How did your first GP visit for menopause go?

[Mathsdebator]

I'm planning on trying to get an appointment to discuss menopause/ HRT when I get back from holiday.

I loathe going to the GP and am guilty of downplaying symptoms and doing the whole "it's probably nothing" thing. I feel like a burden and always think things will go away on their own - so I need a plan!

I'm 47. Last period was March, the one before that was September. I've been evey 28 days since my periods began!

I'm struggling with hot flushes, no sex drive, brain fog, dry vagina, irritability, insomnia...

Just wondering how your first appointment went. Did you take a list? Did you know what you wanted prescribing when you went in?

NICE guidelines regarding HRT changed as of last November. They now say at the first perimenopause symptoms, first line of treatment should be HRT and not the old recommendation of CBT

i had to remind my GP of this when I was getting nowhere

I started with insomnia, night sweats, brain fog, lethargy, aches and pains and anxiety so decided to enquire into HRT. I asked reception if any GPs at the service specialised in women’s health and was told to see a nurse practitioner. She was lovely and sounded keen (I’m 46) until she discovered my mum had breast cancer. She then suggested we do bloods first, I had low iron so she said to try that first. 3 months later I returned still feeling rubbish and she said she didn’t want to give me HRT because of my mum. Everything I read said the risks were fairly low even with family history. So I decided to book a private appointment when researching I discovered a GP at my doctors is a women’s health specialist so I booked a NHS appointment with her. She wasn’t keen but agreed I could try patches. Insomnia, night sweats and brain fog have gone, aches and pains are improving . But I tend to get a bit angry/anxious inthe run up to my period. Weirdly my sister has been on HRT for 12 years now with no concerns from her Gp.

i would recommend you research before you go, have an idea of what you want to get out of the appointment.

Mine was a really easy telephone appointment (this was in the tail end of Covid restrictions) and the GP was happy to prescribe there and then. I'm in general good health and there is no particular history of heart disease or hormone driven cancer in my family. I was three or four years after my last period and my main symptoms were night sweats and very sore joints, both of which stopped within a week of starting the treatment. I have not to this day been asked to do a blood test or even check my BP, unless it's at an appointment for something else.

Your GP was very wrong on some many accounts from what you've posted.

Just out of interest, he said that he used hot flushes as an index, if hot flushes are severe, it is likely other symptoms are linked, if hot flushes are not severe, it is likely symptoms are due to something else.

He also said that it isn't a long term fix, and if you start too young, you need to come off it too young too, and dont benefit in the years you really might want it

The first part here- severity of hot flushes- is completely wrong.
Some women have very few flushes but have other symptoms.

HRT is a long term fix for some women. It's prescribed as prevention for osteoporosis and treatment of it, so could be used for life. Certainly right through their 70s and 80s.

The part where he said 'start young and come off it young' is nonsense.

It's sad and shocking that so many GPs are so ignorant about menopause and HRT.

You've been lucky because many women find their ovaries fail 2 years after a hysterectomy. And also to have good bone density.
1:2 women over 50 have osteoporosis.

Have you been tested for the BRACa gene - your genetic history?
Obviously that is something women should have if there is a very strong family connection.

However, after a hysterectomy, you'd only need estrogen. Women who use estrogen -only HRT have a lower risk of breast cancer than the rest of the female population (not on HRT.) It actually reduces the risk. It's the progesterone side of HRT that is linked to BC.

Don't want this to come over as a 'rant' - but just setting out the facts for anyone reading.

I had no issue at all, I asked for HRT and I got HRT from my lovely doctor. We just had a brief chat about different types before settling on the prescription.

I had an appointment with a specialist menopause GP who works 2 days a week in our practice, focusing on women’s health only. She was amazing, really thorough and knew her stuff. I also had follow up appointments and she identified a pharmacist mistake with my HRT and advocated for me to get it right. So it was a really positive experience for me. I know that I am lucky and other practices won’t necessarily have this service.

I too was professional hard-baller at work. So I adopted that persona. Went in with a list of what I wanted and asked the fastest route to get it. Didn't allow the dr any doubt that this was what was happening. I'd read the NICE guidelines and research papers so was armed ready for an argument. Didn't get one.

As I had increased BC risk they referred me to the meno clinic and I did the same there.

I've been on it a few years now and have agreed with my consultant that 'they will prise the HRT out of my cold dead hands ' 😂😬. It's great, especially the testosterone.

Good luck !

Hi @FrangipaniBlue I'm sorry to hear this, it's shit.

Get an appointment and show them the NICE guidelines. Tell them that this is what you are insisting on. If they don't do that, then make a complaint.

Good luck.

Nice guidelines link. www.nice.org.uk/guidance/ng23/chapter/Recommendations

This. Repeatedly, for many years (I started with symptoms at 36). I told them I have a family history of early menopause and they still kept insisting on blood tests which showed I was apparently fine. Nine years later, when I turned 45, you could have knocked me over with a feather when I was offered HRT randomly at the end of an appointment for something else!

Here the practice nurses handle these things and are excellent, far from discouraging hrt they actively offer it and my nurse at my recent smear was mighty confused why i didn’t want it (I don’t get symptoms so why bother) she was convinced I was underplaying my symptoms but I’m not, I’m one of the 20% that are fine fingers crossed they stay that way, I’m 9 months since last period.

I'd already done the blood test myself. You can purchase them quite cheaply. I then made an appointment as my symptoms were and are horrendous. I saw a much younger woman who attempted to gaslight me into believing I was being OTT and neurotic. She said she could direct me to a forum to chat with other women who felt the same as me lol. My next appointment i plan to ask if I can see a female over 50

I'm 60. I haven't seen a GP for over 20 years, so please bear in mind that it's not always necessary to be "diagnosed" or "treated" for menopause.

But if you think you want or need medication, just do as for any other consultation and make a few concise notes you can refer to (symptoms etc). Then you can be business like and not forget anything.

Blood tests are not accurate especially ones you buy OTC. There was a lot of media publicity on this only last week- saying how they are inaccurate and they mentioned ones for menopause.

Don't focus on seeing 'a woman dr over 50'. There is no guarantee they are experienced in menopause just because they are female and over 50.

Many male doctors are very sympathetic and indeed, most of the top gynaecologists working in menopause and fertility, are men.

ovaries were removed with the hysterectomy, so nothing in your post is accurate or relevant for my situation.

Some women benefit from HRT, some don't, some don't need it, some are endangered by it. I don't think some of these Mumsnet threads give the full picture. It isnt something we should all be fighting for against medical advice.

I would mostly likely be dead by now if I had been given it when I asked for it. And I have been fine without it

I was updating some things your GP told you which are now outdated.

Some of it isn't correct, in terms of how HRT is now prescribed.
Much has changed since 15 years ago and even then what he said wasn't right.

For example, I assume your GP was thinking of the out dated timescales of '5 years on HRT max'. There was a time maybe 15-20 years back when GPs were told to limit HRT to 2 or 5 years but this has since been changed and advice is completely different.

The advice now is that if ovaries are removed before age 50, HRT is prescribed to prevent bone loss and heart disease, the same as if women have POI- even if they are symptomless.

Obviously anyone with the BRACa gene needs to see a specialist for advice.

Women need to 'fight ' if their dr is out of touch, I'm sure you'd agree?

yes of course women should have access to medical interventions they need, I am just pointing out that HRT isn't always the correct medical intervention for everyone, and that isn't always portrayed on Mumsnet.

My doctor wasn't talking about limiting HRT to 5 years, but to 25... maybe what he said was outdated, maybe it wasn't, but he was spot on for me

Both fair points. The GP did my bloods which did confirm my OTC result so no issue there. And yes, agreed about males. Dr's. It's always going to be hit and miss. She did say I could have her but I want to hold off that as long as possible. My main symptom as I am still in peri is bleeding. Never knowing when it will happen and when it does just insane flooding. It's hard to plan anything. I suppose I just wanted some help with that

Thanks all - I'm reading with interest and sending myself notes to print as I lie on my sunbed!

It's been really helpful to read how playing down symptoms is damaging to diagnosis. I did it for years with swollen feet / left leg. I put it down to water retention - it was lymphedema. I soldiered through a difficult pregnancy until a consultant demanded I stay home from work with ridiculously high BP.

I'm going to ring the GP when I get home, ask to see whichever HCP is best and be direct.

I still need to read into what I think would benefit me best prescription wise so I'm fully prepared.

yes of course women should have access to medical interventions they need, I am just pointing out that HRT isn't always the correct medical intervention for everyone, and that isn't always portrayed on Mumsnet.

The OP was asking how to ask for HRT.

Mine went really well.
my GO definitely took me seriously.
she challenged my assumption about vaginal dryness/atrophy and gave me an exam. Turns out I had lichen sclerosis not atrophy so I’m really glad that she didn’t just accept my diagnosis!
she suggested lots of alternative therapies, but also prescribed HRT.
i didn’t stay on HRT (weight gain) and she has been really helpful about that too, and recommended sage tablets for night sweats (don’t need them now, most symptoms seem to have abated three years in to peri).

Eight years ago and my female GP suggested I go onto antidepressants! Made a run for it and made a private appointment with a Dr Pannay who was well known in the medical world.

Still on HRT and he was fab. Cost £250 (8 yers ago!)

Keep it simple.

All you need to say is 'I have a lot of symptoms that are affecting my work (I'm a professional in front of teens all day) and I want to try HRT.'

Your GP shouldn't refuse unless there are any major no-nos and they would be on your medical records already.

Also, if your GP is on top of all of this, they should offer you a choice.
Basically, it's patches, which give both hormones so you don't need think - you just slap them on.

Or a form of estrogen (patch, tablet, gel or spray) and a form of progesterone (Mirena, micronised progesterone .)

The bonus of gel or spray is you can start on a low dose and work upwards over a few weeks without having to go back to the GP for a different patch.

I've used HRT for over 15 years. I was already seeing an excellent consultant gynaecologist and said I'd like to try it as symptoms were affecting my life. He was absolutely supportive.

You should make a complaint. NICE guidelines state that anti-depressants are not the first line of care for Peri symptoms:

https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#individualised-care

1.5.3
Do not routinely offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine as first-line treatment for vasomotor symptoms alone. [2015]

Thank you for the link @itsmeafteralland @cleowasmycatI’m going to go back armed with this as there are some other bits in there that they are not following either!

Twelve years ago - desperately sleep-deprived and not functioning at work, I went to the gp (a young man) to ask for something to help knock my body back into a sleep rhythm (I was managing at best, 3.5 hours). I had the temerity to suggest I was post menopausal which led him to rant that I was “only”peri-menopausal and that he would not give me anything to help sleep except anti-histamines. I asked how he had arrived at the peri diagnosis (hadn’t had a period for five years). Flummoxed him but told me I would be fine. Two years later (and having given up my career as the stress combined with fog and lack of sleep was pushing me to burnout) I spoke to a senior gp who was the menopause master- completely different experience. She was so amazing, supportive and clear that I burst into tears during the consultation (so not me). HRT and continuing reviews ever since - get the expert. She also has an ANP who is trained up and who is an angel. Things have moved on a lot in a short space of time - ask your clinic/surgery if they have a particular group of people who deal with menopause.