HRT - what to ask for at the GP appointment

[Summervibes24]

So after resisting to go down the HRT route I find myself an anxious, low-confident/ self-esteem mess and it's getting worse not better. I have an appointment with the GP on Friday to discuss HRT or anti-depressants but I think I'm pretty decided on HRT.

I know this has been done to death on MN but could someone just let me know what I should be asking for at my appointment so I'm not fobbed off e.g. do I need patches or gel? Should I ask for testosterone too? I know this is going to be trial and error but I'm hoping to get this right as soon as possible.

Book with a GP who has an interest and see what they suggest. We don't start oestrogen and testosterone at the same time , that would be poor practice. If BMI over 30 or any other risk factors for blood clots then should have transdermal.

Thanks for your quick reply. The GP booked me this appt after discussing with them my repeat prescription for anti-anxiety medication so I hope that have an interest.

My BMI is low so that's not a risk and good to know about testosterone.

Oh, love, I hear you. Truly. Menopause can feel like it’s pulling the rug from under you—brain fog, anxiety, overwhelm—it’s like you’re losing yourself, and the worst part? So many of us walk into that GP office, desperate for help, only to be brushed off. I’ve been there, and as a nurse who’s seen far too many women suffer in silence, I want you to walk into that appointment feeling strong, heard, and ready to get what you deserve.

Here are some key questions to ask so you don’t leave feeling unheard:

1.Could my symptoms be linked to perimenopause/menopause?** (Even if blood tests come back “normal,” symptoms tell the real story.)

2.What are my treatment options?* (HRT and non-HRT, lifestyle changes, supplements—what actually works?) If I go on HRT, what’s the best option for me?* (This is important because patches, gels, and sprays are often safer than tablets, especially if you’re at risk of blood clots. Plus, they bypass the liver, leading to fewer side effects.)

The risk of patch/gels vs tablet is this based on research. Tablet 2-4 times more likely to develop blood clot. Patch/gels no increased risk.

3.If HRT isn’t an option, what alternatives can help? but if it’s not an option ask why?
4.Can I have a full hormone panel test?**

5.How will my symptoms be monitored?** (So you don’t have to keep fighting to be taken seriously.) I suggest you monitor them it’s so helpful as it allows you to identify patterns and triggers.
6.What support is available for menopause-related anxiety/depression?**

7.Do I need additional health checks?** (Menopause impacts bones, heart, thyroid—so much more than just periods stopping and hot flashes.

It’s always good to take someone with you for support if it’s an option. If not take a notepad and pen and write down your questions so you don’t get sidetracked. Time is short in the drs room they don’t have enough time again not their fault.
What I would also suggest is being very firm in what you want, if you decide HRT is what is for you then you have to go in with confidence and say “I’ve done my research and based on the nice guidance HRT is the first line of treatment for peri-menopausal women like me. I would like to try the patch to start, ensure you say that you understand the risks vs benefits and that it can take 3-6 months to feel the benefits. Do some more research so your happy with your choice.

Re testosterone I’m sorry to say that many gps are reluctant to R.X for women. Due to
Lack of Licensing for Women
In the UK, there is no licensed testosterone product specifically for women.

Funnily enough though Testosterone is licensed for men, and while some specialists prescribe it off-label for women, many GPs are reluctant due to lack of official guidelines. So you would need to see a specialist usually to get it R.X. I have more information on this but don’t want to overwhelm you with this right now. Menopause is a mild field that’s part of the big issues. Many gps are using outdated knowledge/research there just isn’t enough research on women’s health unfortunately.

There are a lot of fantastic gps out there but unfortunately they don’t get enough training/education on the menopause unless they specialise in it and there’s not many at the moment that do. So the gps want to know that you’re making an informed decision and not just going in on a whim ultimately they want you to feel better not worse.

Lastly, if they try to dismiss you? Ask for a second opinion. Push for a referral. You are NOT “just stressed” or “overreacting”—your body is going through massive changes, and you deserve real support. It’s not just part of getting older it’s the menopause!!! 🫶❤️

Remember when you have knowledge about something you feel confident and that empowers you. When we don’t we fear it it’s human nature becuase we don’t know what is coming next. The key is educating ourselves then we can educate others with compassion.

You’re not alone in this💕. For some time I have been researching, creating and supporting many women like yourself because so many women are suffering in silence. That way women like us can navigate this storm with more power and less fear. If you ever want to chat, I’m new here but I’m here. Please let us know how Friday goes—we’re all in this together. Lots of love Stacey

Look at the website “ menopause matters “ - it really does cover everything.
At the start of the appointment say you have been doing your research on this site and wherever else you have found and have decided you want HRT
GP may then ask why and I would list ( write them down if you want) the clear cut menopausal symptoms you have. I would down play/ not even mention the mood changes as this will only divert the conversation and increase your chances of being “ fobbed off” with SSRI.
Unless you have had breast cancer or have a strong family history of breast cancer ( ie more than one first degree relative with breast cancer- one relative is pretty common as breast cancer is common) then there really isn’t much reason you can’t have HRT
Other reasons to be cautious are uncontrolled high blood pressure and already being well past the menopause ( like in your 60s before you start.
Transdermal is lower cardiovascular risk and I would recommend. If you have a uterus you will need some form of progesterone to prevent you getting endometrial cancer.
Exacly how you take the progesterone depends where on your “ menopause journey “ you are the options being cyclical meaning you have periods and continuous where you don’t. Generally if you have gone less than a year since your last period then you are probably going have to put up with periods a bit longer as the continuous just causes irregular bleeding and confusion too close to the actual menopause.
GP will probably want to confirm contraception is all ready dealt with - some doctors are prescribing COC up to age 50 in low risk women who want HRT and contraception.
personally I think the Mirena IUS and trans dermal oestrogen is great but every one is different
I wouldn’t bother trying to get testosterone on the first appointment as it’s not something many NHS GPs are comfortable prescribing- if you are outside the UK or going private then it’s generally prescribed for low libido but I think once settled on oestrogen.
The very lowest dose of oestrogen is more for bone protection in post menopausal women and isn’t enough to do much for symptoms
You can also look at the BNF online and the NICE guidelines for more info

@Menoglow @DivorcedMumOfAdults - Thank you both - really good advice for me to take to the gp tomorrow.

Just read up on the NICE guidelines, if you do go down the hrt route ask for body identical hrt, so oestrogel or patches (individual preference) plus utrogestan (daily if post meno, or a couple of weeks monthly if still menstruating).

Testosterone later down the line once established on hrt.

Expect a few blips initially maybe nausea or bleeding but obviously that should not persist.

Just read threads on here on Menopause Matters for more info.

In the meantime focus on self care. So omit or limit booze and caffeine to promote sleep and good mood, daily physical activity again to promote good sleep etc.

I disagree with a pp, there is no need to take anyone with you or a pen and paper, this isn't a serious illness with complex treatment indeed it could be sorted via a telephone consult.

How old are you and are you peri or post?

Good luck!

Stay strong 💪 you’re in charge of your future advocate for yourself like you would a loved one. X

@Summervibes24 I totally agree it isn’t an illness 👍 but it can lead to one of many very serious illnesses that can be prevented. Suicide being a major one, cardiovascular disease being the number one health risk associated with the menopause.
By Taking a pen and notepad—it can make all the difference! Brain fog and anxiety can make it easy to forget key points, and GPs are often rushed off their feet, so going in prepared helps you feel more in control.

Here are my 3 top tips. Made simple.

Before your appointment, jot down:

✏️ Your top 3 symptoms affecting daily life.

✏️ Key questions (e.g., What HRT is right for me? What are the benefits of patches vs. tablets?).

✏️ Any advice or medication they suggest. As you may not be ready to commit to any treatment but just want to know what’s available to you.

Writing things down means you won’t leave feeling unheard or thinking I wish I had asked this or that, or I can’t member what they said. When you take a little bit of control even if you don’t use the pen and paper it will trick your brain into believing your in control and therefore will feel and appear more confident which will allow you to make better decisions surrounding your health.

Take care X

I have several friends who have taken the "resistant to HRT" approach and (absent any relevant medical reasons not to have HRT) I don't get it. Even without significant menopausal symptoms, HRT is so important for bone density. I had moderate symptoms - night sweats, unexplained rage, problems sleeping, low mood and a sense of doom all the time - went on HRT and it cleared so quickly. I'll stay on it for life.

After a few months on oestrogen gel (I have a mirena for the progesterone), I asked about testosterone and was firmly knocked back by GP. I had to pay privately to get it at first and after 6 months my GP was then happy to prescribe on NHS. Cost of the private was £200 consultant appt and about £30 for the gel (just once as one dispenser lasts about 6 months).

'Even without significant menopausal symptoms, HRT is so important for bone density.'

I think the issue is it is only protective re bone health while taking hrt and many if not most don't take it forever. Anecdotally, yes I've heard of women in their 70s or 80s taking it but generally that isn't the case.

The small but present well documented risks put women off taking something that only protects re bone health in the short term.

I'm on the fence, I can see why some women take it but equally why some women don't.

I'm in oestrogel and testosterone. I had a blood test that they said was normal but when I looked myself I could see my levels were very low. I had to go private for a diagnosis and then my local GP was willing to go with their recommendations. I'm taking magnesium as well which helps me to sleep better and has reduced fatigue (the two were not related!).

@Janiie I'm 53 and peri

@Elektra1 This is amazing well done!! Such a rare read. 🥰 HRT has so many other benefits than bone health much of the research is so out of date and based on old research if you look into the women’s health institute, it protects against so much more. So amazing to read that you got the treatment you deserve with perseverance 💪 love that!! X

@Janiie "
The small but present well documented risks put women off taking something that only protects re bone health in the short term." These "well-documented risks" derive from decades-old research which has been supplanted.

Yes but sadly we don't have current research to prove safety.

Body identical/micronised hrt is thought to he safer, sadly we don't have stats to back it up.

As i say I'm all for HRT if women are struggling but other than bone health it hasn't been proven to protect against illnesses. Obviously it improves quality of life re sleep, mood, libido, joint pain etc. So for those reasons alone it'll be worth it for some women.

@Janiie the research you're referring to related to a completely different form of HRT to that which is prescribed now. I'd recommend that anyone questioning the benefits of modern HRT should listen to Dr Louise Newsom's podcast and ask their doctor about the benefits/risks of HRT to them.

Yes that is what I said. Current micronised is thought to he safer, but we don't have stats as yet.

@Elektra1 her podcast is amazing!! 🤩

My telephone appointment went along the lines of - "I am 56, 2 years since my last period, recently my menopause symptoms have become a lot worse, <list> but the hot flashes at night are the worst and mean I am only getting about 4hrs sleep a night and it's really impacting my work and quality of life, I am a break point through lack of sleep. I've looked at the patches, gel, spray and think I would like to try HRT - patches, and continuous micronised progesterone orally, unless you recommend something else. I would also like to try estrogen cream for vaginal atrophy."

She listened, asked a couple of questions, sent a prescription to pharmacy - annoyingly for 4 weeks of patches, 60 days of utrogestan and 21 days of ovestin so repeats are all on different schedules and along with my other prescriptions feels like I am in the pharmacy every week! Said we'll review in 3 months.

Glad you got sorted- there are shortages of patches at the moment so probably GP has been told only to give 4 weeks at a time- you know you can get a special prescription fee prepayment for HRT - £20 ish for all HRT for the year.

@Janiie It's not really accurate to say it only protects bones while taking HRT. (There is newer evidence that even after stopping HRT, bones may stay denser for longer.)

HRT builds bone and protects against bone loss. That denser bone doesn't disappear the minute HRT is stopped. HRT has delayed the loss.

So if a woman took HRT from 50 to 65, at age 65 she could still have the bone density of a 50 year old. It had delayed bone loss by 15 years.

That means that if she lived to 85 her bones would be in a better state than someone aged 85 who'd not used HRT. Because their bone density would have declined for 35 years.

The reason there is no unequivocal evidence on micronised progesterone as being safer is there have been no controlled trials. The medics will say 'It appears that...'

However, there is observational evidence from a large French study and a Danish study which point to it being safer. So it's accepted as being safer, if not safe.

Likewise, all the studies that show 'risk' are observational, not controlled trials either. Many rely on self-reporting from women and collection of data from other sources. And all the stats on risk are from data that have excluded the use of micronised progesterone - so they aren't accurate.

@Summervibes24 how did you get on with the gp? X

@Menoglow Goodish - she asked me how I had been since Jan when I last saw her and was really low and I said ok but not sure if I need ADs or HER and she recommended HRT

She asked if I wanted patches or gel for the oestrogen and I said what is better but she had no opinion so I went for the gel - not sure if that is better or not / that stumped me a bit. I will start with one pump.

Also have progesterone tablets to take. I am sporadic with my cycle so will wait til day 1 and start then with both. So let's see - feeling I had a good experience.

*HRT not HER

Thanks @DivorcedMumOfAdults, I am in Scotland so prescriptions are free - it is just finding time to get to pharmacy so regularly that is annoying.