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[Witchinghour]

Just that really,

I'm currently being prescribed estrogen patches, progesterone, and now testosterone. All prescribed by my private consultant and GP wouldn't entertain a perimenopause discussion because I was only 35.

Will they take over the prescription or refuse because it was initiated privately?

Thanks!

[Hollyboll]

Depends on the GP (mostly) and also whether the pvt was from a pvt GP or a consultant - and how high the doses etc.
my GP issued what a pvt GP had recommended, but probably did me some damage because that pvt GP had recommended excessive doses - the BMS put out a statement around Dec 22 saying (basically) prescribers should stick to licence or are responsible for putting patients at risk. Apparently a pattern and concern see press coverage but let’s not go there now!
I’d hope most GPs (tho Obvs not mine) wd follow that.
But if it’s within licence and you have a letter from specialist (particularly if it’s a consultant not a pvt GP) most should be ok on at least oestrogen and progesterone. It’s an easy consultation for them and they are covered by following specialist and bms advice.
I think testosterone might still be a bit more patchy but again if you go armed with a letter and maybe some other info should be ok. Nhs I think still only licenses it for libido no other symptoms so that’s probably the easiest thing to say …

Will be interested in other replies.

Hth.

[CLKD]

It really does depend on the GP - some don't like it if patients go privately without being referred.  Also there is a thought that if a patient pays for the appt., then they should take up the prescription charges too.  GP budgets are very tight so that is quite understandable.

If a GP doesn't want to take on a private prescription then the patient should be referred to an appropriate clinic, in our cases an NHS [or private] dedicated menopause clinic.

However, I believe that it's about networking - the more knowledge gained the better for both patient and GP as well as saving monies in the long term as we all learn more about what is necessary. 

Let us know how you get on Witchinghour?

[Hurdity]

HI Witchinghour

Your doc should not be going by age at all! This is really irresponsible if you are going through a very premature menopause! I presume you have had this (ie that you are peri-menopausal) diagnosed through blood tests? And if that is the case you should not have to have a private prescription at all!! The NHS should be treating you.

So I would say - if your periods became very irregular, your doc should have carried out blood tests as per the NICE Guidelines and the advice on this website: https://www.menopausematters.co.uk/pm-investigations.php

 "in women in whom Premature ovarian insufficiency (POI) is suspected, then measurement of Follicle Stimulating Hormone (FSH) is useful and, if raised, should be repeated around six weeks later. When the ovaries have failed, estrogen level will be low and consequently, FSH level will rise since its level is controlled by a feedback mechanism involving estrogen"

Once premature menopause has been diagnosed, then of course they should be treating you with HRT (or the contraceptive pill which provides oestrogen). To me this is the first thing that should have happened. No question.

A different point about a private prescription - but which should not need to apply in your case - after one private consultation, one should be able to request that the consultant writes to your GP with their recomendations and the prescription. This happened to me with testosterone. IN 2015 I went privately because the NICE  Guidelines had not been released and the private consultant prescribed T and wrote to my GP. Since the first private prescription I have been getting it locally on NHS.

So - the prescription of testosterone may not necessarily be followed by your GP as it would be discretionary and some GPs are nervous - but definitely the regular hRT.

Also re testosterone - I'm interested that you have also been prescribed this even privately, at a young age and I wonder what symptoms led this to be prescribed - or is it standard at the private docs you went to? Have your T levels been tested?

Hurdity x

[Penguin]

I've seen a private meno doctor, who wrote to my GP like Hurdity says above, and the GP prescribed what they recommended to me no problem. I don't agree that just because you can afford a private appointment that you shouldn't then be able get the medication you need on the NHS. HRT is exempt from prescription charges so you should not have to pay for it at all, no woman should. Many people take private appointments because they have not been able to access the specialist care they need, in this case a doctor who knows what they are doing re menopause,  and you should not be penalised for going private given the state our health care system is in. Its not like you are queue jumping, all you've done is get a consultant (who I assume is a specialist in their field) to look more closely at your specific circumstances and prescribe according to need. Your GP clearly didn't know enough to understand the risks of not giving you hrt if you are starting memo so young and they really should have done given the risks involved. I think you've done the right thing and I can't see why a clearly worded letter from your consultant shouldn't result in a NHS prescription. If there's an issue, then I'd suggest finding another GP as itd probably be ego getting in the way!
I'm not sure about testosterone though as I think that is discretionary but defo E and P should be fine. Good luck!

[Witchinghour]

It really does depend on the GP - some don't like it if patients go privately without being referred.  Also there is a thought that if a patient pays for the appt., then they should take up the prescription charges too.  GP budgets are very tight so that is quite understandable.

If a GP doesn't want to take on a private prescription then the patient should be referred to an appropriate clinic, in our cases an NHS [or private] dedicated menopause clinic.

However, I believe that it's about networking - the more knowledge gained the better for both patient and GP as well as saving monies in the long term as we all learn more about what is necessary. 

Let us know how you get on Witchinghour?

Also there is a thought that if a patient pays for the appt., then they should take up the prescription charges too.  GP budgets are very tight so that is quite understandable.

Yes, and I would agree to some extent by the NHS refused to help me. I only went private because they forced my hand. Quite why I should have to pay, financially and physically, because of their mistreatment is beyond me.

I'll keep you posted as to my progress!

[Witchinghour]

HI Witchinghour

Your doc should not be going by age at all! This is really irresponsible if you are going through a very premature menopause! I presume you have had this (ie that you are peri-menopausal) diagnosed through blood tests? And if that is the case you should not have to have a private prescription at all!! The NHS should be treating you.

So I would say - if your periods became very irregular, your doc should have carried out blood tests as per the NICE Guidelines and the advice on this website: https://www.menopausematters.co.uk/pm-investigations.php

 "in women in whom Premature ovarian insufficiency (POI) is suspected, then measurement of Follicle Stimulating Hormone (FSH) is useful and, if raised, should be repeated around six weeks later. When the ovaries have failed, estrogen level will be low and consequently, FSH level will rise since its level is controlled by a feedback mechanism involving estrogen"

Once premature menopause has been diagnosed, then of course they should be treating you with HRT (or the contraceptive pill which provides oestrogen). To me this is the first thing that should have happened. No question.

A different point about a private prescription - but which should not need to apply in your case - after one private consultation, one should be able to request that the consultant writes to your GP with their recomendations and the prescription. This happened to me with testosterone. IN 2015 I went privately because the NICE  Guidelines had not been released and the private consultant prescribed T and wrote to my GP. Since the first private prescription I have been getting it locally on NHS.

So - the prescription of testosterone may not necessarily be followed by your GP as it would be discretionary and some GPs are nervous - but definitely the regular hRT.

Also re testosterone - I'm interested that you have also been prescribed this even privately, at a young age and I wonder what symptoms led this to be prescribed - or is it standard at the private docs you went to? Have your T levels been tested?

Hurdity x

Hi Hurdity,

Thank you for the support.❤️ Honestly have felt quite alone with it all for such a long time.

 I didn't really know what perimenopause was at the time. I was having symptoms of hot flashes and night sweats but because I wasn't consumed by either I didn't twig that is what was happening. I also had some severe vaginal dryness, resulting periodically is tiny cuts on my labia. 😫 But again, I didn't really know what vaginal dryness was so I didn't know what's what It was!

When I went to the GP with very very low, but in range, estrogen and asking if estrogen replacement would help my non existent libido. She raised her voice told me those tests were worthless and what I needed was psychosexual counselling.

She put me off investigating any further but a year later I tested again and it showed below range estrogen and above range FSH so that got me a diagnosis from my consultant.

Consultant has prescribed T due to lack of libido, general weakness, and lack of stamina. I do wonder if she's jumped the gun a bit and I should've increased estrogen first but I'm aware it can be difficult to get so I'm just going to roll with it and see!

[sheila99]

Which testosterone have you been prescribed? If it's Androfemme there's no chance as it isn't available on the NHS.

[CLKD]

Your GP needs a 

Another 1 with no knowledge of peri-menopause then 

Let us know how you get on!

[Hurdity]

Hi again Witching Hour

Thanks for filling me in on your situation.

So what were your periods doing when you started having symptoms and getting the blood tests? That is key really, to know what's going on..., though the fact that your FSH is very high - does indicate peri-menopause, especially if it was carried out at the correct part of the cycle.

The GP should NOT be going by oestrogen levels anyway as these do vary - it is the cyclical changes ( your periods becoming irregular) together with the FSH readings that should give the diagnosis - which it seems you now have.

That being the case I am APPALLED at this: "She raised her voice told me those tests were worthless and what I needed was psychosexual counselling.". I mean it beggars belief!!

If the consultant has prescribed oestrogen progesterone and testosterone then your oestrogen will increase. What dose and type of all of these products have you been prescribed? As sheila99 says you won't get Androfemme on NHS but one of the testosterone products designed for men but which can be prescribed for women at approx 1/10 the dose (I think). These would be Testim, Testogel or Tostran.

You may also need vaginal oestrogen too though hopefully the HRT may obviate the necessity for this, at least initially?

Hope this helps and all the best

Hurdity x

[Witchinghour]

Your GP needs a 

Another 1 with no knowledge of peri-menopause then 

Let us know how you get on!

A total lack of knowledge, combined with a total lack of empathy or curiousity, with a large helping of God Complex.

Honestly came away from the appointment a bit traumatised. I was sobbing almost hysterically on the phone asking for help because I worried for my marriage and she just was brutal.

[CLKD]

Is there another GP Surgery within travelling distance? 

[Witchinghour]

Hi again Witching Hour

Thanks for filling me in on your situation.

So what were your periods doing when you started having symptoms and getting the blood tests? That is key really, to know what's going on..., though the fact that your FSH is very high - does indicate peri-menopause, especially if it was carried out at the correct part of the cycle.

The GP should NOT be going by oestrogen levels anyway as these do vary - it is the cyclical changes ( your periods becoming irregular) together with the FSH readings that should give the diagnosis - which it seems you now have.

That being the case I am APPALLED at this: "She raised her voice told me those tests were worthless and what I needed was psychosexual counselling.". I mean it beggars belief!!

If the consultant has prescribed oestrogen progesterone and testosterone then your oestrogen will increase. What dose and type of all of these products have you been prescribed? As sheila99 says you won't get Androfemme on NHS but one of the testosterone products designed for men but which can be prescribed for women at approx 1/10 the dose (I think). These would be Testim, Testogel or Tostran.

You may also need vaginal oestrogen too though hopefully the HRT may obviate the necessity for this, at least initially?

Hope this helps and all the best

Hurdity x

Hi Hurdity,

My periods were irregular - although not to a medical standard -  was previously regular - but cycles became quite short and would go from 13 days to 26 but everything was different every time. Length of bleed, volume, spotting either before or after or not at all. Not a single element of my period was consistent.

She just barked at me really and had she spent a few minutes actually being curious she would've helped me figure it out but she had already decided that it was a mental health issue, not a physical one. (Even when I told her I was convinced it was hormonal because I just to get a brief flittering of libido when I ovulated.) I spent a year worrying that it was my fault.

I was prescribed 50mcg Oestrodot, 200mcg utrogestan, and now 'a small pump' of testogel.

I have just put my oestrogen up to 75 though as my symptoms were returning (hot flushes, night sweats, and migraines.)

x

[Witchinghour]

Is there another GP Surgery within travelling distance?

There is but for now I'll just keep going via my consultant for reviews etc.

Especially as the surgery has just confirmed it will provide estrogen and progesterone. Testosterone she's refused but a win is a win!

[CLKD]

Tnx for the update.   Testosterone for women has to be prescribed by a Consultant initially I think.

Let's know how you are!