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[Sunnyangel]

I had my appointment this morning. The specialist, a  pleasant woman who also gave a thumbs up to this very website by the way, talked me through my experiences to date- not good ones if you see my previous posts. I had an hour's consultation.

She recommended that after finishing the second loading dose (topical vaginal oestrogen pessaries) that I am currently on, I should have another two weeks of daily treatment. She explained to me that the longer I had been post menopausal, the more likely it was that I could need more time to 'load up' before even thinking of reducing the dose. In fact, she suggests that I drop off the 7x dosage gradually trying two  weeks or so at a time with each reduction until I find the correct dosage for me. She said I could do this over 4-6 months in her opinion.

 She is writing all this in a letter to my GP practice also explaining how miniscule the doses of oestrogen involved actually are (though you would think that GPs should know this as a very basic starting point. and saying that I should be allowed to make my own decisions about what is an appropriate dose for me to be prescribed. The other issue that really cheered me was her assurance that if this didn't work, then there are other approaches which we can discuss, it made me feel less anxious that this now is all or nothing.

I know I am very lucky to have been able to afford this consultation and I feel bad for other ladies who maybe can't but I thought I would at least share the information about a much longer loading dose possibly creating more favourable conditions from which a tapered reduction can be tried.

Of course, I don't know where my GP will go with all of this, we shall see but I hope a strongly worded clear letter will help educate her. She has also written me a prescription that I can cash in if feet are being dragged over this.

I feel a faint glimmer of optimism at last.

[CLKD]

  4 the update.  Each 1 of us is individual. VA treatment is not like a course of ABs which is what GPs/medics should be getting their heads around.

Hopefully your GP will be reassured once the letter arrives that what women need isn't going to kill us! 

Did she mention that a smear can be applied on the outer labia/vulval area if necessary?  I use either KY Jelly or estriol to keep those 'lips' less dry.  Let us know how you get on?

[Sunnyangel]

Hi CKD. Forgot to mention, she said I can also apply estriol cream externally on a daily basis if needed and will ask the GP to prescribe it for me in a bigger tube (have 15mg quantity at the moment). I hope the GP now becomes more helpful (as well as informed) and agrees to all this. We should not have to worry about all this should we? It seems pretty basic to want to lead a pain/discomfort free life and have our doctors well- informed on something which affects so many women. I think we all know that it must be impossible for a GP to be an expert on everything but at least they should be prepared to educate themselves better on this massive issue.
I will update on how it goes.

[CLKD]

I agree that GPs should, now that so much media attention has been shown about menopause, become more informed. 

Good Luck! 

[Ayesha]

After what you have been put through by your surgery, you should never have been forced to go private, it will be interesting to hear how they will respond to this.
One way or another you will know if its all been down to cost or ignorance on their part.

[Minusminnie]

The bigger Estriol tube is likely to be 80g and is 0.01% estriol.
As opposed to 15g @ 0.1%.

[CLKD]

I wonder when the British Menopause Society will send information to every GP Surgery in the UK to update on the effects of hormonal upheaval? And then checking on each GP/Nurse Practitioner what their protocol might be!

[Ayesha]

Sometime never,  they are not fit for purpose!

[Sunnyangel]

Thanks for all the replies.
Ayesha, I must admit I feel somewhat apprehensive about how the surgery will respond to this. I have no idea about how they will react and to be honest, that has been a big worry for me in having the consultation privately and is making me feel very stressed but I didn't see any other way that I could discuss my treatment and also, I know that referral to an NHS menopause specialist could take months and months, even if they agreed to do it.

I forgot to ask if I get a copy of the letter sent to the surgery. Not sure if anybody can answer that question.

I assume that I just wait until I need to hand in a prescription request (much earlier than they are expecting given the recommended increased dose by the specialist) and then see what comes back from them. If they don't want to prescribe the suggested new dose, I suppose they will ask me to call the surgery or make an appointment. I feel so anxious about all this that I spent this morning with a painful headache which I am sure is down to all this stress.

It makes me so angry that I (and many others) am going through all this while some other lucky women ( with better educated and more sympathetic GPs) aren't having to go private and face these very stressful issues. Obviously, I'm truly glad for them but outcomes in treatment should not be so different and shouldn't cause  worry and concern.

[sheila99]

I wonder when the British Menopause Society will send information to every GP Surgery in the UK to update on the effects of hormonal upheaval? And then checking on each GP/Nurse Practitioner what their protocol might be!

I wonder when the BMS will do something about changing the guidelines as that is the only effective way to prevent this scenario happening again and again. I can guess 

Sunnyangel it might be an idea to book an appointment with your GP so you know before you run out if she will change your prescription. If it is the weaker estriol I'd try to get the stronger one.
  I find it hard to believe so many gps are so ignorant, I'm pretty sure mine just hide behind it to control costs. Fingers crossed you get it.

[Sunnyangel]

Thanks Sheila99. You may be right about booking an appointment but I don't relish the prospect. Also, may not happen but what do I do if the GP simply refuses to follow the recommendation? Where does that leave me? A lifetime of paying out for the treatment which other women may get free of charge?

[sheila99]

She might surprise you. If she won't I'd suggest you ask for a referral to an NHS meno clinic, if they say you need more then you'll get it so with any luck paying for your own will be for a limited time.

[Ayesha]

There are complaint procedures you can take if refused adequate treatment for your condition from your GP,  and you do have a good case.
Hopefully this will be sorted out soon, you should not have to pay privately or even wait for a menopause clinic simply to get appropriate treatment for GSM symptoms.

[Sunnyangel]

sheila99-good advice. If specialist's recommendations are refused, I shall press for a referral to a NHS menopause clinic. I don't think they can refuse that.
Thanks for your advice too Ayesha.
It makes a difference to your confidence to know that there is support out there on the forum when things seem pretty bleak and your GP is making you feel as though you are requesting something unreasonable.
 

[Minusminnie]

Thanks Sheila99. You may be right about booking an appointment but I don't relish the prospect. Also, may not happen but what do I do if the GP simply refuses to follow the recommendation? Where does that leave me? A lifetime of paying out for the treatment which other women may get free of charge?

Do you have to see the same GP ? I think you mentioned that it was a third GP that you saw who was unwilling to prescribe.

I would ask for a letter from your private consultation you have after all paid for it.

You’ve been proactive on your own behalf which is to be commended not put down. Any GP is directed by a consultant.

I had one GP in the past that I used to brace myself before seeing. I used to take a list in that I wanted answers to and take my body in….my head was actually elsewhere. Might be one way ?