Why is Hrt not prescribed more?

[Viggooooh]

Just listened to a zoe podcast where it talks about the menopause and that women after menopause are at increased risk of dementia, heart disease and osteoporosis even if you do not suffer with negative symptoms during the menopause

Additionally it talked about the problems with the study in the 2000's that found there were additional risks of cancer and consequently the updated nice guidelines that hrt should be prescribed.

In that aibu to wonder why are we not prescribing hrt as a matter of course as we do with stating for people with high cholesterol? For the health benefit rather than only prescribing for the negative symptoms?

Well to be fair there are also not insignificant concerns re routine prescribing of statins due to side effects and cherry picking of the data to support their use ( studies showed statins reduced mortality from heart disease but not all cause mortality). I’m not sure I’d take them.

it’s probably also a “jam today vs jam tomorrow” argument where the government has to pay for HRT now to possibly avoid costs of caring for someone with dementia in 30 years when those costs won’t be their problem anymore.

Yes I picked statins as a comparison for precisely that reason. Despite the health risks associated with statins they are routinely prescribed. Hrt is not. I didn't even know that there were health risks associated with the menopause just thought that hrt was used to manage symptoms. I suppose the cynic in me is thinking it only affects women so that's why!

@Viggooooh , I’m 50 and I don’t want too take hrt . I have adenomyosis so I’m not keen on adding hormones, I’m also not entirely convinced of the benefits of hrt . It however absolutely should be prescribed to women who want it .

Because HRT and menopause is not an enforced learning for GPs it's an elective. A condition that impacts half the population and not all our GPs understand the massive impact it has on us.

It's a lottery whether your GP is good with HRT etc or not.

HRT literally saved my life, mental health and my career.

I went through early menopause and was refused HRT until nearly 15 years after my last period, despite the recommendation that women in this situation should have HRT. When I was prescribed it I was told it was too late for it to make a difference and I could only stay on it a year.

I now have to pay privately in a country with free prescriptions. A lot of the advice you read here and in the media doesn't work when you are trying to get HRT in reality. The topical oestogen, people always say you can use it more than twice a week if needed and repeat the loading dose if needed but my GP days there's no way they would prescribe it for more that 2x a week. I got one pack of 28 on prescription and that was that so I have to buy that as well but luckily you can buy it over the counter.

I feel there is sexism at play here. My female GP is very patronising and dismissive and I come away feeling like a write-off.

Oh yes absolutely it should be an individual decision between you and your Dr. My issue is that hrt is presented as a fix for symptoms rather than advising that actually your risk for x y z will increase after menopause and that hrt can help reduce that risk. And then allow us to weigh up the benefit for ourselves. Dr. louise newson who presented on the podcast wasn't able to convince her Dr to prescribe her hrt despite her being a menopause specialist.

I had no problems whatsoever getting HRT. I was over 45 and told them my symptoms.

I imagine cost is a factor too.

Although hrt can help prevent some conditions. In hindsight, it may be cheaper to provide hrt than treatment later in life.

I had no problem accessing HRT at 43, just asked for it and was prescribed it over the phone.

I also take statins. They get such a bad press but not had a single side effect, and my cholesterol has reduced from 5.2 (about average) to 3.4. They are a precautionary measure for me to manage risk for both heart disease and dementia.

Hrt is routinely prescribed though?

Only for symptoms. When the data shows whether you have symptoms or not you are at increased risk of heart disease, dementia and osteoporosis

I think in years to come it’ll be a given that you’re offered HRT regardless of any symptoms, to protect you against what you mentioned.

I recently had a blood test for my oestrogen levels prior to be given testosterone and despite being on a 50 hrt patch my levels are really low which made me google low oestrogen symptoms and having read them my GP doubled my hrt dose

Being blunt it's because it affects women. Our healthcare is always the thing that suffers - my GP asked me if I wanted to continue HRT and she said she had to ask as it was expensive. I asked her if she was expected to ask men if they really needed viagra and she said no it was only HRT she was expected to reduce.

To be fair statins aren’t “routinely prescribed” to everyone. They are prescribed when someone’s risk scores are above a certain threshold (QRISK) and the benefits then theoretically outweigh the risk on a population level.

they aren’t just given to everyone above a certain age. Which is really what you’re suggesting for HRT (age/ menopause)

Also number needed to harm with HRT - anywhere between 50-100 depending on type (far less with oestrogen only)number needed to harm 200 with statins.

To be fair , I have had to actively say I didn’t want hrt .

Pharmacies seem to have enough difficulty keeping HRT in stock as it is. Until they can sort out the supply issues, I’d prefer them not to start prescribing it to everyone!

Statins aren't routinely prescribed for everyone, though? They get offered to people who have cardiovascular disease and people with a specific medical and family history of CVD whose cholesterol level hasn't responded to diet/lifestyle changes.

I don't know any women who have even the slightest of problems getting an HRT prescription from their GP. I know three women who were prescribed HRT when they didn't need it, though. All three of them went to the doctor with symptoms that were troubling them and in all three cases the doctor assumed it was probably perimenopause because they were women in their late 40s, and prescribed them HRT. Turned out not to be perimenopause in any of them! And the conditions they were actually suffering from went untreated for months.

I've no problem with HRT - I would certainly request HRT if I felt I needed it. So far no signs of perimenopause but I'm 48 so the time cannot be far off! I certainly don't think there's any evidence that it should be 'routinely prescribed' as a preventative measure to all women, though.

I would also add a gentle reminder here that the Zoe podcast is a commercial venture and linked to the expensive Zoe diet plan primarily purchased by women. It is in Zoe's interests for women to worry about their health. It's always well worth bearing that in mind when listening.

Viagra isn't available on the NHS; you have to pay for it yourself.

The generic version of it, which is a lot cheaper, is available on the NHS, but only for men who have a diagnosis of erectile dysfunction, which is a medical condition, not for men who are experiencing ordinary hormonal changes as they get older. So I don't think the two thing are at all comparable.

I absolutely do think that some women's health issues are under-researched and under-treated, but I don't think that's really why your GP asked if you'd like to continue your HRT.