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[racjen]

My gp is resolutely refusing to continue to prescribe the Evorel 200 patches my specialist has recommended, as she says the risk of thrombosis it too high. Despite me sending her the report from my specialist explaining that this isn't the case when it's transdermal, I've just checked online and she's now removed all my HRT from my repeat prescription list, with no communication with me whatsoever. I feel really floored by this - I know I'm going to have to fight it but right now I just feel really upset. The reason I'm on such a high dose is to get my level up from practically nothing, after chemo-induced sudden menopause, and my specialist has no problem with it whatsoever. Out of interest, is anyone else out there on such a high dose? And have you had any problem getting it prescribed? Why does this have to be such a struggle...

[Dancinggirl]

This is an exceptionally high dose to be on for the long term and I would be questioning why you are not absorbing enough with the patches? 50 is the average dose and 100 is very high!!!
Have you tried Oestrogel - this might absorb better and not require such a high dose.

Have you had a blood test to look at the oestrogen levels while on the 200? Do you really need to still be on such a high dose?  Surely your oestrogen levels have built up by now and, if not, why not?  A maintenance dose may now be more appropriate?

I think a visit with the specialist would be a good idea.  DG x

[Daisydot]

Hi racjen could you maybe ask her to refer you to another consultant of her choice for a second opinion because she may have a valid point and it wouldn't do any harm as you are in a corner now unless you buy the meds via private prescription from your specialist.like all things in life there has to be a compromise and although it's maddening for you it'll be difficult to make any progress unless you go down one of these routes.
I found out via nhs website this week that gps are under no obligation to follow the recommendations of private consultants so yes it kind of questions why the hell are we forking out for them but as you know we can get their private prescriptions for the meds they recommend but most of us barely manage to scrape up that consult fee and hope that we can then use the nhs for any medication etc that is recommended but apparently this is not the case.Its not practical to keep changing our gps in the hope that we get one who is sympathetic to our private consultants recommendations so the only thing we can do try and negotiate with them.You could ask her to put you on the Oestrogel and try managing your dosage needs that way as I've found it much better than the patches that's what I would do until I could see her consultant.because of your health history you don't want to be chopping and changing gps so I'd consider these options.good luck xx

[Annie0710]

There have been women on here on very high dose patches like you, not many but I have seen it

Your gp surely should be listening to the specialist? I thought they were ‘higher up' in the medical ranking than a gp.  Can't you contact the specialist? Or arrange an appointment with the practice manager taking literature to show they're wrong ? X

[racjen]

Dancing girl, I'm not on it long term, I've only been on it this high for a few months, as it was a case of raising my level from practically zero after chemo. My level is now a lot better so I am absorbing, but my specialist wants to make sure that a/ this wasn't just one flawed test which showed my level as much higher than it actually is and b/ that the levels maintains over the next few weeks. The plan is then to drop to a maintenance dose. But my GP doesn't seem to be interested in any of that. It's the fact that she's removed everything I was on from my prescription list, so utrogestan as well, without even contacting me to discuss, that has really upset me. I wasn't even due to pick up a new prescription for another month, so there was no urgency in it. Really starting to hate her....

[Dancinggirl]

Your GP does seem to be really ‘out of order' racjen. Good luck with the fight.  DG x

[Salad]

Hi 

I'm on 200 mcg of Estradot. It has been ordered by a Menopause Specialist (I have it in writing) but my GP is happy to continue prescribing.
Mines also been prescribed to get my level up - I'm due for a review in a couple of weeks. I can't see you're any more at risk if your blood levels aren't too high eg it depends on what you absorb

[Optimist]

Would recommend trying the oestrogel. I don't think I was absorbing patches so well. 200 does seem high but your consultant obviously knows what they are talking about. Your gp is disrespectfully treating you like you don't have an opinion especially to take your utrogestan off the prescription also without having a discussion with you. Can you ask to speak to the practice manager maybe or ask to see a different gp?
Good luck x

[donnacrichton]

I was on 200mcg of estradot but after 4 weeks it fell incredibly high for me so have now have reduced it. It did take a few weeks to build up. I was advised by my specialist it could be increased further to 250mcg if required. X

[racjen]

What symptoms were you getting from it being too high? My symptoms are all mood based and I know you need a pretty high level to have any real effect on depression, whereas physical symptoms seem to respond to lower levels.

[Dancinggirl]

Racjen
When it comes to helping hormone related low mood, I don't think there are any specifics regarding the amount of oestrogen - it is more about absortion and the individual's response to a specific dose.
We are all different, absorb and maintain oestrogen levels diffently and respond differently to any HRT treatment. So while, on this forum, we share what dose we use and respond to, that does not mean it's going to be right for you. i always achieved and maintained very good oestrogen levels on quite low doses of Oestrigel - I never went above 2 pumps a day! Whereas others need 4 pumps per day to achieve the same oestrogen readings !
HRT can improve mood, even at low doses, IF the low mood is hormone related. My understanding is that high doses are sometimes used ‘short term' to either raise oestrogen levels swiftly or to shut down your ovulation to see if it is beneficial. Maintaining high oestrogen levels long term may not be good but to try a high level for a while may help with diagnostics.
You said you have had a chemo induced early menopause - have you had cancer treatment? If so, what type of cancer? Would your GP be concerned that such a high dose of oestrogen might be putting you at unnecessary risk?  Have you seen your GP to discuss the treatment you are getting from the Specialist? Did you get a copy of the letter your specialist sent to your GP? GPs don't always read the letters they get from a specialist- the specialist may not have explained the full reasons for the treatment either, so the GP may not fully understand the reasons for your treatment from the specialist. 
Have you found that this really high dose of oestrogen has stabilised your mood consistently?
I do think the GP is being really unprofessional in his/her approach but you do need to get the specialist to write to them again and you will also need to see the GP to discuss whether they are prepared to follow the specialists advice and, if not, why not. To deny you treatment, they must explain why.  DG x

[racjen]

Yes, I had treatment for Triple Negative Breast Cancer last year. The fact that it was Triple Negative means that I'm no more at risk using HRT than any other woman, and my oncologist sent my GP a letter stating this, so that's not where the problem lies. My GP insists that high dose estrogen is a thrombosis risk and so she's not prepared to carry on prescribing. My specialist has written to her explaining that that isn't the case with transdermal estrogen, only oral, and that although my estrogen has finally reached a decent level she'd like to maintain that dose short term to make sure it stays that way. Estrogen on its own has had a very good effect on my mood; unfortunately introducing progesterone made everything go completely haywire (sparked off major anxiety) so it's a complicated picture and nobody really seems to understand what's going on (and obviously post-cancer there are enormous emotional factors to take into account too). What I do know though is that suddenly cutting off my supply of estrogen is not going to have a good effect on my mental or physical health, so I need to resolve this somehow. I should add that this same GP has refused to refer me to an NHS menopause clinic, so I'm having to pay for a private specialist I really can't afford.

[Dancinggirl]

I hope you find a way forward racjen - you've had a very tough time.  DG xxx

[Dotty]

Can you see a different GP?

[racjen]

I suppose I could ask to see a different GP in the practice but how do I know if they'll be any better? Or am I entitled to go to one in a different town if I choose? I'm feeling so depressed and disheartened at the moment it all feels like too much....