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[Peacegirl]

I'm fuming and tearful. I asked to go on gel and utrogestan to come off the Femoston Conti 5/1 as safer etc but it just didn't work out for me. The doctor wouldn't let me go back to Femoston so I said I was willing to try patches which also didn't work out so I asked to go back on Femoston 'for the time being' as I'm having some other health stuff (thyroid/pre-diabetes/cramp/skin issues/tiredness). 

This is the message - I'm annoyed because in the econsult Id already acknowledged the risk from oral hrt and had said I'd be willing to try reducing again when the rest of my health stabilises.  I'm annoyed becasue no discussion has taken place Ive just been told it's being reduced.

You can switch back to femoston conti. As with all medications it is advisable to take them at the lowest possible strength for the shortest possible time.

There is a risk of blood clots and stroke with tablet HRT (this is not present with gel or patches). With all HRT there is an increased risk of breast cancer - this continues to increase with longer term use and gynaecological cancers. The risk of all these conditions increases with age and therefore so do the risks with HRT, so I would suggest trying to stop the HRT at least annually to see if the symptoms have reduced or resolved and then medication can be discontinued. Please read in more detail here https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/

Please try the lower strength femoston conti for 3 months and then submit a review to let us know how you get on. The lower strength will reduce the risks slightly, but will not eliminate them.

Please can you book an up to date blood test for your cholesterol levels. There is no need to fast

[CLKD]

With all HRT there is an increased risk of breast cancer - this continues to increase with longer term use and gynaecological cancers. The risk of all these conditions increases with age and therefore so do the risks with HRT, so I would suggest trying to stop the HRT at least annually to see if the symptoms have reduced or resolved and then medication can be discontinued.

R U in the UK if so change your GP Surgery.

Also you could be seen at a dedicated menopause clinic - not a gynaecologist - but do make sure that the medics are specialists and not simply GPs that have 'done a Course'.

Keeping a mood/food/symptom diary may be of use too.  let us know how you get on.

[CLKD]

As with all medications it is advisable to take them at the lowest possible strength for the shortest possible time.


that's very flippant!  does this GP consider stopping heart medications, diabetic insulin treatments etc.? 

Have U a Practice Manager to whom you can complain?

[Peacegirl]

Hi, thanks for responding-yeah really stupid generalistic message.  Where I live it's so hard to get a GP appointment - I had to wait 3 weeks and then travel for 45 mins to see someone last time and I consider myself lucky. I was told by the hrt specialist and other GP's that I could stay on hrt forever if I needed to and as I struggle a bit health wise, plus have been willing to try out other methods and it's sent me a but haywire.

Do you happen to know what the NICE guidelines ay around how long I can take hrt for? I'm 64.

[CLKD]

We can take HRT as long as is necessary.

MayB have a lookC at the pink line with white lettering above: i.e. treatments : make notes ;-).

Also deciding which symptom U would like to ease first may be a re-starting point. 

[Penguin]

Extract from NICE guidelines- was on the first page I read:


8 Starting and stopping HRT
HRT can be commenced for vasomotor symptoms or low mood
or anxiety that is menopause related. Since we cannot predict how
long symptoms will last, there should be no arbitrary limits for
duration of use of HRT and previously held views that HRT should
be stopped after 2 to 5 years or at the age of 60 are not backed up.
When women do decide to have a trial cessation of HRT to see if
it is still required for symptom control, either stopping suddenly
or gradually makes no difference to whether or not symptoms
will return.

[Penguin]

https://thebms.org.uk/publications/nice-guideline/

Hopefully this is the link to the guidance I found it in.

The only reference  I can see to questions over continuing hrt is if you have a BMI of over 30, in which case they want to offer transdermal rather than tablet.

[joziel]

That is just old and outdated information from an ignorant GP who doesn't know what else to do. 

You need to find another GP. Is there someone else at the same practice or perhaps another practice nearby you can register with, which has perhaps more young female GPs? (As they tend to be more 'up' on menopause although not always...)

If you google 'balance menopause breast cancer' you will get up Louise Newson's excellent fact sheet about the negligible risk of breast cancer and why this really isn't a concern.

And if you have no other risk factors for oral HRT you should definitely be allowed to continue it. If you want to go private (or can afford to) you can easily get it from the Newson Clinic...

[Ayesha]

As for the pre diabetes, have you considered taking a zinc supplement? I was pre diabetic for years but after I had been on zinc supplements for a year, according to a previous blood test, "I was miles away from being pre diabetic". 

 

[CLKD]

R U taking statins because they can raise blood sugar levels  which I wasn't warned about.  12 months ago my Surgery were telling me that I would need diabetic treatment so underwent lots of tests, I am still angry that they didn't read my notes sufficiently enough !

Let us know how you get on.

[bombsh3ll]

This is very outdated and there are no arbitrary age based cut offs for hormone therapy.

Clinicians who aren't menopause literate tend to overstate the theoretical risks and ignore the benefits, in particular undervaluing women's quality of life as an outcome.

You need to see someone else, and also send a copy of the relevant NICE guidelines to the GP you dealt with, so that just maybe they will read them and the next person might have a different experience.

In the meantime, until you can get your usual treatment re prescribed, taking 2 of the half strength femoston tablets daily is exactly the same as taking the one 1/5 mg tablet.

[pepperminty]

Write an email to the GP quoting the Nice guidelines and provide the link. Also explain in writing that your understand the risks and the benefits . Ask on what basis are they denying you treatment and that you would like it reinstated . Also that you would like a referral to a menopause clinic .

I do hope you get it sorted ,

PMX

[Peacegirl]

Thank you so much for all this amazing advice and support. I really didn't think I was going to have to jump through all these hoops yet again. (had forgotten about Louise Newson so I will quote her as well as the NICE guidelines) I'll probably write a letter so I can lay it all out clearly plus they'll have it in writing (again) that I'm aware of any risks. Will also try the zinc!

[Mary G]

Another doctor talking complete crap.  These people really are wedded to those wretched, outdated and deeply flawed studies of the early 2000s but much of this is intellectual laziness.  Basically they can't be bothered to monitor women on HRT so they try to stop them taking it. 

The updated NICE guidelines are still not cutting through it would seem.  Completely disregard this doctor and try to source your HRT elsewhere but in the meantime, make a formal complaint.

[CLKD]

Also send your comments to the British Menopause Society ..... who are supposedly improving information to GP Surgeries.