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[catlover]

Well, nurse practitioner.  I went this morning to ask for hrt.  To summarise, I'm 51, been having night sweats, uncomfortable bladder and thrush like symptoms along with general can't be botheredness.  I recently had a fibroid removed after horrendous periods, since then i haven't had a period (end December was my last one.)

I want to try hrt just to see i it helps really, I'm also nervous in case it makes things worse!

The nurse asked if I had tried red clover or other natural remedies as they prefer ladies to have tried these first 

I said I'd tried menopace, and she started saying I should try red clover, so I lied and said I'd used the one with red clover in as I really dont want to go down the herbal route.

She then said that the natural age of menopause is 53, which made me feel like I shouldn't be there.

I am not allowed to try hrt without having a full exam first, so Ive had to make an appointment for that, which I'm dreading.   I just feel as if the whole thing is being made as difficult as possible as she doesn't approve of hrt.   When I said I suffered migraines in the past she said that hrt was contraindicated in those cases 

I don't suffer symptoms continuously, they come and go, but are awful when I've got them, I'm currently having a good week, so feel that when she does an internal and everything looks fine she'll say I don't need anything, which might be completely different next week!

I don't know how to deal with it really.

What do you think, am I being silly wanting to try hrt?   I thought I'd made my mind up but I feel like crying now.

[dahliagirl]

Migraine is only contraindicated for taking combine oral contraception pills.  This was introduced about 2007.  It is because there is bad publicity about young girls having strokes when taking the pill - usually during the first few weeks.  As the risk of stroke when you are very young is very low, then it is a relatively big increase in risk for those people.  When a paper came out saying people who had ever had a migraine with aura are at increased risk of having a stroke, a blanket ban was put on all women who had ever had a migraine taking COC.  But not HRT.  If you look on the tabs above, you will see that some people are better with HRT and for those that have migraines from hormonal fluctuations, a patch is probably more even.

I took the pill from age 21 (at uni, when they did ask me about migraines and did everything by the book) and used it for contraception when necessary up until age 49.  This was the FIRST time ANYONE had asked about migraines since I was 21 (various doctors surgeries and FPC) and I was taken off it with immediate effect, even though I had only six months before I was 50    and it was 5 years since the recommendations had changed - much arse covering there    I was mightily aggrieved and spent a lot of time researching the whys and wherefores.

A lot of people have problems with barriers being put up (this is mentioned on the Kirsty Walk programme on I-player at the moment) - at my current surgery my friend is fobbed off every time she goes and it is very difficult to find the strength to follow through.  It is very wearing.

[ancient runner]

Catlover, from what you've said you definitely need topical HRT at the least. That won't sort your flushes or mood but will help the thrush and the bladder.
I can see why they'd want to examine you first but there is I think a general feeling around that we shouldn't be treated for menopause symptoms and should just put up with whatever it throws at us. Maybe if you have a mental list of exactly what you would like to happen, and just be quietly assertive post-exam that you would like to try xxxx and possibly yyy as well.
Also you could print off the NICE guidelines for a bit of moral support.

[catlover]

Thankyou for your replies, it helps knowing that there is somebody somewhere who understands.

I've already made an appointment for Thursday, unfortunately it is with the same NP, but I'm hoping to go armed with the Nice guidelines as suggested.

I'm just a bit gobsmacked at how difficult this is proving to be, it sounds so easy when you read the guidelines, but I now feel I'm expected to jump through hoops and being told things that aren't strictly true, which doesn't inspire confidence.

I'm not sure if any gp's are good with womens health, there seem to be different gp's there every time I go.

Dahliagirl - you've got it spot on, it is wearing when you get rebuffed like that, it's at a point in our lives when we feel low and vulnerable anyway, yet they seem to not listen and plough on with their own agenda.

I'm hoping she will prescribe hrt, I think I'll have to put my big girl pants on and try to argue my case if she refuses. I think I'll be very lucky to get systemic and topical though, so would systemic work on the vaginal symptoms too, or do I really need topical for that?

Sparkle, I am like you!  My fear is that I get really bad bleeding and the fibroid grows again, but I don't want to put up with symptoms either!

It is worrying though because I want to do the right thing and when you don't feel supported in your decisions it makes it harder. 

Why oh why are some medical professionals still not looking at the benefits and not just the negatives?

Roll on Thursday when I have my appointment, I'll update you all on how it goes!

[CLKD]

Because it costs money.  Because your Nurse Practitioner hasn't had any symptoms?   

If she refuses to consider ask to be referred to either an endocrinologist, a Meno Clinic or a Gynaecologist.  Explain that ladies can go 'into' menopause at any age, that you are symptomatic with X, Y, Z which you need treatment for.  Some ladies find that keeping a mood/food/symptom diary useful.

Also - do ask if she can refer you/us to any Peer Reviewed Papers which proves that alternatives work.  We have an alternative 'room' here but often ladies find that initial symptoms are eased, however, when their hormones run amok, any benefits felt are over-run!  Also, Black Cohash etc. shouldn't be taken for long periods of time.

Let us know how you get on.  I would go in with "I've thought constantly about your suggestions but although they might help other ladies, I need something more positive, such as HRT, to ease my symptoms.  Are you able to discuss this with me or do I need referral to a specific consultant?" which will make her see that you are determined to sort this.

You could refer her to MM too ;-).

[dahliagirl]

I have found trying to get a patch out of my practice nurse is like getting blood out of a stone.  I think price is probably the biggest factor.

I was originally prescribed vagifem by the urogynaecologist who did my prolapse op which was helpful.

I would prefer transdermal as there is a history of gall stones in my family and it is better as you get older.  Still, I have managed to get up to 2mg and get vagifem prescribed in a more suitable amount, although she did suggest I might be better with oxybutynin for my problems (having read up about it, probably not).  I find that she is quite forgetful so that what is said at one review will not be remembered next time.

I still think the best you can do is to look after your own health with respect to diet, exercise and mental health, as much as you can because it is good for you, and helps tick a few of the boxes in your favour.

[peri]

Hi Catlover I would go armed with the NICE guidelines as you say and be quietly assertive.  Your nurse practitioner is out of touch and needs reeducating.  Interestingly I had a similar experience with my nurse practitioner who twice tried to force anti-depressants on me, I switched to the GP after that and never had a problem.  I'm sure you'll get what you want if you persevere.  Good luck and keep us posted x

[Maryjane]

This all makes me spit feathers .

Would they tell you to try naturals fro diabetes/thyroid/other problems no , we are deficient and it's our right/choice to take flipping HRT if WE deem it necessary. 😡

[CLKD]

   Maryjane - I spit bricks about these issues.

[catlover]

Well my update - I returned to the GP and my blood pressure was high, I also had a UTI and was given 3 days of antibiotics.   

I decided I'd just ask for vagifem as its supposedly not systemic, but she didn't agree.   I've had to monitor my bp at home and returned today with the readings, which were fine, but she now wants to moitor for a further two weeks and still recommends trying red clover.   

She asked if I was exercising and I answered honestly that because my periods were so bad and I had severe anaemia in the preceeding months that I hadn't been, I haven't had a period since Dec/Jan when I had my fibroid removed, so she suggested a hysterectomy as an option.I wouldn't mind going that route if the bleeding is bad again, but can't see the point of it otherwise?  So I now have to keep a diary of my periods too.     To top it off I think I still have the uti.  I just wish this phase of life was over.

[Maryjane]

I could spit feathers , in general re HRT and 3 days of antibiotics is pointless just makes more and more resistance issues.

[babyjane]

I could spit feathers

I could cry when I read of ladies having this sort of reaction from their GPs and I think they need to get a 2nd opinion.  there are clued up, good, understanding GPs out there.  I know there are at least 3 at our practice because I see them  .

[ancient runner]

Let me get this straight.
You've got UTI symptoms and probable VA, plus a fibroid. You feel dire.
You would like to try a local HRT as NICE guidelines suggest.
You are offered either red clover or a hysterectomy (oh and some ABs which you probably don't need).
So either nothing or a huge operation.
We don't swear on this website but I know what I'd be saying on Mumsnet.

[CLKD]

  + 

Time to change your Surgery? 

Also - do ring your Surgery:  i.e. "I have been advised by the Nurse to take A, B, C and am now asking for written details about the dangers of Black Cohash, also how this compares in Peer Review Papers with HRT, also has my urine sample been sent to a Lab. for proper testing? "

Only if it's been 'grown' in a Lab. can the correct AB be prescribed.  HRT can ease any apparent UTI symptoms, i.e. Vaginal Atrophy. 

Time to speak to a GP or a Pharmacist for better advice?   

[babyjane]

I was having constant treatment for UTIs and thrush.  6 years ago I started to used vaginal HRT (vagifem).  I have not had symptoms of UTI or thrush in the whole of those 6 years.  No brainer to me.  Change your doctor, I think we ladies know more than your current GP seems to