NICE guideline support - once more into the breach

[Damnautocorrect]

I am hoping some of you wise women might be able to help me.
I’ve been trying to get some support for Peri symptoms for about 5 years now. Ive had repeated blood tests in that time, which show FSH levels as normal which means no HRT. After an absolute fight and booking out one appointment everyday for a week, They’ve seen I’ve got vaginal atrophy and have prescribed oestrogen cream which I’ve just started. Whilst it helps that it won’t help with the brain fog, rages, hot flushes, joint pain etc.
I’ve seen a private GP (just put it on the credit card, can’t afford ongoing cost) which the NHS GP refused to even read the letter because I’m one year too young for NICE guidelines.

so! You wise women who understand the NICE guidelines better than I can.
any ideas? In my view the FSH just shows I’m not in menopause (know that). The vaginal atrophy surely proves I am in hormonal decline and it’s unlikely to be a sole symptom.
I appreciate HRT might not be a cure all, they aren’t offering any alternatives other than (direct quote) “live with it”.

edited because I know it’s unto the breach, I didn’t see my phone had helpfully decided into would be more appropriate. I don’t need that gaslighting me at the moment ontop of brain fog 😂

I’ve seen a private GP (just put it on the credit card, can’t afford ongoing cost) which the NHS GP refused to even read the letter because I’m one year too young for NICE guidelines.

I'm unsure what you mean.

which show FSH levels as normal which means no HRT.

No it doesn't. There's no stipulation that says this. Plenty of women have normal FSH levels but are in peri. Blood tests are unreliable and your GP shouldn't be using them as the only guide.

NICE guidelines don't stipulate a minimum age for HRT.
There are women in their 20s and 30s with premature ovarian failure who use HRT. There are plenty of women (here, on the forum) in their early 40s on HRT.

When you saw the private GP, did they agree you needed HRT?
They could have written you a private prescription for a few months of HRT and then recommended your GP followed through. If your GP refuses to engage with this, your only option is to change your GP.

This is from the NICE guidance.

It says 'consider' using FSH levels in women under 45.
It's not mandatory and drs use their own judgement.

3.6
Consider using the person's serum FSH level to confirm menopause only:
in people aged 40 to 45 with menopause-associated symptoms, including a change in their menstrual cycle

in people under 40 in whom menopause is suspected (see also diagnosing and managing premature ovarian insufficiency). [2015]

Thank you so much for taking the time to read my garbled message!

I went to see a private doctor, I put it on the credit card and can’t afford to go back for a private prescription or another appointment. He wrote a letter saying essentially if I was his NHS patient he would prescribe HRT and vaginal Oestrogen.
I took this back to my GP who wouldn’t read it saying it’s meaningless as they are a private doctor not nhs.

the NICE guidelines is interesting, I was under the impression they only prescribed HRT for under 45’s (I’m 44) if the FSH levels indicated menopause (which I know I’m not in, I’m in perimenopause). My doctor also used that as the reason I couldn’t have it.

tried to get another appointment this morning and the only thing they will do is refer me to an nhs gynaecologist and they say the wait is a long time. So I don’t really know what to do now.

Your GP sounds anti- HRT and extremely unhelpful.
How does 1 year make any difference if you have symptoms?

I wonder if they would have refused to act on the recommendations of a consultant - or if they are 'miffed' as it was GP?

To be honest, I'd go back to your GP, I'd print off the NICE guidance- the part I linked to- and take that to your appt. Have a discussion about it based on the guidance.

Is there only one GP at the practice?
Do they not have one who is able to manage women's health and menopause?

You say you tried to get another appt today- the receptionist isn't the gatekeeper- you can request an appt, without saying what you want it for- say it's confidential.

My view exactly on the one year. Surely it’s a window of time not set in stone.
this is the senior gp who apparently has more experience in women’s issues. The first one flatly refused anything.

There is no other GP surgery to change to unfortunately. we have to do online forms to get an appointment where we fill out what it’s for, what we’ve tried already. I did that to try and get an appointment and just got a text saying there’s nothing more they can do so I want to go private or to an nhs gynaecologist

In the reply section of the text message I can free text. So I am tempted to reply with those NICE guidelines you’ve so kindly dug out and quoted. Saying I’d like an appointment to discuss options with them.
sort of ignoring what they’ve put altogether

ive replied. The text box wasn’t big enough for more than a cursory message. I can attach notes as photos though, so I’ve done that.
lets see what they come back with now.
i understand the caution i really do, but these things are hard to talk about. Why do they want women to suffer?