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[MrsMitch]

I'm getting to the stage where I'm considering paying to go to a Newsom clinic for my GSM (there is one near me). I want to make sure I'm as well informed as I can be. So I wonder if those of you have done that could answer a few question, please?
If I was to be prescribed something like Intrarosa, would I be able to then get the repeat prescription from my GP every month?
Would anything I'm prescribed for GSM cause my GP to want to lower my dose of topical HRT?
Because I mentioned reading about Intrarosa  in connection with Louise Newsom & my GP warned me she was dangerous (her exact words) could that cause problems with my GP in the future?
Do the clinics investigate whether my problems are just atrophy or do the make sure there isn't another problem such as something dermatological?
Do they treat bladder/urethra issues or would that still need a urologist if their GSM treatment didn't resolve that?
Sorry it's lots of questions but I just want to make sure it's right to go straight to them or get the GP to refer me to a urologist (if she even will)
Thanks in advance.

[Kathleen]

Hello MrsMitch


I was a patient of Newson Health until about two years ago but I am still on their mailing list and receive updates. They recently changed their name to Newson Clinic ( I think) and they talk about various services they now  offer.

My consultations were via a patient portal as I  don't live nearby and I had to go to my GP for any investigations and use a private company for blood tests. It may be that these services are now in house at their clinic so it's worth checking that out.

I hope this has been of some help and I wish you well.

Take care.

K.

[Minusminnie]

Personally given all your problems I would use my money and pay to see a urogynaecologist consultant if your GP will not refer you.

Newsom health from what I read are all GPs …..your own GP can be directed by a consultant but I’m not so sure when it becomes GP to GP maybe some professional pride there & your current GP seems to want to solve this for you.

One quote I heard from a nhs professional in a different capacity “ GPs are the consultants handmaidens”

[bombsh3ll]

My answer would be YES if you can afford it!

We shouldn't have to pay twice for our healthcare (we have already paid for it through taxation), but for me personally I am not willing to suffer a miserable, shortened life for my principles.

I am on means tested benefits but I still pay for my birth control pill Zoely which isn't funded in Scotland because it's the safest and most suitable treatment for me rather than the older pills I could get free with a higher clot risk and unfavourable side effects.

I have a friend who hobbled around for years, zombified on high doses of morphine who could have afforded a private hip replacement without any real hardship yet she was determined to get it on the NHS. She eventually did, but will never get back the decade of her life that she spent virtually housebound and in agony.

You will need an in person appointment for an examination if there is any uncertainty about whether it is VA and/or another condition.

I don't know about the availability of prasterone on the NHS but this is something you could find out first if it is prescribable in your health board, as there is a lot of regional variation in what treatment people can access.

Newson could also review your systemic treatment because most women don't require any/much less topical VA treatment if they have a healthy level of estrogen and testosterone.

[Northerngirl]

Have you ever been offered the option of seeing a urogynaecologist on the NHS at any point?
I don't really know what to advise as only you know your exact symptoms but if they are all bladder/urethra related and HRT hasn't helped thus far minusminnie may have a good option.
Hopefully the ladies on MM will answer all your questions and then you can make a decision.
I'm a bit like you on wondering whether to go the  private route but my symptoms are NOWHERE  near as bad as yours. Some menopause specialists at Nuffield or Spire hospitals also specialise in urogynaecology....don't know if this is an option you've considered 🤔
Let us know x

[MrsMitch]

As always, ladies, thank you. Your replies have been very helpful. I am going to fill in an e- consult on Monday & ask my GP to call to discuss what's next - obviously because she's been keen to get things sorted I'm going down the NHS route first.
My concerns are simply that because my GP has told me Intrarosa isn't licensed for UK use when it clearly is & that there is no evidence testosterone can help with urethra/ bladder problems, I'm just thinking ahead because I'm concerned the right treatment is unlikely to be offered. She wants me off testosterone & the only result in my latest blood test that was outside the reference limit was free androgen index. Mine was 5 & the parameters on the test result were 0.2 - 3.6. I don't understand how all the levels work but everything else was well below the limits & I am concerned because after my first blood test, the surgery wanted me to reduce the dose but soon after when I saw the menopause specialist she said she was happy with the results & stay on the original dose.
The other concern is that we were also talking about my struggles to lose any weight & the conversation got round to all these weight loss jabs. She was explaining they get lots of patients each week who get these jabs privately & then expect the surgery to prescribe after the initial one. The surgery refuse to do it & whilst I realise it's a totally different thing, I don't want the same to happen if I have a private consultation from Newsom & everything they prescribe or recommend gets refused by my surgery.
So yes, I'm going to ask her if I can/should be referred to a urologist first but I'm at the stage where if I'm going to have an 18 month wait like I did for the menopause specialist I'm thinking ahead about the private route.
I do agree maybe a private urologist is best but it's just that apparently Intrarosa gets testosterone to the area that needs it more directly. Having been on systemic HRT for longer than vaginal oestrogen it certainly didn't help my atrophy symptoms one bit. It was only using it vaginally that helped.
Sorry I'm waffling as usual I'm just trying with your gracious help to work all this out!

[Northerngirl]

You are not waffling at all, you're just trying to get some answers for what is a totally confusing time for you.
I would just say regarding a urologist, make sure its a gynaeurologist because I know there's a difference and you'd probably be better off with the latter.
I'm sorry I can't offer you any advice on testosterone or blood results I've never had mine actually checked....didn't even realise you could get this on the NHS. I recently had a full blood test and they checked everything but hormones....crazy I know!!!!
Make a list of questions for your GP, because if you're anything like me you'll have forgotten half of what you wanted to ask before you get there 🤦🏼‍♀️
Good luck and let us know

[sheila99]

I've recently had an appointment at Newsonhealth and she stressed that she can advise my GP but not force them to prescribe and that things have got worse since the panorama programme. Personally I suspect it's more about cost control and dictatorship from the centre as there seems to be a crackdown on GPS only prescribing within the NHS guidelines. Mine are frightened even to prescribe vagifem more than twice a week or to allow estriol cream for the outside if I'm on vagifem. Pain and incontinence aren't enough for them to increase it. So if you go private I think it has to be with the expectation that you'll be paying for the prescription yourself. Perhaps dubious you can get interosa from an online pharmacy but you can buy a lot of Gina for price of a consultation. I am trying to fix mine with sufficient systemic hrt, currently on 200 estradot and things have improved a lot so I'll pay for the extra estradot if that's the only way to get it (100 estradot doesn't control my other meno symptoms, it isn't only about va). Good idea to rule out other causes first on the NHS if you can. I don't newson doctors are more clued up than any other GP on problems that aren't meno related. Good luck, I hope you can it sorted.

[MrsMitch]

Thank you, Sheila that's very helpful. It sounds as though my GP is therefore likely to refuse any information from Newsom, particularly in light of her comments.
And thank you Northerngirl about seeing a gynae urologist too, I wouldn't have known to do that. At least if my GP will refer me I know to make sure I will see one if those.
You've all helped me to understand what choices I have & whether, at this stage, Newsom would help. I don't think they would at the moment so I'll see where I get with the GP next week. If she doesn't want to refer me at this stage or doesn't refer me to the right specialist, then it might be a case of finding a private gynae urologist.
Thank you all again, things are much clearer now. Unlike the problems with all my bits 😆

[Northerngirl]

From what you've said before MrsMitch your GP sounds like she does want to get things sorted for you ....at least that's a start. Just sounds like she's not a fan of Louise Newson unfortunately.
I'd do some research before you see your GP and find out what the difference/benefits are between a gynaeurologist and urologist....as they say knowledge is power 😀
Good luck x

[MrsMitch]

Yes I agree thats the way forward. I've already learned there are 2 types of urologist for starters!
I think the GP herself has improved hugely over the years because I saw her in 2014 & she was one of many who didn't mention GSM & said peeing more is normal as we age. She's surprised me the last 2 times I've seen her & she's now the surgeries head of women's health.

[bombsh3ll]

It might be worth seeing if you can buy some intrarosa from an online pharmacy, because at least then

a) you will know if it is worth your time, efforts and potentially money pursuing it and

b) Nobody can then tell you "that won't work" or "there's no evidence".

Whilst I am all about high quality clinical evidence in general, this only matters up until the point that an individual tries a particular treatment. After that it is n=1 ie you are less interested in whether 99 other people benefited or not.

[MrsMitch]

I haven't looked to see if you can buy it online, Bombsh3ll,  so I'll go and look. But I agree with you it's worth a try, thank you.
So I've just had a quick look & whilst it's obviously pricey I just want to check if anyone knows are there higher risks by using it vs the estradiol I currently use? Why would my GP think it's not licensed? I've read that the benefits must outweigh the risks before prescribing which makes me wonder.
The only thing I did notice is in the information about it, it says in the tell your GP before using section is history of endometriosis. I had that my whole life adult life completely untreated. But now I'm post menopause is it even relevant? The last TVS I has there was no mention of it but they were looking specifically at the lining of my womb so I don't know if it was looked for or not.
Obviously I can't check with my GP about this! But to me, the benefits might definitely outweigh any risks!

[bombsh3ll]

It's cost pure and simple.

Your GP has a local formulary, or prescribing menu of generally the cheapest treatment for each condition although options are listed second or third line. This is handed down by the health board.

In many cases these are colour coded eg green no problem, amber if you must and some in red or black which they are essentially barred from prescribing on the NHS (although they can offer you a private prescription but that is then on them if there are any perceived risks, real or imagined).

Prasterone is likely on the red list.

This is a separate issue from the product having a licence in the country or not. For some medications there is regional disparity but probably not here.

As long as you are on a progestogen there are no concerns about endometriosis. I don't know enough about using it without any progestogen if there is a history of endometriosis but as we all have DHEA naturally and the dose is minuscule I would think this should be ok but this isn't you anyway.

I take sublingual DHEA myself which is the same substance via a different route.

[Mary G]

My advice to anyone and everyone is seek help from a private menopause specialist if you can afford it. 

From what I am reading on here, there seems to be a lot of push back from GPs when it comes to prescribing HRT and they now seem to be trying to decrease doses and in some cases refusing to prescribe HRT.  There was a time not long ago when the new NICE guidelines were helping women but that seems to have lost traction.  My niece is an NHS GP and she is told to prescribe the cheapest possible form of HRT along very rigid guidelines which often leaves women with no symptom control and having to go through the difficult process of having to make another appointment to get it changed if they lucky.

NHS menopause clinics are over subscribed with waiting lists of over a year in many cases.  That is a ridiculous length of time to expect women to wait.  I would forget it unless you really can't avoid it.