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How often should I see a GP after starting HRT?

On the 29^th October 2021, Carolyn Harris MP will lead an army of supporters to Parliament Square in London to demand free prescriptions of HRT in England (these are already available in Scotland and Wales). She has cross-party support from numerous MPs and the government is “interested” in the Menopause Support Bill that will be presented. While we ‘watch this space’ for progress on this, let us address concerns that some of you have around the process of appointments and prescriptions for menopause treatment.

The fear and inconvenience of frequent visits to their GP, and the cost of prescriptions if treatment is granted, may be putting some of you off deciding to start receiving help for your often debilitating peri-/menopausal symptoms.

What does the guidance say about how often you should be seen if you start taking HRT? Well, it may not be as time-consuming and onerous as you fear. The National Institute for Health and Care Excellence (NICE) have made clear recommendations on this matter – and you can read them for yourself here.

The guidelines state that once the initial prescription is given for estrogen, and progesterone if needed, there should be a review with your doctor or nurse after around 3 months, and then yearly follow-ups after that (see 1.4.19 in guidelines).

Your 3-month review appointment should focus on whether the treatment is working well enough for you and how you are feeling, for example whether you are experiencing any side effects.

After you have had your review, your next prescription should last for 12 months, and you should not be asked to come in every few months to discuss whether or not you should carry on taking HRT – yearly follow up appointments are adequate if you continue to be well.

You can of course, ask to see your doctor or nurse whenever you wish, if the treatment is not bringing the improvement you had hoped for, you have a return of symptoms, or side effects are becoming a problem.

Menopause specialist, Dr Louise Newson, advises that HRT is beneficial for most women in the long term (e.g. forever), as long as the benefits continue to outweigh the risks. Your future risk of cardiovascular disease and osteoporosis (bone thinning) are reduced when you take HRT, and there is evidence to suggest your risk of bowel cancer, type 2 diabetes, dementia and depression are also reduced.

If your doctor or nurse is unsure of the most suitable treatment for you, or says there are reasons why you can’t take HRT, ask to be referred to a menopause specialist doctor. This type of referral is also recommended in the NICE guidelines (see 1.4.21).

Read the NICE guidance at

https://www.nice.org.uk/guidance/ng23/chapter/Recommendations