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.

Hear hear @coffeeandfags99

@coffeeandfags99 that has been my experience too.

No one mentioned it's one part of a wider range of things you should do.

"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."

@JinglingSpringbells you're missing the point here. I'm sure most women at the sharp end of their reproductive years and the most desperate in seeking HRT, have not exactly had a first class experience in wellwoman healthcare. it's a sticking patch. Zoning in on menopause is a mistake. To my mind it needs to start at puberty, identifying problems, monitoring menstrual cycles, hormones twice a year or seeing a gynae for example annually after birth. Chucking hormones at women from 15 is horrible. We are suffering because of it. If we had better medical care across a lifespan we wouldn't be in this mess. Weight management , diet, exercise, pelvic floor health. Imagine how much better it would be if women went into their middle years equipped and forearmed. And not dependent on gp's for a literal sticking plaster that frankly may or may not help or make other things worse. I don't blame those GPs witholding HRT. They are serious drugs and affect your psychological status. No one should think it's a simple fix.

@coffeeandfags99 , I totally agree I have had gynaecology issues since my teens , including being put on the pill at 14 , for over frequent periods . Over the last couple of years I have been diagnosed with ademyonosis via ultrasound. I have also had pnd following the births of two of my children. I am coping with menopause so far , and got me personally the concerns about hrt outweigh the potential benefits.

NH has had a reputation for being the place to go if you wanted a higher dose of oestrogen than you could get elsewhere for years now, and IMO has used this as part of their marketing. There has been an unspoken implication that the willingness to prescribe these doses meant that they had special knowledge and knew what they were doing, and that isn't necessarily true. I remember being utterly shocked after finding out that someone I know who had used NH, in normal menopause in her late 40's, was (very proudly) on a bigger dose of oestrogen than I was in surgical menopause in my 30's, and I was under the care of a specialist clinic with a very experienced gynae. When I asked about increasing the dose he simply said 'we don't do that here because it's not been shown to be safe.'

I also think that LN has been very savvy in her use of social media to market her business. A big part of the problem is that the NHS offering is poor, and many women who should be able to have menopausal symptoms managed at primary care level by their GP aren't able to, and therefore it was very easy for NH to slide in and fill that gap, using emotive language like 'hormone deficiency' and suggesting that HRT might prevent heart disease and dementia, when there aren't studies to back that up. The only thing known for certain is that is decreases risk of osteoporosis, and it slightly increases risk of breast cancer (if you take oestrogen and progesterone).

Same here on all @Toomanysquishmallows Now on HRT but after a very frightening and destabilising experiences several times in last few years and affected bleeding and mental health badly. Feel like I’ve lost my mind several times over. I’m on lower doses of all meds now and introduced cyclogest 200mg which is so much better than utrogestan. And very effective with anxiety. I cannot have that utrogestan stuff in my body - even vaginally. I roll my eyes when the gp starts telling me well it’s all the same… errrrr no!

As a woman who has experienced surgical menopause too, all of this! I have been astonished at the crazy dosages I see prescribed across forums in women of natural menopausal age under the premise of 'poor absorption'. One of note recently is being prescribed 12 pumps of Estrogel (must be a nightmare to apply). And yes - they are ALL consulting NH for their HRT. This just isn't regularly happening re: higher doses/poor absorption at other private prescribers as far as I can see (I do spend a lot of time online and in real life speaking with - mostly - surgically menopausal women).

Well it remains the case that my GP chooses to ignore a request from my Consultant Gynae Surgeon that I be on HRT in the long term, following a total hysterectomy with bilateral salpingo oophorectomy. There has never been a case of breast cancer in my family - but there is generational osteoporosis.

The amount requested is well within NICE guidelines.

The GP surgery has even stopped my Estriol cream for vaginal atrophy, that is really relatively weak hormonally.

And my case is far from unusual.

So have they stopped your HRT now completely @AutumnCrow?

@SebastianFlytesTrousers 12 pumps of gel is an awful lot 😶 I was told once I reached a 100mcg patch that it's normal to feel a boost initially from an increased dose, but that this then recedes a bit as you get used to it and you have to accept that the HRT is to make the symptoms manageable, not to make you effectively pre-menopausal, because you're not.

Yes, they do this every year. They stop my prescriptions. I then ring up and they know nothing, and tell me to submit an online request for a telephone appointment. I do this - easier said than done - and have to go through the same rigmarole of reminding the GP of my surgery, the consultant's letter, the NICE guidelines, my informed consent ...

I then listen to dire warnings of various cancers and dropping dead, and keep repeating myself until they agree to 'one more year'.

This year's phone call is due this morning.

And this is the problem - if the GP says 'No' then I will have no choice but to try and find a private clinic, which could easily end up being NH.

@PeggyMitchellsCameo
Sympathies from me, in a similar position for my fibroids.
Was on HRT for 2 years, forced to stop because it was increasing the size of my fibroids and consequently the pain and bleeding (flooding and clots etc etc.). Just had my last round of pelvic scans (3 year waiting list!) and finally seeing a specialist next week.
I have a good GP now, last ones were crap, and she's pushing a bit to get this sorted, but I feel as though I'm one of an army of confused women who've been asking for help for years and are left to get on with it.
The only answer for me is a full hysterectomy, and at this point I really want it to be over and done.
As for the meno symptoms, they've come back in full swing. There seems to be this no-man's land for women who can't take it and no access to expert (whoever that might be?) help as to how to navigate things without it.
Fingers crossed for your womb biopsy, really hope things are all clear for you. I've had suspicious changes to my lining so I suspect that may be on the cards for me soon too. At least there is Mumsnet - I honestly don't know who I'd talk to about this stuff if I wasn't on here! x

Well she’s posted on her Instagram an hour ago and has had nearly 1,000 comments of support.

The whole thing is a mess and I’m guessing will set women back years and also put many off seeking help and support.

It will also make GPs even less likely to give out HRT. Well done Panarama and the BBC.

Chucking hormones at women from 15 is horrible. We are suffering because of it. If we had better medical care across a lifespan we wouldn't be in this mess.

I'm not quite what you mean by 'chucking hormones at women from 15' Do you mean the pill?

Medical care 'across the lifespan' sounds great also, but isn't going to help everyone. We are also in danger of evangelising weight and diet. I have never taken the pill. I have autoimmunity in my family and low female hormones as a result of hypopituitarism. I can tell you I used to respect GPs as knowledgeable. Regretfully after some really bad treatment that has now changed. I have seen a great many of them. Yes, I 'change my GP'. I live in London. It's easy as chips. Fat lot of good it has done me. The experience has been akin to talking to a photocopier. They know fuck all about hormones. Worse, they will not simply admit their limitations and refer you to someone who does know. They instead behave as irritated gate keepers, as if YOU are a problem for revealing their stopping point. I found this shocking. Some of them have done less training on female hormones or thyroid hormones than some people on a basic biology undergrad course at university. In the end I went private. Forced to. Whilst broke. That money could have gone to many other good uses. I am being chased for unpaid debts. However after feeling suicidal, and frankly put out in the extreme, I had to spend it on my health.

Even failing some other causal factor like autoimmune illness, some of us really suffer when we loss the ability to produce physiologically helpful levels of steroid hormones. After all you have recepters for sex hormones everywhere within your body.

GPs need education. That education should absolutely be mandatory. Women use the NHS a lot more and for longer than men. How the hell are we having to ask and pleas for this?

Even this thread is shocking. How on earth have some GPs only done a mere hour on the menopause and not even that?

Absolutely this. I just wish that women in natural menopause could see a snap shot of what goes on for us surgically menopausal women and what our consultants advise. A far cry from the random 'more is more' prescribing of late.

I'd like to just put it out there too for the 'it's not fair, we should have access to NHS menopause clinics' brigade that there is a shortage of qualified professionals who run these clinics in the first instance.

Another thing to be aware of are the types of patients these clinics help. We're talking surgically menopausal women. Women with POI, some as young as 16. Women with hormone positive cancers who experience sudden menopause because of treatment and/or who are on aromatase inhibitors. Women with complex morbidities. Women (often young) who require estrogen subdermal implants to treat their symptoms and to prevent future health issues, which are only available at the clinic.

Trust me - I've seen a LOT of tears in the waiting room at the clinic I attend.

And therefore perhaps those who feel hard done by can appreciate - maybe - that perhaps they might be a tad luckier than the women who are 'lucky enough' to attend specialist NHS menopause clinics.

I think this is a really valid point and one that again begs the question that it should be gynaecologists that are responsible for initiating this care and then handing back to GP esp if there is a severe medical need which obviously there would be if you have a hysterectomy. It feels like no one takes responsibility and therefore it's impossible to have any kind of individualised plan when it's just left to us to fight for it...

My GP surgery didn't ring during the 8-12 morning slot I was allocated 🙁

I took the morning off for this; but I think I need to give it till the end of the day in case they're running very late - but I really need to make some calls on my phone ...

Hopefully they call you later. I usually call to find out whether I've been missed.

This has become a pretty polarised debate with lots of blame.

For those saying 'GPs need education'. Ok - lots of people have had a standard of care which feels poor and dismissive. So, GPs could up their game. What should GPs not do whilst they are dedicating more of their time on studying and caring for menopause? Do we think that leads to an overall reduction in demand as women will be healthier? Anyone have any thoughts on this?

Yes I am a HCP and lots of people have thoughts about I could work better/harder/more intelligently. I've only ever seen demand and my workload increase and no-one offer me something that I can stop doing. Numerous skillful, hardworking and truly caring professionals have left.

You should accept, @paperfarm , that not every GP can be a specialist in everything which comes across the door, and have the self-awareness to say that actually, Dr Smith is far better trained in menopause than you are, and refer patients to her. And in return, you take patients for whatever you are interested in and Dr Smith is not.

It is not about expecting GPs to be experts in everything and do loads of training. It is about women being fobbed off by GPs who fail to recognise their own failings and lack of knowledge.

All of this 100%!!!!!

I think you are essentially suggesting an alternative model of care - more akin to what happens in the US when family medicine is rare and people see paediatrics/gynae/neuro etc at first presentation. Ignoring the difference in funding for US Vs UK, this is a fundamental rewrite of the current model of care in the UK. That may be the right thing to do. But don't think of it as a 'just do this and it'll be easy'. This will have many good and bad points to it. Change is always easy to suggest. It's what will work better for the majority that's hard to determine.

A GP should take advice and guidance from a woman's consultant, and not stop her prescription every year.

They know flippin well that access to them is limited, so why do they do this?

Do you know what REALLY fucks me off? That there is support for alcoholics, smokers, obesity, asthma etc, BUT, the minute you get breast or other gynae cancer, you are left to rot!

Chop off the breast, fuck up reconstruction, take hormone therapy for years.. You want HRT?? No chance, must take anti depressants. But I'm not depressed. Sorry!! Eventually a willing MS prescribes me a patch and progesterone. Life is good.

Oh dear, another cancer in the womb wall.. total hysterectomy You are suffering from the menopause? Tough shit.. we saved your life! Oh Buggar. the BC is back. Take HRT away quick.

Currently suffering from having no ovaries and feeling very very depressed. No one wants to help. But there is support if I want to drink myself to death!

Where is the support for more complex cases? It's hard enough for otherwise healthy women to be heard, seen and treated for debilitating symptoms. But bring cancer into the mix...

Oh yes and I am one of those women
who has spent a small fortune ( which I can't afford ) on supplements, which has now been revealed, are a waste of time and money!