Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: ellie66 on August 30, 2014, 11:31:20 AM
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http://www.gponline.com/clinical-review-menopause/womens-health/menopausal-and-hrt/article/1309553?HAYILC=NAVARTICLE
Could Dr Currie contact GP Magazine correct this please she is quoted as a references. It is may understanding that HRT can continue indefinitely depending on the risks and benefit. This article is still quoting 5 years!
Its is being used as GP CPD Training Credits and seems to be wrong. This is quite scary "guidelines recommend cessation after five years"
Thanks Ellie
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Ellie it really is scary.
Well done for spotting it.
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You can PM Emma in case this is missed
Honeyb
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I have PMed Emma and Dr Currie. This is quite horrifying that GP magazine are perpetuating bad practice. Its is a journal lots of GP's read.
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Unfortunately I cannot comment on the article even though I have log in as I am well known in GP land. I do not want to out myself re HRT/Menopause etc too personal.
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Doesn't it also say that testosterone is offered in patches? Haven't they been discontinued in the UK?
Taz x :-\
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Yes they have, have n't they. Oh god and GP's are relying this for CPD :'(
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Sorry to my mind this is a well balanced report and I was quite impressed with it, and I read every word.
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It is well written but the advice that HRT is only for five years is a little worrying if a GP follows it to the letter plus the fact that testosterone patches are no longer available is also misleading.
Taz x
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Yes it is a bit misleading we had all this year on here and we pleased I seem to remember re 5 years issue and it was now about risks and benefits rather than a time limit. It needed better researching some will still stick to the 5 years after reading this article.
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It just needs correcting that is all.
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GPs will read this but use it as discretional guideline as most good GPs do.
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Hmmm but as we know from the numerous threads on here women are still being denied HRT against their wishes, after 5 years or cut off at 60 which is not best practice.
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My GPs have got very 'tick-boxy' in recent years and have a 5 year limit, because of breast cancer. They have already told me this. I was hoping that the NICE guidelines would lead to something a bit more patient friendly.................
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Intrinsa Patches,
http://binscombe.net/blog/?p=672 read comments.
It seems that they maybe still available but unlicensed, testosterone gel is licensed I believe.
Testosterone is considered a secondary treatment.
Its difficult to judge about some women being denied HRT after 60 a because we only know what we are told in a post and probably non of the full medical history of the poster, non of us are experts or medical professionals.
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I agree that much of the article is very good - I skimmed through it.
However I quite agree that it is appalling that incorrect and outdated information should be used in a current review article that goes to GPs, and especially as I see it is used for CPD!
What is worse is that the two references given under monitoring HRT are this website and the British Menopause Society but as you say ellie66, as far as I understand nowhere on this site does Dr Currie recommended cessation after 5 years and the British Menopause Society's own consensus statement on HRT says the oppostie.
The relevant info from this article:
When commenced after the age of 51, most guidelines suggest discontinuing after five years.1,2 Commencing HRT after the age of 60 is not recommended and is associated with increased risk of CVD.
The relevant statement from BMS:
The decision whether to use HRT should be made by each woman having been given sufficient information by her health professional to make a fully informed choice.
The HRT dosage, regimen and duration should be individualised, with annual evaluation of pros and cons.
Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.
HRT prescribed before the age of 60 has a favourable benefit / risk profile.
It is imperative that women with premature ovarian insufficiency are encouraged to use HRT at least until the average age of the menopause.
If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of administration.
It is imperative that in our ageing population research and development of increasingly sophisticated hormonal preparations should continue to maximise benefits and minimise side effects and risks.
This will optimise quality of life and facilitate the primary prevention of long term conditions which create a personal, social and economic burden.
http://www.thebms.org.uk/statementpreview.php?id=1
Despite the overall high quality of the rest of the article, it is really quite worrying that such a crucial point which many women face, is simply wrong, and that we are better informed than the author in this respect.
Many times in the past I have posted the link to the last paper from the BMS/Women's Health Concern by Panay et al in 2013, updating info on HRT and recommendations. Here it is again:
http://min.sagepub.com/content/19/2/59
The BMS consensus statement will be based on these findings
Hurdity x
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Thanks so much Hurdity you have referenced what I was trying to say so well :)
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Intrinsa Patches,
http://binscombe.net/blog/?p=672 read comments.
It seems that they maybe still available but unlicensed, testosterone gel is licensed I believe.
Testosterone is considered a secondary treatment.
Its difficult to judge about some women being denied HRT after 60 a because we only know what we are told in a post and probably non of the full medical history of the poster, non of us are experts or medical professionals.
I can't just reply and can only quote - maybe my computer or the system?
Anyway here is the info from BMS about testosterone. No licensed product for women. Intrinsa was licensed but withdrawn.
Testosterone replacement can have a huge impact on general quality of life as well as the libido of many women in the menopause.
The expected announcement by MSD of the withdrawal of testosterone implants has recently been circulated to health professionals. This is a global profitability decision by the company which follows closely on from the withdrawal of estradiol implants.
Even more disappointingly, this decision followed on closely from the withdrawal of the Intrinsa testosterone patches, leaving no licensed female testosterone replacement preparations available in the UK or abroad.
The BMS and all other menopause societies globally, have already protested the withdrawal of estrogen and testosterone implants, which will disadvantage a significant proportion of menopausal women who have struggled with alternative preparations. Whilst the decision by MSD to withdraw hormone implants was immoral, it was not illegal and cannot be reversed.
http://www.thebms.org.uk/newsitem.php?newsid=67
Also - I would say that the stories women report on here about being denied HRT after the age of 60 are usually full and detailed and it is unreasonable to suggest otherwise.
As for not being experts - well most of us are not medical professionals at GP level or higher, but there are nurses on here, and I would suggest that quite a lot of us are experts - amateur maybe - but very well informed about the subject and are able to correct misinformation given by the medical professionals - you only have to read all threads to see this!
Hurdity x
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"In theory it can still be prescribed on the NHS (I believe it is still on the market and supplies are available), but there are two issues that might be a problem. The first is that your doctor may be unhappy to prescribe it now that it is unlicenced, as that does mean extra risk for the doctor. The other is that, with the price rise and the loss of its licence, your local CCG may have black-listed it, which means that local GPs will be heavily criticised if they prescribe it. Unfortunately these are consequences of what can happen when the drug companies make these changes. If you were on it before the change and it worked well for you then you could try appealing the decision with the CCG."
A comment on the article.
Quote form NHS Choices site
"Most experts agree if HRT is used on a short-term basis (no more than five years), the benefits outweigh the risks.
If HRT is taken for longer, particularly for more than 10 years, you should discuss your individual risks with your GP and review them on an annual basis"
We will have to agree to differ hurdity.
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We don't need to agree to differ silverlady as my posts are not my opinion especially - but just what the various papers and authorities etc say!
Re the Intrinsa - I didn't disagree with you - but just quoted what the BMS statement said and clarified that testosterone gel is not licensed. I didn't mention anything about the availability - it has been withdrawn from license and manufacture too I believe. Having looked at your helpful link - this was an eye-opener - it seems that another company bought all the remaining stock after it was withdrawn and sells it for £395 per box of 8 patches. I went to the company's website and through clicking various options got to the point where the patches were offered. Unbelievable! How immoral is that! Of course this is as good as there being none available - because as said in the quote, few doctors are going to prescribe a now unlicensed product and even fewer at that super-inflated cost. I presume anyone who is able to get them does so through a private gynae at that ludicrous price!!! How inequitable!
Re the stopping HRT at 60 etc, it's not a question of differing! I reported the BMS recommendations. The NHS Choices gives the prevailing guidelines and even so does not say that women should stop at 60 - in fact it implies that women may take it for 10 years, and of course individual risks should be discussed. This is completely different from an arbitrary cut-off point imposed by many GPs - many times have we heard women so "I have been told I have to come off at 60". It would be welcome indeed for all women to be given the opportunity to discuss individual risks with their GP!!
Also this guidance (the NHS) differs from Dr Currie's on this site - where the benefits and risks are not time dependent but broadly age dependant - other things being equal. This advice must also be at the root of the problem where women who have been on HRT for longer than 5 years and still under 60 are told they need to come off - whereas the advice on this site is that under 60 the benefits generally exceed the risks irrespective of the time on HRT.
There is some NICE clinical guidance about stopping HRT on the web somewhere which I have posted in the past and will do so again when I find it.
Hurdity x
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Perhaps we need to differ to agree Hurdity :)
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What's CPD?
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CPD=Continuing Professional Development ie GP ongoing training.
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:thankyou:
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A lovely reply from Dr Currie she is contacting GP Magazine. :)
Thank-you for letting me know about this. Most of this is good, but I agree, it is incorrect to say that HRT should be stopped after 5 years. I frequently hear of women having to battle with their GPs to be "allowed" to stay on HRT--it should be their choice! I have fed this back and asked for a response. Have also asked them to refer to 2012 BMS guidelines on HRT.
Thank-you
Best wishes
Heather
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Result.
Now we have to hope someone listens.
Honeyb
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I think that the GP magazine is excellent and I have certainly book marked it, as it is for professionals you have to register to read all the articles
Here is another good report by Dr Gwen Lewis on Menopause and HRT
http://www.gponline.com/hormone-replacement-therapy/womens-health/menopausal-and-hrt/article/1221738
When I go for my estrogen patch, my doctor always goes through the risks and benefits and we go through any health and problems I might have or had, then says you are aware and understand as you are well over the five year recommendation. To me this is a holistic approach, not all women are suitable for HRT.
I don't agree that if a women has been on HRT for years and is obviously thriving even though she is over 60 then she should not be made to come off and it should be her choice., if she accepts any current guidelines and is aware of risks. To my mind this is correct procedure, good patient, Doctor practice.
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I have read through the article again from the GP, it does not say that HRT should be stopped five years
"Stopping HRT
There are no strict rules about when to stop HRT, but most guidelines recommend cessation after five years.
The decision should, however, be patient-centred, with knowledge of potential risks and benefits"
As a layman I cannot find fault with that.
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Maybe it's the part under Monitoring HRT?
"When commenced after the age of 51, most guidelines suggest discontinuing after five years"
Taz x
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Taz it says "suggest" when "monitoring" the GP must make educated decision according to his patient, history and well being, a good GP will use his discretion.
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Although I am not on HRT apart from Vagifem I have found this discussion interesting to follow. It very much depends on the individual GP. I have seen 2 female GPs over the last few years, one is happy for me to use Vagefem as much and as long as I need to but the other one, who I saw when 'my' GP was away, voiced concern about how much Oestrogen I was being given when I wanted to try Oestrogel.
(I should add that 'my' GP let me try Oestrogel with no problem but I didn't continue with it as it was not helpful). I just used that example to show how different 2 GPs in the same practice can be. One doing things by the book and another using her common sense.
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Silverlady, Taz the guidelines re the 5 years are effectively out of date which is why Dr Currie has referred GP Magazine to the British Menopause Society (BMS) guidelines of 2012. See my comment where I included Dr Currie PM to me.
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Think the morale of all this discussion is choose your Doctor with care :)
ellie66 even if the guidelines are updated in the GP report a Doctor will still use his discretion, if the patient is not happy with this, then she is perfectly entitled to seek a second opinion or GP.
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I was going to say the same as silverlady, we have the right to change GP within a practice or even change practice if we feel it would be better for us. I am very fortunate with mine but I realise many are not.
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I did that over the aged 60 thing. Came up with a "no" from all four female GP's in our practice, followed by a "no" from gynae consultant and a further "no" from the menopause clinic. I am not beaten yet though! The fact that I still have to work is something I feel I can use! Maybe the 60 age limit was due to women retiring at 60 back in the day so it was felt we could just recline on our sofas in a soggy mess for the remainder of our lives!
Taz x
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Have you though Taz that there may be a good reason why all these Medics have said no. It might not seem fair but they are privy to your medical records and history.
You are able to use local hormones though I am sure you have said.
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Silverlady we will have to agree to differ. :) It should not be quoting/mentioning guidelines that are outdated at all as per Dr Currie's PM to me as she points out BMS guidelines now longer support the arbitrary 5 year rule.
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No SL - there is no medical reason. My weight and blood pressure are fine. My mum did have a DVT, which didn't kill her I hasten to add, but all of my clotting factor gene tests have come back as ok. My gynae consultant was really quite stern in his advice that all women should be off HRT by the time they are 60 due to stroke and cardio vascular risk which I've since learnt are not really proven. The GP's are also of the same opinion and the menopause clinic also said the same.
There are some interesting comments here http://www.nhs.uk/conditions/Hormone-replacement-therapy/Pages/Introduction.aspx and here http://www.patient.co.uk/forums/discuss/forced-off-hrt-at-60--226242 I am obviously not alone - sadly!
Taz x
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I don't have any choice in what GPs surgery I use as its the only one in the area.
I have found that most of the GPs are ok with prescribing but have mentioned that they would like me to try without it by age 60. I have also been told they will re prescribe if things are unmanageable. By the time I get to 60 I will have been on HRT for eleven years. It's not really something I want to do. I would rather try and come off earlier. I don't want to be on HRT for the rest of my life as there are increasing risks the longer you are on and the older you get.
It may not be what we want to think but the facts are out there. It may not be a huge risk but a risk non the less.
Of course if a woman is happy to accept this then she should be allowed to continue for ever if that's what she wants.
Honeyb
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It's all about quality of life I suppose. I really didn't think that my hot sweats would still be going strong a year after stopping it but maybe I'm just one of the women who never get rid of them unless they are on HRT. I feel I have given it a good go and have dealt with the "fall out" so to speak of a much worsened prolapse once I stopped. So I will remain determined - I have to anyway in order to do my job properly and there is no way I can afford to retire before I get my state pension.
Taz x
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I'm going to show ignorance here so apologies in advance.
when a lady has been on HRT for a number of years successfully and then comes off does the menopause come back? What I mean is does HRT delay the onset or do the natural hormones keep changing so if you come off at 60 you would be where you would have been if you hadn't taken it? If it delays the onset it must be harder to put up with when you are older.
Oh goodness that sounds garbled. If anyone understand my question I would appreciate the answer but if not.............. ::)
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I think some ladies who stop taking HRT do find their symptoms return.
Taz seems to be an example of that.
I really didn't think that my hot sweats would still be going strong a year after stopping it but maybe I'm just one of the women who never get rid of them unless they are on HRT. I feel I have given it a good go and have dealt with the "fall out" so to speak of a much worsened prolapse once I stopped.
Don't think HRT prevents onset of menopause if it's not being used.
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In a lot of cases (all of my friends come to think of it!) the menopause is delayed whilst using HRT. However, the menopause goes on forever. It's not something that happens and you end up the same as you used to be. Things like tiredness, vaginal dryness, insomnia can last for the rest of our lives as the oestrogen levels gradually fall. Mood swings should improve though - whether you take HRT or not - and I must admit that after the first five months or so without HRT (when I felt like I could murder someone!) those symptoms have disappeared.
When I started it almost eight years ago the doc did explain to me that when I came off it there was a high chance that I would be back where I started symptom-wise but in my way of thinking I could have spent those seven years feeling awful and still not see an end in sight. I have a 73 year old friend who didn't use HRT but is still experiencing dozens of hot sweats during the day/night and hasn't been able to make love comfortably for the past 12 years. Such a shame. She is not able to start HRT now due to her age but is sad that she didn't at least have some years of feeling better. She didn't know about topical oestrogen for vaginal discomfort so is going to ask her GP if she can have some. It's a shame that her GP didn't offer it!
Taz x
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thanks for the info Taz2. I am rather clueless as I have not used HRT apart from Vagifem. I do think I have been fortunate as apart from the VA my other symptoms have been manageable and are actually improving after 5 years.3 years ago my insomnia was quite bad but for the last year I have slept well. Never right through but if I wake I don't stay awake. I think I am a bit more rational and less volatile too (well some of the time anyway).
Of course if life had been intolerable of course I would have considered it, I am not anti HRT and I had the thought in my mind that it was an option if things got worse but they didn't. I still get flushes sometimes and night sweats and of course the VA but this is me and I am at peace with myself.
I feel sorry for ladies who are helped by HRT and then forced to give it up if they don't want to. I had no idea that happened to some ladies.
thank you for your reply.
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We are in a litigious society. Also GPs may well be coming up to retirement at the same time as we reach menopause so are already beginning to 'switch down'.
I have been so ill with depression and anxiety for many years - now controlled with medication in the main - that I am well known to my GP who is keen for me to remain well.
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Just catching up - great news ellie66 and great reply from Dr Currie! Well done for raising this important issue.
Hurdity :)
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Thanks Hurdity :foryou:
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"This is lower than the risks associated with drinking 14-21 units of alcohol per week and the respective risks for obesity, nulliparity, early menarche and late menopause"
At least they are stating this :D
I had a bit of a word with my doc as they were so negative at each visit (guilt tripping me!) yet I know they don't make such a fuss about people drinking regularly when the above applies more than whether or not I take my HRT :)
Apparently the same applies for those who like smoked and processed meat - the risk is a lot higher than taking HRT!
Great to see things happen quickly like this, hopefully they will all get the message soon enough and make our lives a bit easier :'( Thank you Ellie and Dr Currie.
:-*
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"Endometrial cancer
Estrogen-only HRT is associated with endometrial hyperplasia and endometrial cancer. This risk increases with duration and is dose-related.
The risk is reduced by supplementing with sequential progesterone from day 10-14 of the cycle. Risk continues several years after stopping.
After treatment for endometrial cancer, HRT should be avoided. The risk of endometrial hyperplasia and endometrial cancer is further increases in obese women"
Sorry but is this missing the information about "Conti" HRT. Perhaps my understanding was wrong but I thought that if we goto the Conti option post menopause then our risk of Endometrial cancer was actually less than "Non Users".
http://www.womens-health-concern.org/help/factsheets/fs_hrtrisksbenefits.html
"The addition of a progestogen every day reduces the risk of this cancer compared to non-users." ???
:-*
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Peegeetip - relating to "I had a bit of a word with my doc as they were so negative at each visit (guilt tripping me!) yet I know they don't make such a fuss about people drinking regularly when the above applies more than whether or not I take my HRT" my doc advised me to stop drinking alcohol while using HRT as alcohol mimics oestrogen. She said that she advises all of her HRT users to do this but she doesn't think that anyone actually does stop! I didn't I must admit!
Taz x
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Hi Taz2,
thanks for the advice on keeping off the vino :D
I think your point shows exactly how there is a culture of misinformation out there feeding our questions and worries.
Each doc seems to have a different slant or nugget of advice which can be true or false or somewhere in the middle.
My own doc didn't mention alcohol :o Yet its much worse in terms what it does to us compared to HRT.
But we may not want to think about that as we sit down to our second glass of alcohol this evening ???
Your doc is part of the way there which is good. Also red wine can act in the opposite way and reduce apparantly.
Perhaps the subject of a future post ;) but a somewhat complex, difficult and emotive subject I fear.
:-*
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It's a case of weighing it all up. Two glasses of wine each evening would put us at double the recommended "units". Two units is a small (175ml) glass of under 12% wine. Frightening!
I think my doc was just saying that by taking both HRT and alcohol you are doubling the risk so either go for the alcohol or the HRT. There's a personal risk quiz on this site http://www.breakthrough.org.uk/about-breast-cancer/breast-cancer-risk-factors
I seem to tick a lot of the boxes - but the main risk is being aged 50-70 from what I can see!
Of course alcohol is a risk factor for many other cancers too. It's important to try to keep a balanced view I guess. I think we have discussed this a few times before. Maybe try a search?
Taz x
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Re: the cut off for some at 60... has anyone thought that we have to pay for our meds, including HRT untill 60... this ruling wouldn't happen to be revenue based would it?? Think how many women would be getting their HRT for free after 60. That's a lot of pennies not coming in..
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There are many women being prescribed HRT or ERT after 60, my doctor alone has told me that there are a lot of women in her practise that are.
Most doctors use there discretion and their patients medical history and health to decide, I don't think its anything to do with cost.
This to me is the whole point of this thread regardless of current guidelines up to date or not, or at least that is what I have been trying to get over.
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Hi
weird that there is such an urgency to get us pushed off a treatment that may reduce and prevent more expense on the health service for between 10p and 30p a day. Hypocritical that they push £1 a day untested Statins so much at the moment for over 60's and yet ignore the benefit of HRT.
I think its a mix of things including some doing it out of rote, some out of concern for patient, some having concern for the cost. Some are above questioning when it does happen and unwilling to often discuss/resolve things we want at often difficult and critical times in our lives.
I noticed a timely quote today in papers that seems to pervade a lot of what we sadly see on the forum.
"Some years ago, the outgoing head of the General Medical Council warned doctors that they needed to adapt to a new age of patient-power. Sir Donald Irvine said: ‘There are still some doctors who dislike what they perceive as their authority being questioned. They resent the assertive patient.'"
Please remember I know a lot of doctors are great and are not like this.
Unfortunately the above quote has been my experience thus far.
:-*
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A few months ago the Chairman of NICE encouraged us all to be more assertive - I mentioned this article in various posts and have lifted the below from these:
Here is a recent article by the Chairman of NICE ( National Institute of Health and Care Excellence) who says patients (sadly) need to be more pushy with their doctors (difficult when you are feeling hormonal)!
http://www.telegraph.co.uk/health/nhs/10595806/NHS-patients-should-be-pushy-with-GPs-about-treatment-and-drugs-says-health-chief.html
In it he says this:
Patients should adopt “American†attitudes and be more pushy with their doctors about drugs to which they are entitled, the head of the NHS rationing body has said.
Professor David Haslam, chairman of the National Institute of Health and Care Excellence (NICE), said British patients should become more assertive and see themselves as “equal partners†with their doctors, with legal rights.
He said patients in this country needed to learn from the Americans, who are far more confident about entering into dialogue with family doctors about their health, and taking an active role in managing their health.
Prof Haslam said too many patients were not being offered medications approved by NICE – and should learn more about their conditions and ask for drugs which should be prescribed for them.
In an interview with The Telegraph, he said: “When products have been approved for use by the NHS by Nice, patients have a legal right to those drugs - as long as they are clinically appropriate. The take-up should be much higher than it currently is." ......
That says it all really.
Hurdity x
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It does.
Wouldn't it would be nice to go to our GPs and feel we could rely on them doing what was best for us...........
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That advice is really going to help a fragile tearful even timid women going to her Doctor about her menopause symptoms!
Its alright to advise that but its in the real world of Doctors and patients, that attitude can backfire.
I would suggest if a woman is feeling fragile she should take her husband/partner along with her to an appointment ( if he is willing) because in my experience men are taken more seriously, if a woman's partner is with her he/she will listen and will more then likely be prescribed what she wants, and be treated with more consideration.
A single woman might feel more confident if she has a friend with her.
Sad but true in some circumstances.
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This statement worries me
Prof Haslam said too many patients were not being offered medications approved by NICE – and should learn more about their conditions and ask for drugs which should be prescribed for them.
Does this mean that we should self diagnose as well as know what medications that are best for us.
Obviously after a diagnosis then we can learn more about the condition and ask appropriate questions.
A lot of doctors do know their istuff and some of us who have health anxiety could come to a very wrong conclusion about what is wrong with us.
Honeyb
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What you say is very true HB also despite what is being suggested most if not all Doctors do have our best interests at heart and going in with guns blazing, I just can't see how that works.
I don't envy a Doctors job, we all have such high expectations.
It is a good idea to have someone accompany you if you are feeling nervous in some circumstances, I do see a lot of that in waiting rooms and at hospital appointments, couples going in together.
"more then likely be prescribed what she wants" I should have said "needs"
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Does this mean that we should self diagnose as well as know what medications that are best for us.
Obviously after a diagnosis then we can learn more about the condition and ask appropriate questions.
HB - It ain't always that easy.
Sometimes, even when we are diagnosed GPs don't give us what we want or need.
I had to speak to several doctors in the practice before I got HRT.
They each knew what they were taking about but had quite different opinions as to what was needed.
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After spending heaven knows how many years training, I don't think I would like to be told by a patient what is wrong with them and how they want treated. Kind of defeats the purpose a bit.
Obviously we can be well informed and have discussions with our GPs.
I always find asking rather than insisting has worked well for me in the past.
We are entitled to the correct treatment of course but a GP has a lot more knowledge than I do, so..... :-\
Honeyb
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Totally agree with asking rather than insisting.
The latter will, justifiably, irritate anybody and put their backs up.
Discussions have to be the way to go.
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Absolutely Limpy.
It's the only way that has ever worked for me and I have a tame GP :D
Honeyb
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Me too, my GP is lovely, the rest of them in the Practice are not bad too :)
On a different note NICE can't even make there mind up about Paracetamol!
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Sorry but other posts have said it all.
A lot of ladies posting seem to have gone to our docs and "asked" only to be refused.
Luckily for me it took till the second visit when I insisted that HRT was for me.
Others have taken more visits or been palmed off with highly addictive AD's at the drop of a hat.
For me it was then given rather reluctantly with a roll of the eye's.
If I wanted a lecture I'd attend the local college :)
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Even MM considers the simple stuff first http://www.menopausematters.co.uk/newsitem.php?recordID=156 for symptoms :)
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Just as many of us have been offered HRT with no difficulty.
You cannot tar all GPs with the same brush, it's neither true not fair.
I have never been lectured in the doctors surgery. Given advice yes which given the fact they know a heck of a lot more than me is fair enough.
Honeyb
x
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The prescribing of anti depressants for hot flushes is now common. These are not addictive anti depressants. They are issued at a lower dose than for depression and have good results and work almost immediately although there are side effects in the beginning for some women. Friends have also had good results, for stopping flushes, from Dixarit a blood pressure medication. HRT is the way forward for some women of course but if the major symptom is hot flushes then it is good to have an alternative. Nice to have a choice.
I believe that some women think the doc has diagnosed depression instead of menopause but this is probably because the doc hasn't explained the use of the anti depressant properly.
Taz x
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I agree with Taz that antidepressants at a low dose can help with flushes and thus help you to cope with life generally when suffering menopause symptoms. Of course they are not for everyone but neither is HRT. My GP is very sympathetic but has no real treatment to offer but explained that trying an antidepressant, in my case, citalopram might help and it has. I don't like having to rely on theses tablets and I am definitely not depressed but I had got to the point of being willing to try anything.
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"If I wanted a lecture I'd attend the local college :)"
College is for learning and fun never for a lecture :)
In all the time I have been a national health patient I don't think I have ever been lectured, not even By M.Os at sick Quarters or Military Hospitals.
ADs in lower doses are prescribed for pain as well. Think it is called off label uses.
The simple truth is menopause is a natural process, some ladies get through with no help, others need help and guidance through it.
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The most important difference between using anti-depressants for menopause, and HRT, is that the former will not restore oestrogen levels and therefore even if some of the symptoms of oestrogen deficiency (let's say hot flushes and anxiety) are lessened, they do nothing to prevent the long term health issues like protection of bone as one example. Menopause may be a natural process but we have had this argument before - this natural process has undesirable consequences for many of us living as we do maybe a third of our lives post-menopause.
I quite agree that the first thing any woman needs to do before thinking about HRT is to attend to dietary and lifestyle changes so that she is in the best possible state of health for this next stage of life - no use thinking that HRT is going to cure all ills if you smoke, drink, are overweight, take no exercise and eat lots of fatty processed foods!
Re the doctor issue - of course no woman should go to the doctors initially with an aggressive attitude - this will get nowhere, but we have had so many stories on here of women doing what the NICE chap suggested, reading up on HRT, asking for a particular product and even then being given something else. And to repeat what has been said many times before - doctors are not gods and any GP who thinks they know it all should not be practising. Of course they cannot be a specialist about everything, and a good GP should acknowledge if someone is well informed. Being assertive is not the same as being aggressive.
Someone mentioned self-diagnosis - well ultimately it is up to the doctor - and usually a specialist for something serious. However in this case we are talking about menopause and HRT - not an illness so not the same thing at all.
I think it is very important for women not to be intimidated into taking medication they may not want when HRT is often more appropriate (if no medical reason why not), and especially if they have asked for it!
Hurdity x