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[dangermouse]

Just got back from the GPs to request HRT for my peri, mainly to try the Oestrogel with the mini-pill. I requested the Oestrogen/Utrogestan combination, as I knew they would have a problem combining the pill with the gel.

After checking with another GP, due to her lack of experience, she came back to say it wasn't a 'no' for HRT at my age (46) but that I would need to see the other GP to discuss further because HRT is strictly for post-menopause and that the new NICE guidelines were still not the regular route due to the 7 year rule - in case I used up the 7 years before I hit menopause when would need it more. I told her I wasn't convinced about the 5-10 year rule and mentioned Studd's views on it, she was very understanding but wasn't in a position to help so have booked to see the other GP next week.

However, she did say that if they say yes, which she was sure they would once they knew I understood the risks, that I am unlikely to get the meds I requested as Oestrogel and Utrogestan are not normally prescribed together as the Oestrogel licence is only for use by post-meno women to use 'as and when', so not everyday where there is a need to combine it with progesterone.

Does anyone know if this is correct? Also, are GPs strict about the 5-10 year rule for taking HRT, as it seems some of you have been on it for longer than this? Surely the pill they're happy for me to take is more risky than HRT?

[Dancinggirl]

Oestrogel is for any stage of menopause   These GPs really need to get educated) Oestrogel is never used on it's own unless you have had a hysterectomy (and certainly not "as and when" needed either), so should always be used with a progesterone if you silly have your womb. I have used Oestrogel since the age of 40, so for the last 20 years!
As to Utrogestan - this isn't always the ideal progesterone for every women so it may be worth trying Provera if they won't give you Utro. If they insist you try pills then go for Femoston 1/10 as the progesterone in this one is the kindest.
Re: the 7 year rule - this is nonsense as well - this refers to post meno use - so if you have gone into post meno at the normal average age of 53, then 7 years of HRT is fine because 60 is still considered the cut off regarding safety - so I believe using HRT in peri meno doesn't count but this will be open to interpretation by many GPs. However beyond 60 the benefits of HRT can outweigh any risks and for many of us HRt enables us to continue working.
I would print out the info under TREATMENTS above to show the other GP when you see them. DG x

[CLKD]

I think that this Surgery should be reported to NICE for lack of education  .  Is there a patient forum that you could join in order to put your point over and find out how other patients are treated?

new NICE guidelines were still not the regular route  - surely these Guidelines were specifically to avoid this kind of mis-understanding 

[dangermouse]

I know?! I asked what it's normally paired with when she said it would be off licence with Utrogestan (as I only want the gel anyway as want to try it with mini pill, which would be off licence) and when she said that I asked if she was getting confused with the vaginal oestrogen, but no, she was pretty sure that the licence was for post meno women as and when without progesterone. She did admit she knew very little and hence had chatted with the other doc to learn.

I'll see what the other doc says, I wanted the gel so could tweak dosage so I'm not interested in any of the other oestrogen concoctions (but will take whatever prog they offer and there may be a Norethisterone one). If not I'll get a tube when I go to Spain in a few weeks to see if I like it and may have to go private thereafter, but really can't afford it.

Our surgery is very strong on their rules,  due to it being so large, but you always get a same day appointment which I know isn't the case with the smaller practices so that put me off of moving when they misdiagnosed my peri symptoms for 6 months.

[CLKD]

You could speak with a Pharmacist B4 your appt.? 

'strong on rules' or keeping their money to themselves?  or plain ignorant 

It beats me how GPs can get away with going against NICE guidelines 

[dazned]

As my gp pointed out to me " these are guidelines only not rules " !
I guess they still will be looking to their budgets come what may unfortunately 

[Mary G]

It's all a bit of a mess really isn't it.  The new guidelines were supposed to stop this kind of thing from happening but clearly the message is still not getting through to many GPs.

The sort of rubbish that some GPs spout is truly frightening and they all seem to be working on out of date information.  It's up to you but you can persevere with this hopeless practice and ask to be referred to a menopause clinic but it might take a long time and by the sound of it, there is no guarantee you will get what you need. 

Alternatively, you can take things into your own hands and buy it yourself in Spain.  I don't know if you have done it before but it's easy to buy both the Oestrogel and the Utrogestan at any pharmacy over the counter and without a prescription but you will need to order in advance if you want large quantities and it is usually next day delivery. 

You could also consider seeking advice elsewhere from someone like Professor Studd but obviously you will have to pay for it.  Professor Studd will write to your GP with his prescription but there is no guarantee they will play ball. 

One thing is for sure, you are not going to get any meaningful advice from your GP because they clearly know nothing about HRT. 

It's your life and your time so don't waste too much of your precious time flogging a dead horse. 

[Kate50]

Bullshit it's just as cheap!  My gynae handed me the nice guidelines and told me join some meno websites.
Oh Lord give us strength it's hard enough as it is! I left my gynae appt last week with the consultant saying I am setting up a meno clinic in accordance with nice guidelines  so make sure your doctor refers all meno queries to me!

[CLKD]

How do we get over this though  .  GPs are GPs because they didn't want to be 'experts' and Specialise.  How can they sleep at night 

[Mary G]

CLKD, the problem is doctors go pretty much unchallenged and they still get their salary at the end of the month when they send you packing with no help or advice.  There is not enough accountability in my opinion. 

Kate50, you are bang on there.  HRT is not expensive and much cheaper than millions of hip replacements and treating all the other illnesses caused by oestrogen deprivation. 

[CLKD]

Many don't like patients going into Surgery with internet info or knowing more about the subject than the GP  . 

[Kate50]

Just came back from DR'S appt for script for hrt as had to have anther NHS approved say so? ? After seeing Studd!
Anyhoo she seemed really pleased that it was same as Studd although this gynae wants me to take more Utrogestan! !!
She said I have taught her loads and will be referring all ladies to her as requested by gynae. She said they were told but to prescribe hrt but AD for meno! I think she will be using it herself.  Came away with a script for 30 tubes of testim!

[CLKD]

Maybe suggest to this Dr that she runs a Meno Clinic?  She can look here too 

[dangermouse]

Does anyone have any more info on the time limit? Not sure if everyone here who has taken HRT for over 10 years has to get it privately.

[CLKD]

I think it depends on the GP/s involved.  Some will prescribe for Life, others are stuck to the 'rules'.  Wonder sometimes whose side they think that they are on