Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: jobeckett on September 15, 2016, 03:27:25 PM
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Hi Ladies,
I see from reading through this forum a lot of women have sought advice from both Nick Panay and Proff John Studds. Both seem excellent practitioners albeit private and costly.
I wondered if anyone has seen both and have any opinions on who is better and/or whether they have individually different approaches towards peri meno women?
I have just started Evorel 50/Sequi and 100mg Utrogestan (25 days out of 28) from my GP (just finished week one, no change other than mild nausea and a slightly 'weird' feeling). I am also taking AD's AA's as I have severe debilitating morning anxiety/panic attacks hence the decision to try HRT (I'm 49, still bleeding although erratically) as it is pretty obvious my hormones have depleted over the past few years.
I realise I need to give it a month or so for any effects to kick in but having suffered for 2 years every morning, I am loathe to waste another year or so trying to find the right dose and the right hormones for my body. I have no family or a partner so feel quite alone, I also have to run a small business to pay the rent and put food on the table - this has suffered hugely as I have had to take regular days off as I can't get of bed most mornings. My biz partner is fed up understandably.
I have discussed this with my GP who is totally supportive in me seeking advice from one of these Gynae's (she only knows of Nick Panay) and has warned me of the cost but I'd rather get it right early on than carry on like this any longer.
Would love to hear of anyone's experience with these chaps and their methods of testing & prescribing correct dosages/brands.
Thanks as always
Jo x
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Hi Jo
I'm not sure whether you know, but Nick Panay does also work on the NHS in London. I have no idea where you are situated but would it be possible to get an NHS referral to one of his clinics? They say there's a long waiting list but a pal was referred quite quickly only a short time ago.
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Thanks Elizabethrose, I am London based so can discuss this with my GP. I'm prepared to pay for a private consultation if I can't see him via NHS although I would like to get my prescriptions via the NHS. I think this is possible?
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If you are London based I can see no reason why you couldn't be referred. Give it a go, it's worth a try and it'll certainly save you the high costs of private care. The clinics will do all of the necessary tests that you can then take elsewhere if you find yourself dissatisfied with your experience.
Some GPs are very happy to issue repeat prescriptions following a private consultation. The only time I've had difficulties was when involved in studies that required 'unusual' methods of drug administration.
Good luck!
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Thanks for the tip! x
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I am seeing Nick Panay in November , be warned a private appointment is a 6 month wait ( what I am doing .)
NHS 12-18 months.
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I had a telephone consultation with Prof Studd and he was lovely. Prescribed his usual routine for me which we're still working through (only at 3 months and he says it could be 6 months before things settle for me). If you can afford it then do it, but if not Nick Panay via NHS is supposed to be just as fab. My GP is reluctant to give me the meds though so I continue with a private prescription which costs me about £75 every 3 months.
I asked for a consultation on the phone while he was on holiday and they called me the day after he came back fitting me straight in for £300. All my Prescription letters are free from him now. And I have a 6 months follow up to book. But he knows his stuff. I wanted to get things sorted too when they started getting out of hand so decided private was best for me.
xx
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Thank you for your views Puddles mum & Maryjane - it does generally feel that Panay has a huge waiting list (he's obviously extremely popular) but I couldn't wait months if my initial trial on HRT doesn't work.
I can't really afford private but I wld find the money for testing although not sure whether cld do the meds privately as well.
All v useful info though.
Thanks very much :-)
Xx
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I had a telephone consultation with Prof Studd and he was lovely. Prescribed his usual routine for me which we're still working through (only at 3 months and he says it could be 6 months before things settle for me). If you can afford it then do it, but if not Nick Panay via NHS is supposed to be just as fab. My GP is reluctant to give me the meds though so I continue with a private prescription which costs me about £75 every 3 months.
I asked for a consultation on the phone while he was on holiday and they called me the day after he came back fitting me straight in for £300. All my Prescription letters are free from him now. And I have a 6 months follow up to book. But he knows his stuff. I wanted to get things sorted too when they started getting out of hand so decided private was best for me.
xx
Hi puddlesmum
I have sent you a PM but it's not showing in my sent items
Annie x
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I am a patient of Professor Studd but I have heard that Nick Panay is also very good. The reason Professor Studd's regime is so successful is because it is flexible and that is vital for women who don't get on with the bog standard NHS regimes which tend be very rigid and 'one size fits all'.
If it helps, you can ask Studd/Panay to write to your GP with their prescription so you can get it on the NHS which will save money.
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Hi puddlesmum
I have sent you a PM but it's not showing in my sent items
Annie x
[/quote]
Replied honey x
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Hi jobeckett
I'm not sure why you want to go to a private gynae?
You are almost there - with your prescription!
One thing I'm not clear about is that you are taking Evorel sequi but I hope you mean just Evorel 50 (Evorel sequi is a continuous combined HRT with two weeks of Evorel 50 (50mcg oestrogen) followed by two weeks of Evorel conti which has the 50 mcg oestrogen + added norethisterone).
However you can't tell anything after 1 week!!! the easiest test for deciding if HRT is working is elimination of flushes and sweats but unfortunately (or probably fortunately you will think!) as you are taking ADs these have probably stopped the sweats so the improvement won't be so obvious.
However you are also taking utrogestan more or less continuously and this could cause a permanent sedative effect especially in t he mornings and can cause nausea too.
Your GP sounds as though she is sympathetic so why not go back to her and suggest going on a cycle so you only take progesterone for a short while per month. That way you will get the benefit of the oestrogen without the permanent sedating effect of the Utrogestan. You should still be on cyclical HRT anyway if you are still having periods.
Personally I prefer Estradot as they are very small but I am sure Evorel are just as good - its just that if you need to increase the dose they are rather large whereas Estradot are tiny.
If you are on a cycle you would take utrogestan (2 x 100mg) from say Days 15 - 26 (or 17 -28) or if you are late peri-menopause with very infrequent periods and therefore not much of your own cycle, even try a calendar month cycle ( take utrogestan on the first 11-12 days of each calendar month).
I would try the regime you have for 3 months at first and see how you feel but preferably with the progesterone on a cycle (ie 2 x 100mg for 11 -12 days preferably vaginally to minimise side effects.
Your doctor should be able to agree to this - after all you have the oestrogen and separate progesterone - and you don't need to pay a private practitioner. The only thing they will give you is a prescription for testosterone too - but it's better to get settled on oestrogen and prog HRT before adding testosterone (if necessary - because some women do not need it.
John Studd pretty much has a one-size fits all prescription which has been widely publicised on here and seems to be 2-4 pumps oestrogel, 7 days progesterone every 4 weeks and small blob of testosterone. From what I've read on here (shoot me down those who've consulted him, if this is not true!) the only variation is upping or reducing the gel pretty much!
If after trying your oestrogen and prog for 3 months it's not right - then you can increase the patch size ( they go up to 100 mcg) or try gel.
You don't need to spend all this money!
I am appalled that the NHS waiting list for Nick Panay is 18 months - I mean what are women to do in the meantime - it is criminal. Those without the funds don't stand a chance. If one pays to jump the queue what happens to those women - the queue gets even longer :( . I don't think he should practice privately. Studd does because he's retired from NHS and is in Harley street only. There should be more NHS meno gynaes!
Also can your GP not refer you to another NHS gynae with shorter waiting times? Have a look on the list of specialists and see if there is someone else?
Hope this is helpful - it's jumping about a bit!
Hurdity x
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I don't think it does take 18 months to get to Mr Panay's NHS clinic - my gp referred me in late July and my appointment is early October. Of course there is no guarantee that you will get to see Mr P - you might have one of the team - but you do know they are all menopause specialists. Incidentally I think it would have taken me longer to see Mr P provately as his waiting list is so long! But I agree with you Hurdity there should be more menopause specialists - it is a four hour round trip for me to go to the Meno Clinic!
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As Fullmoon says, I don't think the NHS clinics for Nick Panay are that long in reality, though they may be quoted as such. A friend recently saw him within two and a half months of requesting a referral from her GP on the NHS. The clinics are for NHS patients only; his private work is carried out elsewhere. It is not a question of one paying to jump the queue to the disadvantage of those who can't: his private and NHS work are managed quite separately in different parts of his life.
He has a whole team of trained hormone specialists working in his clinics, who he oversees. If indeed you are seen by somebody else but would prefer to see him, things are flexible and can be juggled.
As far as prescriptions are concerned, Nick too recommends the Oestrogel, Utrogestan combination, or something very similar, after careful analysis of a patient's history. Like with John Studd, there are also many other prescription combinations regularly prescribed. It's not at all set in stone, it is very flexible
I hope this helps Jo: I think it wise of you to seek advice from others who have seen both men, though I suspect it's pretty unlikely you'll be lucky enough to get a response from many who have seen both. Trust your judgement from the advice given by those who have actually been treated by either but I'm sure you realise there are plenty of other excellent docs out there who would be able to help. Whether it's private or NHS that is of course your choice if you are willing or able to pay.
Good luck to you, I wish you well x
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We now have this running in North London https://www.doctaly.com. Now GPs who work at a practice can see private patients which I suspect is to bring more funding into the practice.
If it's like with therapists, we work in private practice but we can also offer our services to the NHS. The idea is that you have many more clients but you are paid a much lower rate and instead of the client paying you, you claim the fees back from the NHS using our personal provider numbers.
The downside is that because patients receive it for free they aren't as committed and may also attend just to please a family member. CBT has been a big failure with the NHS because it's a type of therapy where the patient has to take a very active part and work hard at it every day. Too many aren't willing to put in the effort. Therefore, it's another waste of NHS money.
I believe if everyone paid a very small amount for appointments it would solve many problems (extra funding, motivation to turn up, taking more responsibility for own health etc.). Then the service would be better and we wouldn't have to fork out hundreds of pounds to see more reliable specialists.
My friend only got the set prescription from Studd and the 'take more pumps' when she got worse. She continued to get worse and is going down the functional medicine route now. Others seem to write about a more bespoke service from him though.
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Thanks ladies for all your responses.
Hurdity - sorry yes you're right, I am on Evorel 50 x 2 weeks & Evorel Conti x 2 weeks (with Utrogestan days 1-25 - 100mg). I'm not sure why I am not on a shorter cycle of prog but I will mention this when I see her for a review in 6 weeks.
I know I am being a little impatient - I should wait to see how this combo settles down (so far I've had a bit of nausea & massive hunger surges) but that subsided after a few days (apart from the hunger surges!!). I was just concerned that I might find myself in a situ where I had to do a lot of trial and error before I found the right balance, hence the thought of seeing a gynae to save the agony of time in finding the right mix. But I will give it some more time as it may well be unnecessary to spend money (that I haven't really got).
Can I ask what difference it makes taking prog for 11-12 days at 200mg than what I've been prescribed?
Jo x
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Hi again jobeckett
OK I'm even more confused - or should it be shocked! If you are taking Evorel conti (ie the combi patches) for two weeks out of four, then why have you also been given utrogestan? This is far too much progesterone - unless you went to the docs with very heavy bleeding and regular periods and she has deliberately prescribed this.
Did you say what your cycle is doing before starting HRT? If you are late peri-menopause (very occasional periods) or post-menopause then you just need the estrogen patches ( ie the Evorel 50 or similar like the small Estradot I mentioned) and the utrogestan Days 1-25 - which may give a bleed in the 3 days off. If you are early peri-menopausal then you can take the same combo but with utrogestan 200 mg x 12 days which would give you a regular bleed.
You could also just use the Evorel sequi which gives progestogen ( via the patch) for 14 days per month and will also give you a monthly bleed.
I still don't think you need to go to a private gynae but just need to go back to your doc to get the right prescription and sounds like she is sympathetic to this. If you can remind us where you are in meno and why she prescribed the extra progesterone then perhaps we can help you before you back to the doc?
Btw although many of us have seen neither Nick Panay nor John Studd - we have read their papers, research and articles, and the many reports from other women who have seen them over the years, and of course there is a strong personal element to how women take to individuals. However if my fairygodmother flew in and offered me a visit next week to a gynae of my choice - of these two, mine would be Nick Panay!!!
Hurdity x
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I haven't read all the responses yet but :
Consultants can work part-time in the NHS and run a Private Clinic. If they weren't running a Private Clinic they may well be tending sheep (as my Boss used to do as he didn't believe in PP work). 18 months is probably because Nick Payne has a good reputation and ladies may well be prepared to wait!!! after all, we don't know do we, so making assumptions
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"I don't think he should practice privately" - would you be brave enough Hurdity to write and tell him! In an ideal World there would be enough GPs and Specialists so that there isn't a Waiting List, but the NHS in particular is in dire straights. Also, are you aware of how many patients fail to attend? I have spent hours on the 'phone or literally driving to collect patients in my car who are willing to take an appt. due to failed attendances!!!!
NHS GPs are not allowed to provide Private Prescriptions. GPs should be more willing to refer patients particularly to Specailists with long Waiting Lists. This situation is nothing new but the proviso should be that patients, should they change their minds or become well, must ring the appt.s office to cancel in good time!
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Interesting Dangermouse - presumably they are part-time NHS GPs? who pay for the use of the rooms, that those patients are charged for lab. work, Nurses etc.? Otherwise ???? That was the problem in the early years of NHS/Private work, the NHS sold theatre time/rooms but the Staff often didn't get paid for caring for the Private Patients. I know of some NHS Nurses who simply refused to do so.
Jo - sadly it will be Trial and Error until you find a regime which suits you which also, might not be a complete 'cure'. Each lady has different chemical make up which alters during The Change (hint is in the name ::)) so it can be a while B4 she notices a difference. Let us know how you get on!
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CLKD is it really true that NHS GPs can't provide private prescriptions?
It's just that one of our friends is a GP and when DH needed ABs last year for an infected toe (nice) and couldn't get an appt with his own GP, our friend wrote him a private script just on a piece of A4, with her contact details and reg. number on it.
The pharmacy were fine about it.
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I don't know if they're part time as they aren't from my surgery. It's a new system that's being rolled out, here's an article on it (but it's from the DM so may have some inaccuracies and exaggerations...)
http://www.dailymail.co.uk/health/article-3792857/Scheme-patients-pay-NHS-GP-slippery-slope-privatisation.html
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Hurdity has a good point!
There is no 'secret' about either of the private consultants. The only thing that may differ is that I know Professor Studd is more ready to prescribe testosterone, which you will struggle to get via the NHS unless you've had a hysterectomy/oopherectomy.
I used to think they would have the 'magic answer' and was desperate myself (but my case is more complex). In my case, I would prefer face to face regular reviews and I have really struggled, so am pushing to see a specialist Consultant via the NHS at the moment.
I would go back to the GP to clarify the points Hurdity raised, and then give it 3 months. OR you could ask right now if you could have the Estrogel/Utro. combo as you'd feel more comfortable with the gel. But usually GP's like you to try 1 combination first and then review after a decent period unless you run into real problems.
Please note too that folk can get a bit caught up in chopping and changing the gel dosage if you have no experience of HRT and what to expect from it (I speak from experience). Any HRT is not an overnight 'wonder cure' so it would probably be a good idea to chat to your GP about what your expectations of HRT are. I know mine are now more realistic than when I first started exploring HRT.
Good luck! xxxx
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By the way Dangermouse - how is your friend doing now? She sounds like she has had a hellish time! :(
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GRL - have bumped my thread on the topic.
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Where can I find the thread please CLKD? :great:
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I bumped it - it will show on your 'unread posts' …….. 'Other Health Discussions'
Can't remember what I called it, meno-brain :-\
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Will search it out, if MY meno brain will oblige. Thank you!! ;) ;D
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Hope you aren't too disappointed ;D
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Tempest - My friend is pretty much back to how she was thanks, so not great but not in hell anymore! Need to catch up with her to see if she's seen anyone yet in the alternative fields as she's pretty convinced, after spending so much money, that Western medicine can't help her right now.
The Pill was my lifesaver earlier in the year, but now the mid-peri surges have stopped I am looking at other avenues with Ray Peat's theories, and adding more fruit and juices has made me feel SO much better! I constantly had sugar cravings before that I would try to ignore as I believed it was bad for me but for my body its calmed a lot of symptoms down and the cravings have finally stopped as I was just having too little from avoiding sugar and intermittent fasting. Ray Peat is very anti-oestrogen replacement though (he likens it to cocaine :o) so this isn't the forum to discuss it on as it would just confuse our already confusing situations! I can only go by my own body and if I feel I need it at a later stage I won't be against it, as I know so many here feel great on estradiol.
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Dangermouse, I'm glad your friend is over the worse of the horror! I hope she manages to find some relief from the alterative avenues. I hear ayeurvedic medicine can be a good route to try. Wish her luck from me!
And.....guess what?? I tested your sugar theory. Like you, I did absolutely no sugar whatsoever not even in fruit! This week, I've been eating regularly (every 3 to 4 hours) and introduced fruit daily into my diet. I have to say that my banana at 4pm has been a life saver! Prior to that, I used to get the shakes so bad and even became rather irrational around 4pm every day. I owe you a huge debt of gratitude. I wanted to give it until today to test the theory, so was going to hunt you out anyway to let you know. You really gave me something to think about after my initial scepticism when you posted about it, and I thought - what if there is something in this?
I'm also eating within half an hour of getting up in the morning too, and this has helped loads! I used to get up and get stuck in to chores before eating something for the first time around 10.30 am and by then, i was literally jittering to pieces. It has really helped.
Thank you so very much!!!
:thankyou:
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I've been telling people for over 20 years to eat every 3 hours !!! even in the night. If 1 gets up to go across the landing in the early hours, then a biscuit B4 going back to sleep helps stop those anxiety surges.
Cutting out sugar completely is difficult. What on Earth did you eat? :-\ ? ……….. also, fruit sugars are fructose ??? so different to hidden sugars in cakes etc..
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I am tempted to go no sugar.
Looking back, in the months before starting peri I gorged on sugar. Loads of chocolate every day, loads of sugar on cereal etc. It was just obscene. I sometimes wonder if that didn't trigger something?
Are you okay to use sweetners in your tea (no longer touch coffee).
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jobeckett - I've replied to your post about your specific case and HRT with suggestions so please read back down the thread as it might have got lost amongst other discussion... :)
Hurdity x
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I fear the thread has gone off topic so will post about sugar in the sugar test thread!
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Good idea ……….
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Oops! My bad - I started this! And apologies go the OP! xxxxx
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jobeckett
my Gp referred me in June to Prof Janice Rymer at Guys meno clinic and I have an appointment late September
Jx
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:thankyou:
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Hi Hurdity, sorry for not responding - in bed with tummy bug but will get back to you ASAP as v interested in your point about too much prog.
Thanks x
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Hi jobeckett
Sorry to hear you are unwell and hope you get better soon :)
Hurdity x
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Hi again jobeckett
OK I'm even more confused - or should it be shocked! If you are taking Evorel conti (ie the combi patches) for two weeks out of four, then why have you also been given utrogestan? This is far too much progesterone - unless you went to the docs with very heavy bleeding and regular periods and she has deliberately prescribed this.
Did you say what your cycle is doing before starting HRT? If you are late peri-menopause (very occasional periods) or post-menopause then you just need the estrogen patches ( ie the Evorel 50 or similar like the small Estradot I mentioned) and the utrogestan Days 1-25 - which may give a bleed in the 3 days off. If you are early peri-menopausal then you can take the same combo but with utrogestan 200 mg x 12 days which would give you a regular bleed.
You could also just use the Evorel sequi which gives progestogen ( via the patch) for 14 days per month and will also give you a monthly bleed.
I still don't think you need to go to a private gynae but just need to go back to your doc to get the right prescription and sounds like she is sympathetic to this. If you can remind us where you are in meno and why she prescribed the extra progesterone then perhaps we can help you before you back to the doc?
Btw although many of us have seen neither Nick Panay nor John Studd - we have read their papers, research and articles, and the many reports from other women who have seen them over the years, and of course there is a strong personal element to how women take to individuals. However if my fairygodmother flew in and offered me a visit next week to a gynae of my choice - of these two, mine would be Nick Panay!!!
Hurdity x
Hi Hurdity,
I am still in peri-menopause and have had approx 8-9 periods over the past 2 years. Some are very scanty, some very heavy - I missed having any between April-July this year but then had one late July (normal).
I have no idea why she has prescribed me this amount of progesterone, being new and fairly ignorant to doses etc.. I just took her at her word and didn't ask (I will on my review). I can't say I feel any difference so far except for the initial nausea, sore breasts and lack of energy. I know I need to hang in there for a while longer before assessing whether it's working / I'm on right dose.
I don't want to have to wait ages to see a gynae, my main concern is that my morning anxiety is not subsiding and it's starting to ruin my life. I thought that if the normal 'one size fits all' doesn't work for me then I'd need to see a specialist to get the right dose. If I can avoid spending any of the high fees they charge then I'd be delighted, I guess I'm just desperate as I've been in hell for 2 years and don't want to carry on.
I wonder if the Utrogestan is making my anx / depression worse if I'm taking too much?
Thanks for listening,
Jo x
SORRY - i should have said I've had 8-9 periods EACH year for the past 2 years!
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Jo, that level of Utrogestan would be completely out of the question for me and yes, it is probably making your anxiety and depression worse. There are some women on here who get on well with progesterone but if you can't tolerate it then you must limit its use.
If I were you, I would seek help privately because you have suffered for two years and I don't see why you should struggle on trying to find someone on the NHS when seeking help privately would be easier. I consulted Professor Studd and I am very glad that I did and would go as far as to way that it was probably the best 300 quid I ever spent - I can't imagine how I could have spent £300 on anything more life changing. Being on the wrong type of HRT and/or the wrong dose (as I was for years on end and so many other women are which is why they end up ditching HRT altogether) is a complete waste of time and my only regret is that I didn't see Professor Studd sooner.
I think you need to sit down with an menopause/HRT specialist and sort out a tailor made regime which will no doubt mean much less progesterone. I wouldn't hang around, life's too short.
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Thanks MaryG,
That's very helpful information :)
I just don't think I can bear waiting anymore - I've tried every med going (apart from HRT) and the swapping/changing every few months of these 'alternative options' has sent my body and brain into despair.
Should I cut down the dosage myself? Hurdity feels I've been prescribed way too much for a beginner (along with the Evorel 50/Sequi patches) which my inexperience but logical brain does make me feel it's a bit too much!
Thank you for your comments, all advice and help is very gratefully received.
Jo x
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jobeckett - I said that you have been given the wrong prescription by the sound of it.
You either need to stick to the Evorel sequi (which is two weeks of Evorel 50 mcg followed by two weeks of Evorel conti which contains the progestogen), or you need to have Evorel 50 mcg together with the Progesterone - which for someone who is peri-menopausal should be 200mg x 11 or 12 days - at least to start with.
You do not need to go and spend £300 + with Prof Studd and you haven't been given a one-size fits all prescription. There are many different types of HRT and it is possible to adjust the doses as it is with private specialists.
You can change what you do without going back to your doctor but it would be sensible to go back to her to tell her you've looked into it and it looks like you've been given too much prog. Maybe she intended to give you Evorel 50 rather than sequi? Even so the Utrogestan should be taken for max 12 days only if taken on a cycle.
The only thing I can think of is that she is trying to lighten the bleeding but at what cost to your sanity?!
So it's your choice - but if you want to go down the separate oestrogen ( ie Evorel) and progesterone route - you will need another prescription because half the pack will be wasted. Just to be absolutely clear - you do have half the pack with Evorel conti patches in it?
Hope this helps and you find a way forward :)
Hurdity x
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Hi Hurdity,
Apologies, yes you did say I'd been given the wrong prescription by the sounds of it.
In my pack of patches - 2 are Evorel 50 and the other two are Evorel Conti (due to start the Conti tomorrow) so feel somewhat nervous about using it. You are right that I should speak to my GP - she is away for another week so I may do a 'walk-in' clinic tomorrow at the surgery to see 'a' GP just to talk this through. I am grateful this has been pointed out as this morning I woke up with chronic anxiety (it's slightly hard to determine whether it's become worse since starting the HRT) or whether I may be reacting to the Prog already - would 2 weeks make much difference or whether I am just being paranoid I wonder? I'm not a paranoid type of person so I'm def not making up these symptoms.
Out of the 9 periods I've had over the past 12 months, only a couple have been what one would describe as 'flooding' but the rest have been fairly normal so I can't think why she would give me so much prog to lighten the bleeding.
Thanks again Hurdity, it's such a blessing to have someone with experience to talk to - advice from women who go through this it def more beneficial than hoping the GP can dish out the right dosage / type!!
Jo x