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"Menopause diagnosis and treatment"

About: General practices in Tayside

(as a service user),

I first visited my GP surgery, just over 2 years ago to find out about the options available to me for HRT. When I told the doctor I wanted to find out about the new HRT products, they said they didn't know anything about the new products and would give me 3 months supply of  synthetic combination tablet,  and that I should go and research HRT products myself. They told me what websites to look at, not what I expected from my GP but I decided I would look for myself. I took the tablets and they made me feel extremely unwell and very dizzy, and bloated but I wasn't able to get a doctor's appointment for 2 years after due to covid. I knew I needed HRT as I hadn't had a period since 2017/18 and I was diagnosed with osteopenia at 40.

I went back at the start of the year when they opened for face-to-face appointments wanting to discuss body identical HRT and how to go about getting testosterone. By this point I had gained 14 lbs in weight although I am active and had been trying to lose weight. Although I knew it's a sign of menopause as your metabolism changes as you get older. 

I came out in tears as the doctor made me feel awful, not only did they question me as to why I "thought" I was menopausal but also told me I had to lose weight without asking anything about my diet or exercise routine. They told me I would not get body identical HRT on the NHS as they are made especially for each individual. I said  that's bio-identical, body identical are made from soya and yams. They weren't happy that I'd challenged her on the difference between them.They asked what my symptoms were and then said they didn't think I was  menopausal, and that they  would try you on anti-depressants and blood pressure meds.  Without checking my blood pressure they turned to the computer.

I said that I didn't want anti-depressants and and that my blood pressure had not been checked. I asked to be referred to the menopause clinic as I wanted the plant-based HRT due to a history of cancer in the family. I was told there was no point as they won't give me them either and if I wanted that then I should go private because I wasn't getting it on the NHS. 

I ended up going private and the consultant I saw prescribed other medication which I thought was the end of it until I found out that one of them was in a gelatin capsule and I have an allergic reaction to gelatin and animal products. 

I had tried asking the pharmacist at the GP surgery if she could find out a list of animal-free HRT's and was told no.

I emailed an NHS consultant in Dumfries and Galloway who was a big help and BMS along with the manufacturers of HRT products so I knew exactly what plant-based  products were available to me. Armed with my new research I found another consultant and they suggested exactly the products I had found through my own research after I had explained my family history and allergic reactions. £200 for a consultation was well worth it to get the medicine I needed, the shock came when I had to pay for a private prescription 4 months worth I was quoted £355 but after shopping around £235 was the final price. 

If I can find out this information why can't a qualified pharmacist find out? So because I have a private consultant I will have to continue to pay for follow-up checks and private prescriptions for the rest of my life at a great financial cost. 

Yet if an NHS consultant can tell me it's available on the NHS from the menopause clinic why did my GP refuse to refer me and told me to go private? I would say lack of menopause training, Which I wouldn't be complaining about if they hadn't told me to go research it myself and come back and they would prescribe it, then when I went back and was told I was not menopausal! I feel they were the one to research it as well and understand that weight gain is something that happens in menopause.   

Unfortunately, this is not the only bad experience I've had at my GP surgery over the years. I've been misdiagnosed or had to fight to be sent for tests and scans.      

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Responses

Response from NHS Tayside last week
Submitted on 23/06/2022 at 09:42
Published on Care Opinion at 09:42


Dear samantha14

Thank you for sharing details of your situation and the steps you had to take to resolve the issue. We are sorry to hear that you have experienced these difficulties with menopause diagnosis and treatment and that this issue has been emotional, lengthy and costly.

Feedback enables an organisation to reflect, identify areas for improvement and revise any processes as required. As each GP practice is an independent business, we would recommend that you feedback your experience directly to the practice to enable them to do this. Your GP practice will have a Complaints and Feedback Policy which will help explain this process.

- NHS Tayside

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Response from NHS Tayside last week
Submitted on 27/06/2022 at 16:32
Published on Care Opinion at 16:32


Dear Samantha14

Bioidentical compounded HRT is not recommended by the NHS as there is a concern about its safety as well as its effectiveness:

https://www.womens-health-concern.org/help-and-advice/the-menopause-explained/
https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/


Bodyidentical HRT is widely available on the NHS- estradiol and micronised progesterone (Utrogestan). As Utrogestan has not been recommended by the Scottish Medicines Consortium as it is slightly more expensive that other progestogens. It is therfore a "restricted" (amber) drug on the Tayside Area Formulary. It is usually prescribed as second or third line, after an electronic discussion with a menopause expert.

Testosterone therapy in women is prescribed to address secondary low sex desire after other causes for this issue have been excluded or addressed, she has no symptoms of lack of oestrogen and her sexual desire has not improved with hormone replacement therapy (HRT) despite using it for several months or more. Testosterone therapy can be considered in this situation according to the NICE Menopause Management Guidelines and British Menopause Society. The prescription for other indications is currently not recommended.

Testosterone is only licensed for use in people assigned male at birth. Menopausal patients use the same products but at a much lower dose. Currently, there is no licensed preparation of testosterone available in the UK to use in women so testosterone gel prescriptions are “off-label”. According to the "Local Treatment Protocol: Testosterone in postmenopausal women with low sexual desire" the patient is assessed by, and the prescription is issued and followed up in Secondary Care (Complex Menopause Clinic).

Patients who believe that they would profit from testosterone treatment can discuss this with their GP. The GP can then refer them to the Menopause clinic if a prescription seems suitable, or ask the clinic for more advice. It is not recommended to start HRT and testosterone at the same time.

Kind regards

Dr Heike Gleser (she/her)

Consultant Sexual & Reproductive Health

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Update posted by samantha14 (a service user)

Thank you for your response maybe you need to educate my gp in the difference between bio identical and body identical as it was her that doesn't know the difference not me so I don't know why you are explaining it to me?

I am also very aware of when and what testosterone can be prescribed for and I didn't ask for it when I went to originally discuss this with my gp I asked what the chance was of getting it further down the line if I needed it? But for my gp to point blank say woman don't have testosterone in their body shows a lack of education. We don't have it at the same level as men but we do still have it.

I guess I will have to continue to fund hrt privately as my gp won't refer me to the menopause clinic at ninewells

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