HRT- update your opinions.

[Missbopeep]

I've been on this forum for a while and just wanted to try to put 'the other side' about HRT.

There are loads of posts here from women who are saying they are 'afraid' of HRT and the side effects etc.

The latest message from several menopausal experts- British Menopause Society, and others in Europe, all led by specialist drs and researchers, is that for women under the age of 60, the benefits- both short and longer term- outweigh any risk.

The MW and WHI studies have been found to be flawed.

There is agreement that there may be a slight risk after more than 5-7 years on HRT, but no more than 2 drinks a day or being a stone overweight.

This risk from HRT may be even lower depending on the type of HRT used and whether it's transdermal or bio identical.

I'm not posting this to say HRT is for everyone, regardless, but equally it's clear that many women- and their GPs!- haven't read the latest research on risks/benefits.

Agree with you. I am currently using a vaginal only HRT and from the leaflet warnings you'd think it was crack cocaine... though the dose is equivalent to 2 ordinary pills a year. It's not working well enough though, and for quality of life I would definitely go for full HRT if the alternatives don't get me back to being able to sit, run, swim without extreme discomfort.
We're living longer than we did, and working longer, and need to be operating comfortably. Health risks appear to have been exaggerated but that message hasn't got through.

How long and how much local HRT have you been using?

That is really interesting Missbopeep. I am 49 and my periods are getting more eratic, no hot flushes yet, but a big increase in allergies (chronic hives) which I have read can be down to lowering oestrogen. My Mum has osteoporosis, so I want to protect my bones, but we also have lots of deaths from stroke in the family, so that is a worry for me .

Hellymelly- have you thought about asking for a DEXA scan to see what state your bones are in now? It is hereditary and a friend of mine was given a scan on the NHS due to her mum having early and severe osteoporosis. You could also arrange for one privately then at least you'll know how things are now.

The age that people had strokes is important- if this was in old age it would not be regarded as a risk for you yet. Also, transdermal HRT ( not pills) is not associated with strokes, or blood clots,( or only very rarely) and new research shows that taking HRT before the age of 60 cuts heart disease by 40%.

Miss Ovestin, for a couple of months, after trying ortho-gynest for a couple of months. Neither quite doing the job sadly.

You need to give it longer. Ortho G is 1/10th the strength of Ovestin so unlikely to make huge differences, and I've been told that Ovestin can take several months ( 4-6) to have full effect. Did you use as instructed? Every day for 14 days then 2 x a week thereafter? You can up that dose- there's no harm - if 2 x a week is not working for you. Maybe try 3x and see if that helps? Or go back and ask for Vagifem which is much stronger and a different type of oestrogen.

Moved from one to the other on the x2 dose, then realised it wasn't enough and did a 2 week nightly stint on the Ovestin, which I completed last week. The following day got the worst cystitis ever, followed by a period which I was concerned would remove the oestrogen before it had done the job. I now seem to have a liquidy discharge (sorry TMI), dramatically reduced outer labia size and frequent burning sensation and soreness. Can't sit down too long, and running gets sore too. Supposed to be having an examination at the GP's in a couple of weeks.

MissB do please tell me more about the 4-6 months bit (I was on Ortho for a couple of months -- during which I had the worst week ever) and then moved to Ovestin probably 2 months ago, but as I say only did the proper preloading in the last few weeks.

Also -- is Vagifem really stronger in the 10mg pessaries than Ovestin? I've tried and failed to find that out. I know it's a stronger oestrogen but someone suggested that it works less well on the receptors in that area.

Sorry to quiz you -- it's hard to get appointments with my GP at present and I am trying to pick up as much information as I can. I just want to be able to sit and work/play piano without problems, go for a run and (ideally) start swimming again without worrying that it'll cause all sorts of problems. It'd be nice to soak in a bath again as well (just water, of course!)

Thank you MissB

It does seem as if the cream can cause burning as you have experienced - I know lots of women who have had this.

I think this is listed as a possible reaction on the leaflet in the pack?

I don't know what to suggest re. that! Some people find ( talking to friends) that it does do the job intended but sometimes there is some short term discomfort- maybe not from the oestrogen itself but from something else in the cream. You might find that now you are using it only 1-2 a week, it is okay- no burning.

Vagifem is different- it's oestradiol- and Ovestin is oestriol- a weaker type of oestrogen. I know nothing about it not working as well but what you said may be true.

TBH I'd stop using it until the irritation has gone, then try again and maybe use just half the dose to see if you react?

I think with the 'few months' thing maybe I was wrong- I'd been told that HRT can take a few months to help with these problems but maybe it's not so long with topical creams.

The discharge is prob from using the cream- it's ll go.
The labia- hmmm- not sure- maybe been like that a while and you've just noticed?

I'll PM you with some other thoughts- ok?

Never had a PM, how exciting!

A PM virgin- find it now!

I will ask about a dexa scan, or have one privately. My Mum is 80, so not young, but she did break both legs in a fall in her very early 50s. I'm not sure if that was down to lack of strength in her bones then or not. Am very heartened to hear that about transdermals. My friend saw a great Doc and has bio identical hormones tailored to her, she feels and looks fantastic.

Oh and breast cancer risk, how does that pan out?

The risk for breast cancer is uncertain. The major studies showed some increase in cases but as these studies have now been shown to be flawed, the situation is unclear. Worst case scenario- those studies- was 2 more cases per 1000 women after 5 years use, and another 6 more after 10 years use. But these were older , overweight women who started HRT in their 60s and some researchers say they were not typical of the women who now take HRT- and that some would have already had undiagnosed breast cancer at the start of the trials.

This link here is to a recent study in Denmark and may interest you- it is on the effects of HRT on bones and heart disease. The study also showed no increase in breast cancer after 16 years' use.
www.bmj.com/content/345/bmj.e6409

If you you google Dr Nick Panay/ Daily Mail/ bioidentical HRT it's worth reading what he has to say on this. Basically, no dr can prescribe bio-identicals maybe in the way you mean because you'd need a daily blood test to get the precise daily dose!

There is a lot of confusion over bio identical HRT- what it should mean is HRT that is the same as we have ourselves- and not one made from mares urine such as the Premarin type used in the US.

You can get bio identical HRT on the NHS- any dr can prescribe this type of HRT either in a patch or gel- it's a 'normal' prescription drug.

www.bmj.com/content/345/bmj.e6409
sorry!

I have always had really positive views on hrt.I remember my mum abruptly becoming menopausal following a hysterectomy[and i guess her ovaries were removed too].She was in an awful state afterwoods,very tearful and not coping with life at all.The doctor prescribed Premarin and she is still on it at 74.She calls them her happy pills and has no intention of ever coming off them.There are risks associated with the long term use of hrt but the benefits for my mum[who is always tripping over things] outway the risks.
I have just started Femoston at 49 due to being perimenopausal.I'm nearly 4 weeks in and feel so much better.I had 3 dc's in my 40's so i can't afford to feel rotten for several years as my kids will also suffer.
Miss Bopeep are you a doctor/Nurse?.You seem to know a lot about hrt and the different preparations and side effects.

My friend sees Nick Panay, he is the man I was thinking of going to.

I agree with everything in the OP about HRT

Just need to clarify a couple of things re vaginal oestrogens since some remarks were made about strength of Orthogynest and Ovestin.

Gunshoes I am not clear from your posts whether you were using Gynest cream or Orthgynest pessaries? Regarding the amounts of Estriol in the 3 different estriol preparations available - unhelpfully the Gynest cream does not say how much estriol there is in one application (not that I can find), but since it is 1/10th the concentration of Ovestin I imagine one application of Ovestin does contain more - although I haven't seen the size of the applicator for Ovestin.

However one Orthogynest pessary contains the same as one application of Ovestin ie 0.5 mg estriol so they are definitely equivalent. Personally I think the pessaries are better as probably don't leak out so quickly as they are solid waxy things.

Although Vagifem contains oestradiol which is around 8 times more powerful than estriol (Gynest and Ovestin) in some respects, I read recently that these two oestrogens work differently on the vaginal tissues by stimulating different oestrogen receptors and therefore the doses needed are equivalent.

For anyone with problems of irritation down there I would always go for the Orthogynest pessaries - there is no applicator and you just push the small waxy capsule up there with your fingers and it does its job. I know it's a personal preference though and many women prefer Vagifem as it's a tiny vaginal tablet.

hellymelly Nick Panay? He's your man - one of the top gynaes - I would jump at the chance to see him!

Good to know he is the top chap, my friend suggested I see him.
teta, I am in the same position as you, have had my two dds in my 40s and now at 49 can't afford to feel so rubbish with small children. I am perimenopausal, so no hot flushes yet, but anxiety, allergies, itchy skin, periods that last weeks etc.

Hellymelly before going onto HRT i had a complete check up.Thyroid,liver function,cholesterol and a blood pressure/weight check and blood sugar.If you have a higher stroke risk it would be well worth doing.I just asked my gp for them.However i believe now,that these checks are rolling out nationwide.
I've also had an increase in Allergies and asthma plus general breathlessness[maybe due to anxiety].I do feel better now though after a month on hrt in spite of a very heavy period[withdrawal bleed].Apparently things take about 12 weeks to settle down in your body after starting hrt.

Hmmm. Never heard of all those tests teta- did you see your dr about feeling unwell generally then decide on the HRT route? Is that why you had the tests?
You'll always have your BP taken and this ought to be done very 6 -12 months, but it's not usual to have other tests done- the NHS couldn't cope!

I had brain fog and this can be caused by anaemia or a thyroid deficiency.I requested a cholesterol test and i needed a blood sugar test[due to glucose intolerance in pregnancy].Gp also did a full blood count to check for any abnormalities.She was extremely thorough and wanted to exclude all other possibilities.My fsh levels came back as fairly high so didn't diagnose a perimenopausal state at all[although this ia apparently wildly variable].The only diagnostic test is trying hrt to see whether it makes you feel better.
I also never go to the gp.Spent years of my life working with them and have lots of family memebers who are doctors.So i think she probably took me seriously when i said i was feeling awful.

That's what I meant then- the tests were not a routine precursor to HRT they were because you felt unwell generally. Most GPs would not do cholesterol tests as routine unless someone fell into a high risk category or it was part of the practice's 'well man-woman' package.
But it's always good to have tests done to see how your health is.

Hi, I'm new to this but found the conversation about Gynest cream really helpful when I was trying to decide whether or not to give it a go. I've now completed the initial 2 week-every-night phase and am 2 weeks into the twice weekly phase and just wanted to feed in that it has made an enormous difference to me and OH. I was diagnosed with vaginal atrophy, which I suspect has been a problem for years but went unrecognised by me and medics, and I would certainly recommend giving it a go if this is your problem. Just feel so much more comfy generally, and actually didn't find it nearly as messy as I'd feared - the benefits definitely outweigh the disadvantages:))

I've found some really useful stuff on this site re menopause hrt etc. really agree with op. also found it odd that womwnseem to be putting up either so much without trying mirena or hrt. especially when there are benefits to hrt. think gps also need some updating too.