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[Ambert]

Hi
I have booked an appointment with my GP next week to ask her about testing/treating my god-awful peri/meno symptoms. Does anyone have any suggestions on how to do this the best way? She's not entirely sympathetic generally and has a tendency to talk over you whilst shoving you out of the door with a prescription.....
Will taking a list with me be looked upon favourably or not? Will she just think I'm a whinger?!
Advice please ladies! 🙄

[Tinkerbell]

A list is the way to go with that type of doctor! think about what you would like to try otherwise she will probably prescribe a one fits all patients prescription
Tests are not normally done as they are unreliable especially in peri. I was never offered or asked for them, I was prescribed treatment based on symptoms

[Tinkerbell]

What symptoms are you suffering from?

[Dancinggirl]

Definitely write down symptoms and questions.  If the list includes, lack of sleep, fatigue, constant flushes, vaginal dryness etc. then  it is not whinging - you are simply telling her what she needs to know.  She may do bloods tests - hormones are notorious for fluctuating so the results may not indicate Meno - she should prescribe based on your symptoms.  She may test the thyroid function as well which is a good idea.
Take print out's from this site to illustrate what you want if need be.
Get clued up  - so read all the info on this site.  Stay calm but firm - if she rushes you then tell her you need things explained - e.g. if she tries to fob you off with ADs/SRRIs then get her to explain why she believes this would be better than HRT???  Don't let her give you these.  The latest NICE guidelines clearly state that HRT should be the first line of treatment for meno symptoms.
If she plays the 'breast cancer scare' card - just tell her you want the symptom relief plus protection for your bones and heart that HRT brings - and that you are quite aware that there is a very,very small increased risk of getting breast cancer but you want and need your life back RIGHT NOW.  Good luck  DG XXXX

P.S. If you want to try HRT then ask for Femoston 1/10 first (not Elleste) as Femoston suits many women very well - although many women do OK on Elleste.

[Ambert]

Aw thanks you two, great replies.

Tinkerbell, my main symptoms are severe fatigue yet I can't sleep, hot flushes, sweating, palpitations, terrible mood fluctuations, dizziness, memory problems, breast pain, muscle pains....blah blah, I could go on.
Dancing girl, I will take everything on board you've said....I need my life back, my husband and kids would like me back too. I feel like a melted snowman 😟
Thank you xx

[Mary G]

Ambert, I agree, don't allow yourself to be fobbed off with ADs or scared off HRT by this doctor.

My advice would be to have a look at the treatment options and try to go for something with maximum flexibility.  I use the Oestrogel (you rub it onto your skin), Utrogestan (micronised progesterone which I use vaginally) regime and find it works very well and it is very flexible which is often the key to success.  It is very easy to adjust the dose very quickly on this regime which has been imperative for me.  It is a cylical regime which means having periods but it is a small price to pay for feeling normal again.

I would definitely avoid oral preparations that are heavily laden with synthetic progesterone because they cause too many side effects like breast pain and often don't work as well for symptom control. 

[Ambert]

Thankyou Mary G, that's really helpful. I will do some research on my options. The way you are doing things sounds really sensible and much the sort of way I'd like to do things, controlled yet flexible.

[Mary G]

Ambert, good luck and please let us know how you get on!

[Dancinggirl]

Ambert - Just want to add that the regime that MaryG is suggesting is not widely known about among NHS GPs so is often challenging to get - it requires some  research and searching in their prescription book as regime is usually prescribed by specialist gynaes.  This is why I suggested Femoston 1/10 to start with as this does have the kinder (less testosterone based) progesterone which therefore suits many women very well, your GP is more likely to prescribe this and whilst flexibility seems like a good thing unfortunately many women start chopping and changing doses from the outset and then end up with more problems e.g. problematic bleeding, fluctuations etc.  Utrogestan can be great for some women but it can bring some negative effects like any progesterone e.g. sedation!!!
Starting with a pill option is convenient and you could be lucky and find Femoston 1/10 ( a sequential HRT) suits you - it should relieves flushes, helps you to sleep and only brings a light withdrawal bleed each month that is not a problem.
I think we are all aware that there needs to be more research and developments in the treatment offered to we women with strong meno symptoms - the HRTs currently available vary and most women will find something that suits them but there will be compromises.  Hopefully in time better options will be available.  I had an premature meno so have used HRT for over 25 years - I have tried just about everything there is to try.  For me Utrogestan gave me the most problems!!!!
We are all different and our experiences will be different so keep an open mind.  DG x

[Mary G]

Ambert, you don't have to use Utrogestan with Oestrogel, you can use any progesterone product but they all have side effects and are the Achilles heel of all HRT regimes.  Most people hate taking them, all the risks associated with HRT are in the progesterone component and they don't help menopause symptoms but they are a necessary evil to keep womb lining thin.

Utrogestan is nothing to write home about and I take it with a huge amount of reluctance but at least you can use it vaginally which means it does not affect your breasts.  If you take too much of it, you will get more side effects but at least it has flexibility. 

DG, I think it probably boils down to this, if you can't use Utrogestan vaginally then you probably won't get very good clearance/thinning and you will probably get far more side effects like breast pain, low mood and breakthrough bleeding so you really need to find an alternative form of progesterone.  Also, if you take it orally, you will need to take more in order to get the same result.

[Dana]

Having a list of questions is a very good idea. Don't feel that you are a whinger. Menopause isn't a disease or an illness, but it is a medical condition, and you have a right to medical treatment.

My advice is don't be too demanding about the kind of HRT you want. If your doctor is as you say she is, being too demanding might just get on her wrong side. State your case and symptoms, and tell her that you would like to try HRT, but let her prescribe what she thinks is best. The main thing is to get the HRT - no matter what kind it is.

Once you get her comfortable with prescribing it to you, you can always have further discussions with her about different options. You never know, she might be impressed by you letting it be known you are have done your own research.

[Dancinggirl]

I agree with you Dana - one does have to be careful with GPs - they don't like to be bombarded or dictated to.
Having got them onside, you can then say you have done some research and apparently Femoston is considered the one that suits women more than something like Elleste?  Hopefully she will let you have this and then if after 3 months you find your body doesn't adjust to this well then you can ask fo the Oestrogel and Utrogestan option.

MaryG - I have tried every HRT going - I have been using HRT for over 25 years now.  Utrogestan, whilst good for many women like yourself, does not suit everyone and actually starting with this could be problematic as it does require more discipline and thought overall.  Using it vaginally does give some issues - many women get nasty irritation around the vaginal area probably because of the capsule covering. You really couldn't use it continuously and taking it on a longer cycle for fewer days should only be done under the supervision of the gynae who prescribed it.  All HRT regimes have to be approached in the proper way - tailoring will only be necessary if you are particularly sensitive and actually the vast majority of women who use HRT are very happy on the traditional HRT pill regimes.

I am taking a break from systemic HRT and only using local oestrogen - Vagifem 2-3 times a week. Though the humid weather has been tough to cope with, I am feeling generally better without HRT now. At the age of 60, I feel my body (especially my womb) simply doesn't want to cope with hormones any more.  The Utrogestan gave me more problems than any other progesterone I have used!!!! I got problematic bleeding, awful cramps, a rash on my face and vivid dreams - through the daytime I felt quite spaced out, which I quite liked, but was probably not a good thing all the time.   I know many women use Provera instead of Utrogestan.
We mustn't forget that what works for us personally, won't necessarily work for others - so I believe we should always keep an open mind - women starting on HRT should not expect to have problems with synthetic progesterones, they are very effective and do suit many women very well or they wouldn't be prescribed. It is very important not to make a women feel she has been prescribed something that will cause them problems - they will then start looking for side effects and feel anxious instead of enjoying the benefits.  There will be compromises with any HRT we take - it's just that the benefits must outweigh the side effects.  DG xxxx 
 

[Dana]

I agree DG. I think we need to be careful about saying certain routines or certain progestogens will do or cause certain things. There tends to be a bit of a tendency to demonise certain HRTs, and that then makes some women feel anxious about what they have been prescribed which is unnecessary stress for them.

Every woman is different and will have preferences for different things. I too don't particularly like Utrogestan, but have no problems or side effects from Provera.

Part of the whole menopause mystique is trial and error and finding what works best. There is no one thing that will suit everyone. A lot of women do very well on the traditional oral HRT, or using progestins instead of Utrogestan.

[Mary G]

Ambert has said she would like something controlled yet flexible so I thought the regime I am using might suit her.

I know that many women get on very well with the bog standard forms of HRT prescribed by their GPs which is great and I have said many times on here 'if it ain't broke, don't fix it'.   

The trouble is, we get an awful lot of women on here who don't fit into that category who are on here seeking advice about HRT and 9 times out of 10, it is the dreaded progesterone component, synthetic or otherwise, causing the problems.  Quite often, people seem to start off OK and then the effects of the progesterone pile up and cause them problems.  Going by what I read on here, there are a lot of women who don't feel as good as they either could or should.

The simple point I try to make is this, if you hate the progesterone in HRT (like me) then using Utrogestan vaginally usually means fewer side effects because it localised and you can take less of it and get the same results, that's all.  Sure, it won't suit everyone but you won't know until you try it and it is better than women getting completely disillusioned with HRT and ditching it altogether. 

DG, why don't you give Femoston another try? 

[Dancinggirl]

Hi MaryG - I don't feel I should use HRT orally at my age.  I was even finding the oestrogen wasn't helping that much either - I really think my uterus won't ‘play ball' any more.  For me, as long as my VA and burning urethra isn't too bad then I'm relatively happy.  There are hassles with using HRT that frankly have to be put up with and I'm now nearly 3 months without systemic HRT and coping reasonably well - it's almost a relief not to be using HRT.
While I do advocate HRT as the best option for treating meno symptoms, I do firmly believe it has to be about the benefits versus the side effects - for me the cramps and bleeding on the sequi regime gave me at least 3-6 days each month of feeling really rotten and when I tried the conti regimes I got problematic bleeding, spotting and felt ‘space out'. 
I'm still not ruling out going back on systemic HRT but if I can cope during these really hot and humid times then winter should be fine.
I intend to do a thread under personal experiences in a couple of months to sum up how things are without HRT, as I know so many women worry about what they will feel like when they stop HRT - it's really not that scary if you are in a good place in your life.  Dg x