Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Tempest]

Hello ladies!

I have been taking a little break as some of you will know if you read my last post. First of all, I would like to say a big thank you for all of your wonderful words in reply to my last posting. It really does mean so much.

I had my appointment with Professor Mary Ann Lumsden on Tuesday, and I have to say that she is a remarkable lady. Very, very professional as one would expect and absolutely top in her field (after all, she compiled the NICE guidelines on HRT released in December last year).

We have a plan. I am to continue for now with Estrogel, using 2 pumps PM and 1 AM (this is the highest dose I have used so far), UNLESS I get bothersome problems in which case I am to phone her secretary and Professor Lumsden will get right back to me. I am seeing her again in 12 weeks, and then we will review. Professor Lumsden says I may be a candidate for an implant if I choose, but was very thorough in pointing out that implants can be slightly unpredictable no matter how careful the choice of pellet strength and that they could not be removed once inserted.

We also discussed testosterone, and for now she says we MUST get my estrogen level balanced first. Again, she pointed out the downsides of TRT such as possible acne, but said she doesn't see this too often. Again, she said that a testosterone implant may be an option for me once I have happily adjusted to a dose of testosterone, but this was for our future conversation.

I spoke to her of this forum, and she says it is very highly regarded.  I also told her of some of the difficulties some of you are still having with getting help from GP's (myself included) and she says it is very sadly common and this is not acceptable, but she is continuing to push to raise awareness with GP's to make sure that they are practising 'evidence based medicine' in regard to prescribing HRT to any woman who needs it for their menopausal symptoms. She most definitely stated that 'transdermal estrogen replacement therapy is SAFE', so this is her view on this portion of HRT if it helps any. Of course, we didn't discuss progestins as I have no need of them, but if I can I will ask her opinion of these next time if you would like to hear it.

I think this gives us something to take to our GP's in that we can print off the guidelines, and use Professor Lumsden's words by pointing out to them that the guidelines are EVIDENCE BASED, and that therefore they should have no problem in following these and prescribing according to our needs. I know this isn't rocket science, but it certainly SEEMS like it when a GP is not up to date with current prescribing guidelines and is resisting our requests for effective HRT.

Also, be sure to note the footnote in the guidelines for any of you wishing to obtain TRT. It does state that at present there is no licenced product available for women, and that TRT is therefore on a discretionary unlicensed basis and is subject to the conditions of prescribing unlicenced medicines. This may help explain why a few of you are having real problems getting your GP to agree to prescribing it. I would suggest that if so, a request for a referral to a Menopause Consultant would be your best bet. I'm guessing most GP's run a mile if they are asked to prescribe anything off licence! This hoo ha all evolved after the withdrawal of the female testosterone Intrinsia patch, so here's hoping a replacement for this is forthcoming in the not too distant future so that GP's can be confident in prescribing TRT again.

Hope there is some info. here to help!

Much love. xxxx

[Annie0710]

Hello you !

I'm so excited you've popped in and posted, I'm really glad your appointment went well and there's someone helping you 💕

Please pop back again, I've missed seeing your posts xxx

[Tempest]

Hello, Annie!

You're so kind! I've missed you too - hope you're doing ok?

[Annie0710]

Well much the same Tempest although I got GP who ordered the scan to call me re:the disappearing ovaries.  She's referred me to NHS gynae or written to him asking if he'd prescribe testosterone by her giving my symptoms/no ovaries or whether he'd prefer to see me.i don't hold out much hope but she said if I end up going private as long as I have a gynae prescription she's happy to put it on repeats

Frustrating that it's going to take a while but at least she listened and cared.  But she admitted she's got no experience in it and uncomfortable to prescribe it herself x

[nothappybun]

Hi,
I am new on here and read your last post.Thank you for your encouraging words. Thank you for being generous so generous thinking about all of us out here on the same boat and thank you for giving us hope.
I really hope things turn out for you this time and looking forward for your updates on how you are coping,
hugs
 nothappybun
                     xxx

[Rhiner]

Hello Tempest, great to see you are back and to hear your discussions with the Prof. Sounds very encouraging. I too was asked to get my levels of oestrogen sorted (which I have done after 2 to 3 months), before embarking on prog or thinking of Testosterone.

It may be of interest, but I find now that I have no need for T, as my energy levels etc are back to normal (pre ovary op), so Im guessing after time the adrenals must make up for the loss from the ovaries (but I know we are all different).

Good luck and keep us posted.
Rhiner

[Hurdity]

Hi Tempest - great news and thanks for taking the time to let us know about your consultation which will be helpful to other women in your position. I had forgotten that she was actually the Chair of the Menopause Guidelines Development Group. I really hope that the new regime that she has suggested will work for you - but at least you know that you can call on a real and knowledgeable expert in the field if you run into problems. This must be so encouraging for you!

Doctors should be fully aware that all NICE Guidelines are evidence based. If they need further information the full guideline runs to 283 pages ( with all the scientific papers to back up the recs)  together with 13 appendices. I haven't read the full guideline but accept that the recs are based on the best possible research info!  Here is the full guideline:  https://www.nice.org.uk/guidance/ng23/evidence/full-guideline-559549261. Sadly it seems that many docs allow their outdated views to dominate and prevail when it comes to menopausal women. Great to remind women about this in your post! We seem to be doing this so much these days - but at least we have had the guidelines now for almost a year. Before this we had to link directly to the papers and perhaps docs don't take so much notice of an individual paper as being less authoritative (despite eg being in the Journal of the British Menopause Society and written by eminent research gynaes!!!)

If Prof Lumsden was really referring to this forum (as opposed to the main MM website managed by Dr Currie which provides wide-ranging info about menopause which of course is very highly regarded!) then that is amazing news! Aside from the reward of helping others and hopefully making a difference, it is wonderful to hear that the professional gynaes are aware and endorse what's going on here on the forum - where we share information and experiences widely!!

Thanks also for re-iterating what the Guidelines says re the Testosterone - (there have been several mentions of this recently) - that they make provision for GPs to consider prescribing it off licence - not that it is generally available or licensed for women. This may well be the sticking point although the latest advice by Nick Panay at the GPs conference which hit the news and was mentioned on this thread (and by Menomale ) http://www.menopausematters.co.uk/forum/index.php/topic,33389.0.html might help to move things forward a bit...

Re referrals to menopause clinic - in fact even some consultants are reluctant to prescribe testosterone - so not even all of them are up to date! At least it is a step in the right direction though....We have to be prepared to fight all the way to get what we need.

Anyway thanks again Tempest - hoping to hear from you in due course to hear that everything is much improved

Hurdity xx

[Tempest]

Thank you so much for all your lovely words!

Rhiner, that is FANTASTIC news that your energy has now returned! This is very encouraging to me as a fellow Surgical Menopause lady. You are in fact correct in your assumption about T - Professor Lumsden says that indeed a lot of ladies DON'T need it if their estrogen needs are being meet by their ERT - she finds that if their estrogen is balanced, their energy, mood and sleep improve and often with this their libido returns. Again, she says this should be assessed on an Individual  basis, and T is an option of course if after balancing estrogen, libido is still significantly impared.

Other research suggests that if estrogen is well balanced, the adrenals are then 'free' to boost testosterone production from this source, and this returns equilibrium in the form of improved libido and energy. HRT balancing is indeed like 'turning a battleship ' I think and I have to say that we are lagging behind here in the UK at the moment in addressing balancing a woman's hormonal needs during menopause. Considering that it's hard for a lot of women to even get their GP to prescribe ANY HRT from the stories I have read here and from my own experiences, we have a long, long way to go sadly!

Hurdity, your words are very thoughtful and insightful as always! Thank you so much for always taking the time to write such kind and supportive replies. It's ladies like you who are helping enormously to bring about change in how women are treated during menopause, and YES - Professor Lumsden is well aware of this forum and the invaluable support if offers women in their time of need. The Consultant's here in Scotland are actually a pretty informed lot, not least because Dr. Currie is 'one of their own' and they are all known personally to each other. I just wish this were the case all over the UK, and that women could have easy access to menopause specialists when needed without having an enormous fight on their hands (Professor Lumsden was surprised I think at the fight I had to be referred to see her)! Again, the NICE guidelines clearly state that women with complex needs should be referred to a menopause specialist - this often doesn't happen. I think any woman who is failing to respond to HRT who has tried several doses and types of delivery pretty much fits the bill (and this should include women who are clearly progesterone intolerant - GP's don't seem to 'get' this and I have read of terrible suffering with this aspect of HRT on this forum).

[Hurdity]

Thank you too for your kind words to us all Tempest.

I agree about the oestrogen - that is interesting what she said about the adrenals  - because my gynae GP said that the extent to which adrenals took over T production post-menopause was down to individual differences - so  in  my case there wasn't anything I could do about it except to take testosterone. I have never had a high oestrogen level post-menopausally - mine is probably around the 200 - 250 pmol/l mark and while this is sufficient - has not boosted T production! I'd love to see any info if you have it? I do think though that a lot more work needs to be done with women of different ages and in different circumstances (with and without wombs!) because as I mentioned recently on another thread (and we do mention regularly!) us oldies (ie over 60's!) with wombs would find it very difficult to have high doses of oestrogen - simply because we would have to have high doses of progesterone as well - and even if we could tolerate it - or feel as well on it as the progesterone, it probably isn't a good thing health-wise in the long term - although there is insufficient research. However this is not relevant to you but just thinking aloud following your comments!

I sincerely hope you continue to do well

Hurdity x

[Rhiner]

Very interesting comments on T production from Prof Lumsden and Hurdity, thanks for posting.  The meno specialist I use is a colleague of  Dr Currie and is very knowledgeable, which helps enormously.

Please keep updating us on how you progress. There is definitely light at the end of the tunnel for you now.
Take Care,
Rx

[dangermouse]

So glad you are getting expert help now! Keep us posted on how you get on.