To feel so confused about HRT safety

[Croissantsetchampignons]

I am 50 and in perimenopause. Symptoms come and go but I don’t feel great at all so am quite up for trying HRT.

But there is SO much mixed messaging about it. I follow lots of people on Twitter, some are very pro HRT like Dr Louise newson & then there’s another doctor called Liz o Riordan who was a breast cancer surgeon who got breast cancer and is very anti HRT and promotes a lot of messaging that it’s not safe.

HOW on earth are you meant to know what to do for the best when there is so much conflicting messaging in the medical profession. I just want to feel better and don’t feel ready to slow down at 50 but by nature menopause makes you slow down obviously!

Aibu to feel confused by it all?

No experience but virtual hug.
I guess it's all about risks and benefits isn't it.
Do you have more non medication avenues to explore? Evening primrose etc?
I know one person who didn't use HRT and one who is just about to start it. Both had very mild symptoms really so it all depends what your situation is. How much it affects daily life etc
Hope you're OK and it all becomes an easier decision for you 💐

You have to look at the data yourself. There is a group on Facebook called The Menopause Support Network which has all the data in its files section. Also Davina McCalls documentary and book are science based.

My symptoms were so bad I felt I didn't have a life really so HRT has saved me. I'm not sure how I could have survived without it- although I did try natural.remedies first and struggled through 6 years. I wish I'd started HRT sooner.

I'm always very suspicious of anyone who is rapidly anti any really useful, and in some cases, life saving medication. I'm not particularly knowledgeable, but I think taking hrt only slightly raises your chances of getting breast cancer.

I guess it's a risk reward scenario and you have to do what is right for you. Personally, I was close to suicidal from lack of sleep, which hrt (oestrogel gel and utrogestan tablets) sorted out almost overnight. I'd say talk to your gp, but they tend to be useless, so try the menopause board on here. You'll get lots of really good info and advice.

I just want to feel better and don’t feel ready to slow down at 50 but by nature menopause makes you slow down obviously!

I don't think it's a given that menopause makes you "slow down". If you have debilitating symptoms then by all means discuss HRT with your doctor. If they are perfectly manageable then just remember it won't be forever.
I had awful hot flushes for two years, nothing else and then freedom. No more hormonal cycles.

I regret not taking HRT, I think a couple of years of it would have made life easier. I was put off by the risk of breast cancer but got breast cancer anyway. HRT also protects your bones so you need to balence risk v benefit.

I am on HRT - been on it since 37 due to early menopause caused by autoimmune issues - and I find it all confusing too. I have been told, by both private (Newson health) consultants and nhs consultants that I am better being on it than off it because at my younger age my body should still be producing oestrogen etc so I’m simply replacing what my body should have - ie like treating a deficiency of any sort, ie thyroid etc (I also have hypothyroidism, lupus and all sorts). I am now nearly 43 and I’m not sure about it all going forwards. The tide seems to be turning a little and people are questioning it all more. There’s a huge Louise Newson “push” to say all the negative studies are unfounded and can be discounted but equally lots of other things out there to say the opposite. It isn’t as simple as people make it out to be. I guess a lot of it is weighing up personal risks vs benefits. I have been told that for me the benefits are huge - bone health mainly due to the risk of osteoporosis from the steroids I need to take for asthma and Addisons, and the overall benefit to heart health / lower risk of bowel cancer which runs in my family. But I have no history of breast cancer and the risk to me personally from that is very low so perhaps I don’t have the same worries about that as someone else.

The one thing that I do wish people would talk about more is that there is no increased risk of blood clots with the patches or gel forms of oestrogen. So many women in the lupus forums I’m on have APS or other blood clotting issues and have been told they can’t have HRT on this basis and it’s just wrong. They are been given incorrect advice and it denies them the right to make an informed choice.

Personally I'm much more wary when the medical profession speaks with one voice, and I'd much rather hear a range of perspectives so that I can make an informed decision for myself. Of course different doctors will have different opinions - this is the case with most things - would you really prefer to only get the official / approved message?

I just want to feel better and don’t feel ready to slow down at 50 but by nature menopause makes you slow down obviously!

That's an odd thing to say. Where did you get that idea?

The reality is that there is clinical evidence supporting and discrediting HRT. It also come down to interpretation of results.

What we know is that everything is about risks which ultimately are low, so it depends on how individuals consider their own comfort with risks Vs benefits.

Why not giving it a go for 3 months? Risks certainly become more an issue with longer term use.

Some find HRT such a relief that it is certainly worth what they deem small risks.

Others don't find the benefit of HRT worth the risks.

HRT did nothing for me, actually made he feel worse and I tried a number of different type/dose but it changed some of my friends life to the point that even if the risks were much higher they would still opt to take it.

HRT has got associated with cancer in the popular imagination in the way other cancer risks have not. If you have individualised risks for cancer, e.g. female relative with breast cancer, cancer gene, previous cancer, then you need individualised advice from a menopause specialist and oncologist. I think Liz O'Riordan has been pushing back at the narrative that even having breast cancer doesn't mean you can't take HRT. And it doesn't but it is incredibly nuanced and individualised. If you do not have a specific individual risk then you can look at the generalised risks for cancer. In general 1 in 7 women will get breast cancer. 1 in 7 women on HRT will get breast cancer. So at the top line level no major increase. At a more detailed level there are many factors known to influence breast cancer, including alcohol, weight, exercise etc. Taking HRT (from memory) is a similar risk for being overweight and not exercising and a lot, lot less than drinking alcohol. For me HRT gave me the mindset to exercise more, which helps manage my weight and last year I stopped drinking alcohol. So it indirectly has significantly reduced my cancer risk. Anyone who doesn't want to take HRT for the very small cancer risk but regularly drinks alcohol I would say is actually totally misinformed about cancer risks. You can access this information to make the decision yourself. But I would straight away discount anyone who speaks in absolutes, or who doesn't take into account nuance.

And also I have ostepenia. So I have the real risk of death or disability from a fall when I'm older versus a small theoretical risk of breast cancer which I feel I'm mitigating. So think about the other benefits too.

If you are familiar with reading scientific literature, there are a lot of meta analyses on HRT available within the public domain which might give you a more balanced view and help reassure you?

I've read loads. There still needs to be more evidence based research.

For me it made my life worth living again.

My mum had osteoporosis my sister breast cancer both didn't take HRT.

Good info here on the benefits and risks from the NHS. I wouldn't personally listen to Davina who obviously has her own agenda or any individual. All can be very biased depending on where they are coming from.
https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/

I don't think you are being unreasonable to be confused but I do think that the benefits of HRT out weight the risks. There is an American Oncologist Avrum Bluming who wrote a book called Oestrogen Matters, his wife had breast cancer and she takes HRT. HRT can help prevent osteoporosis and just as many women die from that as from breast cancer not to mention the protective effects on your cardiovascular system and potentially the brain.

In the end it is really up to the individual to look at the risks and benefits and decide what is right for them, for my I have fewer risk factors for breast cancer like I don't drink, I am vegetarian and have only one relative who has had a non-hormonal breast cancer while I do have relatives with osteopetrosis and who developed heart issues after menopause.

If I were you I would read a wide range of sources and then ask your GP for a trial and see how you feel. That is what I did and once I'd been on HRT I did not want to stop.

HRT lowers the risk of heart disease and osteoporosis. The stuff about breast cancer is from old data and medication, my sibling had breast cancer and I’m happily taking HRT

I think it depends on the person but many people suffer exhaustion in perimenopause, I know I did and after only a week on HRT I felt like someone had put rocket fuel in my coffee. Perhaps some of us are more sensitive to the drop off in oestrogen than others?

Hi OP, I’m not medical but I work in a hospital which does regular menopause q&a sessions. A Dr explained HRT in a way that I liked and hope might help you too - if you have symptoms which are disrupting normal life for you then take it, there may be other benefits to you as well as negatives but if you don’t have disruptive symptoms don’t just take it because you think there might be benefits.

I am sure if you are experiencing difficult symptoms, and consequent sleep disruption, then you would be exhausted. But there is nothing in menopause or particularly in the decades of postmenopause that is inherently related to "slowing down".

I am curious why the OP thinks that.

@lilacsinbloom There is actually a lot of research on the relationship between the Mitochondria and estrogen with estrodiol facilitating the functioning of Mitochondria so there is in fact a direct link to the reduction of estrogen and less energy production in the body not directly related to sleep quality as well as with ageing itself which for many people does precipitate and eventual slowing down.

There is also a lot of research showing that exercise improves mitochondrial function and a lot of the slowing down people assume is part and parcel of ageing is in fact unused muscles leading to sarcopenia and frailty, unnecessarily.

Yes exercise does help but I felt exhausted and I've always been fit and was really struggling to complete my usual runs, walks, and gym sessions. My husband asked me to come on a hike with him one Sunday and I said I just couldn't I could make dinner or go for a walk but not both because I'd be too exhausted. I did not have any sleep issues but my body just felt dead tired even though I eat well and exercise. Within a week of starting HRT this mysterious exhaustion left me and I was back to my old self with loads of energy. Absolutely exercise is important but I hadn't started HRT I doubt I'd be exercising at all now, as I said before menopause potentially affects different people in different ways, I never had hot flushes for example my main symptom as exhaustion which HRT fixed.

It is amazing how any of us managed to even stand up as little girls, pre the flood of estrogen at puberty.

It is very confusing. But ultimately, to me, that means that if something was really obviously "dangerous", like smoking, it would be obvious by now.

So it becomes a personal decision based on your own symptoms. For me that means topical oestrogen cream has put an end to my UTIs and discomfort, so that's a must. Oestrogen has lifted my very flat mood, massively improving my mental health. Testosterone has restored my libido and made my marriage much happier. Not taking HRT would mean frequent illness and discomfort, and borderline depression/unhappiness. So I'm happy to take the risk. without those problems would I bother? Probably not

You don’t feel great, and the probable ‘cure’ to that is HRT, as you’re perimenopausal.
Have you tried any supplements ? That’s what I did first, and my only symptom left was anger/mood, so im on my own 3 month trial as I am also nervous like you. I can say that it has helped so far.

You don't know much about mitochondria and its relationships with hormones or how things like puberty and menopause and ageing affect energy production do you? Why not educate yourself a little then come back and give an informed opinion.