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Author Topic: NICE guideline on menopause  (Read 43292 times)

peegeetip

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Re: NICE guideline on menopause
« Reply #30 on: August 04, 2014, 01:29:43 PM »

"Unfortunately my doctors practice simply direct everyone to menopause matters website and I seriously doubt they have ever looked at it"
Totally agree with this Kelly!

My own Doctor told me to go "look" - and then got all annoyed with me when it contradicted their "hallowed" opinion.

The Doc also tried to tell me that tridestra was for "post meno" also and that I wasn't allowed it - when I wanted to have a 3 month cycle not a monthly one.

I really think they use the "monthly" cycle to try and put us off using HRT when they first deem to allow us that HRT prescription. Especially ladies who are late peri and not used to the frequency anymore.
« Last Edit: August 04, 2014, 01:33:22 PM by peegeetip »
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Kelly

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Re: NICE guideline on menopause
« Reply #31 on: August 04, 2014, 03:13:26 PM »

I totally agree peeweetip can you imagine the outcry if people were simply directed to a web site for any other problems! I have totally lost faith in doctors lately. I just feel they want you in and out as quickly as possible . They just can't give you the time you need nowadays.   
They redirected me ages ago to first steps counselling  for my anxiety and finally they are giving me a call sometime in August . Only a phone call mind I won't see -anyone yet!!!!  Just can't believe the NHS lately!
Kelly

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oldsheep

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Re: NICE guideline on menopause
« Reply #32 on: October 26, 2014, 08:42:11 PM »

I've just read a rather anti HRT article in today's Guardian (Dr Luisa Dillner) in which she says that NICE guidelines are 2-3 years max on HRT.
Is this true? I've been on it longer but am a patient at a hospital meno clinic. Certainly the consultant doesn't believe in this restriction.
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Dancinggirl

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Re: NICE guideline on menopause
« Reply #33 on: October 26, 2014, 08:54:39 PM »

Hi oldsheep
Have a look at the very recent article on the Daily Mail website. There are contributions from leading professional women on HRT including Dr. Currie. It is advocating GPs should be prescribing HRT for women earlier in the peri stage.  The current recommendation is to stop HRT by 60 but even this is not necessarily set in tablets of stone.  Like most things there will always be arguments for and against.
The new official NICE guidelines will be through next year.  Most of the alarming scares from the trials released back in 2002 have now been revised as it was a flawed trial. Maybe Dr. Dillner hasn't read the latest info about HRT or perhaps she is one of those who believe 'the natural way is the only way' - either way, she is perhaps too young to have experienced the meno herself or she has been one of the lucky ones to sail through meno with few if any symptoms.
I wouldn't worry.  Dg x
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Hurdity

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Re: NICE guideline on menopause
« Reply #34 on: October 27, 2014, 10:32:27 AM »

Hi oldsheep

I haven't read all of the articles nor the sources but had a quick glance. As Dancinggirl says the new NICE guidelines are due out next year.

It is very important to note that the information out there does not recommend only using HRT for 2-3 years. The Clinical Knowledge Summaries (CKS) actually say this:

"For vasomotor symptoms, most women require 2–3 years of treatment, but some women may need longer. This judgement should be made on a case-by-case basis with regular attempts to discontinue treatment. Symptoms may recur for a short time after stopping HRT".

This is not a recommendation - but an observation! As always there are often assumptions and differential interpretations made.

This is what the same CKS says about stopping HRT:

Consider a trial withdrawal (if a woman is symptom-free) after 1–2 years.

    Advise the woman that symptoms may recur for a short time once HRT is stopped.
    Counsel the woman about the possible risks of HRT if she wishes to continue treatment, particularly if treatment is being used for longer than 5 years.


The crucial phrase here is: "..if she wishes to continue treatment"

Here is a link to the NICE CKS for anyone who wants to read it:
http://cks.nice.org.uk/menopause#!scenariorecommendation:9
http://cks.nice.org.uk/menopause#!management

The article Dr Dillner linked to is a Drug Safety Update publication and is also referring to this figure of 2-3 years. Here is the article - but it is actually from 2007 so it's out-of-date.
http://www.mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con2032233.pdf

It is a pity that her article is only superficial but to most women appears as in depth and supported by the evidence, and in the Guardian too  ;D

Yes the Daily Mail article is much better and up to date - even though it surprised me to say so !!
http://www.dailymail.co.uk/health/article-2800760/should-women-hrt-menopause-experts-say-s-best-way-ease-symptoms-avoid-long-term-health-problems.html

If the 2-3 year thing was a recommendation we'd all be in trouble!!!

Hurdity x

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peegeetip

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Re: NICE guideline on menopause
« Reply #35 on: October 30, 2014, 11:07:00 AM »

No wonder things are in such a mess. Talk about open to interpretation :o
Even the BMS have said in recent publications that "no arbitrary limit" should be placed on using HRT use.

2-3 years that would be nice if true however its almost always wrong :)

"with regular attempts to discontinue treatment" thats just verging on harrassment!
Perhaps we would all be healthier if docs we're so quick to remind people on other health issues.

"Symptoms may recur for a short time after stopping HRT" yeah right! perhaps whoever wrote that should read this site ::)
Or walk a mile in another persons shoes as the saying goes.

Its is our choice how long we should continue, never the doctors.
They can advise and cajole us all they like but if we wish to remain on HRT then there is nothing they can do.

If its doing good then continue. Simples :)
If you stop, in most cases the symptoms will return for a time that's going to be longer than most of us would want.

The suggestion of a trial period to withdraw seems almost stupid and verging on cruel (based on what we read on MM too).


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Dancinggirl

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Re: NICE guideline on menopause
« Reply #36 on: October 30, 2014, 01:54:01 PM »

peegeetip - I do agree. There is almost an obsession with many GPs to get women 'off this poison' (a women posted on this site that her GP actually said this to her!!).
There is a real need to educate both GPs and women about the menopause and get some real discussion about a sensible way forward.  Hopefully the new guidelines next year will put some clarity into the muddied waters.
When i was advised to take a break from HRT last autumn I wasn't hopeful that my symptoms would subside quickly - I had a 3 year break from HRt before and they never subsided.  What I hoped this time was that, as my life was a bit less stressful at the moment, I would cope better.  The problem this time is my bladder a trophy are far worse - I can sort of cope with the lack of sleep and flushes but the burning pain and constant trips to the loo in the night are driving me nuts!!!!!  Dg x
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Taz2

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Re: NICE guideline on menopause
« Reply #37 on: October 30, 2014, 02:09:11 PM »

What I'd like to know is.. how do we educate menopause clinics to continue prescribing HRT once we reach age 60!

Taz x  :-\
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Dancinggirl

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Re: NICE guideline on menopause
« Reply #38 on: October 30, 2014, 03:37:00 PM »

Let's hope the new guidelines next year gives us all a better quality of life.
If the NHS wants to reduce the amount of visits to the doctor and prevent many age related ailments, then better management of meno symptoms would be an easy way to start.
DG x
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peegeetip

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Re: NICE guideline on menopause
« Reply #39 on: October 30, 2014, 04:48:24 PM »

Its almost maddening when you here that the doctors are going to be paid £50 extra to diagnose certain complaints.
Perhaps they should be docked £50 every time they fail to identify and treat a problem or say something unprofessional (poison comment).

DG so your off HRT for over 1 year now, sorry to ask but how long did it take before bladder atrophy kicked back in?
Are you going to go back on.

As I mentioned yesterday that's one area I don't want to return to. Was out for a long drive recently and it was bliss not having to panic about when/where the next loo stop was, something that was not the case prior to starting HRT.

Taz, as for the meno clinics, not had any experience of them (yet), just local docs.
Either should respect your wishes then move on and prescribe what patient wants.
Same applies the other way if we wish not to have a treatment or operation, its our choice in the end.

I'm not trying to be funny, but it's almost like they are ensuring job creation for the docs.
Forcing a stop at 60 then having plenty of customers coming back regularly with post meno complaints due to lack of HRT.
At a time when they are trying to save money and doling out statins and ad's like no tomorrow.

They don't even have long term usage data on statins yet and the side effects are awful too (includes causing type 2 diabetes).
Just thought I'd also point out that statins cost more than HRT.
HRT = can be as low as £0.10 to £0.20 per day
Statins = £1.00 thru to £2.30+ per day

Imagine the outrage if diabetics got to 60 and they said "right better get you off that poison, no more insulin for you"!
No one would put up with that.

 :o
« Last Edit: October 30, 2014, 05:01:27 PM by peegeetip »
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Hurdity

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Re: NICE guideline on menopause
« Reply #40 on: October 30, 2014, 04:58:43 PM »

It is understandable (but not excusable) that many GPs are out of date with current thinking and recommendations, but perplexing and more worrying if menopause clinics are also restricting prescription of HRT to the over 60's!

I think they are still using the data from that big study which is quoted on all HRT and which hasn't been superseded by a similar study - although there are small studies I understand eg Denmark etc.

The other annoying thing is that the recommendations are there hidden away eg in the NICE Clinical Knowledge Summaries I linked to below, and also in the most up to date papers of the British Menopause Society - where they do not say we should stop at 60, just that caution should be exercised if women start HRT over 60 (as far as I recall).

At least when the NICE guidelines are produced it should all be in one place - and hopefully clear.... no doubt there will be a draft produced for comment at some point so we need to look out for that if our views are sought!

Peegeetip - if diabetics did not have insulin they would die very quickly. Because illnesses exacerbated by menopausal oestrogen deficiency are long term - sadly it is not immediately obvious - but the paper published recently in Climacteric by the International Menopause Society to mark World Menopause Day (Prevention of Diseases After Menopause) goes some way to educate everyone about this.

Hurdity x

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peegeetip

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Re: NICE guideline on menopause
« Reply #41 on: October 30, 2014, 05:13:17 PM »

Hi Hurdity

my only point was that the insulin is just another hormone people can take to help us stay well in the long term.
It has drawbacks and side effects too.

Why the docs see HRT as some sort of poison or contraband is beyond me!

A better parallel would be if a doctor said to a diabetic "reduce" your usage, as they do with those on HRT.

A diabetic wouldn't die however their quality of life would go down hill fast.
They may also suffer from serious health problems in the longer term.

This is similar in ways to someone reducing/stopping HRT where their quality of life reduces quickly.
They may suffer unpleasant and difficult to treat serious problems in the longer term too.

In either case the doc would be just plain wrong.

 ???
« Last Edit: October 30, 2014, 05:27:25 PM by peegeetip »
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Dancinggirl

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Re: NICE guideline on menopause
« Reply #42 on: October 30, 2014, 07:15:36 PM »

peegeetip - I've had the burning atrophy start in my early 40s when I was already on full HRT but was probably into post meno by then and only using quite a low dose of HRT. Though I mentioned this to various doctors I saw, none of them suggested using extra local oestrogen which I now know might have helped.  When I came off HRT last autumn the nurse suggested the local oestrogen and told me I should have started using it a long time ago -  they were familiar with this problem as members of staff at this GP practise were suffering as well!!!
This is why I am seeing a gynae privately to hopefully get advice about how I can deal these problems long term. The local oestrogen is only giving me moderate relief - I still get some nasty episodes and it's generally far worse than when I was on full HRT.  As for the nocturia - well, since having my babies I used to get up once a night, when on systemic HRT I got up 2-3 times per night and now it can be 4 or more times per night!!!  Incidentally, I can go up to six hours without pee during the day - though I make sure I go at least every 4 hours to prevent any infection taking hold. If the gynae suggests I use systemic HRT alongside local oestrogen then I will probably take his advice.

I think there may come a day when they actually encourage women to use HRT to prevent the long term effects of osteoporosis, heart disease, bladder problems etc. - these things end up costing the NHS so much money. We don't hear much about the negative side effects of The Pill these days but the docs are very keen to get every young women onto some form of birth control medication to prevent unwanted pregnancies despite the risk these birth control hormones bring!!
The Pill enabled me to have a career (I suffered with terrible period pains) but I had many horrified people telling me the horrors that would befall me because I was taking these little hormone pills - the scares in the papers were awful at the time.
I think we all want some common sense to prevail.
DG xxx
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Jolly

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Re: NICE guideline on menopause
« Reply #43 on: December 31, 2014, 11:34:00 PM »

Yesterday I had an amazing hysterectomy by Natalia Price at the Oxford Radcliffe women's centre. All women should have the benefit of Ms Price's attention to detail. I had my cervix left but womb, ovaries and tubes removed, I am 54. I am sure that having my cervix will be good for my sex life which is still very important to me and my husband. Take note GP's!
It took me a year to persuade my GP to prescribe bio identical HRT as he knew nothing about it and wanted to give me Premarin. I am very lucky that my GP was willing to listen to my concerns. Unfortunately, although I was taking oestrogen and utrogestan bleeding got out of control and was not helped by standard progesterone. I had biopsies to rule out endrometrial cancer and the surgery yesterday.
I came home at lunchtime today and feel really well with nothing more than period type pain which is easily controlled.  I can now take bio identical oestrogen gel for as long as I like. As I intend working until I am 70 and the lack of oestrogen had a dramatic effect on my memory and cognitive function I am sure I will be able to continue now I'm sorted.
My main concern is that if I was not as determined to get help my life would have been greatly diminished. I have no doubt that I would have stopped my professional work due to lack of memory. Within three days of using the gel I saw a marked difference in my memory and no longer worried that I had early onset dementia.
I believe that many GPs are of the generation trained during the million women study which did so much damage to the idea of HRT. There is just two morning clinics for the menopause for all the women in Oxfordshire and this must be reflected across the uk. When did women over 50 become so insignificant! GP training is essential as is the message that if women need and want HRT it is likely to save costs to the NHS long term.
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Taz2

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Re: NICE guideline on menopause
« Reply #44 on: January 01, 2015, 01:07:51 AM »

Happy New Year and it's great to hear that you have had such a positive hysterectomy experience Jolly. Do you know why your ovaries were removed as well as the womb? Just curious as usually hysterectomies due to bleeding problems result in the ovaries being conserved as they still secrete hormone even when post menopausal.

Now rest and take care of yourself as you have a lot of healing going on. Have you been on the Hysterectomy UK website? This was recommended to me by my gynae consultant and I found it helpful after my own hyster in July.

Taz x  :)
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