How to talk to your doctor about HRT – and get results

Follow our six-step plan to making the most out of your GP appointment

More women are asking their doctor for HRT for treating their menopausal symptoms [1]
Tracking your symptoms and researching the perimenopause and menopause can help
Understand your rights and why shared decision making is important

Only 14% of menopausal women in the UK take HRT, and in some areas it’s as low as 2%. This is despite it being the first-line treatment, as recommended by NICE (National Institute for Health and Care Excellence).

We often hear from women who have had trouble getting a correct diagnosis for their perimenopausal or menopausal symptoms, or who are denied the treatment that they would like. If you are experiencing symptoms and would like to discuss HRT with a healthcare professional, this can feel daunting. And even if you’ve already been given HRT, you might need to adjust it or need to talk about any ongoing symptoms.

It’s worth remembering that doctors want the best for their patients. However, they might disagree with you or, if your situation is complicated, want to find out more, or worse case scenario, not be up-to-date with the evidence and guidelines.

Dr Louise Newson, balance founder and menopause specialist says: ‘I feel very strongly that it’s about having a choice and knowing that there are options available. Women can empower themselves, they can get information, and they can advocate for themselves.’

Here’s our six-step plan to do just that:

1. Do your research

Dr Louise advises: ‘Before that first appointment, download the balance app where you can track your symptoms, and your periods, if you still have them. Read as much information as possible, again there are lots of resources on balance.’

Become an expert in what’s going on in your body – what the changes are, how long they’ve been going on. For a really deep dive, you might like to sign up to Newson Health’s Confidence in Menopause Course.

RELATED: menopause symptom sheet

Then brush up on the guidelines healthcare professional use to advise their patients. The General Medical Council (GMC) guidelines, Decision Making and Consent (read them in full here), states that doctors need to: keep their professional knowledge and skills up to date; work in partnership with patients; listen to, and respond to, patients’ concerns and preferences; and respect patients’ right to reach decisions about their treatment and care.

Similarly NICE’s Shared Decision Making guidelines (NG197) state that clinicians should: encourage the patient to take an active role in making decisions about their treatment; take into account what is most important to the patient, their expressed needs and priorities, and explain treatment options in light of these; have an open discussion about the risks, benefits, and consequences of each treatment option; allow time to answer questions and time to make decisions, making it clear that the patient can change their mind down the line; come to a joint decision that is satisfactory to the patient.

Finally, the NICE menopause guidelines are a useful set of guidelines for doctors in diagnosing and managing the menopause.

Doctors are not always aware of these recommendations, so you may want to print off particularly relevant sections for you and take them to your appointment.

2. Go prepared

‘Once you have tracked your symptoms, and any periods, on balance, you can print out a health report, which pulls them all together,’ says Dr Louise. This will be really useful for your doctor. Also make a note of any questions you might have.

If you feel the usual 10 -minute appointment time isn’t going to be long enough to discuss things adequately, then ask for a double appointment before you book.

And if you feel nervous or just want some moral support, it’s perfectly acceptable to ask a friend to come with you – they can act as a note-taker too.

3. Know what to say

As Dr Louise advises, appointments are usually only 10 minutes so every second counts. Try to be as succinct as you can when explaining things to your doctor.

‘Show them your health report, tell them you’ve read up on your symptoms and say, “I’ve made the diagnosis myself, I’m 99% sure I am perimenopausal or menopausal, I’ve read about HRT and this is what I want,’ says Dr Louise.

4. Aim to make a joint decision

Your healthcare professional may ask you to explain your reasons for your decision, your understanding of what is involved, and your expectations of how HRT would improve things for you. You have the right to choose what treatment you would like as long as you show you fully understand all the implications of the decision, including any risks. This includes any treatment option that your healthcare professional does not think is the best option. Regarding your decision as ‘unwise’ is not enough of a reason to refuse, if you can show you are informed and have considered the consequences of your choice.

Your doctor should answer your questions accurately, and as fully as they can in the time allowed. They should be clear about the limits of their knowledge and, if they can’t answer a question, they should explain whether it’s something they just don’t know themselves or something that no one knows yet because the research hasn’t been done.

If, after discussion, the professional does not consider your treatment choice an appropriate course of action, they do not have to provide it. They should explain their reasons for refusing it to you and explore what other options might be available, including your right to seek a second opinion.

If your doctor wants to provide a treatment for you that you disagree with, say so. Professionals need to show that you consent (agree) to any decided course of action.

5. Face obstacles

‘If your doctor says no, you are allowed to challenge that decision. Say “is there is a reason why you are refusing?”,’ says Dr Louise.

Some reasons women have been incorrectly told they can’t have HRT include: ‘You’re too young to be menopausal’, ‘But you don’t get hot flushes’, ‘HRT is too risky’, ‘The drug is not licensed to be used in this way’, ‘You’re still getting periods’. This is where your research comes in – your doctor may need to see your evidence.

A Newson Health study of nearly 3,000 women showed that 66 per cent had been inappropriately offered or given antidepressants for the low mood associated with their menopause. In this case, Dr Louise advises you to point out: ‘Menopause guidelines are very clear that antidepressants should not be given first line for low mood associated with the menopause because there is no evidence that they will help. Research has shown that if women are given HRT when they are perimenopausal then this can reduce the incidence of clinical depression developing.’

Other women have found their access to HRT is delayed as the doctor wants to conduct a blood test. This may be necessary in some cases, but if you’re over 45 and experiencing symptoms, there’s mostly no need as blood tests are unreliable. ‘It’s more important to listen to the woman regarding her symptoms. If your periods have changed or stopped and you are having symptoms, that’s enough,’ says Dr Louise.

Alternatively, your doctor may say they need to refer you on to a menopause specialist, which can cause long delays. ‘This shouldn’t be necessary unless you have a complicated situation and even women with family history of breast cancer can still safely take HRT,’ says Dr Louise.

Don’t be afraid to advocate for yourself and disagree with the doctor. Listen and consider their explanation. If you still don’t agree, Dr Louise advises saying: ‘I know there are benefits for me taking HRT and I’m prepared to take any risks, they are very small. If you won’t give it to me now, when can I come back and when can I get it and who can I see?’

6. If at first you don’t succeed…

Be persistent! If you don’t get the desired outcome at the first appointment, try again another time, and in the meantime research the evidence base for the reasons why your preference was denied.

You can ask to see another doctor (or nurse) within your practice – ask who has an interest in menopause or women’s health. If there is no one, consider changing practices or consider having an appointment with a private menopause specialist.

If you think writing a letter to your doctor would be useful, this template could help.

Don’t give up. You may need to talk to several doctors or nurses, explaining your reasons for wanting HRT, the information that’s led you to this decision, and that you know what the associated risks might be but that it is still what you choose to do. Persistence often pays off when you can give a clear and rational argument that shows careful consideration of the evidence of the risks and benefits to your health.

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