BBC1, 8PM Tomorrow (Monday 30/9). Panorama - The Menopause Industry.

[SebastianFlytesTrousers]

Documentary presented by Kirsty Wark investigating the multi million pound global menopause industry.

Should be interesting.

@timidviper
I’m glad someone mentioned the thyroid. I was at a different private clinic for 5 years paying for tests and private compounded treatment. I never reached the sweet spot with HRT because I had an undiagnosed thyroid problem. The clinic only looked at sex hormones.

And the fact women are prepared to pay the fees for a private consultation and private prescription is more evidence of so much NHS failure in this area.

They are providing a service. Do people think it’s a charity and she should give out consultations for free?

I’m not with them but I am with a different private clinic. This is because I found the 10 minute appointment with my GP insufficient - they just didn’t know enough.

I was prepared to pay ££ for an hour long consultation with someone who was a specialist and highly educated in this area. We went though all my symptoms, loads of studies etc. I wouldn’t get this from the GP.

I’m lucky that I can afford this. There should be more free clinics funded by the NHS which offer specialist advice for more than 10 minutes.

This program won’t lead to more research. Doctors are reluctant to prescribe HRT anyway because of perceived risk. What do we think will happen now? Less prescriptions probably. And women put off from seeking help and trying to struggle through.

@timidviper I agree with some of your thoughts but there is a downside too to endocrinologists. They aren't usually qualified in gynaecology therefore can't carry out examinations or advise on the whole range of issues that women may experience with periods, fibroids, etc etc in the same way that a consultant gynaecologist can. Most of them (to my knowledge) work with diabetes, osteoporosis and auto immune issues.
I think LN has become 'evangelical' about HRT as a knee-jerk response to the existing lack of knowledge and poor treatment. It was always possible it would back fire - but then so does any treatment and more women have had poor or no treatment within the NHS than through her clinics. I don't know how much she also advocates lifestyle changes and a 'holistic approach' which some of the very best consultants do.

I don't think anyone other than a gynaecologist should be prescribing HRT personally. At least as an initial or annual check. Feels like the French have it exactly right here.

As for bloods being non indicative that's bullshit. Women have been gaslit about iron deficiency for years and told levels are fine based on ancient reference ranges. Any baseline is better than none. And it depends on time of month etc. endocrinologists will be very specific about it - so I don't buy this it's just money saving.

I've had a nightmare of a year on HRT and spent nearly a grand on a private doctor dismissed my symptoms (he is male), put me on unopposed oestrogen to trial, etc etc. I have adenmyosis and I know I had it long before but this made my bleeding insanely bad. I gave up with him - he wouldn't listen and I just found it too annoying. Went back to GP and found a progesterone I could tolerate. And that has been the big difference. Testosterone made me ragey. So stopped that too. I agree I think less is more.

It’s individual though. Less is more for some women. Some women feel loads better on testosterone, some don’t.

I don’t know what the answer is but more education for doctors and more research is urgently needed. And yes looking at how they do it in other countries.

I don't think anyone other than a gynaecologist should be prescribing HRT personally.

Completely impractical given the state of the NHS. At present, the current wait to see a gynaecologist/menopause consultant in Glasgow is 18 months and you won't get referred in the first place unless you are a very complex case.

I was on a Facebook group ages ago headed up by a woman who was the one who went to parliament with the MP to get free hrt. Anyway I was asking many of the questions above - worrying about progesterone at the Time and being unable to take oestrogen therefore. There were "admins" on tbe site who were definitely being paid or incentivised to answer posts and push for HRT consultations that whatever her name is would do. And then they'd write to your gp. I questioned many times about HRT and non hormonal methods and was basically chased off the group and left. This was about 4 years ago I think. I feel like even then I was a lone voice questioning what felt really aggressive and shouty and now I think a lot of this is going to come out. There are users on here who have a lot to answer on this front and acted like the fount of all knowledge when in fact the only reliable source of information is someone who has your medical records in front of them.

I didn't think it was a hatchet job. This oestrogen prescribing issue sounds like they have got into a prescribing culture not individual enough. I don't understand why if there is a poor absorption issue, the oestrogen can't be tried by pill. I know transdermal is safer for overweight women. I am overweight and was given pills when no gel available.

Exactly.

The problem @coffeeandfags99 is that many of us have found that even with our medical records in front of them, the GP is not knowledgeable. Or intested, or concerned. So you have no option but to look for advice/help elsewhere.

Completely agree with last two posters. But nothing is going to progress with this completely fucked two tier system unless the government put more money in. Women are suffering either way.

There is a greater risk of blood clots with the pill. Obviously that risk is still low, I have friends on pills due to absorption issues.

For those that don’t want to take the slight risk then if they are showing absorption problems you can see why an extra pump of gel (with all the correct check ups) is seen as an alternative. It’s complicated. The argument is that the women receiving the highest doses were not absorbing the high dose - they needed that dose to absorb a normal level.

Well that's a whole other argument isn't it. Personally I don't think throwing more money at the bottomless pit of the NHS is the solution, it needs total reform.

Changing attitudes though - you cannot make GPs interested in menopause if they're not motivated to learn or educate themselves.

Having watched the programme, it seemed to be focused on Newson Health more than the supplement industry.
The interviews with other doctors were balanced and tactful. I completely agree with the comments that 'because LN takes 300mcg patches they are safe' as bad prescribing practice and unscientific. None of us know what's behind that or the conversations she has with her specialist.

One issue that struck me was the consultations discussed in the prog were all remote. I understand this is better than nothing sometimes, but you can't help think that deeper conversations might have been had face to face.
There did seem to be some cases of medical negligence but this happens both privately and in the NHS (although that's not acceptable in either case.)

I think the issue with NH is that demand has increased so much that they may be employing drs without much experience, simply to deal with the demand. And also the mantra that high doses are the instant answer without also focusing on lifestyle issues like exercise, good nutrition, etc, that are needed as well as HRT.

It's not about money it's about education.
Many GPs now have had no menopause training whatsoever.
The BMS runs online courses on HRT prescribing, all year round. They are for around an hour! Is that too much to ask that a GP does a course?
They cost around £100.

GPs (like other professionals) should be taking this up as part of their CPD, going to the BMS annual conference, and updating their training. Half their patients are women.

The GPs at my surgery don't read my notes. I can guarantee that when I'm telephoned this morning regarding their latest attempt to stop my HRT ('oooh, cancer risk ...'), I'll have to tell them that I've had my uterus, cervix and ovaries removed.

Earlier this year, I had an in-person appointment arranged for me by the surgery with a GP following a blood test, and when I entered the room she said she had no idea why I was there as she couldn't see that part of my notes (that were on the screen in front of her).

(It sounds like the Village of the Damned, but this is actually in a big town in England.)

So maybe some training should be mandatory? And come out of the practice budget. It's cheap and accessible.

I don’t know what the answer is but an hour of education on this is not enough. I’ve spent two years researching the menopause and looking at loads of studies. We will know more than the GPs. It’s so complicated and individual too.

It's not just menopause though is it. When my kids were smaller I did the Association of Breastfeeding Mothers training as a breastfeeding counsellor and took calls on the national helpline. My training was a lot more in-depth than most GPs have on breastfeeding. They are taught the "medical" bit of mastitis or blocked ducts or snipping tongue ties in babies but many cannot support or advise around things like manging medication, tandem feeding, expressing or contraception and breastfeeding. I lost count of the times I spoke to a mother who had been told to stop breastfeeding by a GP for some reason, or to top up with formula, or not to feed on demand or whatever.

What the ideal would be is for GPs to know their own limitations. In my job I am an expert in certain aspects, can manage other bits, no clue in related fields. But I do have a network of contacts so that if someone approaches me with a project I know isn't in my area of expertise, I can either collaborate with a contact, or pass them on entirely. GPs in my experience don't do that. My surgery (a large suburban practice with 6 GPs and a full-time practice nurse sister) does not have a menopause specialist. Their "well-woman" service is smears and contraception. The system does not allow my GP practice to refer me to another local practice with a menopause clinic or even a GP specialising in menopause.

So the choices are move practice entirely, or just pay to go private if you get no joy from your own GP.

One issue that struck me was the consultations discussed in the prog were all remote. I understand this is better than nothing sometimes, but you can't help think that deeper conversations might have been had face to face.

As I said above, most of these women started looking for help in 2020. Remote was the only option.

And if you can't see your NHS GP in person or at all, a remote private GP may be your own option.

I agree face to face is optimum.

You're wrong @JinglingSpringbells it's not about education. It's about prioritising female hormonal and mental and gynaecological care as a national priority - NOT flogging menopause seminars to overworked GPs and handing out tubes of gel via telehealth bc we don't have a choice.

There has to be reform because this ain't working and I've read years of your posts on the Menopause thread and wondered who you are in RL and your commitment to HRT and now NH. The whole system is broken and there are people like Davina and NH who are not going to be root of it as needed. I do believe NH tried but there are only so many ways one woman can take over the NHS's role - of course it won't work long term and serious consequences will be inevitable.

You also can't change your GP very easily or indeed at all in some areas.

My mother has tried to change GP several times and can't. Her GP has two branches and won't even let her move to the other one - even though she lives closer to it.

Same. The three GP surgeries in my area merged last year into one practice. The next-nearest one is also sharing staff with it and preparing to merge, so we will have one 'super practice' where patients are locked into particular sites under the overall umbrella.

None of the sites provide access to a menopause clinic or a well-woman clinic.

I'll have to move house to change GP surgery.

But if female health has to be prioritised how do you think that's going to happen without training? The training exists already. It's not , however, mandatory.

There are women here who'd be delighted to get Oestrogel but their GPs act as a gatekeeper because some of them don't 'believe in HRT'.

It's only in the past year that menopause has been added to the medical training at university for doctors? Nothing to do with money- but pressure from groups of women.

I think you have misread what I said about Newson Health. I did say there appeared to be a case for medical negligence.