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[devonhil]

Hello everyone,

I am new to this forum (and think it's wonderful!) but reading through all the posts I am so struck with doctors' attitudes to prescribing HRT.

There are some many GPs out there who seem to think that prescribing anti-depressants for menopause symptoms (or increasing doses for those already on them) is perfectly acceptable and even desirable and helpful, but HRT is somehow dangerous and to be avoided! Is there no understanding amongst GPs that this is unprofessional?

The cynical part of me wonders whether there are more savings to be made from anti-depressants (or maybe slightly pushier drug reps in that area of medicine)....

Those GPs who prescribe only anti-depressants are effectively saying that they regard menopause as a purely psychological condition and in no way a physical one. Surely it is both? Surely symptoms such as hot flushes and aching joints have some sort of physiological basis? Without help with physical symptoms (through hormone treatment) what is the point of only treating the pychological symptoms?

I would be really interested to hear other peoples' views on this

hil x

[Joyce]

My mum would have been menopausal in the late 50s early 60s. I was only about 4 at the time, so didn't know. She was given tablets for anxiety/depression. Seems like today's GPs haven't really moved on much. My mum was stuck on them for over 30 years until a psychiatrist said all her problems were caused by the different concoctions she'd been on over the years. Maybe if she'd been given HRT things may have been easier. It must have been around then.

[ellie66]

Hil,

Yes exactly what I have been thinking but an amusing thought are they saying a dry ****is psychological?

I am quite concerned reading this forum about the number of women prescribed antidepressants. They must be receiving the wrong treatment in some cases.

[Joyce]

Most definitely! Having trouble sleeping - antidepressants. Feeling tired, must be depressed - antidepressants. No, menopausal. Most GPs, male & female, don't have a Scooby. I went to GP with interest in women's health thinking, ok will get somewhere at last. Nope, just the same as all the rest. I eventually got one really nice one who I know through my old work, she listened & got me referred to meno clinic. Thast GP only works a couple of half days per week, so it's hard getting her.

[Taz2]

I suppose that now I have been advised not to use HRT due to my age and I've been off it for four months with a gradual return of all the symptoms which drove me to HRT six years ago then the next step will be antidepressants to lift the depression which is slowly descending due to the fact that now I am off  HRT I feel rubbish!

Taz x 

[Limpy]

ADs are prescribed for things other than depression, pain relief being one. The way some of the antidepressants work affect the pain receptors in the brain  this is why they are given. They are used for a physical rather than psychological reason.

I am not rushing to defend doctors but many of them are concerned about the perceived risks of HRT and feel that antidpressants are a lower risk option for some of the symptoms - hopefully not the VA ones!

[honeybun]

I think I have been lucky with my GP.
The first time I went regarding meno we discussed my symptoms and I said I wanted HRT and would prefer patches. No problem.
When my anxiety was bad the first suggestion was beta blockers and CBT.
I did eventually ask for a mild AD but I could not tolerate it at all.

At no time have I ever felt that they thought my problems were in my head and not meno symptoms.


Honeyb
X

[Joyce]

Son's GF has just been prescribed amitryptiline for her gluten intolerance. I explained about low doses for pain relief, but she's not happy!

I'm not due to return to meno clinic until June next year. I'm reducing my HRT in January sometime, but if I manage to get off HRT & symptoms return, I'm thinking of asking for Gabapentin. 

[Kathleen]

Hello ladies.

I suppose GPs are influenced by 'fashion' as much as anything else, and ADs have been around a long time and have a well documented track record.

My mother-in-law tells the story of her own mother's problems back in the late 1930s. She was about 48 and went to her doctor complaining about her 'nerves', his advice was to take up smoking. He was in a good position to recommend it as he was a chain smoker himself. Well you didn't argue with doctors in those days so she duly tried to take up the habit however she only lasted a week as she couldn't abide the taste. No other treatment was suggested so she just battled on and recovered in her own time. I knew her for a brief period and she always seemed a happy soul, living quite healthily until the age of 85. I have no knowledge of what happened to the doctor!
Take care ladies and here's hoping we all make it to the other side, no matter what we need to get there.

K.

[CLKD]

   I think that many ladies appear in the Surgery tearful, probably not able to explain symptoms in a way that points to menopause rather than depression.  So the GP offers ADs which can help ...... allowing the patient to see the wood for the trees.  But we all need more info about menopause and treatments, which is why being here is so useful!

It's the tales I hear about GPs being blunt about not prescribing HRT, not listening to the patient's symptoms, not being understanding in the awful symptoms that hormones can cause. It makes me want to  .........

Read the menus left of screen.  Take a list to the Practice Nurse.  Have several discussions if necessary but try to push for what you think your body requires!

[bev567901]

I agree totally. For nearly a year all I have is an AD & benzo's. Coming here has given me the confidence to ask for HRT  & to know which one to ask for. Is it a coincidence all my symptoms started a few weeks after my first ever irregular period & it took me a few months until the penny dropped myself. What makes me more cross is at 51 I should be in peri or meno but what about the poor people going through it very early what chance do they stand of getting help.  I have ordered my own FSH test off the net & if the GP says its not reliable I shall just say your blood tests aren't either. I am putting a whole package together to show I understand the risks & to show that other people & lots of them have the same symptoms I have. I should not have to do this & it makes me very cross to hear other people in the same situation but so be it xxxx

[devonhil]

thanks for all the responses - it's really interesting to read them.

limpy - I didn't know that ADs were used for pain relief too. Surely a strange solution for long term pain relief though? (cubagirl's son's GF thinks so too).

cubagirl - stories like your mum make me really sad (and also angry). Women of her generation were supposed to just "put up with it as its not a disease". Nor is having you arm cut off but no one would suggest putting up with that without any treatment!

honeybun - so glad you have a sympathetic gp 

Taz2 - is there a valid reason why HRT is not suitable at an older age? I;ve not encountered any clinical trials which show that natural hormones become more dangerous with age. In fact some doctors regard hormones as a treatment similar to insulin for diabetics (which interestingly is another hormone too!) and a life-long treatment. Why not? Isn't quality of life just as important?

bev - brilliant idea to put a package together - united we stand!

ellie66 - lol - dry ***** psychological! mmm...

CLKD - totally agree - see my take on "wood for the trees" below...

Kathleen - I completely agree that it may well be a 'fashion' thing. I am no expert in medical matters but I do wonder if there is a root problem in the source of GPs' information?

I am not trying to be down on GPs as it must be incredibly hard keeping up to date. Sadly, lots of their research literature comes via drug companies (as reading journal articles with less bias is just too time-consuming). If that is the case then they will be reading lots about ADs (a huge profit maker for drug companies) and not a lot about, say, bio-identical HRT which is non-patentable and so not so lucrative. Again, I'm not being down on drug companies - they need to make profits too. Without the knowledge of modern safer HRT (and with memories of the dangerous side-effects of some older synthetic HRT methods) GPs are going to remain resistant to prescribing it which is a tragedy for so many women.

I have seen on some drug-based websites that "BHRT has not been shown to be any safer than regular HRT". That's mainly because there haven't been many trials using BHRT as it is not a money-maker and so lacks funding for such trials!  Without realising that it is very easy to mislead both patients and GPs.

If your main symptoms are depression and tearfulness (which they so often are during menopause) then I cannot blame GPs for reaching for their prescription pads for ADs. It is a problem that we tend to treat symptoms and not causes in the medical world. It doesn't take a rocket-scientist (or even a doctor  ) to determine that the depression and tearfulness have a hormone-balance root/cause and so would be much more efficiently treated with BHRT which would help with the majority of physical symptoms too, than with ADs. These same GPs would then not have to endure us coming back again and again to have the other symptoms not helped by ADs alleviated.

I think lots of us end up in endless loops back and forth to GPs which is no help to us and just seems to make GPs equally frustrated and even more likely to regard us as neurotic and in need of ADs... 

argghhhh!

hil x

[Rowan]

Most HRT on the NHS is BHRT as far as I know that includes patches, Gel and the tablet Hormonin also suppositories. and pessaries.

There are synthetics but you can ask to  be prescribed the Bioidenticals, i.e. Evoral is derived from Mexican Yam, Estrodot from Soy. All hormones are synthesised in the lab, so called natural or synthetic.

Where the confusion comes in is that we can't get compounded bioidentical (made to measure) from our GPs, only from some private Practioners.

Hope this makes things clearer.

[Hurdity]

Hi devonhil

Interesting to read this thread!

I just wanted to take up your points about bio-identical HRT.There is some confusion generally about this because of the different definitions.

The BHRT movement that is called by this name started in America (I think) - due to their different healthcare system and as a reaction to the HRT widely prescribed for many years - ie Conjugated Equine Oestrogens and synthetic progestogens. It was promoted by private practitioners at great expense who would offer to tailor HRT to your needs based on saliva tests, and often involved large amounts of progesterone cream to protect the womb lining.

In UK and elsewhere in Europe, bio-identical oestrogen (as estradiol) has been used for many years (not sure how long!), and bio-identical progesterone has been available (although not licensed for HRT) as Crinone gel (not sure if this is in UK or just US) and Cyclogest pessaries. It is now available as oral capsules and licensed as Utrogestan.

I am not sure what the drug companies are referring to in that statement about BHRT - but there is increasing evidence that using bio-identical formulations are in fact safer so the drug companies making that sweeping statement are talking nonsense! This would stand to reason of course - replacing a hormone with one that is biologically identical to the one you make in your body is likely to be less harmful to you in the long run, than synthetic hormones or those from other animals.

The brands that are sold are patentable formulations (I would imagine) and the different brands are manufactured by different companies, under different names - and therefore are profitable for the drug companies in the same way as any other drug or hormone preparation. You only have to look at the list under HRT preparation ( menu on the left - green writing) to see how many there are!

I think the lack of prescribing HRT by some doctors is sadly -as you say - down to ignorance, combined with what CLKD referred to - women themselves not realising what their symptoms are due to. The terrible thing is that the doctors then treat each individual symptoms in isolation without realising that symptoms are part of the same condition - menopause, and hormone deficiency, and end up being on a cocktail of drugs.

The most important clue to the cause of anxiety and tearfulness - if a woman has not suffered much with this in the past ( except briefly pre-menstrually) and anxiety etc is not due to a significant life-change, and there are other indicators of menopause - then hormone replacement should be tried first!

This is why this forum is so brilliant - because we can all share our experiences and knowledge, and along with the information on this site, help women who have problems with their GPs! 

There is a desparate need for reliable long-term studies on older women using HRT from just before menopause and into old age - and especially using bio-identcial hormones. Sadly I doubt there will be funding for this

Hurdity x

[Taz2]

Hi Devonhil - the reason is that at an older age the stroke risk rises, there is also a risk of heart disease plus the cancer risks too of course. This is for combined HRT not oestrogen only as far as I know. It is a choice of course but it is difficult when faced with the "experts" telling you that really you are better off not taking it. I used to attend a menopause clinic which took me over a year to get referred to and they were excellent but they were adamant that I had to come off at 60. I then discovered that my then GP would be happy for me to stay on it so transferred my care back to her. How fickle is that? I pushed to get referred to the clinic and then when they told me something I didn't want to hear I returned to the GP! Anyway, my new GP (who is absolutely lovely and so brilliant with her patients) is very against HRT at an older age. I decided to give it a go and stopped HRT in August and since then I have had various infections and ailments and a really low mood plus some post sex bleeding. I am having this investigated in the new year and if all is ok I will then decide about HRT. The info here is quite good - interesting that Tibolone in the over 60's doubles the stroke risk - such a shame as well as I would think this age group would appreciate the increase in sexual desire the most! http://www.patient.co.uk/doctor/hormone-replacement-therapy-including-risks-and-benefits

There are some interesting comments on this forum - not sure whether members on this one are also on that one http://www.gransnet.com/forums/health/a1188649-HRT-for-the-over-60s

Taz x