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[Julmills]

I'm a 49 year old living in the UK.  The last 5 years I have been back and fore my gp because of dizziness and extremely tired.  I resigned from my work last December because if stress.  In January I was diagnosed with underactive thyroid and put on meds.  It didn't improve what I was feeling.  At that time I was bleeding constantly so was given something to stop.  I have not had a period now since April this year. I began feeling awful mentally.  Angry, impatient,  weepy,  over thinking,  insomnia,  sweating (only in my face with burning sensation)  my husband dragged me up surgery to obtain hrt,  he said my feelings were psychological and offered anti depressants,  these I refused. . He sent me for blood tests and told me to return, my oestradiol is under 50 and fsh 87. I returned and seen my usual lady doctor,  she refused point blank hrt instead offering anti depressants.  I asked for a referral to see specialist and wax told he would tell me the same so I just left really upset.  I have purchased a natural hrt called nutrition fx and contemplating buying hrt off the Internet but haven't a clue which type etc. 
Up until yesterday my moods were still the same today however I'm feeling OK so do not know if these natural tabs have kicked in.
If you are still reading this post thank you and apologies that it is so long.
My question is can I demand hrt off my gp?  And do they have shares in the anti depression meds because they seem to dish these out quite freely. 

[cjmca]

Gosh what a predicament for you. I'm only 34 and have had premature ovarian failure since early 20s, and have seen my fair share of doctors and consultants. Finally found the right one who put me on HRT pronto. I feel really great on it. Before that on the anti depressants which were useless, and not what was required.

All I can suggest is doctor shop. Try and find a menopause clinic or consultant gynae that specialises in the field. Ask your GP for a referral. Put your foot down if needs be - calm, but firm. "I'm sure you're right, but I would like a referral to Dr. X just to be on the safe side please".  Bollocks they're right, but get a referral out of your GP. You know yourself what you need. And if they won't give you the referral you want, find a doctor who will - some doctors like to dictate rather than listen and prescribe. Everyone is different.  Best of luck and don't take no for an answer 

[Dancinggirl]

What appalling treatment you are being given Julmills - totally unacceptable.  What reasons do the GPs give for not giving you HRT?  Are you over weight? Do you smoke? Do you have any health issues that prevent you having HRT?
Do look up the new NICE guidelines for the treatment of menopause symptoms as it states clearly that HRt should be the first line of treatment on offer.  You should be able to find these guidelines either on this site or on the NHS Choices website.
At 49 you are too young to be low on oestrogen so I would hotfoot back to the GPs with the new NICE guidelines in hand, info from this site printed off as well and ask for a referral to a gynae or menopause clinic for specialist advice. As cjmca has suggested - do approach this tactfully as GPs can be stubborn when put on the back foot but they really should be up to speed not the latest advice from NICE.

You might want to mention that you are concerned about your bone density as you understand that being post menopause so early, and therefore deficient in oestrogen too early, this could have a very detrimental effect on your bones and your heart!!!  Sometimes they need to be scared into action. 
If they do cave in a give you HRt then do ask for Femoston 1/10 as this is tolerated by women women very well - they often fob women off with the cheapest and older types of HRt.
Don't waste money on so called alternatives remedies and please don't self medicate with HRT from the internet as you won't know what you are taking and this can be dangerous.  The NHS should be treating you properly.
DG x

[Charlotte ...]

Mine didn't exactly cover himself in glory either, Julmills, I've gone private and even with newly diagnosed severe osteoporosis, he thinks I shouldn't be on it - three years at most but I plan on staying on it for a long long time. My estradiol was under 40. It's apain in the butt isn't it?

[Kathleen]

Hello Julmills and welcome to the forum.

What is it with some GPs? Surely the menopause is the most likely diagnosis for a woman of your age, with your symptoms, blood test results and lack of periods. Good grief you don't have to be Sherlock Holmes to work it out. Then to be refused hormone replacement for a different treatment entirely is beyond frustrating.

I agree with the other ladies, time to find a doctor who has a better understanding of your condition who can offer constructive help.

I wish you well and please keep us updated.

K.

[CLKD]

   some GPs shouldn't be in Practice 

Change your Surgery if possible.  Go to a Pharmacist and ask which GPs support HRT and try to book with that particular Surgery.  Have a look-see at your local Hospital Consultants and contact to see who is HRT savvy. 

ADs are cheaper and gets rid of the patient quicker than prescribing HRT! but your GP is totally in-correct.  Even if a lady has health problems which may contra-indicate HRT - i.e. being overweight - then the GP has a Duty of Care to encourage weight loss with a view to correct treatment for menopausal symptoms.

Your GP is NOT correct.  Is there a Practice Nurse?

[Julmills]

Thanks ladies for your responses. I was told my gp that hrt only works for hot flushes.  Also told this is a natural progression(doesn't feel natural to me!!!!)  I can't really afford the 34 a month that I paid for the 'natural approach'  my husband wants to come with me to demand the hrt.  He was so annoyed when I came home in tears. I'll try and make appointment tomorrow and let you know how I get on x

[CLKD]

How OLD FASHIONED!  Hot flushes are 1 symptom and not all menopausal women get those or suffer if they do 

Maybe print off the 34 sypomts of menopause (on here somewhere) and certainly tell the GP about this Forum: point out that you have found more information and would like to build a working relationship in order to progress to a more 'normal' state! If he/she seems reluctant ask if there is anyone in the Practice who is more in tune with womens' health - you could look on the Surgery web-site to fine out!

Let us know how you get on.

[Ju Ju]

Thanks ladies for your responses. I was told my gp that hrt only works for hot flushes.  Also told this is a natural progression(doesn't feel natural to me!!!!)  I can't really afford the 34 a month that I paid for the 'natural approach'  my husband wants to come with me to demand the hrt.  He was so annoyed when I came home in tears. I'll try and make appointment tomorrow and let you know how I get on x

I'm all for using DHs as resources! It's interesting how both male and female doctors react differently  to a man. Annoying, but you might as well go with it. Besides which having him with you will give you more confidence at a time when you feel vulnerable. All the best.

[Hurdity]

Hi Julmills

 

I agree with everything that's been said.

I am absolutely appalled - yet another doctor, nay, TWO in the same practice who don't know what they are talking about and doing you a disservice. YES find another doc either in that practice ( ask the receptionists) or another practice, who understand and is sympathetic both towards women in menopause and prescribes HRT. You are probably in late-ish peri-menopause and your symptoms will most likely only worsen.

Here is the link to the NICE Guidelines:
https://www.nice.org.uk/guidance/ng23/chapter/Recommendations

This is the relevant section re HRT and ADs


Vasomotor symptoms

1.4.2 Offer women HRT for vasomotor symptoms after discussing with them the short-term (up to 5 years) and longer-term benefits and risks. Offer a choice of preparations as follows:

oestrogen and progestogen to women with a uterus

oestrogen alone to women without a uterus.

1.4.3 Do not routinely offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine as first-line treatment for vasomotor symptoms alone.

1.4.4 Explain to women that there is some evidence that isoflavones or black cohosh may relieve vasomotor symptoms. However, explain that:

multiple preparations are available and their safety is uncertain

different preparations may vary

interactions with other medicines have been reported.

Psychological symptoms

1.4.5 Consider HRT to alleviate low mood that arises as a result of the menopause.

1.4.6 Consider CBT to alleviate low mood or anxiety that arise as a result of the menopause.

1.4.7 Ensure that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression (see the NICE guideline on depression in adults)

I feel so strongly about this!!!! Great that your husband is willing to help be an advocate on your behalf. Make sure he has read this too....

Also go to the homepage of the website and scroll down as there are other links to do with the NICE Guidelines and responses to it.

If you are also taking meds for hypothyroid then transdermal HRT is probably better (so I've read) - which means combi patches or oestrogen patch/gel with separate progesterone.

Tell your doc about this website  - not especially the forum as many docs might poo poo these as being chat sites - but the main website is run by Chair of the British Menopause Society (https://thebms.org.uk/) and practising gynaecologist Dr Heather Currie.

They do have to prescribe for you if there is no medical reason why not - well I think so anyway.

I've just searched for a post I made a couple of years ago which is relevant: http://www.menopausematters.co.uk/forum/index.php/topic,24333.msg371939.html#msg371939

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." ......

I am sure this still stands.

Do have a quick read up of all the HRT types in HRT preparations ( Treatments tab above) and ask any more Qs before you go.

Hope this helps and let us know how you get on

Hurdity x

[Dancinggirl]

Fab post Hurdity - so helpful.  Good luck Julmills.  Dg x

[Julmills]

Thanks so much for this.  I did actually contact NICE about this because my gp quoted she was following their guidelines.  Did have a response back will search later and paste here.  They basically said that GPS don't have to follow and If I have a complaint to contact my practice.  My gp did ask me why I did not want anti depressants,  I stated that I did not want to get addicted and also if the side affects. It is scandalous,  I really thought that with my levels coming back as they were then I would just be prescribed hrt,  I was at the point of begging then got extremely upset when the gp quite clearly refused. I am not overweight,  am 5' 4. And just over 10 stone,  I do smoke but have not had any other health concerns which would warrant refusal. 
The first visit I had some shining light when I was sent for blood tests but the second visit the gp seemed ready for me and clearly gave me mis information with regard to hrt not helping with moods I did say I feel insane on times and my personality is completely different,  I want to feel me again,  happy, patient,  caring etc,  they are depriving me of this right now with no good reason and I do not know how long these moods will last 

[Dancinggirl]

Give up the smoking and then they have absolutely no reason not to give you HRT.  Unfortunately if you smoke this gives them the perfect reason not to prescribe HRT as smoking will increase your risk of Breast cancer. 
You are absolutely right that HRT should be on offer for you - your GPs should give the correct treatment for your symptoms and that is HRT not SRRIs or ADs. 
Good luck.  DG x

[CLKD]

Say "I'm not clinically depressed, I know any anxiety or mood swings are caused by an alteration in hormones". 

[bramble]

I smoked and got HRT, my friend does as well and she is still on HRT at 72!

Bramble