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.

@NotSoLongGoodbye that's rubbish. What age are you? I've looked back your posts and don't think I can see. I also don't see what peri menopausal symptoms you have.
Basically if you're over 45 I would go back and say you have vasomotor symptoms so hot flushes and sweating etc. They literally can't refuse HRT for these symptoms! Go and see another GP.

@imstilljenny2
I’ve just turned 51.
I reeled off symptoms of insomnia, not every night but frequent e.g. 3-4 nights a week, associated with being hot overnight and an increase in temperature, increased bloating, loss of sex drive, vaginal dryness and discomfort during sex.

after I’d said all this and I’m not sure what my options are and I’d like to discuss this with you, the GP’s response was I’ll send you information to read to which I replied - I’ve done lots of reading and this is where my thoughts are but I don’t know what can be prescribed in Scotland.

I suppose I freaked a bit with the GP’s constant harping on about breast cancer risks and insistence that it’s a maximum of 5 years … I began to think I should wait until I really couldn’t cope, rather than now where I’m just tired and weepy.

it’s utterly shit. I’d rather not have the promise of free prescriptions in Scotland if all we get is the cheapest possible medication from a limited range.

Am going to regroup and try again in a couple of months with a different GP

@NotSoLongGoodbye maybe you confused things by asking specifically for Utrogestan?? When I asked my GP about this she hadn't heard of it.
Perhaps just directly ask to be prescribed HRT next time?
It's not really a cost issue with Provera vs Utrogestan in Scotland. They are both roughly the same price I think.
I think if you ask for HRT and get oestrogen gel and Provera tablets they are worth a try? Maybe someone else will come along for advice soon.
I wouldn't worry about the 5 year issue just now. Just get started on HRT and see what happens 5 years down the line.

@imstilljenny2
GP had heard of Utrogestan - apparently lots of women have been ringing up about it. I asked what progesterone they would prescribe but provera was the only option.

I have JUST found this thread!!!

I am having a F2F with GP this afternoon.

I have clinically low iron (7 ug/L) and sleep apnea which they've been saying explains all my symptoms (insomnia, fatigue, brain fog, joint pain, hair loss, dry skin, mood swings) and having been pushing Anti-D's hard. I've been asking for Iron, and a new filter for my Cpap machine...
But i'm going in this afternoon to insist on HRT too as I am having horrible hot flushes and night sweats now too. I am 53, have had 7 periods in last 12 months with increase in flooding etc.

I am going to ask for patches or gel not tablets as I have gastric issues. Do I need to ask for Provera or Utrogestan as a 1st request???

Well, I've come away with 3m supply of Evorel patches to try.
It's a good start.

How do you feel @52andblue? Did the doctor listen to your concerns and understand ?

I think it’s usual for them to try the patches first as they are a lower dose. IIRC they worked very well for me for about a year.

Better than last year when the same GP said: 'most women sail through, if you really have issues best speak to the local chemist and ask for something herbal?'
This time she started with that again but I said No, then anti-depressants but I said No, then tablets but I said No (as gastric issue breaking them down). I suggested 'patches or gel' and she said OK. I said I'd prefer Utrogestan but she said only avail in tabs in Scotland. She said 'try these patches for 3m and if you dont' get on with them we can try something else or I can refer you to a menopause clinic'. So, I thought I'd try them but I'll be back in 3m if I don't feel better.
She did 'wonder if I needed them as I've had 8 periods in last 12m' but I said the peri symptoms were quite bad, esp hot flushes, and I am 53 1/2 and I want to get HRT started. She said 'only for 5 years mind' and I thought, we'll see when we get there.

Are the pills stronger then @ROSEMARY ?

Just quickly wanted to add to the thread. I asked for HRT about a year ago when I was 48. I have night sweats and terrible moods/irritation - so not depression. I also have awful cognitive decline to the extent I worry about dementia. As my periods are still regular, though very very light, gp wouldn't consider HRT and tried to push antidepressants for about the billionth time in my life. I haven't done enough reading to be sure on timing but at now 49 with these symptoms, surely I could qualify for HRT?

I'm forth valley health area if that makes any difference.

Hi @LatinforTelly I'm in Lanarkshire so don't know if they do things differently from where you are though they shouldn't & I am nearly 48. I have been asking for several years for Hrt (erratic periods sometimes severe flooding sweats etc )and was told no constantly. For the last few months it's got worse so I bit the bullet last week & called for a telephone consultation with a female Gp or the Gp most knowledgeable about woman's health. I then using guidelines for a wee list ready for them calling with all my symptoms & guidelines highlighted to go through it with the Gp. I decided enough was enough & I wasn't taking no for an answer this time. They called back & after a bp check I was prescribed & started Evorel sequi on Saturday. I was just very persistent & determined on the phone. I would call then again & as I did ask for the GP who knows most /specialises in woman's health & don't take no for an answer. We shouldn't need to suffer just because we are woman it's a bloody joke. Good luck.

@LatinforTelly you can still start some HRT while you have regular periods there is guidance on my patches box telling you how to use them if you still have periods Xxx

Why are so many women being pushed down the anti-depressants route? These were offered to me as an alternative to HRT.

@LatinforTelly - I've had 7 periods in last 12m and I got Everel patches.
But I had to push REALLY REALLY hard. Twice, over a year.
I'm 53 and have had worsening symptoms for 2+ years now.

Urtogestran depends on where in Scotland you are - long running saga tbh.

In terms of menopause - its an interesting one. Pateints often get annoyed that i want to rule out other conditions before attributing their myriad of symptoms to menopause . Catch 22 situation because i think they'd be more annoyed if i put every symptom down to menopause and ignored the e.g. thyroid condition they might have.

For the question re bloods - hormone bloods are only advocated if less than age 45, and even then can often lag behind symptoms.

The problem with listening to other people's stories/experience is that every woman is different, with a different health board doing annoyingly different things. Someone might complain that they didnt get X so therefore you wont, but have completely ignored the relevant family history or that they are BMI 45 and thus have a different risk profile.

Ive just read the rest of the thread.
The five year issue highlights very clearly what i mean about personal risk/circumstances.
A 48 year old starting HRT with no risk factors does not in any way need a special 5 yr timeline, they need no more reviews that normally done for HRT - ideally yearly.

Contrast that with a 58 year old with high risk factors and concerning features - they need regular review! And yes there will be times when that prescription risk outweighs the benefits. Given that the responsibility still lies with the prescriber and not the woman (regardless of what the woman states unfortunately) then the script may well be stopped.

@TisTheSeasonToBe really useful to hear about your viewpoint. Thanks for the info.

Are the pills stronger then @ROSEMARY ?

My impression was that the patches were a lower dose than the gel. But I’m not a doctor or HCP. And I think they want to try you on the lowest dose that relieves your symptoms, because of the risks.

I also got the impression that trans dermal was lower risk than pills. But again I’m not sure - that might just have been lower risk for me and not generally lower risk IYSWIM.

I’m a healthy weight, non smoker, very active, normal BP and no adverse family history , so the risks might be different for you. Also I had a late menopause so I’m hoping I won’t be on the meds for a long time.

I also chose to stop drinking alcohol when I started the HRT as alcohol was more risky than the HRT . I decided that the HRT contributed more to my quality of life than alcohol. But that’s just me.

@TisTheSeasonToBe
Interesting - why are anti-depresents still so commonly offered (unless a women genuinely can't be offered HRT)? The information I've seen is that they are only 40-50% effective in helping with hot flashes and may actually make other symptoms worse.

That's interesting, TisTheSeason. I get your point about ruling out other conditions e.g. thyroid but why the push to anti depression meds so often?

Thanks everyone for your advice. I wasn't going to try again with my gp. If she's adamant i cant start hrt until periods have stopped, i'm not going to get anywhere. Was going to do a one off private consult then hope to transfer prescriptions to NHS. A friend did this but she is in England. Maybe we can't do it in Scotland?

Sorry ADreadedSunnyDay, sort of cross post as I didn't see yours before posting!