Hello ladies!
![Smiley :)](https://www.menopausematters.co.uk/forum/Smileys/extended/smiley.gif)
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.
![Smiley :)](https://www.menopausematters.co.uk/forum/Smileys/extended/smiley.gif)
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