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To HRT or not??

(29 Posts)
RafflesWay Sat 14-Jul-12 21:35:04

Hi everyone, would REALLY appreciate honest feedback please? Started peri in 2005 and things have got worse and worse over the years. I was diagnosed with under active thyroid 2 years ago so have to work really hard to keep weight in check and don't want to risk more weight gain as finally losing a little although not enormous - size 14 - but could be very quickly if I didn't follow a very strict diet and exercise gently daily. Hot flushes are now horrendous and extremely debilitating. Have only had 2 periods in 2 years now - 12 months between each! Didn't want to take hrt initially and GP not in favour either though not really sure why. I am 56 and have tried black cohosh, evening primrose oil capsules etc but they don't help at all. I have zero libido and now have started with itchy skin although I moisturise religiously so not really dry. Should I bite the bullet and finally ask for HRT or perservere?? Please has anyone had similar dilemna?

Bellaciao Thu 23-Aug-12 17:53:24

MissBoPeep is posting what is the current thinking re HRT and breast cancer. I have had another look at the literature and can't find anything significant yet about this.

However in any case, the latest information shows that the increased risk of breast cancer from HRT (oestrogen and progesterone) is small and probably nor greater than being overweight or drinking more than the recommended alcohol units per week.

silvercat - I would be interested to see the info from your gynae re cancer risk and transdermal HRT? I presume s/he is referring to the reduced cancer risk from oestrogen only HRT (rather than the route of delivery), compared to oestrogen + prog HRT - which is what the research seems to show? I presume therefore you have had a hysterectomy and are not taking progesterone?

For many health conditions - including coeliac disease, Crohn's disease, epilepsy, gall bladder disease, past liver disease, migraine, thrombosis - the transdermal route is preferred.

For me - it stands to reason that estradiol that has to go through the digestive system and liver, is likely to be associated with more side effects and possibly long term risks, than the same substance going straight into the blood-stream through patch or gel.

Also -much of the research into all sorts of risks has been conducted using synthetic progestins and where there have been studies comparing this to bio-identical ( micronised) progesterone, the latter is associated with fewer risks - although more research is needed here.

Yes it is sad that GP's are often ignorant and some try to prescribe ADs at the first hint of menopause.

MissBoPeep Thu 23-Aug-12 09:11:23

Look, there is no evidence that gel or patches reduce breast cancer risk.
The evidence shows that women who take estrogen-only HRT if they have had a hysterectomy, have less risk from breast cancer. Putting 2 and 2 together, this might mean that it is the other hormone on HRT pills - progestins- which adds to the cancer rsik when your body goes through a typical " cycle"- with both hormones in play as it would it you were still fertile.

Gels and patches may be safer in some respects- but truly, there is no research or stats showing they lower breast cancer risk.

silvercat Thu 23-Aug-12 01:37:00

I'm on oestrogel and was also told (by private gynae) that this has less cancer risk than taking the typical GP-prescribed HRT. He also said that if you have thinning bones (as i do), HRT will not only stop them getting worse but bring about some improvement over a couple of years. I feel great on the treatment so far but that may be because I've also got testosterone gel - something I'd not even heard of until recently. This addresses what I found to be the worst menopause symptoms - less energy, poor concentration and memory and worse anxiety/ability to cope with stress. I couldn't believe the ignorance of my GP on this whole topic, she actually knew less about menopause than I do from googling stuff and came out with things that are completely untrue including telling me I had 'severe clinical depression'.

MissBoPeep Wed 22-Aug-12 19:38:04

I'm going to send you a private message- look in your in-box!

gillypanda Wed 22-Aug-12 19:06:04

That's interesting, MissBP. The lady at the gym was told this by a private gynaecologist and endocrinologist whom she consulted to get information.

I've had masses of investigations over the years about the lack of periods, none have ever given a reason. I do have a bone density scan every 2 years as I am considered to be pre-osteoperosis. My grandmother had it, so I have been tested for the past 6 years, since I moved here and got a new GP. I've been taking a calcium and Vitamin D supplement, but my bones have thinned more in the last 2 years.

I'll chat all this through with the doctor in the morning, but it's very good to get other women's opinions too

MissBoPeep Wed 22-Aug-12 18:50:18

Hi
Sorry but the lady at the gym is incorrect.

The advantages of topical HRT- patches or gel- is that it bypasses the liver. This means there may be fewer side effects on the digestive system, amd possibly less clotting resulting in strokes There is no evidence at all it reduces breast cancer risk.

There are several types of estrogen used in HRT- Premarin uses horses' urine. Other HRTcontains other forms. it's all estrogen though- you can call it " bio identical" meaning it has the same molecular structure as found naturally, but it's still made in the lab at the end of the day!

If you have no had a period for 21 years what reason was given?

You MUST ask for a scan of your bone density as it may be that your bones have thinned from lack of hormones.

The risks from HRT seem to be linked more to the progestins than estrogen- women who take just estrogen HRT have no higher risk of breast cancer , and sometimes less. But you can only do this is you have no uterus.

You can reduce the amount of progestins you take by having a 3-month cycle on HRT not a monthly one but not many GPs go down this route- it's more often advocated by specialist gynaes who know all the facts.

gillypanda Wed 22-Aug-12 18:22:48

Thank you so much for your reply, Bellaciao.

I'm going to write all this down for tomorrow, my GP is lovely and will listen to what I have to say before advising.

And then I'm off to the dentist as I've got a sore tooth, and I'm terrified of dentists and my menopausal paranoia is making everything feel 10 times worse...sad

Bellaciao Wed 22-Aug-12 17:24:32

Yes I'm a long term patch user and fan! Don't let them fob you off at the docs! The difference to wellbeing (as well as long term health) is imeasurable. (not sure of sp). I can function like a normal human being.

I think this has been discussed earlier in the thread.

If you use bio-identical HRT as I do, it is not taking drugs - it is replacing hormones which become deficient in menopasual women ( like diabetics taking insulin and taking thyroxine for thyroid problems).

So yes - if you want to be completely natural then you would need to have an estrogen only patch (or gel) - I recommend Estradot as they are small and stick well, and you will also need a separate progesterone to prevent the womb lining thickening too much. I use Utrogestan - the only bio-identical progesterone licensed for womb protection on the NHS.

Any of the combi patches (Evorel or Femseven) contain an artificial progestin.

All the different types for post-meno are listed here:

www.menopausematters.co.uk/postmeno.php

I also belong to a friendly menopause forum where you can ask about lots of HRT types and everyone is willing to help:

menopausesupport.proboards.com/index.cgi

Hope this helps and good luck with the doc.

No-one needs to suffer as a result of menopause!!!

gillypanda Wed 22-Aug-12 09:23:51

I'm so glad I just found this discussion!

I'm seeing my doctor again tomorrow about whether to start HRT or carry on suffering.

I'm 51, haven't had a period since I was 30 (no reason was ever found, just "one of those things") and have been menopausal for just over a year. The hot flushes are making my life hell, I feel like my head is being boiled from the inside out, about 15 times a day. I don't sleep properly, I'm sad and paranoid about all sorts of things. My weight has gone up such a lot and I just can't shift it, despite swimming a mile a day and eating less calories than are recommended.

My doc has just done blood tests for thyroid, liver function etc and I get those results tomorrow. I'm assuming they're all ok, they were last time he did them, and I'm just a menopausal mess! I am very anti taking drugs and prefer natural remedies, but they've stopped helping too. I was talking to a lady at the gym about HRT patches, and she said they mainly bypass the risk of breast cancers which I associated with HRT, according to her doctors.

I'm obviously going to chat to the doctor tomorrow, but has anyone here used patches and found they make a big difference to their wellbeing?

ameliagrey Wed 18-Jul-12 17:16:07
ameliagrey Wed 18-Jul-12 17:13:33

I was thinking of the more serious side effects- cancer, strokes, heart diseasesad

thenightsky Wed 18-Jul-12 16:57:49

Side effects you say? Interesting. One side-effect that is really annoying the hell out of me is massively swollen ankles. By bedtime my toes look like they are individual little sumo wrestlers! I've always been skinny and boney of foot all my life.

ameliagrey Wed 18-Jul-12 16:06:19

Also- don't want to alarm you Nightsky- but Premarin and I assume prempak are made from horses urine- conjugated estrogen. This was the type of oestrogen that was linked to side effects in the WHI studies- I wouldn't ever touch it if I was ever offered it.

ameliagrey Wed 18-Jul-12 16:04:20

Ditto above comments- that's why gel is not often prescribed- cost factor yet in France it is the most popular/routine preparation.

Bellaciao Wed 18-Jul-12 14:55:31

Hmmm... sounds like you might have been fobbed off there. I mean - they could have let you try for yourself. I don't run but I do a fitness class once a week and nothing's ever happened to my patches from doing that. As long as they are stuck properly according to instructions in a place where clothing doesn't rub it off they should be OK. Having said that I use Estradot which are v small and tough but I use separate progesterone. A few women do have sticking/absorption issues with transdermal methods.
Might have something to do with the fact that Prempak are the cheapest - not that I'm cynical or anything!

thenightsky Wed 18-Jul-12 13:59:47

I originally asked for patches, but was told I wasn't a suitable candidate for them as I go running 3 or 4 times a week so would just sweat them off too easily.

ameliagrey Wed 18-Jul-12 13:13:41

The other point about amount of oestrogen is- the oral route is not the best- you need to take a higher dosage because the liver does not metabolise it efficiently. Changing to patches or gel may suit you better as it's absorbed more effectively and has a lower rate of side effects with stroke , heart disease and clots.

Bellaciao Wed 18-Jul-12 12:59:24

The info re falling oestrogen (as estradiol) came from the International Menopause Society - press release re a workshop clarifiyng the Stages of Resproductive Ageing.
Here's the link - it's quite academic!
www.imsociety.org/downloads/email_downloads/2012_02_16_1773491/straw10.pdf
Diagram on page 3 shows this graphically
Women vary a great deal in how much oestrogen (as estradiol) they finally get into their bloodstream from a given dose of HRT so maybe you do need some more. Some docs may be more reluctant to increase the dose with tabs but you are still young so defo worth a try if that product suits you.

thenightsky Wed 18-Jul-12 12:28:21

Bellaciao I am 53 and been taking it about 2 years I reckon, so the theory about oestrogen levels dropping post-two years would make sense.

This is a VERY interesting and informative thread.

Bellaciao Wed 18-Jul-12 12:14:09

Hi nightsky - it's medium dose. There is a higher one.
How old are you?
I have no experience of prempak as this is no bio-identical - it's the one made from equine oestrogens.
It may be that another HRT type would suit you better?
Depends how far post meno you are too as I understand about 2 years post meno the oestrogen levels really drop to their lowest level so symptoms could start to show at this point.

ameliagrey Wed 18-Jul-12 08:26:46

nightsky- if you go to www.menopausematers.com and look under HRTand the types of product, all preparations are listed as low/medium/ high dose.

Re. types of progesterone.

My dr believes it is progesterone which causes breast cancer. This is shown by the fact that women who take only oestrogen have practically no increase in breast cancer. He also acknowledges that most GPs are not up to date with the research, and dish out combined pills routinely.
The best dose is a transdermal route of oestrogen and progesterone once every 2 or 3 months to give a bleed.

Years ago, women were just given oestrogen. It was found this caused- or raised this risk- of endometrial cancer. My dr believes that the clock should be turned back , as the risks from adding progestins increase breast cancer risk more than leaving it out increase endometrial cancer- which is more esily treated and cured.

I asked him why GPs continue to give women combined hormones when this evidence is there- his response is that GPs are not, on the whole, up to date with meno treatment and research.

It's likely that non-specialists will not offer you this- but if you are well informed you can ask to try this.

thenightsky Tue 17-Jul-12 22:00:17

Prempak-C
0.625mg

I don't know if that is a low or high dose really

Bellaciao Tue 17-Jul-12 21:45:16

RafflesWay - I would say absolutely go for it! You are 56 so really the sooner the better. As far as I remember the research - although flawed - showed the risks of taking HRT, only to increase (slightly) past 60 and for those who started post-meno post 60 - can't remember precisely.
If you are less than a year since your last period you may be put on a cyclical HRt which will give you regular periods but if it's nearly a year you may be able to go onto continuous combined HRT (oestrogen and progesterone) which means you won't bleed ( may have some initially until settled down).
Personally I would go for transdermal (ie patches or gel) which is thought to be sfaer long term. Depends on how you were during periods - eg if you had bad pms during the second half of your cycle - it might be better to go for natural (bio-identcial) progesterone such as utrogestan. Otherwise maybe a combined patch.

The GP might try to fob you off with the cheapest so have a look at what's available - all listed on the Menopause matters website here:
www.menopausematters.co.uk/treatment.php

I think it may interact with thyroid medication so possibly you would need a higher dose but your gynae should be able to advise here.

Btw I am 59 and have been on HRT since just under age 53, apart from 3 months when I stopped age 58. I choose to have a cylce ( 2 monthly) because I don't want to be on continuous progesterone - but many women are happy with this.

The nightsky - depends how old you are and what stage in meno, whether you increase the dose. The standard anyway is usually to prescribe the minimum dose needed to eliminate the main obvious symptoms - which for most women are the flushes and sweats so if these have come back there is a good case to increase - depends on what else you are taking though too? What HRT are you on at present?

thenightsky Mon 16-Jul-12 23:02:11

I've been talking it about 18 months. It's been great, but lately I've been getting dry itchy skin and hot flushes back again.

Has anyone ever increased their dose at they have gone along?

RafflesWay Mon 16-Jul-12 22:56:26

Many thanks everyone! Think from what you are saying I will persevere!

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