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[Bobidy]

Yes, another gp rant to get off my chest. Strap yourselves in.

Went to the gps today and asked for a 100 patch to use in conjunction with 2 pumps of estrogel, plus the estring to use in conjunction with Ovestin. The gp freaked out about the oestrogen and said they would have to speak to a more senior gp, I then got a phone call later to say the senior gp said no way it was far too much oestrogen, with a high risk of breast cancer and thrombosis!!!! If I wanted it I could only get it through Newson Health not the surgery. So even having it in black and white in a Menopause specialists letter makes not the slightest difference to these uninformed pillocks!!!

I don't know what I'm most annoyed about. Them banging on about my risks but we aren't actually that bothered as long as you get the stuff elsewhere. The fact I'm expected to pay for care and medication privately with potentially 30+ years worth of prescriptions not going into the NHS. Them not following the clear advice of a specialist when they must be fully aware they don't know enough themselves.

So yes I'm deflated and mad yet again. Back to slathering loads of gel twice a day and contributing to 40 years of landfill with all those Vagifem applicators.

Can you imagine what it'll be like when Androfemme is finally available on the NHS, there is no way they will ever prescribe it.

Anyway, I'm going to phone around local surgeries tomorrow to see if there are any doctors with an interest in Menopause and change doctors. Failing that I'm going to make an appointment with my practice manager because it's ridiculous. I had 3 years of undiagnosed peri hell, then having to pay privately, and now this ongoing battle for flipping prescriptions where the money could be going into the NHS.

Watch this space.... x

[Joaniepat]

Greatgoddlemighty, if they've got Dr Newson's recommendation, what more do they want? Do you think it is because she is private rather than NHS?

Hearing your story, I feel very fortunate that I attended Mr Panay's NHS clinic and my own GP prescribes their recommendation of 100 mcg Estradot patch, as much local oestrogen as I need and testosterone gel. BUT, I have to make sure that my repeat prescription requests reach him rather than any of the others in the practice. They are all frightened of HRT, including (especially) the one who is allegedly their women's health specialist. No idea what I will do if he leaves or retires. The whole situation with these people is frightening, especially as I'm 70 now and should in their opinion shut up, put up, and go stand at the back of the cave.

Anyway, good luck with your upcoming battles, and do keep us informed.

Love,
JP x

[Bobidy]

Thanks, it's really frustrating. If I could use 3 pumps of gel and 2 Vagifem and feel fine like I did a couple of months ago I'd be ecstatic but I've gradually had to build up to 6/7 pumps to get rid of the symptoms, and 2 Vagifem just aren't enough.

I get that they are nervous about it, but they basically just need to follow instructions from the specialist the same as they would if I'd been to see a thyroid hormone specialist when their patients are on various doses of meds.

I wish there was a consistency of practice so that all gps were confident with meno care and it wasn't such a lottery. It seems very unfair that some ladies get testosterone via Nhs, some cant, some can use daily vagifem, some can't, some can get transdermal oestrogen, some can't, some can get 2-3 months repeat prescriptions, some can't. It's bonkers. It's exhausting to be honest.

I'll have calmed down tomorrow x

[Sammiejane]

hi joaniepat

how are things going on your estradot 100 patch and testogel. x

how is hair i assume its continued to be shed free x

i?m just trying gel and utrogestan together my hair stopped shedding when i stopped the gel and had remained but only been 13 days so time will tell just hope it doesn't shed worse x

[Ladybt28]

You may have calmed down Bobidy but don't give up...make sure your write a stiffly worded complaint to the practice manager and defo look into changing practices! You're right it is bonkers and beyond exhausting, they are a law to themselves.  To be honest they are calling a high profile menopause consultants reputation into question, when they haven't a baldy notion.  I'd ne asking them if they thought they had more expertise than Dr Newsom.  Out of interest if you get nowhere with your practice manager does anyone know if you can complain directly to the Trust the practice belongs to?  I just wondered whether there is a higher authority above the Practice Manager and where it might be? x

[Whatsupwiththis]

Bobidy...there should be NO REASON WHATSOEVER that your GP won't up the Vagifem!  Funny how they will prescribe Viagra at anytime but Vagifem...well that's a female thing and you 'girls' are just being hysterical!  I am so lucky to have a GP who respects my wishes and knows we have enough foresight to understand the risks.  How dare they tell a woman who is mature, capable, intelligent and yes, WE CAN READ the leaflet that contains all the warnings.    There are so many women suffering needlessly because they are treated like young children instead of the brilliant women we all are.  Good for you Bobidy that you're not willing to put up with their condescending attitude.  Makes me livid! 

[Bobidy]

Oooo I've got the fire in my belly now. I'm in the process of drafting my letter to the Practice Manager and will refine this so that it is factual rather than emotional. I'm going to cite the evidence, include the evidence, plus point them in the direction of the BMS training modules, Dr Newsons training days and her evidence resources webpage. Then I'm arranging a meeting.

I feel like they think Dr Newson is some kind of back street charlatan or something so I've included a paragraph with her credentials in it. I feel really protective of her as she's so lovely and does so much for all of us in the background.

Hell hath no fury like a perimenopausal woman high on oestrogen and testosterone!

I'll let you all know how I get on. If I can help every other woman that goes to that surgery it will be worth it fir sure.

Thanks for your support x

[Whatsupwiththis]

👊👏YOU GO GIRL!

[GerryL]

I agree with your view on this Stellajane. I have myself been referred for private treatment via my GP before as has my husband so we have had the same experience you mention.

I believe self referral to a private consultant is somewhat different  in that the NHS has no obligation to prescribe what a private consultant has prescribed you unless you have been referred via the NHS.

I would like some clarification on this as I really don't know how Dr Newson works. I have seen some of her posts on Instagram but is she a purely private GP? Am I right in thinking as well that she is not a qualified gynaecologist? I did look at her website a while ago and had a quick glance at her qualifications but did not see anything mentioning an RCOG qualification. My GP is RCOG qualified and pretty well clued up on menopause so I'm quite lucky in that respect.

[Tc]

You may all find this interesting.

The c and w clinic sent a table to my gp (along with clinical letter) .with instructions.on HRT..

There is a pdf which I cant seem to copy here ...but if you...
Google :  "Chelsea and Westminster gp table hrt"
It will come up as "continuatin/ discharge plans for GPS  C and w HRT table"  and You can open the pdf file.

IIt  makes interesting reading but on this particular subject it states:

Quote "To achieve symptom relief estradiol doses may be increased up to the maximum licensed dose".

Outside of this chart off license doses may be prescribed by the clinic where it is clinically indicated to achieve optimum serum estradiol and symptom relief." End quote.

Now....

The "highest doses" on the chart for patch and gel  is100mcg patch  and 4 pumps for  eastrogel.  Sandrena is listed as being "off license" at 2mg.

I was prescribed 3mg by clinic which is clearly off license.

But, If you look at the table and the wording  of my quotes above about "outside of this table"  it could be construed that anything above 4 pumps eastrogel  or 100mcg patch is off license.

And I believe theres the rub. The off license issue may well be at the heart of this.

It's rather telling that A doc i saw last year stamped his foot and said to me "individual docs cannot be forced to prescribe off license".  Then he said "and I'm not sticking my head above the parapet".

When my local NHS gynae wrote to gp prescribing 150 patch my gp was not happy at all. Even though the consultant had ordered it. In the end she said "on your own head be it".

But I must say nobody in my gp surgery has questioned the c and w panay clinic. Not even an eyebrow raised at my off license dose of 3mg sandrena!!!

 Dare I say it, just my opinion of course, but some consultants seem to have more clout than others or might even be seen to be above question.  Maybe not always a good thing  in the wider scheme of things. But if you have sat with a consultant your gp has referred you to and been fully informed of all the risks and worked out the best plan for you why should that same gp or any general practitioner be able to override this.  is it in the patients interest or is t secondary to the individual docs view on off license products or on HRT or in this case both.

X
 

[GerryL]

I think youre right here Tc. I was just talking to Sammiejane on her topic about my DIL. She is on a 100 patch but she does see a gynaecologist and at one time he was going to put her dose up as she was struggling but then things came good for her on the 100.

I used to go to her GP with her poor love at the start of her menopause after her op. and her GP said that they were happy as the gynae was overseeing her care because they otherwise wouldnt be able to prescribe her higher doses. Of course it helped that the two were communicating dieectly as both are NHS. Maybe thats the problem to a degree too.

I also wonder how it works as I assume private consultants can't access NHS GP patient records so they wouldnt have a full picture of the person they are prescribing to in case they had other health conditions that might affect their treatment.

[Bobidy]

Much calmer today phew...

Yes I agree that it is really important to share records as it would be easy for me to tell a private consultant any old nonsense just to get the meds, or forget to tell them something crucial and get an incorrect diagnosis. But the consultations and tests are very thorough resulting in detailed reports copied to the gp, not that they ever seem to have read them!

We are all just stuck between a rock and a hard place basically.

I asked at my gps if there was a practice/local meno clinic and they said no. By that point I'd had about 18 mortifying appointments relating to my symptoms.

My amazing gyno hyst surgeon didn't really know much about hrt only that I'd need oestrogen post hysterectomy as I mentioned I thought I was starting with peri symptoms and he recommended tablets, which is what my discharge letter said?!?

When my symptoms were so bad and I knew they'd get worse post hyst with conking ovaries I had no choice but to go private as my gps were having none of it... just a vague diagnosis of fibromyalgia with a prescription for amytripoline.

I thankfully found this website, then the Menopause Doctor website as I was extremely conscious of only getting reliable and up to date UK based info and research that I could really trust. I was beyond relieved that I could self refer and dragged myself 3 hours to see Dr Newson as I knew she was the best fit for me due to her constantly researching and being so knowledgable.

There was no alternative for me. Im very jealous of ladies whose gps can diagnose, prescribe and support, or refer to a free NHS clinic. The lack of consistency with this nationwide is absolutely staggering to me. I don't see that ending any time soon despite all the amazing work that is going on in the background to rectify it. It saddens me as so many women will suffer.

The straw that broke the camels back for me was the 'risk of breast cancer' and 'risk of thrombosis' gp reasoning for not adjusting my HRT. We all know now research shows Oestrogen only has no increased risk, maybe even a decrease, transdermal route has no clot risk, gel and patch can be combined, local internal and external oestrogen can be combined and has no BC risk at all.

So for me it seems that my HRT won't be altered based on gp lack of training and confidence rather than actual risk to my health which is wrong. We all have a 1in8 risk of BC with or without HRT, and please don't think I'm being flippant about that, I'm definately not. But I need my quality and quantity of life back by cutting my real risk of heart, diabetes and bone problems.

It's going to be a tricky meeting for sure. But I need to get to the bottom of their reasoning behind it and give them the evidence to be more informed. It's the only way things have a hope in hell of changing. I'm cringing already. Sure... I can't get enough of all this extra stress in my life... not!

[CrispyChick]

What astounds me is that they would rather spend valuable NHS resources on testing us for all manner of things rather than consider hormones and perimenopause!

I've had to find out for myself. Also getting an op on my nose after all the testing 🤣.

[CLKD]

Years ago one wasn't allowed to self refer, even to Harley Street.  Consultants wouldn't accept a patient without a GP referral.  Patients are notorious for not telling the whole 'story' deliberately or simply forgetting ......... where as a GP usually has the whole patient medical history which can be mentioned in referral letters.  I have sat in many consultations when a Consultant has said "And what about X, Y, Z" and the patient goes "Oh yes, I'd forgotten about that".  It can be like drawing blood from a stone getting a complete history 

Many GPs won't prescribe when a patient goes privately, why would they  . 

Also it's the end of the NHS Financial Year.  Call me a cynic ............ what moi?

[Kathleen]

Hello ladies.

I thought I'd comment about Dr Newson.  I should add that I haven't met her but I do recall reading about her in the past. I'm pretty sure that she was working as a GP prior to setting up her specialist clinic and one reason that she developed an interest in the menopause was that she had started to experience intense hot flushes but even  as a doctor she hadn't associated them with the menopause. She has said that it was only when her teenage daughter mentioned that her friends were moody when they began having periods that she made the connection and realised that she hadn't had a period for five months.

Dr Newson certainly has a good reputation for treating the menopause and I expect that she has studied the subject extensively but I don't think she is a qualified gynaecologist. How much this matters is debatable of course!

Take care ladies.

K.