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[Berto77]

I haven't read all the responses but your GP is living in a Cave!

No one is too early for menopause: girls may have 1 peroid or non at all.  So it can happen across the whole age range.  GPs still tend to think that 52 is the age ....... Certainly, HRT will protect heart and bones in the main.  As will brisk walking 10 mins several times a week.  Eating well - mayB have a lookC at your over all diet?

A drop of oestrogen may well cause the skin to become dry: inside and out as well as muscles may become lax = aches and pains.  Do read the 'bladder issues' and 'vaginal atrophy' threads.

What support is your GP offering regarding any weight loss regimes? 

Browse round.  Make notes ;-)  Let us know how you get on.

Hi CKLD,

I know my GP is incorrect as my mum was menopausal in her late 30's but they seem to get so little training on menopause, its disgraceful really. I think the only way to know if hrt will help me is to try it but I'll need to wait and see what the GP says today. It seems that many women have to see a specialist privately then have their recommedations transfered accross to the GP!

I've spoke to my GP about my weight in the past and always been brushed off so I don't think they really do offer any support. I think you have to already be ill with hypertension, type 2 diabeties or heart disease before they offer any help, which is unfortunate. I do want to lose weight and think i could on my own if I were not so tired and unwell feeling all the time!

Ah well, wish me luck for today, sounds like I will need it !

[CLKD]

GPs want to save money too  so every referral costs.

Take a list with you and push your point.  You should not have to pay privately.  I would ask directly for a referral to a menopause clinic, NOT a Gynae!  Different speciality though many GPs seem unaware of the fact.

Let us know how you get on?   MayB seek a dietician within the Group or perhaps join Weight Watchers for support?  No one is too heavy or thin there, it's all about getting to a healthy, comfortable weight in your own time.

Because GPs get little or no up2date info on menopause, wouldn't you think by now that they would try to listen and not be defensive?  U do of course, have Dr Currie in Glasgow who began this Forum ;-)

[Berto77]

I'm back form my appointment and it was a mixed experiance, the doctor was actually really nice and listened to me but obviously very busy. The main issue was my blood pressure which was high at the appointment 170/95 I think. I have to take my own readings for a week then get back to her. If my home readings are lower by then she has offered me EVOREL SEQUI patches which is combined estradiol hemihydrate and norethisterone acetate and an estradiol hemihydrate only patch for the non progesterone part of the sequence. I think if my blood presure remains high I'll need to have that under control before I start hrt.

I did ask for the estrogen only patches and the Utrogestan but she had never heard of it and it wasn't in her database. I did have some information from the british menopause society about migraine and hrt and blood pressure and hrt (from bloodpressure.co.uk) both suggesting that the micronosed progesterone in Utrogestan would be better for me but she said she didn't know enough about it to prescribe it. She did ask if I'd like to go to a menopause clinic given my issues and my requests for a more specific treatment which was good. However I think there is a long wait for appointments. She also said she could ask them (the meno clinic) for advice of what to do in the meantime, she did say she was not especially knowledgable about the menopause.

So I think the plan at the moment is to see how my blood pressure is then if that is ok start on Evoral Sequi while I wait for advice or an appointment from the menopause clinic. We didn't discuss topical estrogen at all unfortunately. I'd like to try it to see if it helps my urinary symptoms any but perhaps I need to give the patches a chance first? I have also seen that superdrug do private prescriptions of topical estrogen for about £55 so I could perhaps do that to see if it helps and then if it does see if my GP will prescribe it.

I'll also look into private menopause specialists in the glasgow area as a back up plan. I'll do a search or ask on here about who people recommend. How do I get to see Dr Currie, is she NHS or private?

I'm going to download the myfitness pal app to log my food and calories and work out a plan, perhaps do the 5:2 and then do walking (which I do anyway) and some strength training. My basic diet is good but i know where I go wrong and I have a good incentive to tackle it now!

Thanks for all the help and advise, I'll be back!

[Postmeno3]

I'm pretty sure Dr. Currie is in Dumfries&Galloway. You can send her an e-mail with your health issues by using the Contact option on the black bar along the top. She charges £30 for invaluable advice and recommendations to which the medical profession seems to pay great heed. Might be a positive next step with a positive outcome re your gp. Good luck!

[Berto77]

I'm pretty sure Dr. Currie is in Dumfries&Galloway. You can send her an e-mail with your health issues by using the Contact option on the black bar along the top. She charges £30 for invaluable advice and recommendations to which the medical profession seems to pay great heed. Might be a positive next step with a positive outcome re your gp. Good luck!

Thank you thats really good information! I will see how I got on over the next week with my blood pressure and GP then do the email to Dr Currie as that sounds like my GP would be more likely to listen to what she had to say!

[CLKD]

You can ask for 'vagifem' or 'ovestin' if you have vaginal atrophy or any dryness.  It's classed as HRT but isn't really, other than to plump up the tissue which becomes thinner due to a drop in oestrogen levels.  U can ring and ask as a separate issue.  The sooner you begin treatment, the better your vaginal health will remain.  We have threads about that too!

You could also suggest that your GP Surgery buys copies of Janes Lewis's book 'Me and My Menopausal Vagina' ;-). Written by a Member about her difficult journey to get appropriate treatment.

Let us know how you get on.  This is an opportunity for your GP to be on a learning curve to, so that she can help the next women along.  Also, make a double appt. if possible next time?  Encourage her to speak to the menopause clinic too.

[Postmeno3]

I think it can be advantageous coming at it from a knowledgeable third party who is neutral, but more influential? Some doctors don't take kindly to patient recommendations. It depends on the relationship, how negotiable etc. You'll know best how that is in your case. Good luck!

[CLKD]

GPs still seem defensive in some areas when a patient makes suggestions  .  In these difficult times, it should surely save time and energy on both sides of the couch ? 

[Berto77]

Thanks Postmeno, I think it would probably sound better coming from another doctor than some upstart patient!

Thank you too CLKD, I would like to try something for my vaginal symptoms, thats been going on a while now and I was always putting it down to other things but with all my research I really think it could be menopausal related. Its can be quite painful and had been bad enough to put me off sex with my husband so I think I'd be justified in asking to try something topical. I think I should be able to try that even if systemic HRT is off the cards for the time being. That book sounds great I will definetly check it out and suggest it to my GP! Hopefully by trying to educate myself and being assertive in trying to get my needs met it will help to improve things, just imagine if all the suffering women went in demanding quality care, it would be a revolution!

[sheila99]

Va will only get worse so I would ask for local oestrogen at your next appointment. Some people are OK just with hrt, others need local oestrogen too so I'd suggest you start on it now and perhaps try to reduce when (if) you've been on hrt for a few weeks. My gp had trouble finding Utrogestan too, it only came up with the 200mg which is licensed for ivf but not for hrt, he shouldn't have prescribed it but he did. The 100mg that is licensed for hrt came under Micronised Progesterone not Utrogestan. This was 3 years ago so it may have changed but would be worth checking. Hrt is only contra indicated for high blood pressure, once your blood pressure is controlled hrt should be prescribed so you should be able to get it even if it takes a bit longer to get there. Good luck, hopefully your BP is OK when you're at home and you'll get hrt soon.

[SamEdin]

Response from SMC if they are relooking at Utrogestan prescriptions in Scotland as prev. 2009 appears to have been economically driven 
Although this study notes post-menopausal rather than peri-menopausal.
Still looking like a tough one to get prescribed even though final paragraph hints it’s not a total block? Consider requests?


Dear Ms Wright
 
Thank you for the enquiry concerning micronised progesterone (Utrogestan). I can confirm that in April 2009, following a full submission, SMC did not recommend micronised progesterone 100mg capsules (Utrogestan) for adjunctive use with oestrogen in post-menopausal women with an intact uterus (HRT) (SMC542/09).  This advice remains valid.
 
As per SMC process, if the company has substantial new clinical and/or economic information then a resubmission may be made. SMC has not received a resubmission to date.
 
Please note that all NHS boards In Scotland have procedures in place to consider requests for the use of a medicine (which has not been recommended by SMC) in an individual patient when a doctor feels this would be appropriate.
 
I hope this answers your query.
 
Kind regards,
 
Jonathan
 
From: [email protected] <[email protected]>

[LSmarty]

I'm in Scotland and been on hrt since I was 32!
Where in Scotland, I was in midlothian and now east lothian and was referred to the well woman clinic and they were amazing, most of the anyway and helped me a great deal at the time.
I'm now back with a local gp so we'll see how that goes 🤔🤪

[SamEdin]

Have you been prescribed body identical progesterone - Utrogestan?

[Seahorse]

Hi SamEdin I live in NHS Lothian area too and I've been unable to get a prescription for Utrogestan on the NHS and have had to go private. My GP liased with the Menopause clinic who said they do not prescribe it but gave no clear/consistent reason why; sometimes referring to the SMC guidance, other times saying it does not provide adequate uterine protection. So in May I put in an FOI request asking for; Any information on criteria for its prescription including the criteria fulfilled by the individuals who have been prescribed Utrogestan for the treatment of menopause symptoms in the NHS Lothian area.
•   Any internal or external correspondence or other information relating to current guidance or practice in its prescription, reasons for not prescribing, or developments of such guidance and / or practice in the future (to include correspondence between NHS Lothian and GP practices on its prescription).
•   Any analysis which has been undertaken on its prescription, including numbers, GP practices or other prescribers involved, costs, criteria and / or other analysis.
They replied  to me last month but unfortunately they have not put their response on their web site yet so I can't post a link.
So bear with me while I try to summarise without turning this post into War and Peace! Basically they have not been able to prescribe it to anyone since 2019 following instructions from the Executive Medical Director in NHS Lothian. "Utrogestan is licensed for this indication, but it is not recommended by the SMC.
When it was considered in 2009, the SMC decided that there was not evidence of additional benefit over and above HRT combinations containing synthetic progestogens that were already approved for this indication. In the specialist Menopause Clinic at Chalmers, we used to recommend use of Utrogestan for women who had intolerable side effects with synthetic progestogens,but in 2019 we were reminded that individual PACS2 applications needed to be made to recommend this medication (I attach the correspondence from that time). Subsequent PACS2 application was rejected. We have therefore been unable to recommend Utrogestan for this indication in Lothian." The menopause Clinic have emailed the Executive Medical  Director in June 2021 highlighting the fact that NHS Lothian is out on a limb in this approach and that they are receiving criticism from their peers and patients. "Lothian patients are requesting Utrogestan in their droves as a result of media coverage and the extensive online presence of private menopause specialists that advocates use of Utrogestan in HRT as standard, because, together
with transdermal estradiol “it is the safest option”. They have asked her to reconsider the current policy and align it with practice in other parts of the country. They say that they will inform GPs if there is any change in the policy.
So on a positive pester power seems to have had an impact at a clinical level and spurred them on to question their practice but who knows if that wil have any impact higher up the chain. I hope this makes sense.

[SamEdin]

Thanks!

Even the SMC response I received indicated some flexibility in what doctors can prescribe, so it’s a shame NHS Lothian haven't reappraised their advice to GPs. But I’m hopeful from your info that the menopause clinic, patient etc. are pushing back to change their stance.

How many people need to go private? So frustrating