Find a BMS recognised Menopause Specialist

[hormonallychallenged]

Has anyone found a specialist using this? After an underwhelming experience with my NHS Menopause Clinic I'm seeking private input but cost is an issue so don't want to get it wrong. I've read that it's better to see a Menopause Specialist versus a gynaecologist.
Using the BMS service there's a private gynaecologist/meno specialist who also heads up an NHS gynaecologiy service local to me. Is this a risk?? My thinking is that being known to my health service she would ultimately be able to advise my GP what to prescribe & would therefore be trusted (as I will not be able to continue to pay privately for prescriptions etc long term). Or will she be too much part of the system & not independent enough?? She is on the BMS find a meno specialist listing though. I'm wary of Louise Newson as I don't want to be put on very high estrogen (doesn't agree with me) & have read that her clinic /way of consulting can be v costly. Guess I'll never know til I try. Any experiences gratefully appreciated.

I've read that it's better to see a Menopause Specialist versus a gynaecologist.

Most menopause specialists are gynaecologists- or they are GPs who've done some meno training.

Many of the UK 'top menopause specialists' are senior gynaecologists.

Any consultant can send recommendations to your GP although your GP becomes responsible for the prescribing from then, if that's what you want.

Any consultant should offer the same treatment whether it's a private appt or through the NHS. It's a medical decision, not based on whether you're seeing them and paying, or not.

You shouldn't worry about it.

Thanks @JinglingSpringbells am prob overthinking it! Hopefully being a gynaecologist and a menopausal specialist they'll be the best of both worlds. I want them to be able to practise outside of the constraints of the nhs (if applicable) & so am wary of wasting precious reserves on more of the same treatment. Hopefully not!

It depends what you want from HRT.

If you are prescribed something off-licence, your GP may not be happy to take responsibility for that. It all depends what it is.

For example, some consultants are happy to suggest longer cycles for women intolerant to progesterone, (not the usual 4 weekly cycle) but that usually comes with the agreement you'd have a paid-for scan now and then.

Likewise, using micronised progesterone vaginally is off-licence and some GPs won't agree (but being honest, how would they control that?)

If you had a very high dose of estrogen prescribed, you might need more progesterone, so this would be part of your prescription that the GP would manage- if they agreed.

To get exactly what you want if your GP isn't willing, then the option is 'fully private' as the consultant manages it all.

Without knowing what you've tried already and what your options are now, it's hard to say.

It might help if you can share what was underwhelming with the NHS provider, what are you taking and what issues are you trying to fix?

Yes absolutely - I’m 53 & 2yrs post menopause on 50 Evorel & 100 Gepretrix continuous for 6 months (this combination at my request for ability to tweak if necessary & benefits of micronised progesterone esp given existing MH vulnerabilities). This has been literally life saving & almost immediately quelled debilitating anxiety, panic, adrenal surges, early panic waking, mood disturbance, extreme emotionality, irritability, rage, stress intolerance, bone pain, low BP & improved my sleep quality. I have pre-existing recurrent depression, anxiety & ADHD which have been horribly exacerbated by peri & menopause. I’m also on Mirtazepine 30mg (of many years) but HRT has been far & away a more stabilising & effective solution & I’m able to distinguish what’s hormonal vs more endogenous underlying anxiety & depression (although it’s tricky at times!).

Given it’s benefits I am loathe to tinker with my HRT without due consideration. However 6 months in & progesterone sensitivity is creeping in & while amazingly calm inducing & anxiety alleviating - I am now experiencing debilitating fatigue, v low mood, irritability, zero motivation or inclination & feeling sedated all the time. It feels v much how progesterone intolerance is described.

I am on surveillance for colorectal cancer (yr 2) & unable to have a mirena coil due to changes to my cervix & vaginal adhesions following pelvic radiation (making access to my cervix also impossible). Naturally I’m v wary of trialling Gepretrix vaginally due to the discomfort & inflammation there that’s still present but I am willing to give it a go (have to use dilators still to ensure it remains open).

I was ostensibly seeing the NHS Menopause clinic to request testosterone - by GP referral - for libido (but really to see if it cld help with energy/fatigue/mood). However as things are being derailed by progesterone sensitivity I raised this subject instead. I explained about being unsuitable for a mirena coil which the gynaecologist would not believe & insisted on examining me internally (where she was unable to access my cervix). One positive is that she is referring me for scan (as I am no longer able to have smears either). When it came to discussing alternative progesterone options, she showed me her screen & the dispensing table & gestured at the continuous column & said “you can go on any of these”. I had read about Femoston being a gentler (albeit synthetic) progesterone & asked if I could trial that one. She told me she would telephone me to discuss dosages, something about her computer, my GP & my pharmacy & bundled me out.

On reading up more about Femoston (on Menopause Matters) the maximum continuous dose is 1/5mg which only equates to 1mg of estrogen. I’m on Evorel 50 & cannot go on a lower amount given the likelihood that I will seriously relapse emotionally. I tried to discuss this with her when she telephoned - she seemed v vague about dosages of Femoston & tried to fob me off with it saying that 1mg will be enough. She didn’t volunteer any alternatives & said I’d have a telephone follow up in 8 wks. Re testosterone she told me to forget about it & try masturbation instead.

So I’m wanting a menopause specialist who will be prepared to treat my sensitivity off licence if necessary. Obviously I can go back to my GP & try combination patches or Provera (with Evorel) without really needing to see a specialist (although again she is v under confident in prescribing any generally). I’ve also read about Tibilone as an alternative.

Thanks in advance if you’ve made it this far!

PS forgot to add if I take Gepretix at night I get horrific nightmares. Being prone to depression I need my sleep to be as restorative as possible & these are disturbingly real & generally involve serial killers (plus I live alone!)

Oh god plus - I trialled a higher dose of estrogen 100 Evorel & felt too jittery & not right. I feel that Evorel 50 manages the estrogen side of symptoms sufficiently. Was hoping a blood test would help me know if suitably estrogenised before starting any testosterone therapy but this was abandoned in view of more pressing progesterone intolerance (& not sure if carried out on the NHS - maybe they only check testosterone levels before prescribing?)

One question- why aren't you using topical vaginal estrogen? (Or maybe you are and haven't said so.) If you need to use dilators for vaginal atrophy you definitely should be using vaginal estrogen at maybe more than the standard dose.

The kind of off-licence regime you might want to try it going onto sequential HRT.

Yes, this comes with the downside of a withdrawal bleed, but for women who are progesterone intolerant, it means you can use estrogen only for several weeks (under supervision is doesn't have to be a 4-week cycle. You may be allowed an 8 week cycle, so 14 days of Utrogestan every 6th week, giving an 8 week cycle in total.)

There is also the tablet form Tridestra which is a licensed packet of tablets, it's 12 weeks with 10 weeks of estrogen only.

In extreme cases you can do 7 or 10 days per 4-week cycle . Again this would usually come with the proviso that you have a scan at least once a year. (The BMS suggests every 3 months but that's not really practical and it's very expensive if you have to pay.) However, the NHS may consider it as you're a 'special case' with your existing health issues.

IMO there is no perfect HRT -only the best out of the choice. I use Utrogestan vaginally on a cycle, and get vivid dreams and sleep less well, but it's preferable to the other side effects I had when trying it daily.

Femoston tablets have a similar progestogen to Utrogestan. So some women find them better.

I know you've found one consultant, but if you're prepared to travel - no idea where you live- there are several excellent ones in London who are all BMS approved and some are former Chairs of the BMS.

Hi @JinglingSpringbells thank you for such a comprehensive answer that's most helpful.
I did ask for vaginal estrogen after surgery for the vaginal adhesiolysis (caused by radiotherapy) but have difficulty tolerating it (Vagifem & estriol) along with soreness & irritation. The area is generally not happy & is very quick to flare up (hence my concern re trying utrogestan vaginally) & I've had repeated infections requiring antibiotics.
Sequential may be a really good option I could definitely enquire about. I'm more than willing to put up with less than ideal symptoms in order to benefit overall. I had such a good initial response to HRT that I am fearful of upsetting the apple cart too much for fear of incurring new & possibly worse ones. A sequential cycle on my existing combination could mean a lot less upheaval (in theory!)
Specialists wise - I'm in the Midlands & cld travel south. Though not in a position (unable to work) to afford top consultant fees - but appreciate the suggestion nonetheless.
Thanks for taking the time to advise - I feel more informed about my options & will no doubt update in due course. Kind thanks

@hormonallychallenged Just tagging you so you pick this up.
I think you should see a specialist partly because there are more options that you appear to be offered.
For example, Ovestin and Vagifem are not the only options. There are weaker products which you should be offered. You can find them here at the top of the page. https://thebms.org.uk/wp-content/uploads/2022/12/04-BMS-TfC-HRT-Guide-NOV2022-A.pdf

They include Gynest, Imvaggis and Blissel.

Regarding fees, most consultants charge around £300-£350 for the 1st and less for follow ups, across the country and in fact some are cheaper in London than the provinces. I think most of Dr Newson's fees are this even for a GP appt with her team.

I'd be wary of a consultant charging a lot less .

Sorry if I've misunderstood but are you saying you've had colon cancer, and radiation, and that's why you're having difficulty with using vaginal products? (I wasn't sure what two year surveillance was- if you've been treated?)
It can be a case of keeping going as lots of women do find vaginal creams etc sting a bit at first but it does improve.

@JinglingSpringbells this is really appreciated - thankyou. I had no idea about alternative topical (& weaker) estrogens so this brilliant information thankyou. My GP is limited & I had to ask the gynae surgeon for it at all post op as I have menopausal atrophy in addition to the radiotherapy induced adhesions. Sorry if it’s not clear in my OP - yes I’m now in my 2nd year post treatment (chemoradiation) for colorectal cancer (actually anal cancer) hence being on surveillance (which will total 5yrs). I think you’re right that I should spend whatever really is the going rate (also helpful to know thankyou) & see a proper specialist. The fear is that I will not be able to afford cumulative costs such as scans or ongoing private prescriptions fees & so whilst wanting someone who can practise off licence to offer me more individualised options, I’m in a catch 22 of being unable to truly afford that kind of treatment, unless my GP is prepared to take this over. Obviously like you’ve said in an earlier reply there’s no way of knowing what my GP will or won’t be happy to take over. But going on my experience to date, it won’t be a lot. Hence my logic (!) that if I saw the gynaecologist menopause specialist that heads up my local NHS menopause service privately, my GP may be happier to prescribe as per her instructions. However having sampled an element of the local menopause nhs service recently - (provided for by a private provider to presumably manage service demand & at a local GP surgery), the approach was very much in keeping naturally with NHS constraints, where they do not permit even vaginal use of utrogestan due to it being unlicensed. So will a gynaecologist that heads up such a service be prepared to offer me alternative options any more so than those of her local teams, were I to see her privately?? It’s all such a minefield but I’m at least much more informed about my options & really appreciate the advice.

So will a gynaecologist that heads up such a service be prepared to offer me alternative options any more so than those of her local teams, were I to see her privately?? It’s all such a minefield but I’m at least much more informed about my options & really appreciate the advice.

I don't know.

I think that your next step is to contact this consultant and ask exactly that- does she work within the NHS prescribing guidelines all of the time, or does she offer off-label HRT where appropriate. You'd be a customer, so there's no point forking out £300 only to find out she's offering you more of the same.

I don't think there is any reason to assume your GP would take more notice of her long term, than they would of an eminent consultant not in your NHS region.

You can usually control how often you need to see a dr privately. Initially it's usually a 2nd appt after 3 months, but if you're settled onto HRT after that, you may just need to 'check in' with them every 6 months. (they do take card payments!)

And you could ask that they write to your GP with their recommendations.

If you want, I can send you some links by PM to places to look at, and many do virtual consultations by video. Also happy to look at who you might see locally if you want an opinion. Or other posters might do the same if you ask.

@JinglingSpringbells if you know of any recommendations that would be really helpful & of course virtual consultations make it even easier. If you don't mind looking at any more locally that would be equally helpful but only if it's not too much trouble. Many thanks 🙏

Looks like PMs are still disabled..@hormonallychallenged Supposed to be back and running this week .

No problem -I’ll try to PM you once they’re back up & running.