First GP appointment about HRT - any tips?

[harriethoyle]

After a few months of night sweats, broken sleep and increasing anxiety, I’ve bitten the bullet and booked an appointment with a female GP to discuss potentially starting HRT. I’m 47 and pretty confident this is peri rather than life stress!

What do you wish you’d known to ask before your first appointment? Or what research did you do which helped? I want to go in fully informed and not be fobbed off…

I wouldn’t give HRT on top of the combined pill sorry OP.
progesterone only pill I would but not combined.
if you’re on a combined pill you’re already getting replacement Oestrogen.

Yes that’s what all the literature I’ve looked at tonight says @lovelydayss - so either I’ll have to change pills or use entirely different contraception which is vexing. I’ve been on microgynon for decades so I’m reluctant to change now but I can’t cope with ongoing lack of sleep! Argh..,

Don’t let them just fob you off with patches. Ask about the spray or gel and testosterone tablets.

I was coming to say this I wish I had known about vaginal oestrogen years ago. Virtually stopped my urinary incontinence.

I’d be giving serious thought to if your symptoms really are due to peri menopause (ie declining oestrogen levels) if you’re already on replacement Oestrogen. I’m not saying they’re not. I’m just saying consider the other possibilities as I can’t think of a single occasion in my 15 years as a GP where some one on the combined pill has truly needed HRT.
However if you’re up for a Mirena coil, I’d say that and some Oestrogel.
Or Utrogestan progesterone is good for sleep either with either oestrogen gel or patch but then obviously you’d need either POP or condoms on top.

Not RTFT but absolutely second this. Don't just say how you're feeling, you have to emphasise the impact it is having on your life. They seem to take that much more seriously

That’s really interesting and helpful @lovelydayss - thanks for taking the time. Maybe I’ll ask about sleep aids instead 🙈 but I don’t think they’ll help work the night sweats. Can they prescribe air con?!

Haha if only!
Maybe just go with the aim of having a good chat and seeing what they think.
I enjoy women’s health so like the chat bit and being early 40s I often wonder how much of my tiredness and being warm at night etc is peri and I think it’s probably very much not clear cut and I don’t think I’m that far into it yet.

Er you say "dont get fobbed off with patches". Why?

I'm on glp-1 and thought patches would mean I don't meed to worry about it going through the gut. Also regular release - and I dont like the idea of gel.

I'm only second month in (and bleeding again after 7 months not!!) but now worried was atches the wrong thing?!

100% agree with this after i was first fobbed off.

You could opt for mirena and oestrogen patch. Mirena will cover contraception and progesterone

awake with night sweats and marking my place.

My GP was lovely. I gave a list of symptoms and said that I want to try HRT, she went through the options and was really helpful.

Do you mean progesterone tablets?

Testosterone is a cream.

Patches suit many women and micronised progesterone isn't always plain sailing- some women hate it.

It's contraindicated anyway. so it's not an option.

(Are you a GP?)

@harriethoyle There is a new type of POP - Slynd- which is available off licence as the progesterone side of HRT.

You can also take a higher dose of the conventional POPs like Noriday.
You'd need to come off the combined pill at 50 anyway.

I'm sure I've read that the combined pill is not as effective as HRT

Thanks @JinglingSpringbells - was going to ask GP about efficacy of combined pill vs proper HRT so that’s helpful to know

You just go in and say you want to try hrt please.

And keep saying it, parrot-fashion, until they listen to you.

If you need contraception still, many women have a Mirena coil for the progesterone element. Then patches/gel/spray for the estrogen.

Agree that female GPs are not always better. I had shocking treatment from two, middle-aged, female GPs who just wanted to fob me off with anti-depressants and usher me out the door. It was a male GP who finally listened.

The combined pill is a higher dose of estrogen but it's a synthetic type and that's why it's contraindicated after 50 because of the blood clot risk.

It's also easier to adjust the estrogen dose with HRT and micronised progesterone is sedative if sleep is your main issue.

Don't assume you will have to fight for HRT . And don't assume female drs are better.

My consultant is male, I'd been seeing him privately (through insurance) before starting HRT (consultant gynaecologist) and when I had issues affecting my quality of life, just said I'd like to try HRT. I'd already been using vaginal estrogen for a year. He was extremely supportive, pro-active and knew what to prescribe.

If you DO have any problems see another GP and if that doesn't work you can (if you afford to) see someone privately, who may be more experienced.

I agree with this in theory and had a word with myself when I saw that I'd been assigned a male GP for my HRT review. However it turned out to be the most dismissive, patronising and maddening consultation I've ever had with any doctor ever. So upsetting I ended up complaining and getting a new review with a female GP (and an apology from the practice). So until I am guaranteed that same level of evidence based care from a man as a woman I'm not going to sacrifice myself on the alter of non-sexism. Certainly I haven't been afforded that professional courtesy in my own career.

OP I am on the gel and mirena coil and after a bumpy time with progesterone tablets everything has settled down and I feel much better than for ages. Lucky you need contraception as getting the coil for HRT purposes takes ages on a waiting list (maybe just in my area?). I lied about it to get it quickly on the advice of my GP as my H has had a vasectomy but you won't have to.

Things are much better than they were on the HRT front in this country but still not as they should be.

Yes - as I said, I wouldn’t give HRT to someone on COCP

Just to reiterate, anyone needing a mirena for HRT, if your GP says ‘so do you need contraception?’, say YES. Even if your partner has had a vasectomy, or you’re a lesbian, or you find the idea of penetrative sex repulsive.
For funding reasons you’ll get the mirena inserted much faster.

Sorry yes progesterone tablets.

I don’t fancy the coil, I confess. I haven’t had children and I’ve heard some insertion and removal horror stories. So reassured POP and HRT are an option.

I refused the coil, twice.

The last time, the male gynae consultant drew me a little picture of a uterus to explain to me where it would go 😑