Blood pressure monitoring BEFORE being issued HRT

[its2025]

HI Ladies - just wondering if this is expected now. I've been considering HRT for sometime and finally got round to having chat with GP earlier today. Discussed all my options and decided to go ahead with continuous HRT - I'm 54. Dr mentioned having a Blood pressure reading while we were chatting - fine - I thought i'd just submit the one reading.
Turns out they need a weeks worth of two readings per day to get an average reading. (this is before they'll even issue the prescription) I've literally never had an issue with my blood pressure. As they need two readings per day - that realistically means I've got to go out and buy a blood pressure monitor to use at home for the sake of one weeks readings.... I'm just a bit baffled and a bit annoyed - it feels like getting the first prescription is just really hard work!

Would they do a 24 hour monitoring instead, with one of those little gadgets that checks your BP every 30 minutes? I'm sure they did that with me.

No I didn’t have this. They weighed me and took my blood pressure - and I assume looked at my notes which would have shown always a similar weight and ok readings. Is that overkill or just good practice - I’m not sure. Have you ever had a history of anything that would make you a risk.

i did get a referral to the nurse though as my symptoms were manifesting as a desire to self harm.

I have no history what so ever of Blood pressure issues. Perhaps that's part of the problem - it's never been monitored before so they don't have any readings to go by?? The consultation I had was over the phone - I was asked my weight and height. Also family history and checked I am up to date with smear and "boob checks" etc.
I phoned the surgery to check and receptionist just said the Dr was being thorough. I wonder what they did before personal pressure monitors were common place?! Seems like overkill to me. TBF - The surgery have their self service blood pressure machine - and I could theoretically go in and use that twice a day - but realistically I'm going to have to by a machine of my own.

Some surgeries will lend you a machine for the time period. You just ask if they have any available.

Complete overkill if you've never had BP issues before. I never had this.

My surgery will lend patients a monitor. It doesn't seem at all excessive to require this check first, since raised blood pressure is such a widespread contribution to serious illness, tends to become more common as you age, and can be worsened by HRT.

The degree of risk from high blood pressure varies depending on which form of HRT you have, so that might explain some variation between doctors.

I appear to have developed major white coat syndrome at the doctors recently, so home readings best for me. I use an Omron machine. Actually my husbands as he has high blood pressure. Can take readings of 2 users. I recently had to do 7 days of readings. I discarded 1st reading and averaged out 2nd two for each day (first reading higher even at home). I sent my daily averages and my overall week average. Very different to my gp reading!
If your gp very near, and the surgery doesn't send your bp into a spin then a possibility but does sound like a faff.
Only did 3 readings a day.

I can understand them wanting to check my blood pressure regularly once i start taking the HRT - I've been told this is usually once a year?? Just seems bizarre they need an average over the period of a week before they even give me the prescription. After all - I've done one check today - and submitted that reading (which was normal).

Thanks @Sheggsie , I did speak to reception about this - and no offer was made to loan me a monitor - even when I questioned the need to buy one.. Might be worth me ringing again tomorrow to see if they have any loan ones.

My bp went up on evorel conti. Switch to evorel 25 and micronised progesterone. BP back down again very quickly. I guess they want your baseline before prescribing.

That does sound OTT. I just had 1 reading at the consultation.

I didn't have my blood pressure checked before getting my first HRT prescription, but maybe it's different now.

In our area, libraries have blood pressure monitors they can lend out for free, so it might be worth checking your local library.

Sounds sensible to me, blood pressure monitors are pretty cheap and it is worth monitoring at home to avoid the artificially high readings you get at the GPs and compare readings at different times of day etc. I am on HRT and check mine every few weeks just to keep an eye of things.

@its2025 GPs astonish me and not in a good way.

If you use transdermal HRT it has no impact on BP and in fact some lower it.

I think that many GPs equate HRT to The Pill and think older women (ie over 50) need a BP check, which is wrong.

It's also completely unnecessary to ask for updates on smears and mammograms- other than as a general health question, which should be on the notes anyway with your GP.

Tablet form which is rarely used now does come with a VERY slight clot risk but far lower than the PIll.

I've used HRT for years with one of the best menopause gynaecologists in the UK and only had a BP check very occasionally as a well-woman check, not connected to HRT.

Having said that it's always a good idea to know your own BP anyway regardless of anything else, and check it once a year or so, and BP monitors are cheap to buy. (Amazon). Get a brand that is recommended.

My GP required a BP reading before prescription & also never gives repeat prescriptions without me going in each time for a physical check. I bought a BP monitor for home as they also want BP readings in between, despite never having issue! Feels like overkill but I couldn’t be without my Oestrogel so I do what I’m told!

Although evorel conti transdermal, my gp concerned it might have impacted my bp negatively due to sythetic progesterone. Hard to be sure due to my ridiculous white coat syndrome! As having spotting as well on evorel conti changed to evorel 25 and micronised progesterone to hopefully help with bp and spotting. Early days...but home bp touchwood good.

I don't think there is any evidence that synthetic transdermal progesterone raises BP. You can check this yourself by researching online.

The risk is blood clots where tablets are metabolised through the liver and can cause changes to the lipids.

You mean your GP asks for a BP reading each month or 3 months?

That is unheard of!

It's another example of GPs not knowing much about HRT.

So do you need an appt to see them every few months?

You should query this with them- it's not in any of the prescribing guidance, which states an annual review only. And even that doesn't include a BP check.

I think from now on my bp at gps will be annually which I predict will result in 7 day home bp reading after every hrt review due to white coat impact!
I have decided to keep eye on bp more than that at home as my Mum started taking bp medication in her 50s and I'm heading towards 60.

I have to have a physical check every 3 months & as part of that, I have to submit a week’s worth of at home readings (as well as having my BP taken when I go in)

I have never seen my GP face to face for my HRT, but before every telephone appointment (I’ve had 5 over the last 16 months) I send in a weeks worth of BP readings as they always ask for them, especially when I have increased dose.

I have a monitor at home as I previously had high BP (which my optician was the first to notice when examining my eyes!), and now after weight loss have low blood pressure 🤦🏻‍♀️

I just take the request as them be thorough, which can’t be a bad thing. I also have annual bloods and weight/height checks.

It’s good to get a blood pressure baseline before starting HRT.

One early symptom of blood clots is a shift in blood pressure, so a blood pressure baseline before HRT and then monitoring during HRT can help prevent a clot getting big and causing a pulmonary embolism or other life threatening issue.

They also may have been directed to take these blood pressure readings so that further studies can be done on how certain forms of HRT lower blood pressure. They can’t prove benefits of HRT without collecting before HRT health data.

@SpiritAdder HRT doesn't raise blood pressure if it's the transdermal type and most women are not prescribed tablets now.

BP tests are not used as a diagnosis for a blood clot.
A blood clot causes symptoms- usually the clot is in the lungs or legs (or brain or heart) - which can be life threatening and needs A&E.

They can’t prove benefits of HRT without collecting before HRT health data.

There is a lot research on HRT and clotting risks- which is why BP doesn't need checking before prescribing some sorts.

Everyone should check their BP regardless of HRT or not, but it looks from these posts that many GPs are conflating HRT with the contraceptive Pill.

Have you ever thought about asking why when it's not prescribing guidance?
I've never ever heard of any dr doing this and I have friends who've used HRT for 20 years.

The guidance is an annual review, with a review at 3 months when starting HRT to see if the dose is working and discuss any side effects. Unless of course you are at a higher risk of something that you've not mentioned.

At my local surgery they prefer doing a weeks readings, to get a more accurate picture.

Some surgeries will loan out bp machines.

@its2025 @FrankieMcGrath
This is the BMS guidance.

https://thebms.org.uk/wp-content/uploads/2016/04/NICE-Menopause-Diagnosis-and-Management-from-Guideline-to-Practice-Guideline-Summary.pdf

7 Review and referral
Review should be arranged with a healthcare professional three months after commencing HRT and, once settled on treatment, annually thereafter.

Blood clot (Venous thromboembolism--VTE)—small increased risk with tablet but not transdermal (patch or gel) HRT. Transdermal should be offered to women at high risk for VTE, including those with Body Mass Index over 30.

NHS guidance
After you start taking HRT
You'll usually start with a low dose, which may be increased later. Your symptoms should improve after a few days or weeks.
A GP will usually recommend a review appointment 3 months after you start taking HRT, or if you change your type of HRT. This is to see how well it's working. If everything is OK, you'll usually have 1 review a year.