Is an internal examination necessary?

[Topaz67]

Recently moved GP. Had a phone appointment this week with GP as an annual review for HRT. I have been taking Vagifem for three years but the prescription for patches is still in the bathroom cabinet unopened as I know it wont help with my symptoms of anxiety, vaginal atrophy and lack of libido. GP has now requested that I have an examination similar to a smear. Why would this be necessary and what are they looking for? GP’s message says “for completeness sake” so feels like a tick box exercise but at the cost of more anxiety for me and a painful experience!

When I went to the GP with what turned out to be stress incontinence and vaginal atrophy she asked if she could have a look. I said yes, but I was too sore to tolerate a full examination. She said that would be fine, had a quick look just externally, said she could see signs of atrophy and wrote me up for a topical gel which she said would be the most comfortable option. So we both came away happy.

but the prescription for patches is still in the bathroom cabinet unopened as I know it wont help with my symptoms of anxiety, vaginal atrophy and lack of libido.

Aren't you going to give your HRT a try to see if it does help?
The things you mention are usually helped by HRT - that's what it's prescribed for, as well as flushes etc.

You don't need an examination for VA unless you feel the treatment you're using isn't helping.

Be aware that many women need systemic HRT (patches etc) and vaginal estrogen to sort out VA.

Why don't you go to the appointment and ask the gp to explain. You don't have to consent.

HRT will help with all of the symptoms you describe. Why haven’t you tried it?

How do you know it won't help if you haven't tried it? Am I missing something here?

Thanks for all your responses. I’ve never had a hot flush or night sweat so I’m still weighing up the risks v. benefits…. DM is riddled with osteoporosis so I’m getting a DEXA scan and so may use it for that benefit. Yet another friend has breast cancer so that is making me look at the statistics. I don’t want the bleeding especially as we’ve a couple of holidays coming up. The instructions say it won’t help my memory which is shot to pieces. However does it make you feel like your old self? Does it give you a boost?

are you up to date with smear tests?

Hot flushes and night sweats are the symptoms that are talked about but many women don’t get them. There are many, many other symptoms of menopause that HRT can help with, including dementia, osteoporosis, brain fog, anxiety, vaginal atrophy and just feeling more like yourself. Not sure what you mean about bleeding? I take HRT and don’t bleed but I didn’t start taking it until I’d gone through menopause. In answer to your question, yes, HRT can absolutely give you a boost.

Your priority is to have a DEXA scan. Take it from there.

I don't think it says on any HRT that 'it won't help memory'- where did you see that? It's not proven to prevent dementia if that's what you mean.

Your GP seems to think you've been using HRT - hence the review?- but clearly you've not been as you'd have asked for repeat prescriptions.

You don't need an internal exam unless you're having symptoms of VA and the treatment you're on isn't working.

This is the Evorel Conti leaflet and I imagine other HRT will be the same. That said preventing memory loss and making me less butterfly brain are two different things 😉

Forgot to add it, that’s how bad my memory is…

I'd recommend doing some more research on HRT. There's a good podcast Peter Attia did with Rachel Rubin which explains a lot. There are also some well researched books, Perimenopause power springs to mind.
The long and short of it is that #1 the supposed link between breast cancer and HRT is absolutely not what people think and in many cases does not exist. #2 oestrogen has many functions in the body and HRT can help with many things not just flushes and sweats #3 women are far more likely to have osteoporosis and cardiac problems and HRT can play a role here to reduce risk.
It's not for everyone of course so I always recommend doing your own research. Some GPs are well briefed but not all so doing your own research in advance is very helpful.

I think that's actually a very poor way of describing what they mean.
If by 'memory loss' they mean dementia, ought to use the word 'Dementia'.
As this is a leaflet in medication, the proper terminology should be used. Dementia includes loss of memory, but so do other diseases.

Sorry for being pedantic. But you've proved the point, saying your memory is poor but-hopefully- that doesn't mean you have dementia!

Many women have what's referred to as 'brain fog' in menopause. That's not dementia and many women find HRT improves brain fog.

HRT has helped me anxiety hugely, it’s the main reason I am on it