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?

The updated NHS recommendations are that the benefits of HRT (cardiovascular, bone, & mental health for example) outweigh the risks, & that the supposed risks of old lack an evidence base

https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/

https://thebms.org.uk/education/principles-practice-of-menopause-care/bms-ppmc-resources-toolkit/what-are-the-benefits-and-risks-of-hrt/

https://www.chelwest.nhs.uk/your-visit/patient-leaflets/medicine-services/hormone-implants-in-hormone-replacement-therapy-hrt

I am feeling this now. I am 47 and tired a lot. My sleep is fine but I wake up every morning dragging myself out of bed. I do running but I am finding on my usual runs I have to a stop a couple of times. I have been to a womens clinic and was asked about hot flushes sleep etc but all that is fine it is purely the exhaustion that I am sick of. My bloods have come back fine but I was prescribed the hrt patch. I have the mirena which is sorting my progesterone. I actually haven't taken it yet not sure why but hearing how it has helped your exhaustion I think I will

@Dulra I hope it does help you, lots of women are amazed at how much more energy they have after starting HRT. Good luck!

Far out! I bow to your superior knowledge, my learned friend.

Do please stop quoting me. I asked the OP why she said what she said, not you.

I think you need to look at your personal risk factors and how hrt might help or hinder. I am using it because my bone density is poor but if that was not a worry and I had a genetic dispositions to breast cancer I might reconsider.

You then need to weigh this long term risk/prevention against the need to mitigate any short term menopause symptoms such as hot flashes or aches and pains.

I am 45 and started a low dose a few months ago due to very annoying night sweats where I had to sleep on a towel most nights. It’s really helped and I am happy to stay on the lowest dose possible to make a difference and then can adjust up later if needed. As others have said, it’s a cost benefit analysis but I’m really pleased I started it. No negative side effects all so far. Just annoying glue marks from the patch which I need to use oil to get off my thigh- but that’s a small price to pay for a good night’s sleep and my energy back!

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.

The biggest risk for breast cancer by far is age and being female. All those other "risk factors" are so tiny by comparison as to be insignificant.

Talk to your own GP or go to a well women clinic . Get your information from health professionals, not the internet.
I've been on HRT for a few years now and it's brilliant.

Sorry meant to quote that first para from a pp.

I was diagnosed with breast cancer aged 48, before I was perimenopausal. It was oestrogen fuelled so obviously HRT is not an option and I've been taking medication yo artificially suppress my natural oestrogen ever since.

I should finish taking it next year andni cannot wait for all the debilitating menopausal symptoms to subside.

I will develop osteoporosis.

Not really sure what I'm saying but I'm pretty sure that if I hadn't had bc or been high risk and they'd been a medication which could have prevented me feeling the way I
have for the last 9 years, I would definitely had taken it.

Okay okay I should have said controllable risk. But the same point stands. If you're truly worried about the breast cancer risk of HRT then I'm assuming you're equally worried about equivalent or higher ones. If not then you're falling foul of crappy media hysteria and need to properly research.

The thing is you can never really know whether it is safe for you as there are so many factors involved. I took hrt for 13 years and developed breast cancer which tested very high for both oestrogen and progesterone so I suspect it was a big factor in why I got it.
However, there is a history on my dads side, sister, grandmother, two great aunts who all lived to a good age, late 80’s to 95 but all had breast cancer later in life.
I don’t know if that was a factor either, my dad died at 85 and never had cancer and it was never suggested I had genetic testing.
My mum took hrt for 25 years, died age 87 , never had breast cancer. My Dsil died of it age 43 and never took either hrt or hormone contraception. I have one friend whose had it twice and never took hrt
but my neighbour who’s 78 has taken hrt for 30 years despite her maternal grandmother dying from breast cancer at 50 and she’s not had it .

I also thing stress can play a big part, my oncologist told me to make my life as stress free as possible going forward and just try and be as healthy as I can without being obsessive. I try and eat healthily and walk a lot but I’m not extreme but I have definitely reduced my stress levels by retiring and I now put myself first more. I appreciate this is not easy to do if you are younger and juggling children and work.

I would say take hrt if you have really bad symptoms which are affecting your life but if you can manage without it then don’t take the risk. I also have osteopenia despite taking it for 13 years so there’s no guarantee with that either.

Nothing is 100% 'safe'.

There are risks to taking any drug. There are risks to not taking a drug too.

Weight up what's right for you given your individual risk.

Eg weight/smoker/family history/ lifestyle

Does anyone know why oestrogen increases energy levels for some? I've read it's got something to do with uptake of glucose from the blood into the muscles which would explain it in part. But I then don't understand how you no longer need that same biochemical pathway in later life when you stop taking HRT. Does muscle mass decrease to match the lower oestrogen levels?

I would be cynical about anyone who tries to make things more difficult for women.

My understanding is that certain types of breast cancer mean that it is a bad idea to have HRT. For the rest of the female population, it is ok and may even help to prevent it as you are more active etc. The type of HRT used now is very different to the type used say 20 years ago, and it is also different from hormonal contraception.

There are benefits of HRT such as preventing osteoporosis, strokes, heart problems etc, and there are arguments that it also helps to prevent dementia -there are mixed results of studies on that.

I am not taking it myself because I don't need it currently/yet, but a relative of mine had a hysterectomy in her early 40s and is now in her early 80s and has been on it the entire time with no apparent problems.

You don't need to stop taking HRT.

I've been on HRT, because of early hysterectomy, for 37 years. No problems. I have checks. No problems..👍

Because I am bloody knackered. Nothing remotely odd about it. Our bodies slow down as we get older.

In the months before I started HRT, for perimenopause symptoms, all I did was sleep or want to be asleep. I didn’t have the energy and motivation to even wash my hair anymore or walk to the corner shop, and my aching hips contributed to that.

I had to started to think there might be something seriously wrong.

It was just days into HRT that my energy began to return. The aching stopped within weeks and most of the other troublesome symptoms stopped or reduced.

But that tiredness was absolute and I remember thinking that I felt 100 years old!

As someone considerably older than you, I would like to let you know - no, they don't. Perhaps in our 80s. Or if uncared for, or care of pain, or after a lifetime working in a physically demanding job. Bodies don't just "slow down" at 50.

By all means use hrt, but do something else for your body and overall health as well. The Age Well Project presents things simply and is a good place to start.

This is a useful chart

From the NHS:

https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/

This addresses risks for those under the age of 60. The risk/benefit ratio begins to change somewhat at 60+.

Interesting note: "Research has shown that taking HRT has little or no effect on the risk of getting coronary heart disease."

and

"More research is being done to find out how taking HRT affects some other conditions, such as dementia and diabetes. Any increased risk or benefit is likely to be small."

Overall it's a clear, balanced assessment.