Private Doctor- Menopause....advice please.

[MrsHench]

I've booked myself in to see a private menopause specialist next month, so needless to say its going to cost a lot, nearly £300 for a 1 hour appointment. I've already had the blood tests done which cost me £130.00 and apparently, i can request to see the results beforehand. Could I take those results to my own NHS GP surgery and cancel the private appointment as i still have time? My surgery have been okish (not terrible but not great) in managing my HRT but i never feel like I've had my hormones checked properly for Oestrogen, Progesterone so I don't know if my absorption is good, bad or indifferent; plus a few years ago i was told that I had a thickish lining of the womb but it was only minimal reading of 33 I think so I needn't worry ( it was a blood test that tests for cancer ca 125) but no mention of a follow up or anything since then. I wanted my Testosterone level checked as I suffer with depression & I know that i would never get this checked or precribed on the NHS. It seems so unfair to have to fork out so much money just because nhs won't test. Any advice welcome and sorry for the long post.

Lots of the tests that private doctors do aren't evidence based or necessary. No reason to have oestrogen or progesterone tested.

Yes you could take them to the NHS. But your NHS GP may not interpret them for you, which the meno doctor would.

Also my NHS GP does test testosterone and prescribes it. Have you asked if they will?

@oldclock my private gynae tested my oestrogen levels as I had been on HRT for two years and still having hot flushes despite 100mcg oestrogen so he tested to see my absorption.

My GP, who is the menopause lead at the practice informed me that testosterone would only make the difference between me wanting to have sex once a month and maybe I would want it twice.
No, it actually gave me the energy to be able to lift my head off the fricking pillow every day.
They had absolutely no intention of prescribing it for me and I would not have got my hands on it without a private prescription

@oldclock Why aren't they necessary? I always thought Oestrogen levels would need to be checked as it determines the HRT dose they prescribe for the individual.
@Notsurewheretostarthere I see your point about them not wanting to interpret the results but surely if for example my Testosterone was very low and it's affecting my depression wouldn't they precribe Testosterone for me? It just feels like everything is a battle and we have to jump through hoops to get anywhere and I just don't have the energy.

OP, generally HRT is prescribed on the basis of symptoms not levels.

If your testosterone levels are low there is a reasonable request for T from your GP. depends on your area I think. My surgery does prescribe it, but I had to say I had no libido. Which I didn't and now i am very happy with my libido!

@Noelshighflyingturds mine was the difference between having no sensation in my nipples etc and not wanting sex ever and then wanting it a lot. I mean there was a material difference.

I also had high oestrogen, the mirena coil and vaginal oestrogen cream so they probably all played a part.

@Noelshighflyingturds that's good to know. I've heard it can help not just low libido but energy levels too. Did you have a blood test before they prescribed?

No, they just pretty much assumed on the basis of my symptoms. The sheer exhaustion that my testosterone would be on the floor.
It’s definitely not a magic wand
But it helped to give me the motivation to do more cardio, which I think and then gave me more energy
And of course gets the weight off as well, so then you’re more physically able to do more

Yes you have to for T. And I have 6 monthly blood tests to check my levels are not too high.

There's quite a lot to unpick in your posts @MrsHench
First- how old are you?

And you're already on HRT?

I've been on HRT for over 15 years with an excellent meno specialist (privately) and they refuse to test my estrogen because it's never an accurate reading
HRT dose is decided on your symptoms. The way forwards is to start low and increase.

If your specialist has tested your estrogen while you're on HRT that's a rip off.

I'd think again.

I'm 56.
Yes, already on HRT prescribed by my own gp and have been for 4 years but tweaked so many times .
The private gp suggested I have a blood test for Estradiol, Testosterone and Sex Hormone binding globulin.
This was off the back of my enquiry where I mentioned very low mood, low libido, sleepless nights. I'm at my wits end with it all.

I think one problem now is that so many GPs are calling themselves 'specialists'.
A specialist was always a consultant and ideally they should be a member of the RCOG. The fee you're paying is the same as you'd pay for a consultant.

It feels unethical to run a blood test before they have even met you. If you need testosterone then yes, it does need an estrogen test beforehand, but this should all be up for discussion at your appt, not beforehand.

Has your GP changed your type of HRT, method of delivery (tablets, gel, spray) and gone through all the options for type of progestogen?

No, absolutely not, no-one with any knowledge of HRT would titrate HRT dose to oestrogen levels, in fact there's a recent BMS document out about how inaccurate this is.

if for example my Testosterone was very low and it's affecting my depression wouldn't they precribe Testosterone for me?

I know you didn't address that to me, but no, testosterone is used for one very specific indication and it isn't that.

What's the website of the private dr? Happy to have a look at their qualifications if you like

What's the website of the private dr? Happy to have a look at their qualifications if you like

Unfortunately many GPs who call themselves 'specialists' are not. They may have done a very short course with the BMS ( for around £100, online) on prescribing and think that allows them to charge the same as consultants.
The internet is bursting with them now - in demand.

They don't have the depth of knowledge or the experience of a consultant who is a gynaecologist or sometimes an endocrinologist. But even with a consultant you need to read their bio and see if they are experienced in menopause/HRT, as they all have their sub-specialities.

Oestrogen is prescribed on symptoms not blood tests. If you still have symptoms you should be prescribed more oestrogen, unless you are at the highest dose in which case they can do a blood test to check absorption. My symptoms didn't go until I was on 100 patch.

Testosterone you are meant to have a blood test before you start but only to check you are in the 'female range'. The NHS will only prescribe for low libido so you have to go with that, 'my poor husband' bla bla bla. Talk about poor quality of life etc. Even them some health trusts won't prescribe it because its not licensed. Why? Well, I think they can't be arsed doing a study because it's old women who really don't matter. If a man couldn't have an orgasm they'd be falling over themselves to help.

Testosterone has been a gamechanger for me. I had no sensation at all and it has come back. It has also helped with energy levels. Luckily I see an NHS menopause specialist who prescribed it.

At the end of the day it should all be prescribed based on how you feel.

Exactly. And bios can be very will written if you don't know what you're looking for. Hence my offer to have a look, as I do know what I'd be looking for.

I appreciate your help and advice, thank you!
@JinglingSpringbells
https://www.saidemanpractice.com/
@oldclock https://www.saidemanpractice.com/

She's a qualified Dr, a GP and Diploma of the Faculty of Sexual and Reproductive Health (latter is quite common.)
You can find the course she did with the BMS on their website- just google the search words.

I'd say she is reasonably well qualified but it doesn't explain why she did blood tests first, unless you had made it clear you wanted testosterone. As PPs say this necessitates a test of your estrogen.

Her fees are quite high for a GP (many consultants in London hospitals or clinics working privately are around the £300 figure.)

To be 'kind' to her she may have thought she was saving you time by doing a test ahead of your appt, but on the other hand they can usually turn round blood tests in 24-48 hours.

Going back to your first posts- what HRT have you tried and doses?
You might get enough info here to ask your GP for different types/ doses.

BMS advanced certificate is solid but then it's even older than she's doing those weird bloods. I would ask her to explain what they are for and how she will use the results.

@MrsHench Testosterone on the NHS is only for libido.
If you feel low, it's most likely too little estrogen or the wrong kind of progestogen.

What type are you on / have used?

Do you use patches, gel, spray for estrogen and what dose?

I'd say she is reasonably well qualified but it doesn't explain why she did blood tests first, unless you had made it clear you wanted testosterone. As PPs say this necessitates a test of your estrogen.

No it doesn't.

@JinglingSpringbells Started on Evorel 50mg, then moved up to 75mg and now on 100mg. Also taking 100mg Progesterone per night. Broken sleep every night.
Should I cancel my appointment then? Is it all a waste of time and money?

I don't know to be honest because I don't know what your GP has suggested or what you have tried.

For a start, you could try Oestrogel instead of a patch. 2 pumps= 50mcg patch , 3 pumps=75 and 4 pumps=100mcgs.

On a continuous combined basis, with the high dose you're on now, the BMS suggests 200 Utrogestan daily.

You could try cyclical HRT, so using Utrogestan for 12 days per cycle. (Utrogestan is renowned for giving low mood.) If you are seriously intolerant you can (usually with specialist advice) use 10 days a month or even go to a long cycle where you use it every alternate month.

I'm many years post meno and cannot tolerate daily Utrogestan - gives me migraine.

Many GPs are reluctant to suggest cyclical to women post meno but it really is possible and reduces side effects of progesterone (friend of mine still does this in her 70s, on the NHS.)

There is also the Mirena coil as an option.

Femoston tablets have dydrogesterone as the progestogen and it's almost as body identical as Utrogestan but some women tolerate it better.

If you saw someone privately they would probably suggest working through the options. But your GP may do the same if you ask.

If it's mainly sleep that is the issue have you tried lifestyle measures like exercise, no alcohol, no caffeine etc later in the day?

Can you elaborate on that?