Any advice welcome…

[doneitagain12]

My mum is going through the menopause, she’s 59, 60 next year. Shes been going through it a fair few years now. But in the last year or two has majorly struggled. She is on Estraderm MX 25 patches, changed twice weekly alongside Utrogestan 100 mg taken daily at night.

We made her a Drs appointment last week, which was scheduled for a telephone appointment on Friday - they never called.
This was to discuss her ongoing symptoms which are :
extreme low mood/sadness
fatigue (despite still sleeping well)
night sweats and hot flushes
anxiety
brain fog
lack of self confidence

We wanted to discuss the possibility to upping her HRT dose as we realised she’s on the lowest dose, aswell as changing to ether the spray or gel as she finds the patches can come off without her realising and also she can forget when she’s meant to change them (how many days it’s been on etc)

Can anybody offer any advice on how to help her?? What she should say to the GP to get help, anything outside of a prescription that could help? What I can be doing for her to make any of it any better - I hate seeing her so down and not herself xxx

What a shame she didn’t have her HRT reviewed sooner. It’s good practice once settled on HRT to have an annual review to discuss if it’s working well.
When I briefly used Estraderm, I found that they dropped off too. Estradot patches are in short supply. Evorel patches are an option, or if she prefers she could discuss switching to Oestrogel which is applied daily. Two pumps would represent an increase to the next dose up to the 25mg patch.

if she were to stay on the patch, it’s a case of picking two days a week like Monday and Friday and sticking to them. Phone reminders could be set up if she forgets.

What to say to the doctor…..at its simplest she could say the patch is not controlling her symptoms as she still experiencing XYZ and she would like to increase it.

The doctor might have been called away on an emergency so unable to make the phone call. Maybe phone reception to either request another appointment or she could write a letter or message via an online portal if available.

When you say 'we' made her an appointment is she struggling that she is needing this much support? If yes I'd really try to book a face to face and see if she can have a full assessment bloods etc to check if anything else going on such as thyroid issues etc.

In the meantime she could administer utrogestan vaginally, no need to ask gp or change prescription just the same capsules. Many women do this and it does reduce side effects such as fatigue/low mood etc.

If she's forgetting when she's applied patches definitely suggest she asks for gel. Have you noticed any other cognitive decline though? As I say yes possibly all meno related but it could be other stuff going on. Was she fit and well with good mental health until peri or has she always had anxiety related issues?

Good luck anwyay

Has your mum ever had a review of her HRT? How long ago did she start HRT?
Is she able to arrange appointments for herself? Is there a reason you are stepping in?

Her dose of hrt is very low. It's probable she needs a higher dose.

HRT should be reviewed after 3 months, then again at 6 months, to review any changes needed to the dose. Legally, all drugs are supposed to be reviewed every year.

Is she motivated to use her HRT? Forgetting to change the patch or getting confused could mean she's not 'bothered' or not understanding that missing days on a low dose is impacting on her health.

Out of interest has she asked you to step in or are you doing it out of concern?

You sound a very caring daughter!

Is your poor mum struggling so much that she needs you to advocate for her?
She really needs help

So I helped her because everything is done via econsult forms now and she’s not the best at doing these. She much prefers to call, so I just helped her by filling in the form for her and also encouraging her to go back to the Drs for help.

She hasn’t had a review of her HRT, since 6 months post being placed on it. She admits herself she probably should have seeked help long before but thought it was just ‘one of those things’.

The good news is, she’s got an appointment booked for next Friday. So hopefully, she’ll get some help. I have also encouraged her to ask for a blood test aswell to see if anything else is contributing to her fatigue etc.
x

Sorry the call never came, that's so frustrating. A few things that might help her get more out of the next appointment.

NICE guidance (NG23) says HRT should be reviewed three months after starting or changing it and then at least once a year, and sooner if it isn't working or there are side effects. So she's entitled to ask for a review now. It helps to go in with a short written list: which symptoms, how often (how many sweats a night, for example) and how much they're affecting her days. Then say plainly that her current HRT isn't controlling them and she'd like to talk about a higher dose or a different form. You could sit in on the call if she'd like you there.

On the patches coming off, the NHS advice is to stick them below the waist on clean, dry skin with no cream, moisturiser or talc, away from tight waistbands and skin folds, and to wait an hour before anything that makes her sweat. If remembering change days is the real problem, a gel or spray used at the same time each day might suit her better, and that's a fair thing to raise.

For the low mood, NICE says HRT can be considered when low mood started around the same time as other menopause symptoms, and CBT (a talking therapy) is an option alongside it. If you're in England she can refer herself to NHS Talking Therapies without waiting for the GP. If her mood ever gets very low or she says she doesn't want to be here, that needs a same-day GP appointment or a call to NHS 111.

If you have the cash (like 250) then a private menopause doctor can be incredibly helpful. It's just a thought. My local clinic is absolutely brilliant.

If the ops dm isn't online we dont know if she has missed messages. Our med reviews are often as messages not phone calls.

My parents don't use the Internet, things do get missed sadly and we often have to pop in and ask the receptionist to get them to chase something up.

Imo the ops dm needs a full in person assessment even with a nurse specialising in meno issues to get the optimum dose, the best method for her be it gel or patch and bloods to check for other issues.

On a slightly different note @doneitagain12 there are various ways your Mum can learn how to use the internet. Local towns often run free 'help sessions' to help people navigate websites etc. You might be able to find these for her- maybe start with Age Uk or CAB ? Or her local Facebook group?

Your mum's quite young still and many of my friends who are 10+ years older than her are proficient with using the internet.

That’s a very low dose, I needed 75mg. However I found that the gel didn’t work for me at all, even at a higher dose and you have to apply every day and as I was using 3 pumps had to apply to a large area and wait to dry. Patches are easier just need to set reminders I change mine Monday and Friday.