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[Northstar]

Hi all. I’m 44 and have had perimenopause symptoms for the last 18 months. I have had several GP appointments about it so far. On the latest appointment I asked to start HRT and am currently being told no as I have a family history of breast cancer (father and great-aunt). I know that using HRT does not increase my existing risk and it says so on British Menopause Society website. So I need to convince my GP. My worst symptom is repeated UTIs and also my brain fog has caused me to get lost in the town I have lived in for 20 years!
Also the GP has asked me 2 or 3 times now if I get hot flushes and because I don’t she seems a bit skeptical. Never mind the long list of other horrible symptoms. She also said nausea wasn’t a perimenopause symptom.
I’m a little bit stuck and considering going private. Has anyone had similar experiences?
Many thanks.

[CLKD]

HI!  You may feel stuck but she certainly isn't up2date!     whilst we shouldn't need to pay for advice, it is often the quickest route.  Don't go to a Gynae unless they have knowledge of menopause. 

Is there a Nurse Practitioner with more menopause treatment knowledge?  In the meantime ask your surgery for a referral to a dedicated menopause clinic as there are waiting lists both in the NHS and private sector.  Many GPs still believe that we can't be in peri-menopause unless hot flushes ground us  - some ladies however don't experience flushing of any sort and mine lasted about 3 months once periods had stopped.

Do be aware of vaginal atrophy and bladder problems - 4warned is 4armed ;-).  If your GP isn't au fait with symptoms you may be treated un-necessarily with antibiotic treatments.   GPs don't seem to be aware that atrophy mimic repeated urine infection-type symptoms really really well.  A fresh urine sample should be sent to a Lab to be tested for infection, a dip stick test won't be enough.

Let us know how you get on.

[Northstar]

Hi CLKD

Thank you for your reply. I will find out if there is a menopause specialist or a menopause clinic that I can be referred to.
They have been prescribing anti-biotics each time which always seem to work very quickly. They have usually been sending my urine sample off for testing. A couple of times it has grown something but usually not. I have been worried about the repeated antibiotic use.

[CLKD]

ABs can certainly ease symptoms, they were prescribed 3 times when I complained of frequency and burning.  My GP happened across my sample waiting to be sent away and diagnosed VA. 

I also find when I feel the need2P that swallowing 2 Nurofen 3 times a day for a couple of days eases those symptoms.

Some hospitals may have menopause clinics, might B worth while looking at local websites. 

[Northstar]

Thank you. I’ll give the nurofen a go next time.

[CLKD]

R U saying that your Dad had breast disease? 

Even if a close relative has had breast cancer there is no reason not to discuss treatment with a medic who is au fait with HRT.  MayB make a note of symptoms then see if there is a menopause Nurse at your GP Practice?  No woman should suffer symptoms!

[Northstar]

Yes it was my dad that had breast cancer which seems to immediately make all the medics freak out because there is little or no data on male breast cancer. So they have said my risk of developing breast cancer is moderate. However on the British Menopause Society website it says that in my scenario taking HRT would not increase my existing risk.

[CLKD]

So which route would you like to try to ease symptoms?

We need to have Quality of Life . 

Male breast cancer is under rated and unless men go public it is little known about. 

[pastie supper]

I had over a year battling with my GP, trying to get HRT.
I'm a slim non smoker with no family history problems and still I wasn't allowed HRT because NHS prescribers are allowed to pick and choose what they prescribe and to whom. Guidelines are simply that, guidelines.
I went to a specialist and got them to tell my GP to give me oestrogel and utrogestan as I'd been asking for over a year. I was hugely symptomatic, the gynae commented on how much I was sweating the whole time I was there. She said that indicated no ovarian function left at all. I'd had to change my clothes multiple times a day before HRT.

I was 52/53 when all this was happening and I haven't had a period since I was 51, definitely post meno.
I asked my GP why it took 13 months and a letter for her to prescribe HRT, she said the problem was my choice of HRT was too risky without specialist say so, because they can't know if the woman will take both parts properly. She already knew I feel awful on progesterone so she decided I wasn't getting HRT unless I chose combined patches or combined pills and then she would know I wasn't skipping out the progesterone from it.
When I say she knew I had bad side effects on progesterone, it was a case of I told her and she assured me I was wrong, women don't react badly to HRT if it's HRT they need. As I'd reacted badly to Evorel Conti patches, I wasn't allowed anything else except tibolone.

I believe her facts and reasoning are both at fault here, but as a patient you either go along with your GP's beliefs or find another doctor.
There are no available GP places in our area, so I couldn't change GP, but seeing a private specialist would have hurried along the process. My GP seemed scared to prescribe it to me, like there could be terrible outcomes if I had HRT, hard to know. She sounded somewhat embarrassed on the phone after I got my HRT.

So that's how I got HRT despite having an uncooperative GP, I saw another doctor, eventually.

The government aren't putting any of the money they promised into the NHS, so I think you're likely going to have to pay to go private for at least one appointment, even just to get a letter to your GP nudging her along, then go back to the NHS for the prescriptions, hopefully.

Good luck, let us know if you get anywhere!

PS I thought it only increased the risk of recurrence if you yourself had had breast cancer and it doesn't increase the risk of getting it for the first time

[Northstar]

Thank you for your replies. I would like to try oestrogen patches or gel. I have already had a mirena coil for 6 years with no problems.

I think you are right that I may have to go private to get things started which I am happy to do if it doesn’t work out with the gp.

[Penguin]

I think as well it is a matter of informed consent and your body, your choice.
 So even if you are at increased risk (not saying you are), then they should surely be able to advise you of said risk and let you weigh up the risk vs quality of life and make a decision for yourself as the adult woman that you are.

Pastie Supper it sickens me to hear what you went through with your GP - particularly about only being willing to prescribe a combined type because they don't trust you to take it properly. How dare they say that to an adult women. Honestly words fail me and I am sorry ypu had that experience.

[CLKD]

I asked my GP why it took 13 months and a letter for her to prescribe HRT, she said the problem was my choice of HRT was too risky without specialist say so, because they can't know if the woman will take both parts properly. She already knew I feel awful on progesterone so she decided I wasn't getting HRT unless I chose combined patches or combined pills and then she would know I wasn't skipping out the progesterone from it.

How patronising  .  Surely that's the same with any medication prescribed that medics won't know whether the patient takes it or not?  When MinL was given a 24 hour heart monitor and told to continue as normal, she move to stay with her eldest son so that she didn't do anything  .  I was SO cross as it didn't give a correct reading  in fact I'm still angry about her attitude 20 years later.  What a waste of NHS time.

Also if patients get appropriate treatments it in the long term, surely saves the NHS money as they don't need repeated appt.s?


If ladies are so at risk from HRT having had breast disease treatment, are they not advised to have mastectomy?   There is a Dr often quoted on the Forum: of course name escapes me  : who has advised both his wife and daughter on HRT even though they have had treatments.

[Northstar]

CLKD. - is it Professor Baum?

[CLKD]

 .   That rings a bell - mayB put his name into the search box on the Forum to C what shows up?  Then let me know ;-).