Finally feel like I'm at the right dose of HRT but GP is telling me that I need to consider stopping soon?

[moderdy]

I am 48 now. I've been on HRT since 43. I started on a 50mcg estradiol patch and 200mg progesterone (utrogestan) capsules 12 nights a month. After a few years when my symptoms returned I had to fight to get moved up to 75 mcg estradiol and then again to 100mcg. Prior to each increase I felt like hell, I wasn't sleeping, I had terrible joint pain, hot flashes, the worst brain fog and low mood, crippling migraines and there were times I seriously contemplated ending my life because it just wasn't worth living like that. I've just had my first review with my GP after starting the 100mcg (she has me in to do my blood pressure, weight and blood sugar, cholesterol every 6 months while I'm on HRT) and my blood pressure is down, cholesterol and blood sugar are now in the healthy range when previously they had been creeping up high. Its not all perfect but I was telling her how much better I was feeling and sleeping, that I was exercising more, doing strength training, losing weight and back working again. She said that was great but then reiterated how "you can't stay on HRT forever" and that in the next year or so we'd need to have a conversation about my reducing the dose and then stopping essentially as soon as possible as I have already been on it now for 5 years.

I just can't face the possibility of stopping at any point or not for a long time. I'm not even 50 year so still have almost two decades where I will need to be working and earning and I just have no quality of life without the HRT being at the right dose. I'd love to try the testosterone and be prescribed some vaginal estrogen but it feels like any mention of additional hormones is met with such resistance from my GP.

I was searching online about this and found the UK GP subreddit where it looked like a lot of GP's were saying the same kind of things that HRT was too risky and that demand for it had got out of hand, that is should only be for hot flashes and was over prescribed and demanded for mental health and sleep issues now. This was in a post after a high profile HRT advocate was diagnosed with breast cancer.

I do want to stay on HRT long term, I looked at the nice guidance and the British menopause society and both say there is no longer any defined deadline to stop HRT and that staying on longer term is a choice to be made between the patient and doctor taking individual risk factors into account. Why are GP's ignoring the guidance like this and how can I stay on HRT long term, for me my life was hardly worth living without it.

Your GP is talking absolute nonsense.

I would switch to a new practice if you can or ask to see a different GP in your current practice.

It always make me so angry that so many GPs are completely ignorant when it comes to so many aspects of women's health.

Do GPs actually believe this or is it just a money saving exercise?

Report her for not following NICE guidelines— she doesn’t know what she is doing.

Yes sorry, thats rubbish that you were given that advice. I hope you got it sorted.

She's an absolute dunce. The ignorance of some GPs - still after all this time and all the publicity - I hear about on here angers me.

I have been soooo lucky since I first starting experiencing peri symptoms at 45. The NICE guidelines had just been updated, my GP was on the ball and had no qualms prescribing.

There is one (youngish) female Dr at the (large) practice who told me I'd have to come off HRT at 60, and that Vagifem was adding to my risk. Both incorrect. I have switched to oestrogel which isn't quite going as smoothly as I hoped...yet...

Luckily I knew my stuff my then via the NMS, NICE and Mumsnet so I ignored her and now when I do an e-consult request not to talk to her.
You are so stuck if there is only one GP at your practice and they are ignorant.

... and yes, I never had hot flushes, and only a few night sweats. TBF I used to think that was the main (even only) symptom of menopause, but I'm not a DR so you'd expect them to know better than me.

A gp should be adapting to what you want and need not filling you with worry.
Bullshit cancer causes cancer l.. todays treatment risk is so low. When i went on it the doctor gave me the stats it wasbt rven woryh worrying about...if it happens since cancer is in our fam so what.. deal eoth it if it does.?!
The person who was high "profile" was that proven from being on hrt?
Stop reading and lsitening to shit and go grt a new gp or private care.

This is ridiculous! You had an early menopause so it’s important to be on HRT at least until you reach average age of menopause to avoid the increased risks of osteoporosis and heart problems associated with that. Average age of menopause is around age 55 so your GP should be actively encouraging you to stay on HRT until at least then. Latest research shows those who had an early menopause who take HRT up to normal menopause age are at absolutely nil extra risk of breast cancer than those going through menopause at a the average age who never take it. So his pushing you to stop taking it now is actually harmful to your health.

Even after this age the extra breast cancer risk is minimal and must be balanced against the benefits of HRT, which for you are considerable. This is why NICE guidelines are that patients can decide to take HRT for life if they wish.

I started menopause very abruptly at 41 due to a brain tumour (not diagnosed until a year later) and my GP refused to prescribe it at first saying “what will you tell your children when you get breast cancer”! I then developed osteopenia which didn’t improve on calcium tablets. Finally at age 50 a hospital gynaecologist prescribed HRT and my bone density returned to normal within a year. I have had similar conversations with my GP when I reached 55 when they tried to persuade me to stop taking it. I quoted the latest research and NICE guidelines and stated I intended to take it for life as I didn’t want to end up with osteoporosis, which is a major killer of women in older age. They have backed off as they can see I mean business.

I don’t know why GPs are like this about HRT, Maybe it’s because they haven’t updated their knowledge about it since medical school, which is frankly professional negligence. More probably it is yet another example of medical misogyny which sadly is very common.

My mum is 87 and says she is never coming off it. She's had a few fights with GPs and nurses over the years though.

Get the NICE guidelines and tell your GP to read them and stop acting like it's 2006 not 2026.

I am not on HRT because I haven't felt that I need it. My mum had a hysterectomy in her 40s so went on it then and has never stopped.

I think they are trying to save money as well. I would be embarrassed to be so clueless about HRT when I am a doctor. I realise GPs can't be experts in everything - but if we know that the message has changed on HRT and can read NICE guidelines, why can't they? I've read them on other areas too.

There is no age limit to HRT use.

Some of the best consultants in the UK have patients on it at 80 and 90.
(I was told this, in person by one.)

Hopefully, the OP is sorted now.

Both my GP and my gynaecologist (in their mid-late 60s) have told me they have no intention of coming off it unless they have to.

HRT worked like magic on me but after 5 years my GP suggested trying to come off it and I was happy to try. After a good few months all the horrible symptoms came back so I went back on it.
If you’ve been on it for a long time I don’t really understand what the problem is with in seeing what happens if you come off it. I would have preferred to come off it to reduce the risk of cancer. It’s a small risk but it’s still a very real risk. You can always go back on it if the symptoms return.

HRT has a life changing effect on me. I sleep well, I feel lively and healthy, and I don’t get hot flushes or that horrible creeping sensation over you skin. I feel so much more comfortable.

I’ve never been someone who has suffered with anxiety but I do wonder if HRT makes me a bit anxious. I can wake up feeling a dread of something even though I am happy and very luckily don’t have external things to cause stress.

I

My GP talked about stopping my HRT, I simply told him my gynaecologist had told me he liked his patients to remain using it for the rest of their lives, he has never mentioned it since.

I think there is still a bit of the " it's all in their mind" attitude too.

Potentially. Or just that women are just too stupid to know anything about their own bodies. But you'd think female GPs would have more nouse.

I don't know why there is this bias against male doctors. There are good and bad doctors of both sexes. Many male gynaecologists, who specialise in hormones, are brilliant as they have gone into the profession really wanting to help women.

The top consultant menopause gynaecologists in the UK (with a few exceptions) are male, they have written/ updated the NICE guidance and the British Menopause Society guidance, and they really are on 'women's sides'!

It's just old fashioned sexism I'm afraid. Expecting a female GP to be empathetic and clued up just because she's female is nonsense, as is expecting a male GP to be heartless and ignorant just because he's a man. And even worse, making excuses for him on the basis of sex.

Obviously ALL healthcare professionals should be offering high quality evidence based care, and it's appalling that it's not the case, but let's leave sex out of it