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…

Tbf with a 10 min slot going for a good chat may not be realistic.

Op, many gps are very clueless with meno issues so I'd read up on it. Read NICE guidelines, read threads on here. Be clear telling them what your issues are don't list chapter and verse of every twinge.

If you're sure you want hrt say clearly 'I've read the guidelines, I know the benefits and risks, I want to try micronsised body identical HRT and have a review in 6 months'.

I wanted to make it clear in case the OP thought it was an option depending on the doctor's personal opinion. When a dr says 'I wouldn't give it' they may think another dr would , rather than it being against medical guidance.

And that's your choice to make! Was just suggesting as another option. Hope your appointment goes well.

I’d agree with taking in a checklist of symptoms. You can find templates online. And, as well as saying how much it’s affecting your own quality of life, I have heard from other women that the deciding factor for their GP was to hear how it was affecting the quality of life of husband/ partner, children. 🤷🏻‍♀️

I don’t think the implant is contraindicated, maybe ask about that. I wouldn’t have the coil either.

Please don’t post nonsensical tripe like this. Being offered patches isn’t being “fobbed off” - it may be the most appropriate method to offer eg if a woman is on weight loss injections, or admits she’s scatty and wouldn’t remember for use something daily.

The consultation should be a joint enterprise to establish the most appropriate treatment. For example me saying “maybe a patch would be beneficial” isn’t fobbing you off.

Women are all different and thus should be offered a treatment plan THAT SUITS THEM. All options should be offered and discussed where appropriate, and steering a woman towards one may not be “fobbing them off” but a result of considered options based on knowledge, research and what sounds best for that woman.

And no you can’t use HRT and a combined pill but some newer generation combined pills can act like HRT as they contain estradiol which is the same sort of oestrogen in HRT, as opposed to ethylestradiol which is in traditional combined pills.

So pills like Zoely and Qlaira. In younger women they can be worth trying as a first option especially when you need contraception too.

Just thought I would update as I was extremely grateful for the help, particularly from those who were HCP.

GP was great - no issue at all with prescribing HRT. Asked why I'd waited so long when I told her my symptoms! but I explained that my job is very stressful and so wasn't sure if anxiety, poor sleep etc was to do with situational stressors rather than peri... A little bit of pressure to have a coil rather than POP but I pushed back on that and so she's going to switch me to POP for contraception, daily oestrogen gel, starting at 1 pump but can go up to 2, and progesterone tablets days 15 - 26 of a 26 day cycle before bed, which apparently will help with my sleep too. Review in 3 months.

Am starting next Monday because I've got two parties at which I intend to wear cream clothing this weekend and I DO NOT want a breakthrough bleed at either!

Thanks again for your collective help, much appreciated.

That's great but just one point. You will create an HRT cycle- you can't wait for mid cycle in peri as it will be early or late.
Most GPs suggest 2 weeks on it, 2 weeks off.

Many specialists suggest 12 or 14 days per calendar month (starting on the same DATE each month.) This is advice from my consultant for women using it in a cycle.

If you don't get on with it you can use the new POP Slynd which covers both contraception and HRT.

I'm probably being very dim @JinglingSpringbells but I don't quite understand your comment that I can't wait for mid cycle in peri - I am mid cycle now, about 7 days in and GP said it was fine to swap to POP next week and start with gel then and then progesterone. Are you saying I should wait until I finished this pack of microgynon or that I should start straight away? GP said I didn't need to finished current microgynon pack. Sorry to be dense!

Sorry to confuse you and you're not being dim.

What I meant was if you start HRT progesterone (not the POP ) mid cycle this month, start the next progesterone cycle on the same date next month.

In peri a natural 'mid cycle' eventually doesn't happen every month. You might have a 6 , 7, 8 week cycle. You might miss several cycles. Your cycles will be unpredictable and usually further apart.

It's best to stick to the same date each month for the progesterone.
So if your mid-month date was 1st August, the next would be 1st Sept and so on. That's setting an HRT cycle.

It's something that has been discussed here a lot and my consultant is not the only dr suggesting women do that- many other posters are told the same.

If you're moved onto a POP and you stop bleeding because of the continuous progesterone (which is likely) you can then use continuous HRT progesterone instead of cyclical anyway, so do review with the GP if that happens.

Thanks @JinglingSpringbells that really helps.

But in that case she could be using Slynd, the POP, which is available off-licence as HRT, as it does both. OR 3x tablets of the POP Noriday.
Does your practice offer those, (out of interest?)

I got a telephone appointment told gp my symptoms then she asked if id prefer gel,patch or tablets then prescribed.

Exactly, which is why if a woman wants contraception and HRT I am so chuffed I can now offer Slynd!

I don't tend to prescribe Noriday as we've had supply issues of that in my area, so I tend to use Slynd.

Some GPs are still prescribing desogestrel POP for contraception and adding cyclical HRT which is a bit arse-about-face IMO. Why not just get them on Slynd...

It was all going too smoothly. Went to Boots to collect my prescription and they’ve only prescribed two of the three medications- but doubled up on one of them. Not clear which yet because they’re just filling the prescription but I am WAY too perimenopausal to fathom why the pharmacist can’t understand the difference between three boxes containing 2 separate medications in various quantities and 3 different types of medications. 🤬🤬

I just told the gp my symptoms . Then gp explained all the different options to me. Left with prescription. Felt better I. A few days.

And when you get the prescription, take 5 mins before collecting it from pharmacy and get the HRT pre-payment certificate- £20 ish pounds a year and covers all your HRT!

Ive signed up for the annual all prescriptions one. About £10 a month and covers everything! (I get adhd meds and inhalers too)

I'm about to have this discussion with my gp so this thread has helped alot!
Can I ask a question please.. I have endometriosis and had an implant for years to help manage my symptoms but had a break and now I'm suffering again so would like to ask about having the implant back in.. I'm 47 and my periods are not regular, maybe every 4 months I miss a period altogether. I have other symptoms also like sleep issues, aching hips and brain fog
How would the implant affect a decision for which HRT I'd have, if at all?
Thanks for any information

@SandyToes46 no the implant will have no bearing on HRT selection.

Echoing others; take a full list of symptoms and tell them how badly they are affecting you. I had to take the blood test before they would prescibe HRT and thankfully it showed declining hormone levels and I got my patches quite quickly. I was prepared to fight a "normal" blood test and insist on needing HRT with the doctors, as I have been made aware from MN that the blood test doesn't always show the full picture.

This is excellent advice ☝