To not want HRT

[Howszaboutthat]

Need some advice from ladies-in-the-know

I never got on well with contraceptives. They gave me perma-pmt and acne. So, for the last 15 years I’ve had a copper coil which is coming out soon. I was hoping to just ride it out sans synthetic hormones.

I’m 46.

However, Over the last year, the brain fog and poor sleep has set in. I’ve partically solved this by giving up alcohol, taking vitamins and magnesium. The brain fog is getting worse. I feel like such a dunderlinger and my role requires a lot of brainpower.

Other thing - dryness down there. My first UTI in 25 years.

What can I do that is not going to turn me into a fat, lifeless blimp? I was hoping to ride this out. But I think I need to re-think. Also I don’t have time to be endlessly up the doctors (we’re not allowed time off work for appointments in working hours)

Any advice? Am I doomed?

Also, I find Lions Mane brilliant for cognition, brain fog etc.

The pro-HRT brigade here are so incredibly defensive.

I'm not "pro-HRT". I am very happy being on HRT and it was the right decision for me. If other people decide it's not right for them, then that is the right decision for them.

What does grind my gears is misinformation about the risks or otherwise of HRT. Because with outdated/irrelevant information, women can't make proper decisions, can they?

You are describing typical menopause symptoms. Nothing perimenopausal about it.
HRT cannot be compared to contraceptive hormones, the dosage and the type is different.
personally, HRT was a life saver for all the things you describe. It also protects bone health and heart health.
You should make an appointment with a gp
or gyn to get your hormone levels checked and to get yourself properly informed about the difference between contraceptive and hrt hormones. You don’t need to take hrt, but there is no need to suffer from menopausal symptoms.

It does, in fact, mention transdermal HRT in relation to an increased risk of blood clots.

I'm sure the usual suspects will be along shortly with some excuse to minimise it and attack me but it's there in black and white, my bold below.

Furthermore, we observed an increased risk of venous thromboembolism with several hormone therapies: oral combined continuous (hazard ratio 1.61, 95% CI 1.35 to 1.92), oral combined sequential (2.00, 1.61 to 2.49), unopposed oral oestrogen (1.57, 1.02 to 2.44), and transdermal combined (1.46, 1.09 to 1.95).

But they are relevant because they are still being prescribed. Tiblone in over 70 countries for example.

And propellor planes still fly, but the odds someone asking this question is getting on one are low.

Yes, it's good to be informed and make an informed decision, so if you had said

There is some new research that shows an increased risk of heart disease, heart attack, stroke and blood clots from oral HRT such as Tibolone apparently

it would have been not only factual, but helpful instead of potentially needlessly alarming.

And, by the way, I'm not an HRT advocate. I just think that some women sail through menopause, some struggle but are fine, and some have a terrible time and it would be a shame for people in the last group to be scared off from accessing help.

It would be interesting to know how many women on this forum are on oral HRT. I'm guessing it's a low percentage as it seems to be a very rare first port of call for prescribing.

It’s an interesting point - I guess historically a lot of us wouldn’t have made it as far as menopause before something else took us out. We are expected to spin a lot of plates - work, raising children, perhaps caring for older parents…it’s a lot to cope with as well as the menopause. I’m not saying our ancestors necessarily had it easier, conditions were harsher but probably less bandwidth required.

And to respond to the PP, I am not disputing at all that HRT is a massive help for many women - it’s more just that it seems to be almost expected that it will be necessary, and used as the first port of call when there are more natural options that can be tried. I seem to be doing ok on just supplements, I do notice the difference if I don’t take them so I believe they are helping. Personally I have high blood pressure a strong history of cancer on the female side of my family, so whilst I absolutely haven’t ruled HRT out if I feel like I’m not managing, I’d prefer to not take it if possible.

The mirena coil is only the progesterone part of HRT. The oestrogen is what you need to address menopause symptoms. You have to take progesterone alongside oestrogen to protect the endometrium but it won't do anything for your symptoms by itself.

Perimenopause means the period of life in which a woman experiences menopausal symptoms. Menopause means the point at which your periods have stopped. The symptoms (perimenopause) can go on for a decade or more.

We're not defensive we're sick of being judged? Are you like this with other prescription medication? Do you ask people in your life who take heart medication, or thyroid medication if they're aware of the side effects? Everytime you see someone drink alcohol do you ask them why they're accepting the increased risk of cancer? If you don't challenge everyone else why are you doing it with HRT? It's a prescription medication, prescribed by a professional who has already assessed the risks with the person. And your ill-informed opinion adds what? It's incredibly hard for the women who need it to get the help they need. I just don't understand the people who come along thinking they have to cut them down. Especially when they don't know what they're talking about.

Transdermal combined is one type of transdermal and probably the least used. Most women get their HRT from transdermal oestrogen (patch, gel, spray) and get the progesterone separately.

And lots of women don't have progesterone at all. Women who have had a hysterectomy clearly don't need progesterone to protect their uterus.

I'm 41 and tried HRT to see if it helped my sleep. It didn't. I don't have any other symptoms enough to continue.

Hrt made me feel like I was floating above my own body - a horrible feeling. I also felt out of control of myself, like I might blurt out something really odd or embarrassing in company.

It's put me off trying again unfortunately, so I'm going to see how I manage with my usual diet, lifestyle, exercise, creatine and supplements.

@Checkcheckout

I can totally understand avoiding HRT is there’s a high risk of cancer: that’s completely fair. Why didn’t you just say that? Without all the “medicalisation” stuff.

I bristle at the use of the word “natural” in this context: firstly because its scientifically meaningless and misleading and also is often used as a way to bully women in particular into feeling guilty about getting help (pharmaceutical or otherwise) with sometimes debilitating biological symptoms.

Very happy for you to avoid HRT for your very legitimate reasons but please don’t imply that avoiding it until its a matter of last resort should be the goal for all of us.

IME the brain fog does lift eventually. You're likely progesterone intolerant, there's a lot of us. I did try various hrt preparations and each one caused significantly worse symptoms than the menopause itself, even the menopause clinic couldn't help me. Some of us just can't take it and there's very little understanding of progesterone intolerance in the medical profession.

Why do you think this? Weight gain is mainly caused by menopause changes not HRT used to control those changes.

I put on over 3 stone before HRT. I've realised that for me personally an increase in cortisol was partly to blame. Also, fat cells contain oestrogen which our bodies are craving, so the body does all it can to create fat. Mine succeeded! I was hoing to the gym 4 times a week at the time and eating healthily and yet was gaining weight.Sadly my TDEE is now 1400 calories.

I resisted HRT gor 6 years and it's the biggest regret of my life. I was an absolute mess.

Oral oestrogen being linked to blood clots, like the pill, isn't new though, and it's why transdermal has been the preferred first option for years

Yes, so being in a medical journal this helps doctors not to prescribe this oral form of HRT. Trans dermal HRT is the most prescribed form and doesn't have these risks.

Yep and we have had no issues prescribing oral contraceptives for years even knowing the risks. Medical misogyny all round. The pill prevents pregnancy so that’s fine.

But shock horror if women want to top up their depleting hormones through menopause. That’s ’medicalising’ a natural process.

People aren’t ’pro HRT’. It’s just shocking how much misinformation and lack of knowledge there is around HRT. I spent a long time researching it. Reading books and all the studies. Because GPs don’t seem to be that knowledgeable. The official line from the NHS is now that for most women the benefits outweigh any risks.

It has been life changing for me. I don’t want to murder my husband anymore. I have slept better than I have in years. My mood is better and stable. I actually have some motivation and energy back. I wish I’d started earlier.

That’s not being pro HRT. It’s not not for everyone.

But I’m bemused, even at myself for being on the pill for 15 years!! Without batting an eyelid. Yet I was scared to go on transdermal HRT. And we have to wonder why that is. There’s a lot of work to do to undo the damage that the flawed WHI study did 20 years ago. That is why many of us on here are vocal. It’s important people have all the facts and can make an informed decision. Not one based on fear and misinformation.

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How did you combat the cortisol, if I may ask? I am also putting on weight despite exercising and a great diet. I try to get enough sleep and time to myself.

I never got on with the contraceptive pill so never used it. I have been on HRT for around 8 years now - a total lifesaver that enabled me toparent a tricky teenager and hold down a professional job, marriage and life. I still take it as I still work full time and daren't risk coming off it as it helped so much. I understand it is now considered safe for long term use as the benefits far outweigh the risks. I haven't gained any weight - but I do eat healthily and exercise.

I also eat healthily and exercise. I was a size 8 before menopause hit!

I didn't combat it. HRT helped with everything else but it's impossible to lose weight as I need to eat only 1000 calories a day. I ended up using Wegovy.

Excess cortisol also caused gum disease which has also stopped since HRT.

Yes, menopause & middle age is what can cause weight gain & loss of muscle mass. Not HRT.

There is evidence HRT causes an increase in boob size, isnt there? I have gone from a 34 A to a 34 DD.