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[Francie]

Hello, I am a new member and would appreciate some advice please.
 Am nearly 53 and thinking about starting HRT. Until last month I was having periods regularly but now my next one is a couple of weeks over due. This has coincided with the start of night sweats and anxiety, although symptoms seem to have eased off at the moment. Also have noticed that my hair is thinning quite a lot. I guess that my hormones are fluctuating.
I went to the GP last week and had an idea that i might want to start an oestrogen patch plus Utrogestan. However the GP hadnt heard of Utrogestan and tried to direct me to other things. I resisted on the basis that wanted least androgenic progesterone ( also still suffer from occasional acne). She said that she would speak to the local NHS expert and get back to me.
She phoned me yesterday to say that the specialist only uses Utrogestan when the more popular preparations are not well tolerated and also said the Urtrogestan was not that well tested or words to that effect. I was offered 1/10 Femostan - tablet form, oestrogen only for part of month then with progesterone added for the remainder.
She said that the progesterone in it is less androgenic.
I had wanted to use a patch where possible, to avoid the liver and also because I believe patches have better stats for avoiding DVT. Femostan would be tablet only.
She said that I should try it for 3 months and if not suitable she will prescribe what i want.
Not sure what to do? I want to take the best preparations possible and not sure whether I should try and see someone privately. Any advice please?

[ellie66]

If it where me I would keep insisting.  My old GP started me on Femston 2/10 about 3 years ago when I was 44. I am known to be sensitive to progesteron. About 10 years I had a Mirena coil for contraception (NOT for HRT) Consultant gynae was prescribed Sandrea oestrogen gel to counteract the side effects of the Mirena.

The Femston was fine but my menopausal symptoms started creeping back. It is the least androgenic HRT

My new GP (who is a colleague of mine) prescribed Utrogestan and Ostroegel this Sunday. He has never prescribed it before. I was talking to to another GP last night a close and friend and colleague and he has never prescribed it either. 

I am starting on 3 pumps of Ostrogel a day (everyday) and Utrogestan 200mg on days 15 to 26 inclusive.

My GP and I where working out cost so he did not get into trouble with his Prescribing Advisor it slightly cheaper than patches. If that is any help to tell your GP.

I have a thread going about this prescription which I will keep updating.       

[ellie66]

EDIT:  It may be worth asking your GP precisely why she does not want to prescribe Utrogestan and Oestrogel?

[Francie]

I did ask that and she said - after having spoken to the NHS menopause expert for the area - that Utrogestan had not been extensively tried and tested. Sounded fishy to me - especially since Utrogestan is specifically mentioned on the patient.co.uk website as being beneficial terms of reducing risks associated with HRT and I showed her the extract during my initial consultation.

I wonder whether it could be because of cost? I have a relative who is a GP and he hadnt heard of Utrogestan but said that cost wouldnt be an issue, however i'm not so sure.

Thanks for the advice - still considerng my options!!

[ellie66]

Francie, re cost it works out slightly cheaper than patches I think its £9.93 a month as oppose to £13 odd for patches. If it where me I would insist but then I am gobby and opinionated so and so  You could try telling her you are saving the NHS money hehehehe

I suspect its a case your GP is scared as she has never prescribed it before but its very annoying you are suffering as a result of this. 

[ellie66]

Francie, Forgot to say I am prone to PMT and spots and I had both on Femston another reason why I switched to Utrogestan and Oestrogel.

 A few months when my GP and I started to discuss changing my HRT he said the Prescribing Advisor would be pleased I was Femston because it was cheaper than patches. He initially was thinking of patches for me but for reasons unrelated to HRT we decided they are not suitable.

[Francie]

Thanks for all the info which is very useful. Problem is that it takes about 3 weeks to get an appointment with the GP. I think I will go to a specialist meno clinic
and see someone in the know

[Hurdity]

Hi Francie

Sorry to hear about your problem getitng the prescription you ask for.

Utrogestan is the market name for micronised progesterone - which is bio-identical to our own progesterone we produce so not alien to us as are the synthetic progestogens. No matter that your GP had not heard of it. It is licensed and available and is on the list of approved HRT.

Any compound that is licensed has to go through a certain amount of testing/trials beforehand (although this is a controversial area as to whether they are adequate) so how can your GP say that it is not tested. If she says it isn't tried and tested then as a GP she ought to be more clued up and accept that it is an approved compound, especially as it is progesterone!

This sort of thing makes me very angry and sad too on your and other women's behalf. When I first asked for Utrogestan after a brief break from HRT, my GP hadn't prescribed it either and had to look it up, but I told her that's what I wanted and why and she was fine. Yet another example of the difference in different geographical areas.

I can't believe she refused even after you had done your homework. I'm with ellie on this one - I don't take no for an answer especially as there is no good reason - it's your body.

I agree I would not take pills if I asked for patches and all doctors should respect your preference here. I would definitely go back and also print off the list from this site. You should not have to use a mode of delviery you have specifically asked not to have. I started on patches straight away for the same reason.
http://www.menopausematters.co.uk/to_progestogens.php

There is a lot of information and papers I could direct you to but probably not at this stage?

You should not have to go privately to get what many of us do on the NHS with no problem and you can also quote us if you like! However whatever you need to do to get results - if you can afford it. I have never had private medical care but I understand once you have seen the gynae they can send the prescription to your doctor so you don't have to keep paying for appts - someone with experience will correct me if I'm wrong.

Also your symptoms will come and go for a while as your oestrogen rises and falls. The temporary cessation of flushes often signals a period is on its way, but eventually in many cases they stay for good!
Good luck

Hurdity x

[Francie]

Thank you very much for your advice Hurdity
Yes I feel very frustrated having prepared for my appointment and put my case for what I wanted. I feel a bit upset with myself for not arguing more when she rang me back the following week, but
I was in a noisy students union with my daughter  - (who was attending a uni interview) and it was a bit difficult. It just makes things so much more difficult when you get someone who thinks they are well versed in an area when in reality they are not.
I may leave things for a few weeks and see what happens re symptoms etc.
Thanks again!

[honeybun]

I know that some would not agree but this is just a thought.

Your GP said to try what she had prescribed for three months and if you were not happy she would prescribe what you wanted. Wait a couple of months if you can and then go back and say it does not suit and then come away with your preferred HRT and start from there. Don't take it meantime if you can wait a little while longer.
Then you save money by not going privately.

Honeyb
X

[Francie]

Yes thanks thats certainly an option I might take x

[CLKD]

I would want to see the 'menopause expert in the area' ........... ask your GP to refer you?

[Francie]

She wont want to do that, taking the view that she has done me a favour by already contacting her on my behalf. I tried to refer myself but not possible, has to come from GP. My GP thinks she is a bit of an HRT expert herself - ironical I know bearing in mind that she hadnt even heard of the drug I wanted to talk about. I also had to spell it out why I wanted a patch rather than tablet.
Thanks to everyone for your help - really appreciate it XX

[CLKD]

She hasn't done you a favour  ......... she has found out information for herself: which may be a quicker way of treating you rather than waiting for a Clinic appt.: but if she continues to phaff, I would ask for that referral.