Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Peacegirl on July 26, 2024, 01:05:51 PM
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I'm fuming and tearful. I asked to go on gel and utrogestan to come off the Femoston Conti 5/1 as safer etc but it just didn't work out for me. The doctor wouldn't let me go back to Femoston so I said I was willing to try patches which also didn't work out so I asked to go back on Femoston 'for the time being' as I'm having some other health stuff (thyroid/pre-diabetes/cramp/skin issues/tiredness).
This is the message - I'm annoyed because in the econsult Id already acknowledged the risk from oral hrt and had said I'd be willing to try reducing again when the rest of my health stabilises. I'm annoyed becasue no discussion has taken place Ive just been told it's being reduced.
You can switch back to femoston conti. As with all medications it is advisable to take them at the lowest possible strength for the shortest possible time.
There is a risk of blood clots and stroke with tablet HRT (this is not present with gel or patches). With all HRT there is an increased risk of breast cancer - this continues to increase with longer term use and gynaecological cancers. The risk of all these conditions increases with age and therefore so do the risks with HRT, so I would suggest trying to stop the HRT at least annually to see if the symptoms have reduced or resolved and then medication can be discontinued. Please read in more detail here https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/
Please try the lower strength femoston conti for 3 months and then submit a review to let us know how you get on. The lower strength will reduce the risks slightly, but will not eliminate them.
Please can you book an up to date blood test for your cholesterol levels. There is no need to fast
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With all HRT there is an increased risk of breast cancer - this continues to increase with longer term use and gynaecological cancers. The risk of all these conditions increases with age and therefore so do the risks with HRT, so I would suggest trying to stop the HRT at least annually to see if the symptoms have reduced or resolved and then medication can be discontinued.
R U in the UK if so change your GP Surgery.
Also you could be seen at a dedicated menopause clinic - not a gynaecologist - but do make sure that the medics are specialists and not simply GPs that have 'done a Course'.
Keeping a mood/food/symptom diary may be of use too. let us know how you get on.
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As with all medications it is advisable to take them at the lowest possible strength for the shortest possible time.
that's very flippant! does this GP consider stopping heart medications, diabetic insulin treatments etc.?
Have U a Practice Manager to whom you can complain?
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Hi, thanks for responding-yeah really stupid generalistic message. Where I live it's so hard to get a GP appointment - I had to wait 3 weeks and then travel for 45 mins to see someone last time and I consider myself lucky. I was told by the hrt specialist and other GP's that I could stay on hrt forever if I needed to and as I struggle a bit health wise, plus have been willing to try out other methods and it's sent me a but haywire.
Do you happen to know what the NICE guidelines ay around how long I can take hrt for? I'm 64.
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We can take HRT as long as is necessary.
MayB have a lookC at the pink line with white lettering above: i.e. treatments : make notes ;-).
Also deciding which symptom U would like to ease first may be a re-starting point.
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Extract from NICE guidelines- was on the first page I read:
8 Starting and stopping HRT
HRT can be commenced for vasomotor symptoms or low mood
or anxiety that is menopause related. Since we cannot predict how
long symptoms will last, there should be no arbitrary limits for
duration of use of HRT and previously held views that HRT should
be stopped after 2 to 5 years or at the age of 60 are not backed up.
When women do decide to have a trial cessation of HRT to see if
it is still required for symptom control, either stopping suddenly
or gradually makes no difference to whether or not symptoms
will return.
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https://thebms.org.uk/publications/nice-guideline/
Hopefully this is the link to the guidance I found it in.
The only reference I can see to questions over continuing hrt is if you have a BMI of over 30, in which case they want to offer transdermal rather than tablet.
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That is just old and outdated information from an ignorant GP who doesn't know what else to do. ;D
You need to find another GP. Is there someone else at the same practice or perhaps another practice nearby you can register with, which has perhaps more young female GPs? (As they tend to be more 'up' on menopause although not always...)
If you google 'balance menopause breast cancer' you will get up Louise Newson's excellent fact sheet about the negligible risk of breast cancer and why this really isn't a concern.
And if you have no other risk factors for oral HRT you should definitely be allowed to continue it. If you want to go private (or can afford to) you can easily get it from the Newson Clinic...
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As for the pre diabetes, have you considered taking a zinc supplement? I was pre diabetic for years but after I had been on zinc supplements for a year, according to a previous blood test, "I was miles away from being pre diabetic".
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R U taking statins because they can raise blood sugar levels >:( which I wasn't warned about. 12 months ago my Surgery were telling me that I would need diabetic treatment so underwent lots of tests, I am still angry that they didn't read my notes sufficiently enough !
Let us know how you get on.
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This is very outdated and there are no arbitrary age based cut offs for hormone therapy.
Clinicians who aren't menopause literate tend to overstate the theoretical risks and ignore the benefits, in particular undervaluing women's quality of life as an outcome.
You need to see someone else, and also send a copy of the relevant NICE guidelines to the GP you dealt with, so that just maybe they will read them and the next person might have a different experience.
In the meantime, until you can get your usual treatment re prescribed, taking 2 of the half strength femoston tablets daily is exactly the same as taking the one 1/5 mg tablet.
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Write an email to the GP quoting the Nice guidelines and provide the link. Also explain in writing that your understand the risks and the benefits . Ask on what basis are they denying you treatment and that you would like it reinstated . Also that you would like a referral to a menopause clinic .
I do hope you get it sorted ,
PMX
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Thank you so much for all this amazing advice and support. I really didn't think I was going to have to jump through all these hoops yet again. (had forgotten about Louise Newson so I will quote her as well as the NICE guidelines) I'll probably write a letter so I can lay it all out clearly plus they'll have it in writing (again) that I'm aware of any risks. Will also try the zinc!
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Another doctor talking complete crap. These people really are wedded to those wretched, outdated and deeply flawed studies of the early 2000s but much of this is intellectual laziness. Basically they can't be bothered to monitor women on HRT so they try to stop them taking it.
The updated NICE guidelines are still not cutting through it would seem. Completely disregard this doctor and try to source your HRT elsewhere but in the meantime, make a formal complaint.
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Also send your comments to the British Menopause Society ..... who are supposedly improving information to GP Surgeries.
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Good idea.
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Thanks again for the amazing support and help around this. I've done a letter which I haven't sent yet so if anyone has time (and the will as it's very long) to check it over I'd be really grateful. If not no worries. This is mark two - the first one was a bit angry ;D
"Dear Doctor/s,
Thank you for response to me econsultation telling me to take hrt at a 50% reduced dose. I’m very concerned and hugely anxious that my hrt is being reduced without discussion with me
Whilst I’m not against the idea of reducing or trying transdermal hrt at some point - in face it was me who suggested this when I changed from Femoston Conti to try Evorel gel/utrogestan 6 months ago - I feel this should happen as part of a discussed and collaborative treatment plan which takes account of my general health and life situation at the time. I’m currently living with pain, side effects, fatigue and extensive periodontal issues which are being treated with limited success. It’s really important to me that I have stability around at least one area, namely hrt. For 6 weeks now, after reverting back to Femoson Conti 5/1using supplies I had left, this aspect of my health is now stable again following 5 months of hellish menopause symptoms.
So, whilst I understand the slightly elevated risks of taking oral hrt and would like to move away from it, now is not the best time for me to do this and to reiterate, I would like this to be discussed with me.
I’m happy to attend an appointment but I was trying to avoid taking up a valuable doctors appointment not to mention the difficulty of getting time off work to attend a lot having of medical and dental appointments recently. Please note I only have three weeks of Femoston Conti left.
Regarding the note from the doctor on the econsult:
As with all medications it is advisable to take them at the lowest possible strength for the shortest possible time’.
I would rather not taken even an aspirin, however my understanding (and the Portsmouth menopause specialist I saw confirmed this), is that according to NICE guidelines:
Since we cannot predict how long symptoms will last, there should be no arbitrary limits for duration of use of HRT and previously held views that HRT should be stopped after 2 to 5 years or at the age of 60 are not backed up
Also Ruth Devlin who you cite on your website says:
For a long time now many GPs have taken women off HRT as a safety precaution in relation to heart and breast health but research shows that women can now remain on HRT indefinitely
https://www.letstalkmenopause.co.uk/post/hormones-do-we-don-t-we-and-the-risks-re-breast-and-heart-health
https://www.portsdowngrouppractice.co.uk/help-and-support-service-types/menopause/
Whilst Dr Louise Newson, menopause specialist states
Women taking HRT should have an annual review to ensure they are still getting benefit, but it is no longer about taking the lowest dose for the shortest time”]
https://d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/363/Safe HRT prescribing.pdf
Just to reiterate I’m willing to consider reducing in the future but would like to have a say in my treatment plan and have other health O(and life) factors taken into account.
You appear to be requesting another blood test - can I know why this is? On my patient record, I seem to be being asked to have another thyroid test? This was done and came back normal (two weeks ago)"
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I would add something about the information about breast cancer risk being overstated and coming from the now discredited WHI study.
By the way, I don't think you need to repeat many times that you are willing to reduce in future. It just weakens your argument and gives them a chance to restart all this up again. There is no research which says you need to reduce your dose as you age. Many women can and choose to, but if you end up getting symptoms back when you reduce, obviously you can't...
You could also state that you would want to be seen in an NHS menopause clinic before having your HRT reduced. (This might at least buy you some time and hopefully the NHS menopause clinic are going to agree with you because they have access to the latest research and info.)
There are a few typos by the way.
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I would say try and reduce the text, I honestly can't see them reading it all. Have a read through and see what you can leave out but obviously keeping to the more important relevant points, that message that you want to get over.
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I think that's a really powerful letter and I love your references.
I would get rid of the word "anxiety" though and just say I am concerned. You want to appear calm and articulate not fuel any "all in her head/hysteria" beliefs that a certain generation of practitioners still harbour.
You could also add (if true) that your mammograms are up to date, you have a normal BMI and a healthy lifestyle, and no family history of thrombosis, and therefore the theoretical risks of oral hormone therapy are in your case minimal, and that you are also taking it for osteoporosis prevention as your mother/sister whoever had multiple fragility fractures.
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I would add something about the information about breast cancer risk being overstated and coming from the now discredited WHI study.
By the way, I don't think you need to repeat many times that you are willing to reduce in future. It just weakens your argument and gives them a chance to restart all this up again. There is no research which says you need to reduce your dose as you age. Many women can and choose to, but if you end up getting symptoms back when you reduce, obviously you can't...
You could also state that you would want to be seen in an NHS menopause clinic before having your HRT reduced. (This might at least buy you some time and hopefully the NHS menopause clinic are going to agree with you because they have access to the latest research and info.)
There are a few typos by the way.
Thanks great advice and yes I must check for typos! :)
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Many thanks for advice on letter - all taken onboard.
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I'm fuming and tearful. I asked to go on gel and utrogestan to come off the Femoston Conti 5/1 as safer etc but it just didn't work out for me. The doctor wouldn't let me go back to Femoston so I said I was willing to try patches which also didn't work out so I asked to go back on Femoston 'for the time being' as I'm having some other health stuff (thyroid/pre-diabetes/cramp/skin issues/tiredness).
This is the message - I'm annoyed because in the econsult Id already acknowledged the risk from oral hrt and had said I'd be willing to try reducing again when the rest of my health stabilises. I'm annoyed becasue no discussion has taken place Ive just been told it's being reduced.
You can switch back to femoston conti. As with all medications it is advisable to take them at the lowest possible strength for the shortest possible time.
There is a risk of blood clots and stroke with tablet HRT (this is not present with gel or patches). With all HRT there is an increased risk of breast cancer - this continues to increase with longer term use and gynaecological cancers. The risk of all these conditions increases with age and therefore so do the risks with HRT, so I would suggest trying to stop the HRT at least annually to see if the symptoms have reduced or resolved and then medication can be discontinued. Please read in more detail here https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/
Please try the lower strength femoston conti for 3 months and then submit a review to let us know how you get on. The lower strength will reduce the risks slightly, but will not eliminate them.
Please can you book an up to date blood test for your cholesterol levels. There is no need to fast
There are online private clinics like Louise Newsome.