Peri menopause and HRT

[dodobedoop]

I've been having night sweats and hot flushes during the day to for a while. Finally went to GP, had bloods taken and she has confirmed it is peri menopause.
Am beyond tired at the mo with being awake so much at night.

GP did say if this is unmanageable, to go and we will discuss treatment.
What I would like to know is if I go on HRT now, is it just delaying the symptoms? When I come off it will I have the symptoms then?
Thanks

[whattodoforthebest2]

Hi Dodo

Sorry I can't tell you what's it like after you come off HRT, but I can tell you that I'm sleeping better since I started taking it around 4 months ago, also much less irritable, less moody and no hot flushes at all now. Other things which might be explained by HRT are: more energy, feeling 'normal' again, less headachy. However I get lots of aches and pains, so it isn't curing everything.

I'm pleased that mine is being monitored very carefully and so far I'm v v glad I'm taking it.

[dodobedoop]

Thanks Whatto

I might give it a go then. I have to be top form for work and just day to day stuff.
Some days I have to get up from my desk and move as can feel myself nodding off

Irritability wise I don't think I'm any worse than usual!! But I get this hot feeling in my head too.

[PollyPerky]

Look at it this way- even if it was to delay it, would you rather have say 5-10 good years without all this, on HRT, or not?

There is no way of telling how you would feel post-HRT. Women who do come off it often feel fine especially if they come off it very slowly over 6 months or longer. Others have all the symptoms back (sometimes for years and years) and have simply reduced those years by being on HRT.

It's a bit of a misunderstanding that HRT delays things. My dr says some women never get rid of hot flushes (my mum, for example) even at 80- whereas some women find they are all over in 2-5 years.

The other thing to think about is that HRT isn't 'just' for symptoms like flushes and sweats- it's good for bones, bladders, brains, reduces colon cancer, stops arteries furring up, keeps your vagina functioning and not shrivelling up.....

Convinced? :)

I've used it for 7 years and don't intend to stop unless there is real reason to.

[dodobedoop]

Ah thank you Polly. Yes I am indeed convinced.

[lokijet]

My GP put me on other meds to deal with night sweats etc rather than HRT so maybe see whether say and discuss which symptoms impact you most

[dodobedoop]

Ah ok. I was hoping to stay on the mini pill so alternatives to HRT are worth a thought too. Thanks lokijet.

[PollyPerky]

Just to make you aware of the NICE menopause guidelines (worth reading- all online)- GPs are advised not to offer alternatives to HRT unless there are medical reasons why a woman can't use HRT.

There has been a lot of concern amongst meno consultants that GPs are over-prescribing anti depressants to deal with sweats. flushes and low mood in women who are not depressed. The first line of treatment should be lifestyle guidance then HRT.

[dodobedoop]

Thanks Polly. I've been doing some reading and apparently it is safe to remain on the mini pill and to take HRT.
I like to think I'm pretty healthy, not over weight, I run about 10k a week and exercise also.
After another long night and tired day I'm going to book to see GP.

[dodobedoop]

Back again!
GP won't prescribe HRT due to family history of thrombosis. So I've been prescribed Clonidine for the flushes, and was offered low dose anti depressant for mood swings, I've opted against those, and warned DP to be afraid!

[PollyPerky]

dodo- it does depend on exactly what your family history is.

This is from the NICE guidelines

.5 Long-term benefits and risks of hormone replacement therapy

Venous thromboembolism

1.5.1 Explain to women that:

the risk of venous thromboembolism (VTE) is increased by oral HRT compared with baseline population risk

the risk of VTE associated with HRT is greater for oral than transdermal preparations

the risk associated with transdermal HRT given at standard therapeutic doses is no greater than baseline population risk. [in other words, transdermal gives no more risk that not using HRT at all]

1.5.2 Consider transdermal rather than oral HRT for menopausal women who are at increased risk of VTE, including those with a BMI over 30 kg/m2.

1.5.3 Consider referring menopausal women at high risk of VTE (for example, those with a strong family history of VTE or a hereditary thrombophilia) to a haematologist for assessment before considering HRT.

The NICE guidelines also say , 'no automatic exclusion [from HRT] because of medical history.'

You can challenge your dr and ask for another opinion.

What kind of history is it? Just as an example, my maternal gran had a heart attack at 60 (she was very overweight) and died from a stroke at 81. My maternal uncle died from a heart attack at 51, my mum had a TIA at 80. I see a very good meno consultant and am assured that none of the above family history has any relevance for me. There is also recent evidence that HRT started before age 60 gives benefits in terms of heart disease and reducing arterial plaque.

[dodobedoop]

Thanks Polly. I have a strong family history of DVT, both my Mum and her Mum. Also my Mum had a blood condition (can't remember name of it now) that meant her clotting factors were not stable, although no reason to think that this is hereditary.
The GP did read about referral to haematologist when factors indicate this may be required, but she seemed this not to be needed, and ruled out the HRT altogether.

I'm back in two weeks for review of new meds so will address the discuss the guidelines with her then.
Thank you!

[dodobedoop]

Oh, and will also read re the transdermal option.

[PollyPerky]

It's good that your GP is concerned, but it's not so good she is not up to date. The British Menopause Society is having their annual conference in 2 weeks time. It's hoped that the NICE guidelines will be shared again with GPs and HCP who attend the conference- and through the media so that the launch of the guidelines last November is not forgotten about. It's clear from forums that very few GPs have actually read and digested the guidelines.

[KindDogsTail]

I heard from a friend who went on HRT for the allowed amount of time, that yes the symptoms still came when she came off them. They had just been delayed.

Perhaps the GP could go over all this with you OP to confirm this ir otherwise.

[KindDogsTail]

Have you looked into natural alternatives, including magnesium?

[PollyPerky]

There is no 'allowed time' for HRT. That is one of the new recommendations from NICE- no time limit. If you read the BMS consensus statement it's on their website too. Woman can stay on it forever if they want to.

As for symptoms coming back if you choose to stop, well, some women find they do, others don't. The point for many women is they'd rather have 5, 10 or 20 years free of symptoms while perhaps we're managing teenagers, elderly and sick ageing parents and work, then maybe stop and deal with any symptoms when those pressures aren't so great.

[PollyPerky]

Just to add- it's really individual. GPs don't know the answer. Research shows that 5% of women never get rid of hot flushes (my mum swears she has them in her 80s) and 20% of women have them for more than 10 years. But the thing is, HRT is not just for symptoms like that- it's the long term loss of oestrogen that causes problems- like osteoporosis, heart disease, and so on- and it's also supposed to prevent dementia, colon cancer and other more serious illnesses.

[dodobedoop]

Thanks KindDogs, I will look at natural alternatives if I draw a blank with the HRT.

That's exactly it Polly, I get so tired that I can't function. I had to move away from my desk this week as was actually nodding off
I really need to be able to deal with work, DD and just life really!

[PollyPerky]

I don't know anything about your mum and your gran but were there underlying reasons for their DVTs? ie smoking, overweight, high cholesterol, inactive lifestyles?
It also depends on how old they were when they had these things.

Your GPs a bit 'off' TBH to refuse you specialist blood tests before she rules out HRT- it ought to depend on those results if she considers you at risk. but as the NICE guidelines say, transdermal shows no increase anyway, so she's not educated on it.

[Everytimeref]

Try taking sage before going to bed. It really helped me with hot flushes.

[dodobedoop]

Both mum and gran were young, I'm thinking 30's/40's when they had the DVT's. Both very healthy, active. Not sure if my gran's occurred during pregnancy. I will
speak with my aunt about it.

I will also read up on the transdermal option so I can go armed with knowledge! Thanks Polly, I appreciate your help

Thanks for the tip Everytimeref.

[PollyPerky]

I hope you get on okay :)

If you do have to look at other options the Royal College of Gynaecologists produced a research paper where they had reviewed all the scientific evidence for alternative options.

www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/pi-alternatives-to-hormone-replacement-therapy-for-symptoms-of-the-menopause.pdf

It's worth a read because it's easy to waste a lot of money on things that supposedly work!