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[Dancinggirl]

The last few nights have been very hot and humid - it's been torture for me as I'm not on HRT at the moment.
Could you perhaps write a letter including a print out of the email from DR Currie to give in before you appointment asking the doc to read in advance so you can discuss this when you see her? Explain that you wanted some advice from a specialist on menopause and HRT to see if there was a better approach to dealing with your terrible sweating and this was the easiest way to get this advice.  You may like to mention that DR Currie is part of the team who are putting together the new guidelines for the NHS on the treatment of Menopause that will be released in 2015. If you then go in and she hasn't read it you can start by asking her to do so and take it from there.
I understand you worry but you need to 'bite the bullet' somehow.

DG x

[Dandelion]

The last few nights have been very hot and humid - it's been torture for me as I'm not on HRT at the moment.
Could you perhaps write a letter including a print out of the email from DR Currie to give in before you appointment asking the doc to read in advance so you can discuss this when you see her? Explain that you wanted some advice from a specialist on menopause and HRT to see if there was a better approach to dealing with your terrible sweating and this was the easiest way to get this advice.  You may like to mention that DR Currie is part of the team who are putting together the new guidelines for the NHS on the treatment of Menopause that will be released in 2015. If you then go in and she hasn't read it you can start by asking her to do so and take it from there.
I understand you worry but you need to 'bite the bullet' somehow.

DG x

Hi DG

Sorry to hear you have had problems with heat, I can't imagine how horrible you have felt without hrt. Why are you not on hrt?
I have my appointment on the 9th so I don't think there is really enough time for me to send my Doctor a letter for her to read as she only works part time.
Maybe I should book a later appointment?

[Liz]

I've been very hot the past couple of days too, Dandelion.  I've just started on the HRT last weekend, but I'm putting it down to the humid weather and hoping the patches do their business!

[Dancinggirl]

I came off HRt for a break last autumn.  I am 58 and the nurse at the GP practise I saw thought I should see how I coped without HRT for a while.  During the winter I was OK but this long, hot and humid summer has been challenging.  I am seriously thinking of going back on HRT.
Re: seeing your GP on the 9th. If you can get the letter to her so she can at least read it on the day you have your appointment that would be good.  Could you hand it in yourself on Monday?
If you go to the appointment in a positive frame of mind and emphasise your need to get some decent sleep without waking in terrible sweats all the time, hopefully she will listen to your problems and be open to Dr. Curries suggestion. Simply ask her if she will let you try the patches to see if they work better for you.
Sometimes we need to handle our doctors with care - they are human with fragile egos so we need to be careful they don't feel the patient is demanding something that they don't think is right or makes them look ill-informed.
Good luck.  Dg x

[Dandelion]

I came off HRt for a break last autumn.  I am 58 and the nurse at the GP practise I saw thought I should see how I coped without HRT for a while.  During the winter I was OK but this long, hot and humid summer has been challenging.  I am seriously thinking of going back on HRT.
Re: seeing your GP on the 9th. If you can get the letter to her so she can at least read it on the day you have your appointment that would be good.  Could you hand it in yourself on Monday?
If you go to the appointment in a positive frame of mind and emphasise your need to get some decent sleep without waking in terrible sweats all the time, hopefully she will listen to your problems and be open to Dr. Curries suggestion. Simply ask her if she will let you try the patches to see if they work better for you.
Sometimes we need to handle our doctors with care - they are human with fragile egos so we need to be careful they don't feel the patient is demanding something that they don't think is right or makes them look ill-informed.
Good luck.  Dg x

Hi DG

Sorry that you are having problems yourself with meno.

I decided that I will write a note and give the doctor it to read at my appointment. I wil also take along a print of Dr Currie's email.
I have written a note out, but I am struggling not to make my own doctor look ill informed.
Below is a copy of the email from Dr Currie, and below that is a copy of the note I have prepared so far. If you can think of anything I can add, I will welcome the suggestions.

Dr Curries email
Thank-you for your question and I am sorry that you are having these
problems.
There is a huge variation in how much estrogen we absorb from the bowel
from tablet HRT, and then how quickly we break it down--some women just
do not get enough estrogen into the system from tablets to control the
symptoms. Therefore if no help from Femoston 2/10, would agree that
patches would be better. With a history of migraine, patches anyway are
preferred rather than tablets so migraine is NOT a reason NOT to use
patches, instead, migraine is a reason to use patches!  --sometimes the
daily fluctuation of hormone levels from tablets can worsen migraine
while patches tend to provide a smooth level of hormone more directly
into the system.
Evorel sequi would give a medium dose estrogen and contains progestogen
for the 2nd half of the pack, leading to a monthly bleed.
Regarding other investigation, suggest checking that thyroid function is
oK, unless it has been checked recently.
I hope that this is helpful.
Best wishes
Heather

My note
I recently asked to try the HRT patches as an alternative method of delivery, as my meno symptoms have made my life a misery for the past year, but Dr ***** refused them because of my migraine auras.
I was desperate for some advice and have been in contact with Dr Heather Currie NHS consultant Gynae at Dumfries and Galloway Royal Infirmary. She is also Chairman of the British Menopause Society, and Director of Menopausematters, a famous British menopause site which many British GP's direct their patients to.
In exchange for a fee (which goes towards site maintenance costs) Dr Currie answers women's questions by email.
I've got a copy of her email in my bag.
She says tablet hrt can worsen migraine due to the fluctuation in oestrogen levels and that patches are best for it as they give a smoother level.
She also says some women on tablets don't abosrb enough oestrogen from their bowel to stop their symptoms.

The doctors appointment i have on Thursday is only ten minutes long. Somehow I felt more demanding handing in a letter before thursday's appointment, as my doctor is very busy.
I just hope she believes the email is actually from Dr Currie, and that she does not put up a wall without reading my note.
She is the doctor who said that I would just have to go through menopause. She is also the doctor who I told I am scared to try norethisterone.
I will give evorel a go, and hope it doesn't make me feel horrible like some women on here.
I feel it would be too much to ask again for the utrogestan/micronised progesterone, as none of the doctors found it in their book.
Maybe the evorel doesn't work, I will email dr currie again regarding utrogestan, but surely I cannot be that unlucky, given the lack of luck i have had so far with hrt and meno.

[CLKD]

Why not see your Practice Nurse instead of the GP?  For a more relaxed discussion?  Also, a patient is able to make a double appt., I usually ask for a late session so that if it 'runs over' my GP isn't expecting anyone else.

Your GP may have had an 'off' day.  Please consider that GPs are over-worked, they are put under huge pressure by the Government of the day to meet 'deadlines', they may also have had to give the previous patient/s bad news and still be half thinking about that.  They, like us, also have home worries.  It would be nice to believe that GPs focus purely on the patient in the room at that moment however ………

Putting the message from Dr Currie into the Surgery earlier than your appt. should be OK.  It gives the GP time to read the information and if necessary, contact Dr Currie with any queries. 

[Dandelion]

Why not see your Practice Nurse instead of the GP?  For a more relaxed discussion?  Also, a patient is able to make a double appt., I usually ask for a late session so that if it 'runs over' my GP isn't expecting anyone else.

Your GP may have had an 'off' day.  Please consider that GPs are over-worked, they are put under huge pressure by the Government of the day to meet 'deadlines', they may also have had to give the previous patient/s bad news and still be half thinking about that.  They, like us, also have home worries.  It would be nice to believe that GPs focus purely on the patient in the room at that moment however ………

Putting the message from Dr Currie into the Surgery earlier than your appt. should be OK.  It gives the GP time to read the information and if necessary, contact Dr Currie with any queries.

Hi CKLD

We don't have a practice nurse at our surgery. We don't have anyone who specialises in meno.
Also, my doctor only works part time, and is only at work one day before my appointment, as she is off on mondays and works on a hospital ward on wednesdays.
She is so busy that I very much doubt she would have time to read the letter if I sent her it beforehand.
The fact that the doctors are so time strapped is one of the things that contributes to my stress.
I had booked thursdays appointment to deal with another matter.
What did you think of my letter to the doctor?

[Dancinggirl]

Good luck  DG x

[CLKD]

Is your GP on a training rotation then, i.e. 6 months in each speciality before qualifying? (sorry if you've explained this but I'm tired this evening) :  I know that when I was in the hospital GPs headed the Casualty dept. several times a week but that was on their 'off duty' days - if they weren't in Casualty they would be out doing hobbies. 

I thought all GP Surgeries now have Practice Nurses, as well Nurse Practitioners who can write prescriptions to save GP time, also access to physio., Phelbotomists etc.    ……… ours is a satellite surgery but we have access several times a week to all that is on offer daily at the main surgery 5 miles away. 

It should not matter what I think about your letter; the important issue is that Dr Currie replied and you now have information to take to your GP.

Good Luck!

[Dandelion]

Is your GP on a training rotation then, i.e. 6 months in each speciality before qualifying? (sorry if you've explained this but I'm tired this evening) :  I know that when I was in the hospital GPs headed the Casualty dept. several times a week but that was on their 'off duty' days - if they weren't in Casualty they would be out doing hobbies. 

I thought all GP Surgeries now have Practice Nurses, as well Nurse Practitioners who can write prescriptions to save GP time, also access to physio., Phelbotomists etc.    ……… ours is a satellite surgery but we have access several times a week to all that is on offer daily at the main surgery 5 miles away. 

It should not matter what I think about your letter; the important issue is that Dr Currie replied and you now have information to take to your GP.

Good Luck!

Hi GKLD and DG and thanks for the good wishes.

No problems CKLD, the trainee GP was the one who refused me patches.
The GP I am seeing on Thursday is the one who said that I would just have to go through the meno if none of the hrt suited, and both of them could not find utrogestan.

The GP I am seeing on Thursday is an older established GP and is going through meno herself but is not allowed hrt.
She works on the local hospital ward on a wednesday as part of her duties.

I am debating whether to make another appt with another GP about the hrt.
This is because when I got addicted to valium, that same GP was not happy with prescribing me enough pills to do a safe slow taper.
I took in a print out of part of the Ashton Manual, which has a safe taper protocol and is written by a consultant psychiatrist at Newcastle Hospital, but when I told my GP this, she said she did not care who it was written by.
This makes me worried that she will also not care who my email is written by.

Does any of you think that note I have written above sounds like it will insult the doctor at my surgery?
I am open to any suggestions to make the note better.

thanks

[CLKD]

I would be worried too but I would by now have a Plan of Campaign.  I think referall to a Gynae or memo-clinic would be my request, after all GPs are there to prescribe and if they are not able to 'solve' the problems, then they should refer to the appropriate Consultant  .

Do you have a Cottage Hospital then?

[Dandelion]

I would be worried too but I would by now have a Plan of Campaign.  I think referall to a Gynae or memo-clinic would be my request, after all GPs are there to prescribe and if they are not able to 'solve' the problems, then they should refer to the appropriate Consultant  .

Do you have a Cottage Hospital then?

Hi

We have a community hospital and I think the ward my GP works on is a geriatric ward.
I forgot to answer your question re practice nurse, we definitely don't have one, cos I asked. I have seen nurses there before but when I asked about one re meno the receptionist said no.
I think my surgery are a bit sick of me regarding hrt, what with me asking three times about utrogestan/micronised progesterone.
Can they refuse me a referral to a gynae?
I'm just really scared of one more knock back.
I am worried I will have to go private as theh costs are astronomical.

[CLKD]

All Consultant referrals cost the Practice but this shouldn't deter one should a patient require it!  Thank you for explaining the role your GP has on a Wednesday, similar situation in 'cottage' hospitals which are probably GP-led.

You think your Surgery are 'sick' of your being there often, but it's often the way at 'our' age, we don't go for years then suddenly we require more care  ……. but that's your interpretation because you are worried over-all!

Even if you go 'private' your GP has to refer you.  What would you consider astronomical? after all you will be paying for 'time'.  My only criteria is that I get the 'full' hour ……. !

[Hurdity]

Hi Dandelion

Firstly you should not have to go privately as the NHS should be there to treat you. It does sound as though you have been unlucky and from what you are saying, it seems unfair that your previous medical history might be clouding their treatment of you.

You should absolutely not be made to feel stressed and especially as you say you have had problems with depression and anxiety.

(By the way CLKD - it is not the job of patients to make any sort of allowances for doctors and how they might be feeling. Of course we should be polite and listen, and of course they are human like the rest of us, but they are not gods and they are paid a huge amount of money to treat us in a highly professional way. I realise also that they may well be overworked - but they are paid for this and it is their professional responsibility to ensure that patients needs come first. If anyone is belittled or made to feel uncomfortable or that they should suffer (eg through menopause) then they are failing in their job, which is to focus on each patient fairly and give the best possible treatment and advice.)

Dandelion - if the doctors can't find Utrogestan they are just stalling you. Irrespective of what they look up in their books it is listed on this website as you know. Also I just put this into a google search "general practice doctors - where to find medications listed book" and MIMS came up 5th (I do hate it when organisations get so well known by those in the know that they don't tell us mere mortals what their acronym stands for!!).
http://www.mims.co.uk/home/

Anyway this has all the medications listed so all they have to do is go to MIMS and put Utrogestan in the search box on the right and it comes up listed - as for menopausal disorders. They will find it. It doesn't matter if you go over your time of 10 mins. You need to finish what you went to your appointment for.

If you do get this far they will need to know that the 200 mg cyclical dose is discontinued so you will need double the amount of 100 mg.

I agree with CLKD do ask for a referral to a menopause clinic if they are not properly listening to you.

I hope you don't mind my saying but if it's a long way away could you get help with travel costs from the powers that be to attend a medical appointment?

Personally in your situation I would prefer not to try Evorel but if you wanted to start transdermal HRT - patches I would suggest Femseven - but you may need some extra due to sticking problems!

Having said all of this - peri-menopause is a tough time with our hormones fluctuating and even though I was not a depressive, I was a weepy thing a lot of the time - and I didn't understand why because my periods were still regular! Even with the best HRT you will still go through ups and downs in mood but at least you will know that you have the best possible hormonal support.

Hope this helps

Hurdity x

[Dandelion]

Hi Dandelion

Firstly you should not have to go privately as the NHS should be there to treat you. It does sound as though you have been unlucky and from what you are saying, it seems unfair that your previous medical history might be clouding their treatment of you.

You should absolutely not be made to feel stressed and especially as you say you have had problems with depression and anxiety.

(By the way CLKD - it is not the job of patients to make any sort of allowances for doctors and how they might be feeling. Of course we should be polite and listen, and of course they are human like the rest of us, but they are not gods and they are paid a huge amount of money to treat us in a highly professional way. I realise also that they may well be overworked - but they are paid for this and it is their professional responsibility to ensure that patients needs come first. If anyone is belittled or made to feel uncomfortable or that they should suffer (eg through menopause) then they are failing in their job, which is to focus on each patient fairly and give the best possible treatment and advice.)

Dandelion - if the doctors can't find Utrogestan they are just stalling you. Irrespective of what they look up in their books it is listed on this website as you know. Also I just put this into a google search "general practice doctors - where to find medications listed book" and MIMS came up 5th (I do hate it when organisations get so well known by those in the know that they don't tell us mere mortals what their acronym stands for!!).
http://www.mims.co.uk/home/

Anyway this has all the medications listed so all they have to do is go to MIMS and put Utrogestan in the search box on the right and it comes up listed - as for menopausal disorders. They will find it. It doesn't matter if you go over your time of 10 mins. You need to finish what you went to your appointment for.

If you do get this far they will need to know that the 200 mg cyclical dose is discontinued so you will need double the amount of 100 mg.

I agree with CLKD do ask for a referral to a menopause clinic if they are not properly listening to you.

I hope you don't mind my saying but if it's a long way away could you get help with travel costs from the powers that be to attend a medical appointment?

Personally in your situation I would prefer not to try Evorel but if you wanted to start transdermal HRT - patches I would suggest Femseven - but you may need some extra due to sticking problems!

Having said all of this - peri-menopause is a tough time with our hormones fluctuating and even though I was not a depressive, I was a weepy thing a lot of the time - and I didn't understand why because my periods were still regular! Even with the best HRT you will still go through ups and downs in mood but at least you will know that you have the best possible hormonal support.

Hope this helps

Hurdity x

Hi Hurdity

I prefer utrogestan but Dr Currie's letter says evorel.

What do you mean by stalling with regards to utrogestan?
Why would they want to delay me feeling better?

Also, I am scared to ask for utrogestan on top of everything else.

Do you think I should write another email to dr currie explaining the difficulty I have had with my GP and mention  utrogestan plus her previous email?

EDIT. I just looked up utrogestan on mims
I was going to get the pip code, as a lady on here said it was made by ferrier but mims says its made by besins. This means I can't give them a pip code.

This is getting too difficult and complicated and I feel like giving up, yet this meno is making my anxiety so much worse. I just dont feel I stand much chance of getting what I need.

I keep going on about time because the doctor said to me last week after refusing patches that I have run out of time, and the other gp also stands up and ushers me towards the door really quickly.