Useless advice from GP

[Rhiandrath]

I have been on 0.25 Evorell, which I am aware is the lowest dose, for 7 weeks now. I had started to see an improvement but all my horrid symptoms have started to come back, so reached out to my GP to see about increasing this. A nurse practitioner called me back and suggested sticking two patches on for 50 and then try to decrease again in a few weeks as they ideally want me on the lowest dose possible. I am sure this is NOT the advice, to chop and change my dosage, and with symptoms, am I not entitled to be on the right dose for me, not just the lowest dose. I asked if there was a menopause specialist at the surgery and she said no there isn't and they all know a bit about it. I feel floored and upset, I have had the worst weekend ever battling this, not sure where to turn really.

Sorry to hear you’re feeling unsupported op. HRT is a bit of a minefield and so variable person to person. I think the advice to increase the dose seems a sensible plan to see if it helps relieve the symptoms. I’m not sure about the plan to decrease it again though. Perhaps if the higher dose works for you then ir will make a good case for you to stay on that dose?

They are wrong because the right dose is one which manages your symptoms. There is no point using hrt if it's not working.

The guidance is the lowest dose to treat symptoms- not just 'the lowest dose available'!

Make an appointment to see your GP- not a nurse- and stick to your guns.
If they are stubborn, ask them to show you the guidance which they are quoting- they will struggle as it doesn't exist.

TBH you need to be assertive and explain calmly that the guidance is not the lowest dose but the dose that manages symptoms.

A 25mcg patch is very low. It's one that much older women over 60 are advised to start on. The usual dose for younger women is 37 or 50.

Personally, I'd ring your local sexual health/family planning clinic and ask about their menopause clinics. They often run both contraceptive and separate menopause clinics. You'd usually be seen my a gynaecologist or a specialist nurse, but IMO, they will have far more knowledge of menopause meds/support than both your GP or practice nurse.

www.nhs.uk/nhs-services/sexual-health-services/find-a-sexual-health-clinic/

I thought NHS menopause clinics were like hens' teeth- I've never heard of anyone using them unless referred by a GP for something very complicated. There's nothing on the link about them offering menopause support.

The other option is to see someone privately, but that costs, of course.

The point is her GP/ nurse need to follow guidance, not have women looking for other options taking up their time and effort.

Thanks, I thought exactly this. I have written and asked for my GP to follow this up. Increasing the dose to then decrease it seems ridiculous to me. As you say, it is the lowest dose which treats your symptoms rather than just a low dose.

Re: the clinic point above, I asked about it during the call and she said there is a menopause clinic but I wouldn't have a chance of being seen as the waiting list is ridiculously long...helpful.

I am considering private at this point tbh.

Stick to your guns. I've found they cave in when you confront them with the evidence.