Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: devonhil on December 08, 2013, 11:42:05 AM
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Hello everyone,
I am new to this forum (and think it's wonderful!) but reading through all the posts I am so struck with doctors' attitudes to prescribing HRT.
There are some many GPs out there who seem to think that prescribing anti-depressants for menopause symptoms (or increasing doses for those already on them) is perfectly acceptable and even desirable and helpful, but HRT is somehow dangerous and to be avoided! Is there no understanding amongst GPs that this is unprofessional?
The cynical part of me wonders whether there are more savings to be made from anti-depressants (or maybe slightly pushier drug reps in that area of medicine)....
Those GPs who prescribe only anti-depressants are effectively saying that they regard menopause as a purely psychological condition and in no way a physical one. Surely it is both? Surely symptoms such as hot flushes and aching joints have some sort of physiological basis? Without help with physical symptoms (through hormone treatment) what is the point of only treating the pychological symptoms?
I would be really interested to hear other peoples' views on this
hil x
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My mum would have been menopausal in the late 50s early 60s. I was only about 4 at the time, so didn't know. She was given tablets for anxiety/depression. Seems like today's GPs haven't really moved on much. My mum was stuck on them for over 30 years until a psychiatrist said all her problems were caused by the different concoctions she'd been on over the years. Maybe if she'd been given HRT things may have been easier. It must have been around then.
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Hil,
Yes exactly what I have been thinking but an amusing thought are they saying a dry ****is psychological?
I am quite concerned reading this forum about the number of women prescribed antidepressants. They must be receiving the wrong treatment in some cases.
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Most definitely! Having trouble sleeping - antidepressants. Feeling tired, must be depressed - antidepressants. No, menopausal. Most GPs, male & female, don't have a Scooby. I went to GP with interest in women's health thinking, ok will get somewhere at last. Nope, just the same as all the rest. I eventually got one really nice one who I know through my old work, she listened & got me referred to meno clinic. Thast GP only works a couple of half days per week, so it's hard getting her.
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I suppose that now I have been advised not to use HRT due to my age and I've been off it for four months with a gradual return of all the symptoms which drove me to HRT six years ago then the next step will be antidepressants to lift the depression which is slowly descending due to the fact that now I am off HRT I feel rubbish!
Taz x :-\
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ADs are prescribed for things other than depression, pain relief being one. The way some of the antidepressants work affect the pain receptors in the brain this is why they are given. They are used for a physical rather than psychological reason.
I am not rushing to defend doctors but many of them are concerned about the perceived risks of HRT and feel that antidpressants are a lower risk option for some of the symptoms - hopefully not the VA ones!
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I think I have been lucky with my GP.
The first time I went regarding meno we discussed my symptoms and I said I wanted HRT and would prefer patches. No problem.
When my anxiety was bad the first suggestion was beta blockers and CBT.
I did eventually ask for a mild AD but I could not tolerate it at all.
At no time have I ever felt that they thought my problems were in my head and not meno symptoms.
Honeyb
X
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Son's GF has just been prescribed amitryptiline for her gluten intolerance. I explained about low doses for pain relief, but she's not happy!
I'm not due to return to meno clinic until June next year. I'm reducing my HRT in January sometime, but if I manage to get off HRT & symptoms return, I'm thinking of asking for Gabapentin.
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Hello ladies.
I suppose GPs are influenced by 'fashion' as much as anything else, and ADs have been around a long time and have a well documented track record.
My mother-in-law tells the story of her own mother's problems back in the late 1930s. She was about 48 and went to her doctor complaining about her 'nerves', his advice was to take up smoking. He was in a good position to recommend it as he was a chain smoker himself. Well you didn't argue with doctors in those days so she duly tried to take up the habit however she only lasted a week as she couldn't abide the taste. No other treatment was suggested so she just battled on and recovered in her own time. I knew her for a brief period and she always seemed a happy soul, living quite healthily until the age of 85. I have no knowledge of what happened to the doctor!
Take care ladies and here's hoping we all make it to the other side, no matter what we need to get there.
K.
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:welcomemm: I think that many ladies appear in the Surgery tearful, probably not able to explain symptoms in a way that points to menopause rather than depression. So the GP offers ADs which can help ...... allowing the patient to see the wood for the trees. But we all need more info about menopause and treatments, which is why being here is so useful!
It's the tales I hear about GPs being blunt about not prescribing HRT, not listening to the patient's symptoms, not being understanding in the awful symptoms that hormones can cause. It makes me want to :'( .........
Read the menus left of screen. Take a list to the Practice Nurse. Have several discussions if necessary but try to push for what you think your body requires!
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I agree totally. For nearly a year all I have is an AD & benzo's. Coming here has given me the confidence to ask for HRT & to know which one to ask for. Is it a coincidence all my symptoms started a few weeks after my first ever irregular period & it took me a few months until the penny dropped myself. What makes me more cross is at 51 I should be in peri or meno but what about the poor people going through it very early what chance do they stand of getting help. I have ordered my own FSH test off the net & if the GP says its not reliable I shall just say your blood tests aren't either. I am putting a whole package together to show I understand the risks & to show that other people & lots of them have the same symptoms I have. I should not have to do this & it makes me very cross to hear other people in the same situation but so be it xxxx
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thanks for all the responses - it's really interesting to read them.
limpy - I didn't know that ADs were used for pain relief too. Surely a strange solution for long term pain relief though? (cubagirl's son's GF thinks so too).
cubagirl - stories like your mum make me really sad (and also angry). Women of her generation were supposed to just "put up with it as its not a disease". Nor is having you arm cut off but no one would suggest putting up with that without any treatment!
honeybun - so glad you have a sympathetic gp :)
Taz2 - is there a valid reason why HRT is not suitable at an older age? I;ve not encountered any clinical trials which show that natural hormones become more dangerous with age. In fact some doctors regard hormones as a treatment similar to insulin for diabetics (which interestingly is another hormone too!) and a life-long treatment. Why not? Isn't quality of life just as important?
bev - brilliant idea to put a package together - united we stand!
ellie66 - lol - dry ***** psychological! mmm...
CLKD - totally agree - see my take on "wood for the trees" below...
Kathleen - I completely agree that it may well be a 'fashion' thing. I am no expert in medical matters but I do wonder if there is a root problem in the source of GPs' information?
I am not trying to be down on GPs as it must be incredibly hard keeping up to date. Sadly, lots of their research literature comes via drug companies (as reading journal articles with less bias is just too time-consuming). If that is the case then they will be reading lots about ADs (a huge profit maker for drug companies) and not a lot about, say, bio-identical HRT which is non-patentable and so not so lucrative. Again, I'm not being down on drug companies - they need to make profits too. Without the knowledge of modern safer HRT (and with memories of the dangerous side-effects of some older synthetic HRT methods) GPs are going to remain resistant to prescribing it which is a tragedy for so many women.
I have seen on some drug-based websites that "BHRT has not been shown to be any safer than regular HRT". That's mainly because there haven't been many trials using BHRT as it is not a money-maker and so lacks funding for such trials! Without realising that it is very easy to mislead both patients and GPs.
If your main symptoms are depression and tearfulness (which they so often are during menopause) then I cannot blame GPs for reaching for their prescription pads for ADs. It is a problem that we tend to treat symptoms and not causes in the medical world. It doesn't take a rocket-scientist (or even a doctor :P) to determine that the depression and tearfulness have a hormone-balance root/cause and so would be much more efficiently treated with BHRT which would help with the majority of physical symptoms too, than with ADs. These same GPs would then not have to endure us coming back again and again to have the other symptoms not helped by ADs alleviated. :(
I think lots of us end up in endless loops back and forth to GPs which is no help to us and just seems to make GPs equally frustrated and even more likely to regard us as neurotic and in need of ADs... >:(
argghhhh!
hil x
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Most HRT on the NHS is BHRT as far as I know that includes patches, Gel and the tablet Hormonin also suppositories. and pessaries.
There are synthetics but you can ask to be prescribed the Bioidenticals, i.e. Evoral is derived from Mexican Yam, Estrodot from Soy. All hormones are synthesised in the lab, so called natural or synthetic.
Where the confusion comes in is that we can't get compounded bioidentical (made to measure) from our GPs, only from some private Practioners.
Hope this makes things clearer.
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Hi devonhil
Interesting to read this thread!
I just wanted to take up your points about bio-identical HRT.There is some confusion generally about this because of the different definitions.
The BHRT movement that is called by this name started in America (I think) - due to their different healthcare system and as a reaction to the HRT widely prescribed for many years - ie Conjugated Equine Oestrogens and synthetic progestogens. It was promoted by private practitioners at great expense who would offer to tailor HRT to your needs based on saliva tests, and often involved large amounts of progesterone cream to protect the womb lining.
In UK and elsewhere in Europe, bio-identical oestrogen (as estradiol) has been used for many years (not sure how long!), and bio-identical progesterone has been available (although not licensed for HRT) as Crinone gel (not sure if this is in UK or just US) and Cyclogest pessaries. It is now available as oral capsules and licensed as Utrogestan.
I am not sure what the drug companies are referring to in that statement about BHRT - but there is increasing evidence that using bio-identical formulations are in fact safer so the drug companies making that sweeping statement are talking nonsense! This would stand to reason of course - replacing a hormone with one that is biologically identical to the one you make in your body is likely to be less harmful to you in the long run, than synthetic hormones or those from other animals.
The brands that are sold are patentable formulations (I would imagine) and the different brands are manufactured by different companies, under different names - and therefore are profitable for the drug companies in the same way as any other drug or hormone preparation. You only have to look at the list under HRT preparation ( menu on the left - green writing) to see how many there are!
I think the lack of prescribing HRT by some doctors is sadly -as you say - down to ignorance, combined with what CLKD referred to - women themselves not realising what their symptoms are due to. The terrible thing is that the doctors then treat each individual symptoms in isolation without realising that symptoms are part of the same condition - menopause, and hormone deficiency, and end up being on a cocktail of drugs.
The most important clue to the cause of anxiety and tearfulness - if a woman has not suffered much with this in the past ( except briefly pre-menstrually) and anxiety etc is not due to a significant life-change, and there are other indicators of menopause - then hormone replacement should be tried first!
This is why this forum is so brilliant - because we can all share our experiences and knowledge, and along with the information on this site, help women who have problems with their GPs! :)
There is a desparate need for reliable long-term studies on older women using HRT from just before menopause and into old age - and especially using bio-identcial hormones. Sadly I doubt there will be funding for this :(
Hurdity x
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Hi Devonhil - the reason is that at an older age the stroke risk rises, there is also a risk of heart disease plus the cancer risks too of course. This is for combined HRT not oestrogen only as far as I know. It is a choice of course but it is difficult when faced with the "experts" telling you that really you are better off not taking it. I used to attend a menopause clinic which took me over a year to get referred to and they were excellent but they were adamant that I had to come off at 60. I then discovered that my then GP would be happy for me to stay on it so transferred my care back to her. How fickle is that? I pushed to get referred to the clinic and then when they told me something I didn't want to hear I returned to the GP! Anyway, my new GP (who is absolutely lovely and so brilliant with her patients) is very against HRT at an older age. I decided to give it a go and stopped HRT in August and since then I have had various infections and ailments and a really low mood plus some post sex bleeding. I am having this investigated in the new year and if all is ok I will then decide about HRT. The info here is quite good - interesting that Tibolone in the over 60's doubles the stroke risk - such a shame as well as I would think this age group would appreciate the increase in sexual desire the most! http://www.patient.co.uk/doctor/hormone-replacement-therapy-including-risks-and-benefits
There are some interesting comments on this forum - not sure whether members on this one are also on that one http://www.gransnet.com/forums/health/a1188649-HRT-for-the-over-60s
Taz x
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thanks for clearing things up Hurdity and silverlady. I had no idea that so many UK HRT products are bio-identical already. It's good to know that when we do manage to get HRT we're getting the good stuff!
It seems that that the bio-identical bit is more true of the oestrogen side of the treatment than for the progesterone? I have seen quite a few threads where members are on progestins rather than progesterone. I think some GPs aren't aware there's a difference :(
Quite a few people here talk about having problems with progesterone-intolerance. Again, it would be interesting to know whether that's to progestins rather than bio-identicals.
Sadly, the internet is full of bodies claiming bio-identicals are no safer - some even imply they are more dangerous as they haven't been tested as thoroughly :o Lucky for us, most of them are based in the USA which is very behind in it's HRT research (or more in thrall to drug companies..)
The two thing I find particularly sad about this forum's members' interactions with their GPs are:
1. how many of the doctors don't seem to believe their patients when they say they are peri-menopausal or menopausal! Why on earth would we make it up?
2. how older post-menopausal women are treated. How cruel to suddenly pull the hrt rug from under someone's feet and state that they can't have it any more? I've read time and time again on this forum words to the effect of '"I want quality of life more than quantity" - I completely relate to that myself.
Taz - just read your recent post. The interesting thing about risk factor studies stating things such as "double the risk of stroke" is that the risk is very personal and may be low for a particular individual to start with. The risk of stroke is probably higher for an overweight stressed 40 year old than for a fit 70 year old so to use such reasoning to remove a treatment from someone needs to be based on the individual's health not a knee-jerk reaction. The stress of resumed menopause symptoms on withdrawal of hrt could well cause a much higher risk of stroke than the hrt that the well-meaning GP is 'protecting' the patient from!
All this points to the need for people to be treated as individuals - I think that may be too optimistic of me!
hil x
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limpy - I didn't know that ADs were used for pain relief too. Surely a strange solution for long term pain relief though? (cubagirl's son's GF thinks so too).
Given that ADs are supposed to affect the pain receptors in the brain, why are they a strange solution for long term pain relief?
The Drs have b---ar else to offer for long term pain. ADs may not work, they certainly haven't for me with MS pain, but I can understand the logic of using drugs which target the areas of the brain which are involved in pain.
If ADs are not used then we get onto the drugs used to treat epilepsy, again not something to be treated lightly but needs must........
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I was given amitryptiline to relieve the pain of fibromyalgia and it worked quite well and was at a lower dosage than for treating depression. I think that the older style tricyclic anti depressants are useful for pain relief.
Taz x
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Limpy
I take your point about ADs working on the pain receptors in the brain and so providing pain relief. I just meant that they are maybe a controversial choice given their psychological addictiveness over the long term. Though I suppose plenty of regular pain-killers are addictive too (i.e codeine).
My DH has a chronic condition too (severe psoriatic arthritis) - he's 43 and has had it for 10 years :( There has been no mention of ADs in his treatments so I'm assuming that they aren't suitable for all types of pain?
I feel for you regarding treatment for your MS - there really are so few options for chronic pain and so many are just downright dangerous. I personally would consider ADs one of the high risk options though..
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Sadly, the internet is full of bodies claiming bio-identicals are no safer - some even imply they are more dangerous as they haven't been tested as thoroughly :o Lucky for us, most of them are based in the USA which is very behind in it's HRT research (or more in thrall to drug companies..)
They (the bodies) will be talking about the (mainly American - but some also in UK) private consultants who prescribe "bio-identical hormone replacement therapy" that I was referring to - rather than the proprietary bio-identical formulations that are tested and licensed for use on the NHS at the specific doses available. I understand that these other ( non NHS) treatments may well not be tested in the doses and formulations that they are given and especially when using progesterone cream (I know someone in Oz that spent a fortune on such treatments), since this is not advisable as giving sufficient protection to the uterus from over-stimulatiom by oestrogen.
Inadequate thought it is, at least the products available have been tested to some extent, at the doses available, even though as menopausal women we would like to see trials involving more women and over a longer period of time.
Some women are only intolerant to progestins - and even then maybe just with some specifically - eg the androgenic types, but some are intolerant to all progestogens. Fortunately these women are in the minority but nevertheless it becomes a depressing struggle to find an HRT type that gives better health and quality of life overall, and some have to resort to hysterectomy in order to be able to take the oestrogen they need.
Hurdity x
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Just wanted to say that SSRIs are often prescribed for hot flushes where other menopausal symptoms are not bothersome. Smaller doses are prescribed than for depression and in some women they work well. Blood pressure lowering medications, in low dose, such as Dixarit are also used to alleviate flushes so although it may seem that anti depressants are being offered for menopausal symptoms almost in error this may not be the case.
Taz :)
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I was given combination of Amytriptiline & Gabapentin for neuralgia a while back. I was also attending an osteopath for back pain. He was horrified that I was on both & suggested that the ADs should be stopped ASAP as I could become hooked. I'd never even been warned of that aspect. He said all I needed was the Gabapentin. I came off both though as it gave me a scare. GP said I could take the ADs long term if necessary.
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Amytrip is a really old anti depressant but it's not like a benzo and addictive. I took it for quite a while and stopped without any side effects. The dosage should be really small for pain relief - I was on 10mg and you can take up to 150mg a day so it really is a tiny dose. Were you on a high dose Cubagirl. It is unsettling to be told it is addictive when your GP said otherwise.
Taz x
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Think it was only 10mg Taz, but may have been 20mg. My mouth was so dry too. Pain was always worse at night, but pain always is. GP consulted neuro specialist who suggested the Gabapentin also. Had the pain for best part of 6 months. Get odd twinges now & then, but just take normal painkillers for it.
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Glad it's manageable now. It's difficult sometimes to know what to believe!!
Taz x
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I'm scared of all those types of medication as is my brother. My mum ended up on so many, we called them her uppers & downers. She lived to 80 mind you, but often wonder if her depression & anxiety had been managed better, she would have enjoyed life more.
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Me too. I have diazepam but very rarely take any. I am to much of a coward.
They do have their place though and I'm sure if managed properly then they make a huge difference.
Have you see your number of posts CG 9999. Getting into big numbers now ;D
Honeyb
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I was given combination of Amytriptiline & Gabapentin for neuralgia a while back.
Gosh CG how did you cope with taking both together, how long were you taking them?
I have used them separately and found they both make me very groggy. Brilliant for getting to sleep but not so good for getting on with real life
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Limpy
I feel for you regarding treatment for your MS - there really are so few options for chronic pain and so many are just downright dangerous. I personally would consider ADs one of the high risk options though..
Thanks Devonhil
As you say there are so few options for chronic pain relief, and codeine is a definite no no. The thing is when ADs e.g. - Amitryptyline - Nortriptyline - are used for pain relief it is a very small dose.
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Limpy
it's good to know that the AD doses which create pain relief are very small. I think the troubling thing for a lot of chronic pain sufferers is the length of time they need to be taken for - even small doses of a drug create anxiety if you know you'll be taking that dose for 40+ years. I know my DH agonizes over the amount of ibuprofen he takes every day, especially as he is so young. Problem is the alternatives (steroid injections directly into the joints) are also not a very attractive option.
His doctors keep telling him that the drugs he already takes (including injecting methotrexate) aren't dangerous but then again they insist on monthly blood tests which kind of suggests the opposite....
hey ho
hil x
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Biodentical hormone therapy is US is confusing. To me, the estrogen patches are bio identical and well-tested, but the compounding pharmacies and so called experts pushing these pharmacies are suspect, again, to me. I once took Premarin tabs,which are not bio identical but are synthetic using horse urine and they were totally successful for me, but I had side effects of sore boobs and twenty pounds extra weight. When I stopped them abruptly, I almost immediately got a prolapsed bladder. Not one women I know who has had a hyst and is on Premarin has a prolapse. I moderate a prolapse forum so am fairly aware of this complication. However, you could not pay me to go back on Premarin because I am afraid of the long term effects. I was on it from 41 to 61. I switched to the patch, which helped my prolapse quite a bit, alone with an estradiol cream and will be on it for life. To me, the estradiol patch and cream are impossible for me to live without. I look ten years younger than I am, and feel I am healthier than most. If I forget a patch, I know it so. I will always feel that our bodies have not had time to mutate in ways to match our greatly increased life expectancy following our child bearing years. I do get a mammogram every 12-18 months and almost expect I will eventually get breast cancer. My mother is 97 and is still on Premarin and did get the safest form of breast cancer at 84 and her oncologist told her she could go back on Premarin and she has had no recurrence.
I think it is an individual decision, but my last three gynecologists have said they themselves would be on it forever. I feel and know that estrogen affects so many body functions,including brain, so I am willing to take the risk. As I say this my young neighbor has just had a second surgery for aggressive breast cancer. I don't know what form of estrogen she has been on.
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I can vouch that you look much more then ten years younger Trey, would like to include myself too.
We all need estrogen all our lives from puberty onwards.
Patch and cream and Gel are the best way, even better when you have had a hysterectomy. I am able to dose according to how I feel without worrying about protecting a womb.
I think even using a tiny amount of estrogen is better then none along with a good healthy life style and supplements.
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Limpy I took at bedtime, didn't work until PM. Guess I slept off any effects.
HB, I'm such a chatterbox! ::)
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Trey
that's really good to hear that you are a long-term user. It seems that for a lot of people on this forum that their GPs opt for a "couple of years on HRT to see you through then off again" and then they're left in the lurch and still with the return of lots of unpleasant symptoms.
I agree that we all need estrogen (amongst other hormones) for life. From an evolutionary point of view, women weren't designed to live much past menopause. As life expectancy has only really soared (for most women) over the last 100 years, so hormone deficiency has become much more of an issue. Plenty of us have 40+ post-menopause years and that's a long time to be hormone-deficient and feeling lousy.
I appreciate there are risks but then risks seem to increase for everything as we get older - with or without HRT. Feeling better (and looking better from the sound of it! :)) are important too.
It's very encouraging that there are women like you who can and do choose to keep taking hormones on the other side of the menopause. It seems that HRT should not necessarily be considered a simple aid for 'getting through the menopause' but as a whole-life option for those who make an informed decision to keep using it.
hil x
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Well said. Many docs in UK do not seem savvy re HRT and many will not prescribe, especially to women they consider too old but who are symptomatic.
Meg
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Cubagirl:
Just wanted to let you know that my dad who is 84 has taken nortryptiline and gabapention for about 25 yrs every day for painful neuropathy of his feet. He is not a diabetic and they don't know why he has this.
He also takes blood pressure medication. He is fine and not groggy and for years drank 2 martinis every night, but hasn't in the last 10 years or so. He said the gabapentin kept him up at night!! He still drives on 4-5 hour trips , goes to grocery etc....very active.
I have taken gabapentin for a back problem for pain in the past for about 5 years and had no side effects at all. When I stopped it a couple of years ago, there were no withdrawal symptoms.
Gabapentin is excreted mostly unchanged, so other then some people getting groggy, it doesn't have much in the way of side effects. If you need to take it for pain, it is probably better than taking a lot of pain relievers long term as it doesn't affect the stomach or liver. Adding a low dose of amitrip/nortriptyline with it is very common practice in the US in neurologic illness associated with pain.
Please don't be afraid to take it if you really need it.
Andius
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Andius,
that is a really good point about the effect of long-term pain-killer use on the liver. It is definitely a factor which needs considering when comparing ADs and other pain relief for chronic conditions
your dad sounds amazing by the way!
hil
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Interesting Andius. Thanks.
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I agree that we all need estrogen (amongst other hormones) for life. From an evolutionary point of view, women weren't designed to live much past menopause. As life expectancy has only really soared (for most women) over the last 100 years, so hormone deficiency has become much more of an issue. Plenty of us have 40+ post-menopause years and that's a long time to be hormone-deficient and feeling lousy.
I'm not sure about this devonhil
I haven't looked at the stats but I remember reading somewhere that our lifespan has not changed much in the past X years, but as you rightly say our life expectancy has changed dramatically. There is a difference between the two.
I had a quick trawl and here is one statement from US Nartional Institute on Ag(e)ing:
There are "two kinds of life span. One is maximum life span, the greatest age reached by any member of a species. In humans this is 120 years, we think. The other is average life span, the average age reached by members of a population. Life expectancy, the number of years an individual can expect to live, is based on average life spans.
Average life span and life expectancy in the United States have
grown dramatically in this century, from about 47 years in 1900 to
about 75 years in 1990. This advance is mostly due to improvements
in sanitation, the discovery of antibiotics, and medical care. Now, as
scientists make headway against chronic diseases like cancer and
heart disease, some think it can be extended even further.
Maximum human life span seems to be another matter. There is no
evidence that it has changed for thousands of years despite fabled
fountains of youth and biblical tales of long-lived patriarchs.
However, very recently, the dream of extending life span has shifted
from legend to laboratory. As gerontologists explore the genes, cells,
and organs involved in aging, they are uncovering more and more of
the secrets of longevity. As a result, life extension may now be more
than the stuff of myth and the retardation of disease and disability,
realistic goals."
I would say from an evolutionary point of view we are designed to live past menopause. Natural selection - through survival of the fittest - will favour any women who lives long enough to raise her last child, because her children are more likely themselves to survive and reproduce.
However - that doesn't alter the truth of what you say - we may well live more than a third of our lives in an oestrogen deficient state and for many of us - if restoring our oestrogen levels a little improves our quality of life for most of those, then we are prepared to take the risk of sacrificing a few years of our own lifespan.....
A civilised forward thinking society will recognise that this choice is and should be ours :)
(just wanted to use one of the santa smileys!)
Hurdity x
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Hurdity
you're absolutely right - sloppy writing on my part!
I think the main point to be made is that very little data is available on the consequences (good and bad) of HRT in later post-menopausal women - 10/20+ years after menopause. Probably as most women are encouraged to come off HRT around 60. Without any hard clinical data, the risk-factors touted for avoiding longer term HRT are based purely on extrapolating data from younger women and not on assessed clinical results for this older age group.
hil
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Hello,
Just wanted to add my experiences and thoughts here. I have not had a period for a few months now, the doctors conclusion all 4 of them is that at 51 depression is to blame. My blood test results back in July suggested that I had a much younger physiology for someone of my age. Yet the peri symptoms are awful I was given femostan 1/10 by GP, (reluctant to give me hrt), and it did not help. I went back and said as much, and was told, the same thing "you are young and depressed", that's all.. well at 51 I may look young (most think I'm around 35 years old, on accounf of being small). I am bashing my head against a brick wall. The missed periods and peri symptoms came before the depression which has been bad, as hair has been falling out again!
I cannot believe those so called doctors who infer that the menopause is a physchological illness, how on earth can this be possible it is a physical event, the female bodie's reproductive system calls time. Are they suggesting that hormones do not play apart? Are they stupid? Is the earth flat? I am fed up of their incessant panning of of AD's on people, fine if it works, but how do you stop taking them.
It's like these doctors who suggest that ECT is helpful,a revival from the 50's.
I am sorry but some doctors are convinced that depression is the cause of all ills, not the other way around. I have a friend who's thyroid was so bad, she was suicidal, thankfull she was taken seriously by a good doctor and treated, and guess what her depression has gone.
I'll finish my rant, by saying that the NHS is trying to save cash, I wonder how many patients who visit their gPS' walk away with prescriptions for AD's? I would be interested to know.
If AD's work as an interim solution for peri phase for some, that's great. But the menopause is vey much a physical thing, understatment.
I am just fed up with GP's in practices....grrrrr.
LFS
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LFS I could have written that, I am 51 & same as you blood test showing an FSH of 2. I have no hormone meds just an AD, diazepam & sleeping tablets. I know these are acting as a crutch & not helping 100% although I think I did get down having felt ill for so many months. I am not depressed though. This is hormonal I know it, its like the way you feel before a period only all month. Frustrating is not the word I get quite angry about it at times xxx
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Hi bev - a level of 2 is extremely low - even in young, fertile women. Have you ever been investigated regarding this. There is a condition of the pituitary gland which leads to a deficiency in sex hormones I believe.
Taz x :-\
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LFS - I empathize so much with what you're going through.
I think GPs are trained to treat depression as an isolated illness. Whilst it can be of course, it usually isn't independent if accompanied by a large number of menopause-type symptoms!
I do think medicine is the wrong way round. Doctors are trained to treat symptoms and not causes. i.e. symptom = depression, treatment = AD and symptom = aching joints, treatment = anti-inflammatories. Instead a more enlightened approach would be "here are a range of symptoms including depression and aching joints, what could be causing them?" With that way of thinking more doctors would see that the cause is probably hormonal and the entire list of symptoms may well respond to a single treatment - in this case HRT.
It is incredibly frustrating how much happier GPs are to prescribe ADs to HRT. Why are so many convinced of the efficacy and safety of ADs? It really scares me how readily they are handed out.
hil
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Hello,
Firstly Bev, I really feel for you, sounds similar to myself and it is rotten. I had blood tests at meno clinic that showed a relatively high FSH, 22 - 24, well high-ish, and low levels of oestrogen, yet 1 year down the line GP blood test showed an FSH of around 5. It was explained to me that not all FSH peptides are measured, frequently in peri stage, blood tests can vary so much, all they provide are a snapshot of circulating levels of hormones at any one point in time. There is so much more to this.
I know that there are dissorders of the pituitary gland, which is , also responsible for regulating thyroid function, it's a mine field. Bev could you go back and ask for more tests to be done?
I am sorry that you are so unwell, I do feel for you.
Devonhil, just think you have hit the nail on the head there, it's all back to front. The latest thing is low levels of vitamin D, and supplementation. It's like the chicken and egg thing. It's so cheap and easy to send patients on their way with an prescription for AD's. I also think it's highly unfair to tell a patient that they are depressed, how arrogant is that. I am sorry, but I feel that the NHS is no longer fit for purpose, well not at a primary care level anyway. I am fedup with these GP practices, where they allocate the least amount of time possible and then sit with their heads in their computer screens, barely willing to communicate, and the patients is made to feel like a nuisance. I have given up my my practice, they're just awful.
sorry to say. I totally agree with you, and its a great discussion.
::)
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I feel part of the problem is they don't have the time to really listen to the patient, or even the desire anymore with all the advancement in medicine and the regulations and legal issues concerned now. They also have no incentive as they are being paid less and less and not on their experience or treatment of the patient, but on saving money. Complex patients cost money. Medicine used to be an "art" that some docs practiced well and others got by well enough with their education. Now it is like a computer program that the doctor must follow and you are only allowed one problem due to little time available.
The doctors have become "providers" and they just provide the route to the "diagnostic flow chart" for your symptom with the "likely" drug or treatment given at the bottom (end). If they follow the "likely" path, it is considered acceptable. The art of medicine has become like a computer program that even other allied heath professionals like nurses have been taught how to navigate. The problem is that those don't have the education or experience to handle anything very complicated or to integrate different health problems.
Only the ear ache, sore throat or high blood pressure, ect. is considered at a time. The whole person and their other issues are ignored for the most likely problem or the easy solution. If you don't fit that, then they aren't willing to work out the issues until the next visit, when it is time to start all over again with the "other" most likely problem. It seems to take forever to get a decent evaluation as they send you to each "specialist" to have you follow down their respective flow charts. If you don't fit or the treatment doesn't work, then you are off to the next specialist or considered a difficult patient or a "flake". Each specialist only handles their branch of medicine, so you must see another you have an ancillary issue outside their field.
It can be very frustrating. I can't imagine what it must be like to have major health issues in old age. Trying to navigate the medical system would be like having a job in retirement! Staying healthy is really important.
Andius
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Andius, LFS (and everyone else!)
you are so spot on about the irritating way GPs immediately start tapping into their computers the minute you mention a symptom. It feels like they are just using a program where symptom is typed in the top with the goal of a particular drug coming out the other end. Whether it's because we, as patients, expect to leave clutching a prescription or whether GPs feel that they should give us one I don't know. I think it is really interesting in Andius' post that doctors are called 'providers' with the emphasis on providing drugs rather than as 'carers' - which tends to be the description given to low-paid/low-status health care (mostly done by women!). Providers tend to be quick and drug-based, carers less hasty and working without drugs.
As Andius says there is a kind of flow chart system for each symptom which could potentially mean being prescribed a separate drug (and maybe even a separate appointment) for each symptom. Whilst I appreciate the NHS is cash-starved surely someone somewhere has worked out the maths:
(1 symptom x 1 drug) x lots of short appointments = lots of drugs + lots of time + frustrated patient + irritated GP
(multiple symptoms x 1 drug/regime - HRT) x 1 longer appointment = one drug/regime + medium time + happier patient + fulfilled GP
the first one is what usually happens and it surely costs much much more than the second? Especially if some of those single symptoms involve being sent to specialists (rheumatologist for joint paint for example). With the emphasis these days on 'customer satisfaction' I would also be prepared to bet that the second example, where the patient feels listened to, is much more likely to make everyone feel better!
I wonder how much money is wasted with hasty diagnosis designed precisely to save money >:(
hil
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Head in the computer syndrome very prevalent in US as well. Disgusting.
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I must be very lucky because my doctors surgery just don't do this at all. There are eight doctors and not one of them has made me feel as if I was not important. The don't sit behind a desk looking at a computer. They only refer to the computer when they are looking at my records.
If people are unsatisfied with the service they get then complain and change surgery if you can. There are good doctors out there, it's just a case of finding them.
Honeyb
X
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Mine are great too. They always have a good look at the notes on the screen before asking what's wrong and the doc I am seeing at the moment gives you as much time as you need. It is an accepted fact that if you have an appointment to see her then you are usually at least 45 minutes late going in. I don't feel that I am being treated via a flow-chart at all. Is this how the American system works Andius?
I thought that doctors were called providers because they "provide" a service?
Taz x :)
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The GPs at the surgery I attend are really good.
I tend not to see the same one each time, it depends on who's available, but they all really speak and listen to you.
I know what Taz means about going in late though, but it does mean they DO listen to you.
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Just on the subject of bioidenticals in America - I blame Oprah, Suzanne Somers and Robin McGraw (Dr Phil's wife) for most of the misunderstanding.
I'm not in America, but I remember seeing one of Oprah's shows a few years back and it was all about "Oh my gosh" there is this wonderful "new" thing called bioidenticals, except you can only get it if you go to a very expensive compounding pharmacy. Suzanne Somers was there talking about her whacko ideas, and Robin McGraw was extolling the virtues of getting her hormones "specially designed" for her. Yeah well she's got the money to pay for them I guess.
There was absolutely no mention whatsoever that bioidentical hormones were already freely available and approved by their FDA, so of course all these poor women were sitting in the audience looking like this :o.
I'm also on another health forum (different topic, but with largely American posters) and if you mention "bioidenticals" there, most women seem to automatically think of compounded hormones. Even here in Australia, where I live, a lot of women don't even know that bioidenticals are available from their normal doctor and pharmacist. I've had many discussions (and debates) on this other forum, and I think I am starting to make a difference because I've been able to give them plenty of legitimate information to back up what I'm saying. However, I still get a bit frustrated by women who buy these OTC and online progesterone creams thinking that's going to be some sort of “cure-allâ€, but who can blame them though. There are so many dodgy internet sites, that claim they have all the answers, so it becomes very easy to believe them.
I actually try to avoid using the word "bioidentical" now, because I know how much it is misunderstood in different countries. I prefer to use the word "natural", because it says what it is on the tin. Somehow there needs to be more information put out in the public domain in all countries that "natural" hormones are available and cheap, and you don't need a compounding pharmacist to get them.
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thanks for that Dana
I know I have been confused so it's good to have it explained.
I think there are still lots of synthetic HRT treatments in the US (some of which have had quite nasty side-effects and have put women off HRT) - maybe they are behind Europe (and Australia?) in using natural versions? I read somewhere that natural hormone HRT as been the standard treatment in France for decades.
It seems that most eostrogen parts of HRT are natural but there are still quite a lot of synthetic progesterone substitutes (progestins) being used. My GP didn't know much about natural progesterone and clearly hadn't prescribed it (though she was happy to when I asked and mentioned that it was often called micronised progesterone). As lots of women on this forum seem to struggle with progestins it would definitely be worth trying the natural version instead.
hil
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Hormones, natural, compounded, bioidentical, conjugated, made to measure, over the counter, bought off the internet what ever you want to call them, they all have the potential for side effects, plus making you feel great or not so great.
Its the dose, type that suits you, that is the right one for you, no woman should be made to feel she has made the wrong choice whatever HRT she chooses or if she chooses at all to take it.