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[Sunnyangel]

I recently posted about my trials and tribulations with my NHS 'care' from my GP. It's all a bit convoluted but in essence, I have seen 3 GPs along the way (just how it happened, it's a fairly big practice and you get who you are given because no GP there works every day) and now I have managed to get a consultation privately (which had been cancelled by someone else) for September 3rd instead of having to wait until the 17th, but still with the same menopause specialist. One of the Practice GPs who prescribed me Estriol cream in addition to the Estradiol topical vaginal oestrogen pessaries has just left the practice- she was ok. A second one whom I saw when I was having a number of symptoms with the loading dose was unsympathetic and told me that even if things continued to get worse, I would have to stick to the 2x week post- loading advice for 3 months at which point she might consider writing a referral.

Well, things did get worse quite quickly on the 2x week regime so I went back again to try to argue my case but saw yet another doctor ( not one I knew) who said second loading dose prescribed but after that, back to 2x week again and if that doesn't work, no more but must try some ,as yet, unspecified cream. No explanation, no dialogue, no reason, just a total shutdown of the subject. Nanny knows best! I don't want to have to pay for this but I don't feel I'm getting anywhere  at the moment. I'm being treated like a naughty schoolgirl who has questioned the teacher. I have had a lot of discomfort. I envy ladies who have got sympathetic, informed and helpful GPs but I can't see my GP practice changing, they all seem very entrenched in outdated information which is why I feel I need to bypass them if I am to get anywhere.

 I am still on my second loading dose and beginning to feel better again but dispirited at having to go back to 2x week soon with the very real possibility that it will all get worse again. I think I need a higher dose but this has been categorically ruled out by my GP- I am prepared to envisage alternatives but only after trying out an increased dosage of Estradiol FIRST to see if that is all I need .BTW, I am 60, have no other health issues, don't smoke or drink, am not overweight and am fairly active- not quite the Party-Girl I once was!!

So, on to the questions.
I have read mixed reports about menopause specialists but am really hoping for a positive outcome.

Am I wise to mention my treatment to-date in a critical manner or would I be treading on dangerous medical ground? Do medics stick together?

Any thoughts on how I should approach the consultation regarding my desired outcome i.e. a more frequent dosage of Estradiol.

Should I/could I mention any of the documents that posters like Ayesha have put links to, or would that be a bad idea?

Anything else I should/ shouldn't do?

I've been very stiff upper lip previously during my appointments, as women often are, but now my lip feels very wobbly indeed. Should I let it all out at the appointment or will I just come over as some unhinged woman of a certain age?

I'll be very grateful for any input.

[sheila99]

Any menopause specialist will be well used to unhinged women of a certain age! But really, you've been refused appropriate treatment and they're ok with you being in pain when you don't have to be - how else so they expect you to react? It's very likely the specialist will have seen many women in your situation and will be sympathetic. She is there to help you whereas for the NHS cost seems to be a higher priority than women's wellbeing. I've been refused adequate va treatment on the NHS so have gone private too.

[Sunnyangel]

Thanks Sheila99- I hope it works out as well for me as it has for you. This whole situation is making me feel very, very anxious and stressed which is probably not helping my physical state. Fingers crossed for a positive experience.

[Ayesha]

Go there and speak your mind, tell them you are being refused the extra treatment required to control your symptoms and the reason you are there.
Its either your GP's are ill informed or they are just thinking about costs. Vagifem pessary was a higher dose years ago but its now lower and deemed ok to increase up  to five pessaries a week if needed. I personally use every day like a lot of women plus Estriol for the outside with no trouble from my surgery, or the one previous to that.

There is no reason why you can't say to them what you have learned from doing your own research and quoting what you have read in the BSSM Position Statement.
I have a feeling they will be sympathetic to your plight.


 

[Jules]

I think it's that there's no directive given to GPs to ensure parity. It shouldn't matter which surgery we have to use, we should expect the same standards. I don't know what I'd do if my GP surgery started limiting my supply. They used to but then relaxed their opinion. If some of us are given BP meds or statins to prevent future illness why is it any different with treatment for menopause. I hope you are listened to

[Sunnyangel]

Thank you Ayesha and Jules.
It is an interesting point about how there should be parity of treatment no matter which surgery we use. How can these decisions be based on evidence and medical best practice if women presenting with similar problems have such different outcomes and treatments?Some women are left in pain and discomfort, others are given treatment which enables them to resume a normal life. It does make me wonder if it is simply down to costs? Excellent point too about preventative statins. Women are being penalised for trying to optimise their health and last time I looked, the amount of oestrogen you produce isn't really something you can have any control over, unlike certain other medical issues such as BP issues where lifestyle choices may have some impact- for some people at least.

[Jules]

Exactly. My GP told me my BP readings would be ok in America but in this country they get people on meds in the hope of saving money down the line. So do they not think the same applies to menopause? What would happen if we were walking around with burning and god knows what between our legs when so many older women now have to work, or provide free childcare for grandchildren and/or care for older parents. At my age,my grandma had none of those demands, she was being looked after by my 42 year old mum. I'm dashing around like a rabied dog so I expect to be supported by my GP in staying fit to do it.