HRT: What to ask for at initial appointment

[Traveltart]

I realise HRT can be trial and error until the dose etc is right. Given that GP appointments are harder to swing than Oasis tickets at face value, it would be nice to get it semi right from the start.

What did you ask your GP for or what combination would you advise to ask them for? Most doctors are not experts in this so I would like to go in there armed with suggestions.

Symptoms: fatigue and brain fog, sluggish metabolism, sore legs and ankles when walking sometimes.

I may have beginnings of some hot flushes at night or it could be bloody warm for this time of year - not sure which it is but I don’t want to go through this.

I am 50 so do not want to be fobbed off with anti-depressants.

Have started skipping periods for the first time (have been regular as clockwork with short cycles).

No known history of ovarian or breast cancer.

Hit me with what combo worked for you. Many thanks! Appointment on Friday morning!

Transdermal is the preferred option, so patches or gel & progesterone. I also have the topical oestrogen.
Are your smears and mammograms up to date as they always ask at my surgery.

I had my appt almost 2 weeks ago. It was fine, really positive! I didn't need need cry or beg or cajole.

I knew I wanted to try HRT. I understood the possible risks and probable benefits and made it clear that I did so.

I knew I needed oestrogen and progesterone as I'm still having periods/I have a womb. I what I wanted: transdermal, and what I did not: Mirena. I also wanted to try topical oestrogen cream.

I didn't get asked about smears or screening mammograms. I'm too young for the latter and have withdrawn from the list for the former - and that should not presume you from having medical treatment anyhow.

I just did an Econsult as I thought my thyroxine needed adjusting.

For some reason they did an FSH test as well the regular thyroid function tests.

Had a phone call, GP prescribed HRT, that was it. 10 yrs later I just send an Econsult requesting changes or increases.

No one asked about smears and I was 43 so too young for Mammograms.

Im 53 never had a mammogram. Stopped having smears about 7 or 8 yrs ago. No one has ever mentioned it.

I would avoid your Dr and go to a menopause specialist who can listen to your symptoms and they can actually advise you on what you need based on your symptoms. GP's are no good as a first point of call.

You don't "ask for" anything at a doctor's appointment - you explain your symptoms etc to the qualified health professional, and they decide what to prescribe, if anything.

I think it depends on your GP - mine is a woman about my age and is really clued up. She gave me lenzetto spray for oestrogen and utrogestan for progesterone. I’ve since switched to a Mirena having been very anti-one originally and have just started on testosterone and estriol cream. She’s been brilliant at listening to symptoms and suggesting tweaks. Definitely give it a go but don’t be afraid to ask to change if things aren’t working - there are lots of options now.

Go in armed with your symptoms and an idea of what you might prefer but they should explain all the options to you. The options will also depend on if you're still having periods or not.

Yep this was my experience too -well the Dr was not my age but was very clued up. And the whole conversation was well, this may help with some or all or your issues but obviously there are no guarantees. Shall we try <this> for 3 months, then we can adjust as needed.

@Pedant61 The fundamental guidance in the NICE meno guidelines is that the consultation has to be one of discussion, where women's preferences are taken into account.The old 'dr knows best' is not how it works now. Women are supposed to be equal partners in the choice of HRT (and if they want it at all.)

So, that means doing some research and deciding what type pf hrt you might prefer- patches, tablets, gel, maybe the Mirena coil for the progesterone part, etc.

Sadly, as posts here show, many GPs know nothing about HRT- they get no training on it unless they have CPD which they choose to initiate.
Many women here have actually been mis-prescribed and sometimes even dangerously so.

Wild people saying here they are in their 50s
and never had a mammogram.

@Traveltart You don't need any questions about smears or mammograms as they are separate issues. Your GP should ask you those anyway but not in relation to HRT.

Have a good read around about it- the website of Dr Louise Newson is good and also the medical info on Menopause matters ( author is an NHS consultant.)

Have a think about what you'd feel comfortable with- ie some women love patches (I'd hate one!), others like gel or spray and tablets are fine if you have no risk of blood clots.

Hope it goes well.

You must have had amazing GP appointments, never gaslit, never known more about your own body and in fact medical condition than the GP.

My HRT appointment went like this, I would like HRT and let me tell you why I think that. That was on the advice of my older sister who was fobbed off with anti-depressants rather than HRT for a while. She also had to go private to get the testosterone because the wait list was 12 months for NHS. She had the blood tests to prove her testosterone was low but it is monitored by the hospital, not the GP surgery.

I couldn't actually get the HRT that is recommended by The British Menopause Society for my endometriosis. I had to go back for a second appointment with the same GP with a bloody print out of NICE guidelines, BMS and ESHRE (European Society of Human Reproduction and Embryology) on endometriosis. Finally she gave in but not without telling me that I would have all these horrendous side effects. I haven't experienced any and I am 7 months in.

It is meant to be collaborative between the patient and the GP and I have had some great experiences with GPs recently but the last 20 plus years, not so much.

Please ask for a heart and diabetes healthcheck too. Fatigue, sore legs and ankles and night sweats are not just symptoms of menopause. I would hope the doc would suggest those anyhow, but sometimes recently the "I want hrt, dont fob me off" insistence can stop other questions being asked.

The NHS invite is over 50. I do know some women were slightly over 50 ( like 51-52) when they have had an invite.Maybe that's what they mean?

Yes - absolutely. It’s just I don’t leave in the UK anymore and where I live it’s from 40 that you start doing a yearly mammogram. I think I never realised how poor was the NHS in many ways until I moved away, if that makes sense.

Sorry to hear about your esperience. Out of curiosity, has the HRT worked for you then -
endometriosis wise I mean.

sorry to derail this post.

@Yogafiend yes I feel like a new person. I am monitoring endo flares to see if it is getting any worse than normal but it isn't. I actually realised I must be in peri when my daily symptoms seemed to reduce which was an incredible relief.

I am on the lowest dose for both oestrogel (because I use a hot tub for pain relief from endo so I cannot have the patch) and continuous progesterone. I have had no bleed through either just normal periods as always. Feel free to PM if you have any questions.

@MarlowCrossing - really pleased to hear it’s working out for you. It’s nice to hear a positive result. I had to have a surgery to remove mine in the end so was curious.

Wow! Thanks for all the responses! I had to go to an event and totally forgot I started a thread just a few short hours ago (brain fog!).

Can I ask why some people hate patches? Is it the feeling in your skin? Why is gel preferable? I don’t like the idea of the pill for some reason but can’t articulate why. Definitely not Mirena for me.

Yes still have periods although I haven’t had one for two months which is weird… Though I am 50 I guess!

Wasnt Dr Newsom’s clinic criticised recently over some of the prescribing practices?

I have actually read loads around it but have forgotten most of it and have a hellish week with daytime and evening events!

I was using Mumsnet as a form of (intelligent!) AI…

Have you done this privately and if so, can you transfer the prescription to the NHS eventually?

So what other option did you get, I am not there yet but also don't want mirena due to past womb issues, if you don't mind me asking what brands and what dose, I know individuals vary, but for ideas?

Patches are fine for some people but they are a relatively large patch stuck on your bum so anyone seeing it knows you're on HRT! If relevant.

. Some women find the adhesive hard to remove. They also mean you can't change the dose yourself, which you can do with estrogen gel (from a low 1 pump to 4 pumps a day, although the higher doses can need more progesterone.

The Newson clinic has grown hugely. There are dozens of doctors on her website, so you'd find it easy to get an appt. Many are GPs with hrt training. The prescribing issue was around very high off-licence doses of estrogen. Obviously you don't have to agree to that if it was ever suggested.

Some GPs will continue to prescribe privately prescribed HRT (but they don't have to.)

It depends what you want and how straightforward it is. I've had private HRT for many years partly as my consultant doesn't just support me with HRT. They are a consultant gynaecologist/ meno/ hrt expert and I wanted the continuity- they did my smears and other issues.

Maybe start withy our GP and consider private if you don't get the response you want.

I bought hrt through Superdrug, tried that for a bit and then asked the gp for a repeat prescription. I was about 2 years post last period though so it might be different.

@JinglingSpringbells you can change patch doses yourself by cutting them depending on the patch type.
You can definitely cut the Everol brand patches.