Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: joziel on June 24, 2022, 04:41:19 PM
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I am probably just venting here ???
After trying 3 different GPs at my previous practice (none of which seemed to know much about HRT or make me have much faith in them), I switched practices to one which a friend had recommended - telling me that her GP specialised in the menopause and was doing her training with the BMS. To switch practices, I had to do an intake interview, provide a urine sample, do the whole blood pressure bonanza and all the rest of it. I really liked the young GP who did my intake but really I was there to see this GP my friend had recommended. I mean - she was doing a training with the BMS, right? So she had to know her stuff. She might be a bit conservative (like the BMS) at the worst, but even so I'm not really doing anything very radical...
I had to wait 4 weeks for a double appointment with her, but I wasn't in a rush...
Saw her today and OMG, NOPE! This is what I was told:
1. If my Estradot patches get increased above 75, I will need additional progesterone. I tried to point out actually, it's if it goes over 100, some believe that additional progesterone should be provided. But since I am already taking desogestrel POP, I would probably be fine even then... But no. Apparently she has just done a training with the BMS and this is what she was told. :o
2. I shouldn't be using both Vagifem pessaries (2x weekly) AND Ovestin. It should be one or the other. No matter that I am using one internally and one externally. And... I'm not applying the Ovestin to the vulva, am I? (Errrrrrrr... where else would I be putting it? On my nose?) She conceded I might apply it very sparingly maybe once a week to my urethra but that's all. I managed to get both to stay on my repeat prescription list by agreeing to be very sparing. Because she had 'never heard' of someone having both. (?!?!).
3. If I start to bleed, I'll have to go on sequential HRT apparently. Even though I have endo and endo sufferers should have continuous HRT. So I should just stay on the desogestrel and not try going to 200mg of utrogestan because woe betide I might bleed.... (Could I not just switch back to desogestrel should that happen, even so!? And anyway, she hadn't even asked me if I was bleeding and when and how much already, to date!)
4. There is no optimal level of estrogen for bone protection. She should just treat symptomatically up to 100mcg - so there is no need to check my estrogen levels. (I tried to explain that yes, they should treat symptomatically - in that blood tests should not be required before HRT is prescribed - but that doesn't mean there isn't also a minimum estrogen level which is optimal for bone health. Which is at the very very least 250nmol+, but optimally around 450nmol+ really. But no, apparently this is wrong. She has never heard it.)
5. I am on testosterone for low libido, right? Because there's no other reason to be on it. She can show me the BMS statement from last week (thanks, but I've already read it and found it very conservative)....
Now thoroughly depressed. Also didn't really feel 'seen' or my concerns really appreciated or investigated. She was not concerned about the high blood pressure symptoms or heart palps unless I pass out or faint, or have chest pain associated with it. She couldn't suggest anything for the over-production of mucous I get from my right nostril, especially after eating. Or the tearing right eye. She offered me some steroid spray but I refused, knowing it's not allergies.
Then she told me my time was up. And I didn't like her as a person very much either. It's one thing for a doctor just not to know much, but they can at least tell me that and investigate. They can make me feel like they're on my side.
So - now it's back to the drawing board. Thank goodness for my (incredibly expensive) Newson GP in all this. I do have all my meds on repeat at least now, but this GP is not someone I'll see again. I think I am now at GP number 7. And this one was supposed to be doing a BMS training. :-\ I might need to change practice AGAIN.
I'm not a doctor or a medical expert, but I've had to learn a lot about all of this myself. I am managing myself through it all. And I just keep looking for someone who knows more than me, someone I can really trust and know is on the right page. And someone I have access to, in person. (Newson GP is remote.) So they can do exams on me, refer me on for tests, do bloods etc. There is going to be a local menopause clinic opening here in October, so might now try to hang on until then.
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What a total let down! I cannot believe the hoops you had to jump through to just join the practice. It is odd the GP has menopause training yet does not know the basics of ovestin. I can totally understand how disappointed you must feel. It is just so infuriating how we have to go through so much just to get basic help for menopause.
It is good to hear a menopause clinic is opening near you in October. In the meantime, is it possible for you to see an NHS one? If you live too far then you could have a phone appointment.
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So sorry to hear about your depressing experience. I absolutely dread going to the G.p nowadays. Last two appointments about non meno related stuff, both G.p’s jumped on the HRT and told me I shouldn’t be on hrt patches as well as vagifem pessaries. I despair. I’ve been learning as I go along thanks to this forum and other sources of advice. If ever I need to go to the GP I now have to go armed with loads of printed info from various sources just in case! It fills me with massive anxiety and really puts me off going. Might be worth trying the meno clinic like you say. Hope you can find someone to trust and help you there xx
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That surprises me not a bit! She's with the British Menopause Society. So what? Obviously she won't vary from what she's been taught.
If they were active GPs would know more about menopause symptoms and treatments.
Stick with the Newson Clinic. Let us know how you get on.
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What an ignoramus frankly. My blood is almost constantly at boiling point about the "care" I got from my gp practice so it's grim to read posts like this attesting to the paucity of good primary menopause care.
That there is no minimum E2 guideline for bone density is preposterous - needs to be at least 300 and anyone with meno dep/anxiety might need to go as high as 800. I have this written black on white in my follow up letters from Nick Panay's NHS clinic at chelsea.
I got osteopenia needlessly because gp doesn't 'do' measuring so take matters into your own hands - perhaps do your own tests with medichecks if you can until you can get to a meno clinic
What I do when these triggering encounters happen is allow myself a little time to cry/rage etc and then cast about for new solutions, no use wasting one's time with these people.
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I'm sorry you had such a let down of an appointment.
I've learnt over the years (not menopause related) to trust my own knowledge regarding certain medication & treatment as not ALL GP's know everything. I was once told by my old GP that i didn't need to take enzymes to help me digest my food, which are an essential medication for cystic fibrosis. My CF team went crazy as i couldn't get them prescribed. Suffice to say i changed GP's.
Good on you for being firm & standing your ground. It would've just been nice for you if you had a better understanding & knowledgeable GP
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Thanks everyone, at least I don't feel so alone with it all :'( She also said that I should have had estrogen bloods run when I was on desogestrel (before starting HRT). Which I just know isn't correct - you can have FSH run whilst you're on the POP, but you can't have estrogen run accurately to tell you what your own ovaries are up to - the POP messes with the results.
I am a bit confused about being peri and needing to take continuous progesterone due to endo, at the moment. Just in terms of bleeding patterns... and what is 'okay'...
Before I was on HRT, when I was just on the desogestrel POP, I used to get light spotting for about 5 days once every month or two. When I told my GP at the time about it, she wasn't worried and said that pattern was classic for hormone-related breakthrough bleeds on a POP. I had an ultrasound a couple years ago (before HRT, on the POP) and everything was fine.
I had my FSH done at the end of last year (age 43yo) and it was still low (4) - so seemingly I wasn't totally menopausal and I am peri.
But due to endo, I have to be on continuous progesterone as it helps suppress endo.
But what does this mean in terms of bleeding? It is unlikely I'm not going to bleed at all if I am peri and on continuous HRT. It's more likely I'm going to continue to have breakthrough bleeding, like I did when I was just on the POP, right? So is that okay for me and I should just accept it?? I keep meaning to ask my Newson doctor about it and forgetting because I've only been on HRT 3 months so it's not that relevant yet(!).
I guess other options are scheduling a bleed but not withdrawing the progesterone for as long or as often... like the 3-monthly bleed idea which not many people use now? Or taking the progesterone for 25 days of the month...so I don't stop it for as long, but I still get a scheduled bleed. Or should I even go on the combined pill until I'm 50 when I might be able to use continuous?!
At the moment I have only bled for 7-10 days after each estrogen increase. But today I started spotting again and it's not after an estrogen increase. ::) Then the GP today freaked me out by saying I'd have to go on sequential if I bled. Which I know is BS. But you can't put someone my age and in peri, on continuous, and expect them not to bleed at all really... can you?
I just feel like I need some creative thinking outside the box and the doctor today was completely useless. She couldn't even think inside the box ;D let alone outside it ;D
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Omg... So awful. Totally get that they can't think inside the box, never mind out of it.
I'm currently under a bhrt clinic for diagnosis and hormone treatment. Some are horrified by the thought of using an unregulated bhrt clinic - I have no choice. My GP and NHS meno clinic could not help. Told me to try every pill under the sun.
So dissapointing. The nhs have spent a lot of money on uneccesary tests for me. Only for myself to finally conclude it's all hormonal.
I feel like we've been born 100 years too early. When all sorts of advances have been made in life, it's been quite shocking to discover how backwards we are with menopause. God, I'm only peri, I'm not even there yet >:(
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A lot has been made in medical advancements overall, but GPs don't seem to keep up.
This isn't simply menopause ......... I've had some horror stories in recent weeks about other specialities!!!!
What's a BHRT Clinic?
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Bioidentical hrt. Clkd. The o es that compound hormones for you.
Yes, you're right. It won't just be meno, but... Most ladies seem to hsve the same story for meno. Very sad. :(
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I’ve had similar experiences Joziel, it’s so frustrating. I’ve sat in a few appointments where it was obvious I knew more than them but didn’t want to sound like a smart arse so just pointed out the NICE Guidelines and research studies on my iPad.
My GP will not prescribe the E I need even though my consultant wrote to her, he’s in Zurich so she dismissed his advice after very in-depth tests / scans that I couldn’t access, even privately, in the U.K. I now have to buy all HRT apart from testosterone which the GP agrees with.
Very annoyingly my GP was ok to prescribe diazepam, sleepers, schedule 2 painkillers and AD’s. Not knocking Women who need these meds but none provided hormones and I knew they were my best chance to stop this madness.
I’m very bored on the peri bus but no way I’m starting conti HRT for as long as I can.
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Well that just about sums it up joziel! The recent BMS statement being put into action in the real world!
It’s beyond comprehension that this situation exists and is nothing short of pathetic.
How very frustrating for you but so very useful to let us all know. The newbies will learn what they’re up against in the future if things don’t go to plan for them and give them courage to be as proactive as they can for their own health. xx
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Oh I’m sorry you had a v frustrating appointment Joziel. You must feel so disappointed :( Don’t lose faith and you’re v lucky to have a clinic opening nearby in a few months. I bet it can’t come soon enough!
May I ask what the statement the BMS made was about? What’s been going on there?
I saw a specialist who is part of the BMS and I mentioned I’d seen Louise Newson ok-ing the use of Utrogestan vaginally and asked if I could do that. Her reaction surprised me - she said I MUST not take it vaginally and that Louise has apparently “upset alot of people at the BMS” for saying as much. Sounds like there’s been some drama there!
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I think there is A LOT OF POLITICS going on ;D ;D ;D ;D
I do think Louise Newson has a massive presence and platform - what with her podcast (actually, two podcasts!), website, Balance app and being in the first Davina documentary. I reckon the BMS are threatened by her really. I mean, an individual doctor now has more influence than the BMS itself. And they want everyone to tow their incredibly conservative line.
It was v interesting to me that she didn't feature at all in the second Davina documentary. I don't know if that was done deliberately so the documentary didn't take sides in clearly some debate going on behind the scenes and risk alienating doctors further.
However, having done the Confidence in the Menopause course from Dr Newson myself (I did have to say I was a practice manager on the website ;D ) and having now met with a doctor allegedly doing the BMS training.... er, I know where my money is!
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Hmmmm interesting… An HRT power struggle!
I haven’t seen the second Davina doc yet, I must watch it.
I love that you said you were a practice manager by the way ;D ;D
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You can register here(!): https://www.fourteenfish.com
It's free. I felt like saying I was a practice manager I was at least not claiming to be a medical professional ;D
My Newson Health GP was very impressed her patient had done the course ;D In my review, she even said to me "So, now you've tried going back on desogestrel, what do you think you should try next?", as if I were a medical student ;D ;D ;D ;D And I said "Double the utrogestan?" and she said "Exactly".
Maybe I've missed my calling ;D
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Brilliant ;D I know where to come for more advice then!
Thanks for the link 👍🏼
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joziel - may we join the queue ........ your Fees might be ;D
Isn't it awful that those 'giving advice' can't agree within themselves >:(
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So sorry you went through all the hoops and still have a crap GP. It must be very frustrating when you are as knowledgeable as you are and they are dismissive. I am glad that you at least have access to a private GP that seems to know what they are doing.
On point 1 about having to take progesterone even if on desogestrel: I saw my GP on Thursday and he told me that the advice had changed since my previous appointment (which was about a month ago so it's very recent) and you are now not required to take additional progesterone if on deso. So she's wrong about that (or my GP is).
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Nicodemus, I wish that were true - but it's not :'( Not unless you double the desogestrel and take 2x POPs every day:
"Earlier studies have reported that desogestrel 150 micrograms is effective as the progestogen component
of HRT with no increase in the risk of endometrial hyperplasia.33-34 There is lack of evidence on the use of desogestrel 75 micrograms as the progestogen component of HRT. If desogestrel 75 micrograms is used as contraception in women receiving HRT, it would be recommended to add further progestogen (e.g. Utrogestan 100 mg daily or 200 mg for 12 days a month) to provide adequate endometrial protection."
Taken from here: https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf
I've looked around the BMS site and can't see any other info there about it. The study which used double the POP dose is here: https://pubmed.ncbi.nlm.nih.gov/8429799/
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Thanks everyone. The sad thing is that I believe I know the bare minimum but clearly some GPs who fancy themselves to take a specialist interest in the menopause, know even less than that. Which just leaves you wondering around in a kind of shock at the level of knowledge out there. Frankly I wouldn't care, except that GPs are the gateway to meds and healthcare.
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I wonder who funds their 'research' in order for them to be so pedantic?
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I’m so sorry you are going through this. I too have had a frustrating appointment with my GP this week. She is meant to be the knowledgable one in the practice when if comes to hrt. I have POI and she basically said (after only trying two types of hrt) that maybe hrt just doesn’t suit me and that they’re giving it to me because of my age (39yo) but maybe instead they will just pump me with loads of calcium😡….shocked! At this point I too am thinking about a move to another surgery. Useless and never seem to have any answers.
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Who do you think mind fund the research CKLD?! x
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Kat36, that's awful. At your age you for sure need estrogen. Goodness....
I think I'm just going to wait till October and see if this local menopause doctor's clinic is any good. It's private but the prices are really reasonable. Till then I just keep on with Newson Health. There is also the option of seeing a gynae locally also privately, who has come highly recommended for menopause stuff and HRT.
But at the moment I don't need any particular help. It's just if something goes screwy, you can need someone quite soon with all this and if you don't have the right person in place, then you get in a mess. Which is why, even though I have nothing urgent going on, I was trying to find someone... ho hum...
But we are also going to be moving house in the next year so spending loadsa money trying to find someone local here who can be My Person, might just work out not very cost effective....