symptoms, she's probably just being thorough, rather than any kind of gatekeeping.

How old are you OP?

You shouldn't be randomly trying hormonal medication to see if it would work (not least because of a possibility of a placebo effect). Your GP is doing the right thing by sending you for tests

Blood test is pretty standard.

Your gp is right

Thank you for your replies, as I said I'm not a medical expert, so it's reassuring to hear this. I'm 55.

I think it's reasonable to make sure that your symptoms aren't thyroid related before jumping into HRT. Unfortunately thyroid meds often need to be tweaked as we age.

Once your thyroid condition has been sorted then I'd expect your GP to be amenable to HRT discussion.

My GP surgery is very positive and clued up about HRT and it was still several weeks before they prescribed it for me - they ran a barrage of blood tests and made sure it was safe (medical family history) and the tests also flagged up some vitamin and mineral deficiency which was really useful to know (and did account for some of the symptoms) so i wouldn't assume your GP is withholding HRT.

Took me about 18 months to get mine. I had been on some other medication. But it was really drawn out process - blood pressure checks, blood tests & lots of appointments. I finally cried (I never cry) as I was so exhausted all the time. She finally gave in & let me have patches. I don't know why it took so long. I was over 50 by this point.

Speaking as someone who's taking HRT and levothyroxine, I think a single blood test to check that you're properly dosed up for your thyroid is entirely appropriate. Dosage does sometimes need to change over time.

If you had serious hot flushes, which are quite menopause specific and only rarely caused by hypothyroidism, then I'd agree that she was just putting you off.

I think because of the increased risk of gliomas and breast cancer, the benefits of taking HRT must absolutely outweigh the risks. GPs have to exercise due diligence.

What is she blood testing for? If Estradiol, Progesterone and Testosterone are being tested along with the Thyroid levels and Vitamin D, then that's definitely information that would be helpful in determining HRT dosages.

To buck the trend...I called the surgery for an appt about a specific issue (vaginal atrophy), hoping to score some oestrogen pessaries on repeat. I'm 51 and took HRT previously, but I let it run out and I thought I'd be fine without it.

When asked what I wanted the appt for I said vaguely "menopausal issues". They booked me in with the Nurse Practitioner - who happens to be a menopause specialist. She spent a good 25 minutes explaining that the approach to menopause and HRT had been outdated for years, that women should be replacing their declining oestrogen to protect their bones and cardiovascular health and pelvic muscle tone etc and that HRT should be prescribed far more frequently for those happy to take it. The old stigma of "getting through without it" is long gone - we do actually need oestrogen!

I walked out with three months of Evorel patches, Utrogestan and pessaries. My sleep was rubbish, these days it's brilliant.

Granted, my only existing condition is chronic migraine, but perhaps they'll be more willing once they've confirmed that your thyroid is properly controlled?

Just to add, I asked about the risks of cancers and she indicated that the risks are way lower than previously due to the relatively recent availability of "body identical" hormone, and that your risk of cardiovascular problems and osteoporosis due to low oestrogen are much higher.

Would you not normally have a regular review of your thyroid meds anyway @Appalonia ?

And are the symptoms you have the ones you'd experience without thyroid treatment?

I think she's being super-cautious. As there is a 3-month 'trial' of any new hrt to see if it's helping, she could have started you on it and then also checked your thyroid if, after 3 months, the hrt wasn't helping.

There is no 'rule' about 'over medicating' using two drugs that are for different conditions.

If you get your thyroid results back in a few days, take it from there.

Yes me. I’ve no underlying issues though, my G.P gave me citralopram - I’m not depressed or anxious! I just have night sweats, hot flushes, rage, some joint pains. I got some excellent advice on here. I dislike my G.P very much, they’ve given me the wrong medication before that made my condition worse, ended up in hospital. So there is no trust at all. He told me I can’t be menopausal as I don’t have grey hair (I colour it ffs) or wrinkles. I’ll try one more time, need to get my smear done first.

I also found out that you can HRT from Boots and Superdrug, I had no idea.

Of course doctors gatekeep prescription only medications, that is why they are POMs. That's the point. A face to face consultation (cannot believe you are complaining about being offered a F2F) and bloods to rule out other conditions- bloods and consultation presumably being free at the point of delivery if this is via the NHS- are pretty basic. What's the alternative, you just ring up and say, I have (insert symptoms that could be caused by any number of conditions including one you have already been diagnosed with) and I want to try such and such meds, and they just say OK then how much do you want? If that was the case there's no point in having doctors at all, might as well just put a vending machine out the front of the clinic with all the drugs in it and let the general public have at it.

At 55 it’s safe to assume you are menopausal and that HRT would help do don’t let them fob you off. Also if the libido issue isn’t resolved within a couple of months of oestrogen and progesterone then Do ask for testosterone to be added if you’re low/within range for that too. I’ve recently started and it’s made a big difference to the strength of my orgasm and the shrinkage of my clitoris! Don’t leave it until it’s too late to reverse.

Read up on NICE guidelines and some of Dr Newtons work so that you’re confident in what you need and why.

Oh and I also have low thyroid which I medicate with a thyroxine alternative - there are indeed lots of overlapping symptoms so it’s good to get tested for thyroid hormones as well as sex hormones, but there’s absolutely no reason not to medicate you for both, as the causes of both are so different even though the symptoms may be similar.

I WASN'T complaining about having face to face consultation! I was only offered a phone consultation when I went to the Drs. Maybe things have changed, but before Covid, if you asked to see a Dr, you would automatically see a Dr in real life. I would have liked to have actually seen a Dr ( especially as she said she would need to take my blood pressure )

I think you may have misinterpreted what I'm saying. My concern is that I felt dismissed because I also have an underactive thyroid and didn't want the issues caused by menopause confused with them. Tbh, there's probably a crossover, but as I'm not a medical expert,no have no way of knowing which is which.

Thank you for that, I know you understand what I'm trying to say!

"think you may have misinterpreted what I'm saying."

OK, fair enough, and I'd be fairly annoyed if they don't investigate or try empirical HRT if your thyroid levels turn out to be normal, or if they're low then corrected but the symptoms don't resolve and you get fobbed off.

OP I am 53 and had a phone consult on Friday to request vaginal oestrogen. GP was very helpful and asked if that was all I needed. I said I didn’t want hrt at the moment( mum had bc) but she said to come back if I changed my mind and I could have it. No blood test mentioned. It’s my understanding that blood tests for menopause are unreliable. Or is she testing thyroid?