GPs, the NHS and Menopause Care – Marie
Case study: Marie
Married with two children (24 & 26 years old)
Job: Marketing Director
Summary of case study: Here, Marie focuses on her experience of the NHS, its attitude and the care she has experienced in diagnosing and treating her for the menopause in the hope it will improve the care and support that many ladies who are unable to afford private treatment may be receiving now and in the future.
I’m a marketing director for a group of 5 companies and have been very fortunate. I have always enjoyed good health both physically and mentally. I have a strong marriage and I’m really lucky to be part of a really strong family unit.
All of the above was true up until roughly 5 years ago when I started to experience symptoms, I now know to be a result of the menopause.
Back then I rarely visited the GP and believed in a positive mind when it came to health matters, confident that any health issues would pass. However, following a prolonged period of feeling like something was not quite right around five years ago, I made an appointment with my local GP who happened to be male and new to the surgery.
I explained my symptoms; tightness in my chest, painful joints, pins and needles in my fingers and toes and a burning sensation in the palms of my hands and soles of my feet. I was also experiencing a sensation of things crawling over my skin. Whilst these symptoms were not constant the regulatory with which I was experiencing them was increasing. He asked me my occupation and immediately diagnosed my symptoms as stress related. I left with an inhaler for the tightness in my chest and the offer of antidepressants which I declined and told to return in 3 months if the symptoms were still occurring. I felt deflated and that the appointment had been a waste of time.
The symptoms continued and I began to feel that there was maybe something more seriously wrong with me. I was becoming forgetful, I wasn’t sleeping very well, I went from being really capable to getting overwhelmed by the smallest things. I would panic if I had to travel somewhere new and the thought of standing up and doing a presentation would throw me into meltdown in case I experienced a hot flush or simply forgot what I was talking about. I gradually stopped finding any enjoyment in my life and was dragging myself through the days.
It was at this point, about 12 months after my previous appointment, that I arranged to see one of the female doctors at the surgery. She was more sympathetic and did not immediately put everything down to stress as she could see from my notes and the state I was in that this was totally out of the ordinary for me.
20 Years earlier I had been tested for MS as I had Retrobulbar Neuritis but everything came back ok and I returned to full health. Based on this and the fact I have private health cover with BUPA I was referred to a neurologist. The tests all came back fine and my symptoms were put down to me suffering from hyper sensitivity, whatever that is supposed to mean, and again I was told I would benefit from an antidepressant which again I declined because I truly did not believe I was depressed. At this point I lost all faith in my local doctors’ surgery as it was clear to me that if I refused the antidepressants then I was choosing to not get better and I felt like I was dismissed.
It was around November 2017 that I saw a TV programme about the menopause and the symptoms that the women were experiencing and it was like someone had switched a light on. I listened to the stories of these ladies and the symptoms they were experiencing and I could relate to 90% of them.
It was at this point that I naively thought changing my diet and trying to do more exercise and taking a few supplements would make everything ok. I was still having a monthly period so didn’t class myself as menopausal but now knew that there was something called the perimenopause.
Unfortunately, none of the above really helped and by October 2018 I felt like I was living my life looking in from the outside and saw a person I did not recognise. I was on the verge of quitting my job, I avoided my family and friends and felt like all the joy had been sucked out of my life. My symptoms were now pretty constant and I went to bed dreading waking up. I can see why this might look like depression but I honestly had no reason to feel like this.
At no point during any visits to my local GP did anyone say that this might be a result of the menopause.
As a Director I am expected to have a well woman check yearly from the age of 50. This is something I had done via BUPA and thank god I did. The Doctor I saw was brilliant. I had all the tests and examinations required and then she sat with me to discuss them and this is when I broke down and told her how awful I felt. She listened to me and then said the words ‘I think a lot of your symptoms could be a result of the menopause and it would be really beneficial for you to speak to someone about the possibility of HRT ‘
BUPA does not have any provision in its healthcare package for support with the menopause so she said I would be reliant on a GP that was sympathetic and knowledgeable about the menopause or I could go private and she gave me the details of the Newson Clinic in Stratford Upon Avon and some websites I could visit to gain a better understanding of the menopause and the effect it can have.
As soon as I arrived home, I called my doctors surgery and asked if the surgery supported HRT and was told no they did not. I contacted the Newson Clinic and joined the waiting list for an appointment. Fortunately for me they had a cancellation a week after I registered and I was able to see the wonderful Louise Newson and that’s when I started to get my life back!
I was prescribed oestrogen gel and progesterone tablet and given a detailed letter to take to my GP so that my medical file was up to date. I was also given lots of information relating to the menopause and lifestyle changes that can help and also a brilliant leaflet on the workplace and supporting menopause. At this time, I was the only female member of the board of directors and this leaflet was a great way of bringing this topic into the open and seeing what we needed to do to support other women that may also be struggling with menopausal issues.
I called my Doctors surgery and explained I needed an appointment to update my GP about some HRT medication I was being prescribed and was told they did support HRT and that I had previously been misinformed. I went to my appointment feeling upbeat and positive that I was going to manage this transition through what I now understand to be a common issue for many women my age.
However, this was not the case. The female doctor I saw was not helpful in anyway. In fact, the word hostile springs to mind. I gave her a copy of the letter and she basically asked why I had gone private, to which I explained I had been informed that this practice did not support HRT. She proceeded to tell me all about the serious health implications HRT could result in and that all of my symptoms could easily be associated with anxiety and depression and that a mild antidepressant should have been trialled first and that I had jumped into taking HRT. She also questioned whether what I was talking was even licensed which given the letter referenced NICE and was a detailed account of what treatment I had been prescribed was evidence she hadn’t read the letter properly. I was then basically told that I needed to trial an antidepressant first and if the symptoms did not diminish then she would consider me for HRT. She also emphasised that if it was prescribed by her it would be for a limited amount of time.
I told the doctor that I had been given lots of information relating to the risks associated with HRT and how to limit them and I believed that this was the right thing for me to take. I’m not stupid and take my health seriously and had been very well informed so I was making a choice based on lots of information. It was at this point that I was advised my 10-minute appointment slot was complete and there was nothing she could do for me. So basically, she would not be taking Louise Newson’s advice and taking over my HRT care. As you may appreciate, I will never go back to my GP for help with HRT again.
No one used to talk about the menopause, it was associated with getting old, being past your best and I guess something to endure. It has been really sad for me at times to be in the company of other ladies and see the signs that someone is experiencing a hot flush or forgets what they are saying mid-sentence and the knowing looks we give each other basically saying I understand what you are going through.
This experience has changed me, I talk openly about it to friends’ colleagues and family. My Husband and children refer to things as before gel and after gel. It’s my family’s way of acknowledging for a while I was not myself and humour helps us normalise it. I talk openly about it at work and our HR department has introduced policies on supporting women suffering from the effects of the menopause. We invest in supporting mental health so why not the menopause. I know some amazing women who have been blindsided by the menopause and it is heart-breaking to hear women tell me if they had understood what was happening to them and they had received some support their marriages would not have broken down or they would not have walked away from jobs they loved because they felt they couldn’t cope.
I think the NHS is a wonderful organisation and I am grateful to live in a country that provides this service. However, in the case of supporting and helping women understand the menopause it is woefully inadequate and the information and support that is being offered in the local community is not good enough. Most women cannot afford the expense of private HRT indefinitely and I know it is Louise’s intention to get our own GP’s prescribing and managing our HRT so she can help more women but the bottleneck is being caused by the lack of education for GP’s about modern HRT and its benefit.
The work that is being done to raise awareness and re-educate the medical profession and women themselves is vital and I am truly grateful that I have been able to get the help I needed. I hope that someday the level of care Louise Newson and the BUPA doctor I saw will be available to all women regardless of circumstance.
Whilst I understand that HRT is not a miracle drug and cannot solve everything it has enabled me to get back to living a good life and finding joy in my life once again.