I have a nasty feeling the GP surgery are going to try and discontinue my HRT...

[GlomOfNit]

I left it too late to put in my order before Christmas and it then slipped my mind, so I'm currently going cold turkey whilst waiting for my online request to be approved - but turns out, it's annual review time! (that came around fast. I'm not entirely convinced it's been 12 months. They may have a new policy.)

This was a new one on me - I did a questionnaire answering things like 'what is the exact name of your HRT?' (do they not know?), questions about if I've had a hysterectomy (again, I'm fairly sure they should know this), any odd bleeding, up to date on mammogram and smear etc. How long have I been on it? Is it helping? Do I want to stop?
etc etc

I was then asked if I could provide a home BP reading. Mine has been in the 'grey area' between normal and high for a couple of years or so. Not been an issue so far. But I get very anxious about it and even at home it can come out high as I get stressed about it! I had to do 4 readings, I discounted the first as it was ... high, and I'd successfully put myself into a calm 'happy place' to try and bring it lower. That worked, and I averaged the last two readings which gave me 127/83. Not great but not officially 'high'.

However, my GP clinic are fairly anti-HRT on the whole and often tell me that I'm only 'allowed' to be on it 5 years. We know this is balls but that's what they tell me. I think it's been 4 years now.

My brain is addled but is it not the case that modern preparations of bio-identical HRT don't carry a BP risk? I'm on Sandrena gel, 2 x 0.5 g sachets, and 2 Utrogestan caps 14 days a month. And topical oestrogen gel for my fanny.

HRT sends my blood pressure really high, some people are BP sensitive to the progesterone but yours is normal at 127/83 so I wouldn't be stressing about that at all. The questionnaire will be the same for everyone, hence them asking what meds etc, then reviewed by a nurse or Dr. It sounds like a normal 12 months review so honestly I wouldn't stress about it.

Utrogestan can lower BP which is why it's taken at night.
I once had a very dizzy spell after taking it and not getting into bed for an hour.

It tends to be the older types of estrogen that were linked to blood clots.

HRT and high BP- the medical guidance is to treat high BP (same as if not on HRT) either by diet/ lifestyle or meds.

If you have a problem with the practice, print off the advice from the British Menopause Society (they have consultants who also write the NICE guidance) which says no limits are to be put on HRT because it's individualised and depends on your risks and benefits.

Meanwhile the British Heart Foundation has good tips on lowering BP on their website if you need help (sorry if you are aware already.)

I think you’re jumping the gun here by suggesting your GP is going to stop your hrt, on what basis do you think this? Because everything you’ve written sounds entirely standard, except maybe the “max 5 years” thing but as you say you haven’t been on it 5 years yet so irrelevant.

Yes to me your post sounds like you're incredibly anxious for no reason. You've had a completely standard 12 month review and your blood pressure is entirely normal. Ive never heard of a 5 year policy before. You may want to just clarify this with your GP.

They are standard questions that will be asked to everyone - patients often get grumpy when we ask the name of the medication they’re requesting and make comments that we should know, it’s on their record etc, but some people are on a few types of HRT and we want to ensure it’s recorded exactly what they’re requesting. I don’t think it sounds like your GP surgery is going to refuse it, they’re just doing their job.

Well, I am incredibly anxious generally, so there's that!

No, it's just (as I stated) that my GP practice can be quite out of date with some of the things they've told me over the years about both perimenopause and HRT, and I can think of 3 separate GPs who have, since I got started on it, told me how I mustn't be on it for more than 5 years, that the safest dose is zero (as in, 'we need to calibrate your dose and we think it's too high ' - this was a year or so ago when I was on 4 Sandrena sachets, 2g in all - 'and there's a continuum between too much, eg, your current dose, and the safe dose which is none at all'), and so on.

The 5 year thing is clearly rubbish as far as NICE guidelines go and I have pointed this out to them before but there you are. It's come from 3 GPs, over the years, as I say.

My first two readings this morning were in the region of 140/34 which freaked me out a bit. I managed to calm down and got an average of 127/83. Which is viewed by NHS as 'borderline' actually, not 'fine' - below 179/79 is meant to be normal if I remember correctly. There are also tolerances for doing it at home, again on the NHS website - I think they knock 5 points off the systolic number (so, 135 rather than 140) if you read it in a non-clinical setting for their 'high' cut off.
https://www.nhs.uk/tests-and-treatments/blood-pressure-test/

thanks, that's very reassuring. The questionnaire was new to me - can't remember how the last 12 month review was done and obviously it involved a BP reading and I think my weight/BMI, but this format is new and asks a lot more questions. I'm sure it's just dotting all the I's and crossing the T's!

I definitely do need to lose weight though. I'm 5'2" and I think 11 stone. Must go and get something back for the local council gym membership. (god I hate the gym)

I think they knock 5 points off the systolic number (so, 135 rather than 140) if you read it in a non-clinical setting for their 'high' cut off.

Surely the reverse is the case?
BP rises in a clinical setting (white coat syndrome) so it's more likely to be accurate at home.

It's worth reading the BHF website on reducing BP.
You don't need to go to the gym. Walking fast for 30 mins a day (more if you can) cutting down on salt and increasing fibre etc can do a lot.

If they try then l would either follow their complaints procedure, if they are going to make up rules which l am assuming are not evidence based and based on NICE guidelines. Or get a new GP's practice. Sending sympathy as my GP's are terrible and make up random rules to suit themselves

Oh, what I was trying to say is that I read on some NHS trust page or other, the fact that they view the top number as 'high' if it's 140 and up for BP taken in a clinical setting, and 135 or over as 'high' if taken at home, because you might be expected to have slightly lower BP in a relaxed setting.

I've had these the last couple of years and it's fine, also I had high bp on HRT and they just added a med for the high bp didn't take me off it. Stop worrying OP