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.

Hellish the way women need to be clued up in this as we expect gps to be so ignorant and backwards in treating something every woman goes through, to some degree.

The Davina McCall documentary was interesting and worth a watch

My GP was awesome, but she has an interest in gynaecology. She put me on oral estrogen (sp) and a coil for progesterone. Worked a treat.

I would have argued hard for it if there had been an issue though, because I literally couldn’t work with menopause symptoms, and I’m the only wage earner for the family.

Yes, I have just started tracking my symptoms. This is a really interesting thread, I appreciate it.
I realised the other week that I spend a lot of time avoiding things which will raise my anxiety, and somehow it is anyway there constantly.

I listen to podcasts when I am awake at night and eventually I go back to sleep. Sometimes I just get up but then I am exhausted by the afternoon.

Can i ask on here what people's anxiety is like? I thought my worsening anxiety was just me being silly and getting old, but now I'm wondering if its menopausal?
Sorry to ask on your thread @NotSoLongGoodbye

SSD

It's horrendous and exhausting, I didn't realise it was such a big part of menopause

The Balance app on Dr Louise Newsons website is good for sharing people stories and anxiety seems to be a common feature with all of them

Meg Matthews website is also interesting

I didn't know that dizziness, numbness , dry mouth etc are all symptoms

I thought my dry mouth was caused by anxiety. At the moment my anxiety is relentless but usually it goes in waves.

@ssd I have never ever had anxiety issues in my life until I had my hysterectomy. In the last 5 years I have had two very bad episodes, ended up both times at the doctor and bursting into tears in the surgery. Mortified.

Both times was given a prescription for anti depressants but urged not to take them and explore other avenues first. Both times I did lots of Headspace listening and self-help and it passed, which makes me think it was hormonal rather than something deeper. Anxiety with other causes doesn't pass in 10 days.

I also have a dry mouth, and aching joints, and although I went to bed after midnight last night and was exhausted, it took me forever to drop off to sleep.

But it's the hot flushes.... DH has taken to calling me Katy Perry as she;s hot and cold too. .

I went with a host of issues, excessive periods, insomnia, possible persistent UTIs, joint pain, occasional vicious flushes ...aged about 51, saw GP who seemed extremely clued up and offered Vagifem and a referral for the heavy bleeding.

Gynae recommended a new Mirena, dealt with a fibroid/polyp and somehow I ended up with a referral to the local Menopause Clinic at Ninewells.
Appointment with them was heavily weighted toward offering antidepressants, but with a decent enough explanation of other options and possible risk factors associated, I made it clear that I would require a straight replacement of the lacking oestrogen, it makes no sense to me to muddy the waters with other meds. They recommended the gel in conjunction with the new mirena should I feel that things were not improving.

Carried on for over a year with the vagifem/mirena and realised that the flushes and insomnia were probably going to kill me so went back to original GP to request the gel and that's when it all went downhill, after a fairly heated discussion with some heavy duty scare tactics about breast cancer/womb cancer/strokes/clots/high blood pressure and where she actually said "gel, what gel??? There's no gel. For HRT it's pills or patches" I asked to be referred back to the Menopause Clinic, GP looked back at my notes, read the letter they had sent and promptly handed me a prescription for Oestrogel and said "oh if they have said you can have it that's fine!"

I was too scandalised to query this miraculous appearance of the non existent gel!

SO to sum up I would say my experience is varied. Know what you want, be able to rebutt the scare tactics and ask about Menopause clinics.
Tbh I think I was sent there as locally there was an appointments issue which led to a backlog so that patients were being parcelled off outwith their direct area in order to get early appointments,

I do think it is better to try and see someone with more specific knowledge as some of the GPs are not good

Thanks for answering me. But can i ask what your anxiety takes the form of? For me its health anxiety, im so anxious about getting something serious and getting ill. The worry is off the scale. I'm anxious about life in general but my health worries are relentless. Tried cbt, counselling etc, nothing touches it.
Again sorry to derail @NotSoLongGoodbye

@ssd - I have a tendency to get anxious about health stuff too. When I'm suffering insomnia I find myself worrying about low level issues but I cannot get them out of my head. It's only been in the last few years that this has happened.

I had a telephone consultation last year for perimenopause symptoms aged 45 - the main ones for me were insomnia, anxiety, hot flushes, lack of concentration / confidence and mood swings ( I was either raging or greeting). I was offered Trazadone on the first call as the GP though I would be miraculously cured if I got a sleep but she also booked me in for bloods. 2nd consultation I said I wanted HRT and she prescribed me Novofem which seems OK but there was no alternative HRT offered.

@ssd

Thanks for answering me. But can i ask what your anxiety takes the form of? For me its health anxiety, im so anxious about getting something serious and getting ill. The worry is off the scale. I'm anxious about life in general but my health worries are relentless. Tried cbt, counselling etc, nothing touches it. Again sorry to derail *@NotSoLongGoodbye*

Something happening to DS, losing my job, parents dying, getting into trouble at work . None of which are likely t happen

I was prescribed Utrogestan tablets straightaway and have had no problems continuing to get them.

@FullMoonInsomnia

Message deleted by MNHQ. Here's a link to our Talk guidelines.

Why on earth would my message be deleted to a doctor specialising in the menopause??

My GP was fine. First I was prescribed the patches which worked well for a year or so. Then my symptoms got worse so now I take the Oestrogel and Utrogestan tablets.

Never had any problems in getting these prescribed.

@NotSoLongGoodbye wondered how you got on.
I had asked a similar question on the menopause board. I think your question relates specifically to Utrogestan which is not accepted for use in NHS Scotland by the Scottish Medicines Consortium. The first line oral progestogen would be Provera (medroxyprogesterone) which is not micronised so has a higher breast cancer risk. I've just been started on oestrogen gel with Provera tablets so I'll give them a try. If I don't get on with Provera I will go back to my GP and request Utrogestan. These can be prescribed but may need to be justified by the GP. I've got a bit of experience of prescribing medicines not accepted for use by the SMC as I'm a hospital pharmacist. It's not a complete no, just needs some justification.
Also if you don't get very far with your GP you could email Dr Currie who is a Scottish consultant and runs Menopause Matters and I'm told can advise on the prescribing of Utrogestan. It costs £30 per email.

Oh and meant to say if you look on Menopause Matters (Google Provera or Utrogestan) it looks as if many women really don't tolerate Utrogestan but get on fine with Provera. So worth a try.

@imstilljenny2
My tel appointment with the GP is Wed - I had to cancel my first slot as I ended up having DS friend round that morning and didn't want to be discussing vaginal dryness in front of two ten year olds, one of whom (my son) has hearing like a bat! Will update

Good luck. I've been lucky and my GP surgery has been brilliant. I was prescribed HRT age 43 no problem at all. I asked for testosterone gel and my GP referred me to the menopause clinic again without any problem. Every GP I have spoken to has been great so I'm sure you'll get on fine

I went to my gp in England last year with anxiety - I had to take a trial week of steroids to confirm asthma and didn't know how bad for anxiety they could be. Have had depression from time to time in the past but this was totally new, and accompanied by insomnia. No idea about periods as have always had a mirena. Prescribed antidepressants- much stronger than what I'd had in the past, also suggested I do all the mindfulness stuff which categorically does not work for me.

Moved to Scotland; contacted gp and explained I didn't want to take the ADs; she gave me evorel and pessaries and within a few days I felt like me again. Still a bit depressed, but in the normal way!

My work has a big push on understanding menopause at the moment and a few of us who are mid 40s and previously quite ambitious feel we've been a bit destroyed by the lack of confidence that arrived with peri. I'd quite like to come out of this and keep moving up, and I hope my general oomph continues to reappear. Hugely appreciate having such a good gp.

Well an update. It didn't go well.

Female GP is going to send me information. There was an emphasis on the continued breast cancer risks, even though I said I thought this was less clear cut than it used to be.
I was told categorically that I would be expected to come of HRT after 5 years regardless - because that is what the guidance says.
No to the Utrogestan - it's not prescribed on the NHS in Scotland apparently.
I shouldn't automatically assume HRT is the right course of action - I was steered towards the anti-depressant route which I said no to.
Herbal remedies were mentioned.
Yes they would prescribe topical estrogen for vaginal dryness but there was only a choice of Vagifem or Ovestin, so I am considering this.

I'm just a bit deflated and upset now. It's clear I'm going to have a massive fight on my hands to get anything. And I can't help suspecting that it is all because of cost and that as usual women are bottom of the pile for healthcare. I just came away thinking I should put up and shut up. I'm in NHS Lothian area by the way.