My GP won't prescribe HRT — what to do (UK). Finally Seen

Your rights under NHS guideline NG23

NHS guideline NG23: Menopause: diagnosis and management is the controlling document. Updated November 2024. It states:

HRT is recommended first-line for vasomotor symptoms (hot flushes, night sweats), low mood arising in menopause, and for osteoporosis prevention in women under 60.
Body-identical HRT (estradiol + micronised progesterone) is the standard formulation.
Diagnosis in women over 45 is on symptoms alone — no routine blood tests.
The benefits of HRT generally outweigh risks for women under 60 or within 10 years of menopause.

A GP who refuses HRT without documenting a specific clinical contraindication — or who refuses because "your bloods are normal" — is not following NG23. That refusal can be challenged.

The "normal bloods" problem

This is the most common dismissal pattern we see. A woman in her late 40s or early 50s reports classic perimenopausal symptoms — irregular periods, hot flushes, sleep disruption, mood changes, joint pain, brain fog — and the GP orders FSH and LH. The results come back "normal." The GP concludes she is not in menopause and refuses HRT.

NG23 paragraph 1.2 is unambiguous: in women aged over 45 with menopausal symptoms, diagnose without laboratory tests. FSH fluctuates wildly during perimenopause. A single "normal" reading is meaningless. The diagnostic test is the symptom pattern.

If you are under 40, suspected premature ovarian insufficiency does need FSH testing — but that is a specific exception, not the general rule.

How to get a second opinion

You do not have to accept the first GP's refusal. Your options:

Same-practice second opinion. Ask the reception to book you with a different GP. You do not need to explain why. If reception asks, say "I would like a second opinion on a treatment decision."
Document the refusal. Before you leave, ask for the refusal in writing — either in your medical record or in a letter. Ask which guideline the GP relied on.
Bring NG23 with you. Print the relevant paragraph. The more prepared you are, the harder it is to dismiss.

Referral to a menopause clinic

If your practice is not confident prescribing HRT — especially for complex cases, women with migraine with aura, previous clot history, or when testosterone is needed — you have the right to referral.

Ask your GP for referral to the local NHS menopause clinic or Women's Health Hub.
If local waits are long, use Right to Choose to pick any NHS-funded menopause provider in England.
Your GP must process the referral. The choice of provider is yours.

Private options

If NHS access is blocked and you can afford it, private menopause clinics offer telephone or video consultations. Key points:

The HRT prescribed is often the same body-identical medication (estradiol patches/gel, Utrogestan) — no special "private-only" formulas.
Initial consultations typically cost £200–£500. Prescriptions are private and paid separately.
Some clinics offer shared care — they initiate, your NHS GP takes over prescribing. Not all GPs agree to shared care.
Avoid clinics selling compounded "bioidentical" HRT. NHS guideline NG23 does not recommend these — they are unregulated and untested.

When and how to complain

If the refusal is a one-off from a GP who otherwise engages, a second opinion or referral may resolve it. If the refusal is a pattern — multiple GPs at the same practice, or repeated dismissals despite NG23 — a formal complaint is appropriate.

Stage 1. Write to the practice manager. Set out the dates, the GPs, the refusal reason given, and the relevant NG23 paragraph. Ask for a written response within 10 working days.
Stage 2. If unresolved, escalate to the Integrated Care Board (ICB) — the NHS body that now oversees GP practices.
PHSO. If the ICB does not resolve it, the Parliamentary and Health Service Ombudsman can investigate.

The most effective complaints are specific: date, GP name, what was said, what guideline was ignored, what outcome you want.

Frequently asked questions

›Can a GP legally refuse to prescribe HRT?

Yes, a GP can refuse — but only if they have a documented clinical reason. NHS guideline NG23 recommends HRT first-line for most symptomatic perimenopausal and menopausal women. A blanket refusal without engaging NG23, or a refusal based on 'your bloods are normal' in a woman over 45, is contrary to the guideline and can be escalated.

›What if my GP says my blood tests are 'normal'?

In women over 45, NHS guideline NG23 explicitly says do NOT use FSH testing to diagnose menopause or perimenopause. FSH fluctuates during perimenopause and a 'normal' result does not rule it out. Diagnosis is on symptoms alone. A GP insisting on bloods is going against the guideline.

›Can I see a different GP at the same practice?

Yes. You have the right to ask for a second opinion from another GP at the same practice. You do not need to give a reason. If the practice refuses, you can request this in writing and escalate to the practice manager.

›Can I get HRT from a private clinic instead?

Yes — but you will pay privately for consultations and prescriptions. Body-identical HRT (estradiol patches/gel/spray + micronised progesterone) is the same whether NHS or private. Some private menopause clinics offer telephone appointments. Costs vary from £200–£500 for an initial consultation, plus prescription fees.

›Should I complain formally if my GP refuses HRT?

First, get the refusal in writing with the clinical reasoning. Then ask for a second opinion or referral to an NHS menopause clinic. If the refusal pattern continues, a formal Stage 1 complaint to the practice is appropriate — especially if the refusal ignores NHS guideline NG23.