HRT symptoms returning after a year on meds: can they wear off? Been denied a review.

[RumPidgeon]

Not sure where I stand with this so came to seek advice:

menopausal, on HRT (1mg Elleste tablets), been on them for a year. For the last 4 weeks I have been experiencing the very same problems that got me to take the medication in the first place: hot flushes, poor sleep quality and very little sleep, then permanently fatigued all day. I feel sad, not depressed, just meh.

I contacted the GP to ask for a review and the nurse said I couldn’t get a change of HRT meds and has prescribed some sleeping tablets (but only 7 “because they’re highly addictive” 😳

What can I do in this situation other than going private?
I’m convinced the effectiveness of HRT meds is wearing off but the nurse said this cannot happen. I have no idea so please share your views with me. Thank you!

Honestly, it's pathetic! Ads, sleeping tablets, things will sort themselves out?
Has she done any HRT training?

If you use gel you can apply it any time you like.The only thing is you can't shower, bathe or wash it off for an hour after applying.

I've been on HRT 4 years that was the last time my blood pressure was checked. I think I'll just do it myself.

If symptoms are returning then you need to increase your oestrogen. You start on the minimum dose to control your symptoms, and increase as your natural production of oestrogen diminishes.

HRT does not cause your testosterone to reduce. Testosterone reduces naturally as part of menopause. If you supplement it without already having enough oestrogen HRT, your body will convert the testosterone supplement to oestrogen.

Antidepressants can help, but only when depression remains after adequate HRT has been used for several months. It is in addition to HRT, not instead of.

You can use topical HRT even if you spend your entire day in water. You simply must not wash the area where you apply the gel or spray for one hour after application. After that hour, anything goes. Some women do struggle to keep the patches on in prolonged wetness.

You can apply HRT at any time of the day. If you don’t have a hr between applying it and getting in the water, I would apply it at the end of your working day. Personally, I don’t apply HRT at bedtime because I wouldn’t be able to cuddle dh for an hour after.

You should be having reviews with a GP or menopause specialist (who might not necessarily be a GP or Consultant).

You cannot be denied access to a GP.

@RumPidgeon I am afraid you will need to be insistent that you are seen, if your practice cannot provide care then you need a referral to a specialist.

If you get to see you GP, take a bullet pointed list of the symptoms you are currently experiencing and do some research before you go in, you are being told consistently on this thread that your dosage should have been upped during your first year, you know it worked initially but from what you are saying, it has gone below plateauing and is worsening. There is no reason for any woman to put up with second class care. Tell them that you expect them to be professionally curious especially as over half the populations in the UK are women. And suggest they set up a menopause group at the practice.

You deserve better and you deserve it, now.

I have the tablets as I bleed on the patches and my skin is too sensitive for the alcohol in the gel. I take 2mg of estrogen ( Elleste solo). I believe that 2mg is the equivalent of 4 pumps of gel, and a 100 HRT patch.

I saw a private menopause Dr as I was fed up with the lack of information from my G.Ps, I also use testosterone. I have reviews with a nurse, currently we have a trainee in her final year. I know more about it than she does and I’m not boasting, I’ve done a lot of research due to being very sensitive to progesterone and trying to find a regime that works for ME. I think it’s very poor and not giving a good enough service for women.

'I have reviews with a nurse, currently we have a trainee in her final year. I know more about it than she does and I’m not boasting, I’ve done a lot of research'

Perimenopause is definitely an area where a lot of patients are better informed than some professionals, because we've had to be! I have a GP now who is generally v good and helpful, but even she was telling I'll probably need to come off HRT when I'm 60 🙄 I'm 46 now so I'll cross that bridge as and when!

Thank you for the many great replies. Loads of info and I was glad to hear it as I obviously have no clue and been royally fobbed off.

I have written a small paragraph on notes based on all the advice and cited Nice guidelines - probably a bit heavy handed but I‘m not taking any chances.

I have detailed the telephone conversation with the nurse and while I appreciate her opinion I am seeking an appointment with either the GP or a menopause trained specialist. Our AskMyGP gets overwhelmed by 9am each morning and shuts down so I saved this and will copy and paste it on Monday morning to make sure I get seen and something changes.

Thank you to everyone who took the time to respond and help. 🙏

My drs have never done this.

@definitelynotAI You need a review legally once a year.
Some drs do a 6 month review to check the dose is okay.

You don't need BP checks every 6 months.
They are done initially, by some drs, but not at every appt.

Blood pressure and HRT are not related in the same way as the Pill, but BP needs to be controlled by meds or lifestyle regardless of HRT.

Most people now do their own BP at home (for health not just HRT!) - monitors are very cheap and it's far easier than having it done by a dr.

Advocate for yourself. I ask when I want my meds reviewing (I'm on different ones) I don't wait for them as they don't know how I am feeling at any given time.

I am totally able to advocate for myself.

I have had HRTs increased and changed over the years. I just do an Econsult and tell the GP what I want. The prescription is sent straight to the chemist.

Oral estradiol is perfectly safe for the majority and often better suited to athletic women and swimmers than patches or gels, so make sure that what you choose reflects your lifestyle and individual needs rather than statistically minuscule risks that are often blown way out of proportion.

If you are active enough for gel or patches to not stick, your individual thrombotic risk is likely to be very low in the absence of other risk factors.

But absolutely if what you are on is not meeting your needs, continue to be the squeaky wheel and go armed with NICE guidelines.

In my opinion it is borderline malpractice to just shut a patient down and send them packing with tranquillisers after they have perfectly reasonably asked for a review of treatment that is not having the desired effect.

I wonder how often this happens to male patients whose treatment for something isn't working - probably far less often!

Oh that's interesting. I started on tablets. It was a few years ago though. The GP asked me to look at the options and let her know what I wanted to try. Upped the dose after a few weeks and that was it sorted.

They call me in for a BP test whenever needed and from time to time send some review questions before issuing the next prescription. They ask about side effects, if my symptoms remain under control and am I happy to continue the regime I'm on.

I hate to see women having a hard time 'convincing' doctors to let them have HRT. I was fully prepared to go private if the GP was obstructive.

OP, did they give you the clinical reason for not increasing the dose?

Have a look at the NICE guidlines, if you're in the UK.

As you're already on it, you probably don't fall into the group that cannot have it. There are circumstances where HRT should be prescribed with caution though.

You need regular reviews with HRT and as for not being able to change, that’s rubbish if the one you’re on is not suitable.