Experiences of approaching GPs in Scotland re HRT

[NotSoLongGoodbye]

I'm deliberately not posting this under menopause because I want experiences of people living in Scotland only.

I'm been getting some peri symptoms for the last 2-3 years and they are becoming more troublesome. I have a tel call with GP booked next week and have been doing a lot of reading around HRT options as want to go in well informed.

But it seems that one of the progesterones prescribed in England (Utrogestan) is not recommended in Scotland - because of cost. I'm utterly appalled but not surprised by this - free prescriptions obviously only extend to cheapest available medication unless case can be made for alternative. That aside I've talked to a couple of friends and their GPs have been useless re menopause issues - merely signposted them to websites or suggested antidepressants.

Would you mind sharing your experiences so that I'm forewarned or pleasantly surprised. Have to admit I am going into this feeling it is going to be a battle to get taken seriously and would like to be proved wrong.

Well I shall let you know, @NotSoLongGoodbye as I intend speaking to my GP about this tomorrow.

I have had a hysterectomy, about 5 years ago, so no periods. But the hot flushes, the night sweats, the recurrent UTIs, not being able to sleep, anxiety - just done with it now.

Will let you know what they say, if I can ever get a face to face appointment.

Oh and meant to add - the being taken seriously is a massive issue.

One GP in my practice seemed to think me loosing industrial quantities of blood every month and being on permanent iron tablets due to a mahoosive fibroid was just one of those things. Go away and rest, and take some paracetamol.

The other lovely GP asked me why I'd put up with it for so long, ordered a battery of blood tests, prescribed tranexamic acid and referred me to a gynaecologist.

Both middle aged women, incidentally.

I think it’s very patchy. The GP I saw , about 8 years ago, told me that I ‘had to deal with menopause sometime’ and refused to prescribe. I was pretty upset and didn’t push it. But my younger sister had it recommended by her GP just a few years later.
If you don’t get a sympathetic response first time, ask if your practice has a GP with a special interest in menopause or gynaecology, and ask to talk to them.

@TheGenealogist
Good luck and hope your GP listens.

I am curious about this as I am experiencing high levels of anxiety and insomnia but I don’t have any other symptoms (yet) aside from menstrual flooding and clots (lovely). I know nothing about HRT and I suspect if I go to the GP, I will be given antidepressants (which I am prepared to try because I am fed up of the anxiety, but it would be good to know if that is the right solution).

My experience was okay, but I had read a lot of MN threads about the difficulties others have had, so ahead of the appointment I read through the NICE guidelines (and was able to refer to them in passing during the appt, which took place over the phone).

I also thought beforehand about the precise wording I was going to use to describe my symptoms and practised them, to make sure I didn’t end up minimising what I was coping with through sheer habit of “not wanting to be pushy”.

That mental rehearsal boosted my confidence and, I think, also helped me to keep the conversation from veering off into territory where I might be fobbed off.

You don’t have to accept it if they tell you to try antidepressants first, not if you don’t think you need them.

(Sorry, that last remark in my post was to the pp who mentioned antidepressants)

I had a hysterectomy 5 years (kept my ovaries), started having some symptoms 2 years ago, although my symptoms were also similar to diabetes.

Once my Dr took my bloods, confirmed it was the menopause, and checked my blood pressure was within range, she had no hesitation in giving me HRT when I asked for it.

In my experience it's best to ask your practice for an appointment with a GP who specialises in or has an interest in women's health - otherwise you run the risk of wasting your time and not getting the support you need.

If you do get prescribed HRT it will probably be in tablet form initially - because it's the cheapest option - but you should be offered a review after 3-6 months and can ask for gel/ utrogestan at that point.

Good luck!

I got hrt no problems with hot flushes, nightsweats and insomnia as main symptoms. I asked for patches and Dr agreed (late 40's still menstruating, erratically).
I'd gone previously for insomnia and very bad pmt and was told nothing they could do .
I think basically you have to mention hot flushes if you want hrt.

Oral Utrogestan is a green list treatment in Scotland and has been since 2017. Check the date of the advice you're looking at, also the type of preparation.

Thank you UnitedWire I don’t know if I need anti-depressants or whether it is (peri-)menopause (I am late forties). I am just finding the level of anxiety unbearable and having to do a lot of mental work to keep grounded and sick of waking at 4 or 5 am.

@Orf1abc
Thanks for that. The information I had read was older but there were also a number of threads on the Menopause matters / Menopause society pages detailing problems people had getting prescribed Ultrogesten. I looked at the formulary pathway that GPs use for prescribing and it wasn't a option for GPs to select - had similar issues before with other medication so assumed the worst.

@KatySun
I've had lots of insomnia recently too - usually between 2.30-4.30am. It's grim

I used to live in England, and my GP there (saw 2 different GPS at the same practice) said I was too young (late 30s) to be perimenopausal, despite having a medical history which indicated high risk of early menopause. I was sent for scan instead to investigate for fibroids, none were found.

I visited my new GP when I moved to Scotland a couple of years later, described my history and symptoms, and was offered HRT there and then. The GP described the options available, I opted for HRT patches, and was given the prescription. A few weeks later I felt ‘myself’ again for the first time in 3 years. Am still annoyed I’d put up with the symptoms for so long, it almost cost me my job!
So my experience of GPs in Scotland has been positive, not sure how typical this is.

I've had a really good experience - sympathetic and informed GP who spotted perimeno right away, even though I was only 42 at the time (I didn't spot it). Did my bloods immediately, and strongly encouraged me to consider HRT. I have Evorel patches and cyclical Meroxyprogesterone tabs. Works like magic. I had to go back to different doctor to get dosage raised (then approaching late 40s) as hot flushes and anxiety back. Again, no problem. Helped immediately.

I think, like anywhere (and as confirmed by pps!), it is a bit of a lottery. The first GP I saw gave the standard "ooooh, you're very young for that" (late 30s, but with family history of early menopause) but agreed a series of blood tests to check for that, and other stuff my symptoms could be. The blood tests (quite unusually I think) did show my hormones were all over the shop, and the GP referred me to the hospital. He was reluctant to give HRT until then, but offered the contraceptive pill and told me to go and read about it.. .

The consultant at the hospital suggested I "may want to think about" HRT as a preventative/ protective measure (osteoperosis/ heart) but I also could just see how my symptoms panned out, and suggested other things that some women found helped (giving up alcohol/ caffeine/ spicy food, taking various herbal stuff, trying CBT - even more ). And she gave me a sheet about HRT to read...

I faffed around for a few years and early in lockdown my symptoms worsened and became unbearable, so I went back (virtually) to my GP (a woman this time) prepared for a fight. She basically said straight away - yes, you obviously need something... What would you like? I wanted a transdermal oestrogen, so suggested oestrogel/ utrogestan, the MN favourite. And as you found, she said that wasn't prescribed in Scotland, but she gave a prescription for Sandrena (in little sachets rather than pumps) and provera tablets as the progestogen. I find that works well, for me, though didn't have anything to compare it against. I had to up the oestrogen dose to get rid of flushes totally, and it's not entirely got rid of the low mood/ anxiety (though, given lockdown, that may actually be unrelated!), but did improve it a bit, and I do feel much better and less "foggy/doomy" . I haven't had any issues with supply - I know that was a bit hit and miss at one point.

Bloody awful! I was given anti depressants at first and then went back and forth for six months until I got hrt. I didn't know that there are different doses and it should be reviewed regularly , I approached her recently again as haven't felt a difference and went sent for blood tests . The have since discovered Dr Louise Newsons website and her Balance app and I am phoning go tomorrow armed with lots of info.

Go on her website and download the app, the stories are amazing and I think you would be better informed before approaching your gp

NotSongGoodBye I am sorry you are having insomnia too, it is grim.

I approached my GP about HRT and was referred to the menopause clinic in Edinburgh. There I saw a specialist who went through all the options with me (I opened for Evorel patches). I had no issues getting HRT at all. I’m due to go back soon to review my prescription and check if it’s still working well for me. I appreciate it depends on where you live and the services in Edinburgh may not be available all over Scotland, but my experience was a very positive one.

I have been reading the various websites and I can't believe how ill-informed I am generally about all this. Mind you the women in my family all seem to just put up with anything ...

I looked at the menopause clinic in Edinburgh and they are quite clearly saying now that GPs should not routinely be referring - only if it is a 'complex case' etc etc.

Yes, recently.
I was completely dismissed by the first two, the third listened and was brilliant.
Oddly, the third is a man, the first two women.

@KatySun. Have been tracking my symptoms for months as for ages thought it was a reaction to stress/ Covid , then the heatwave but pretty clear now something else going on. I have started getting out of bed at whatever time it is and doing easy yoga stretching - that seems to get me off to sleep again - eventually

thanks everyone for sharing