Do you have to take HRT ????

[scottswede]

I am 50, peri-menopausal and wondering if you need to take HRT.
Symptom wise I am not at the extreme end of the spectrum, though maybe it will be worse later on.
Has anyone got to the other end without medications?
How much of an impact does taking/not taking meds have later on in life?
Is there any natural help that 'really' works?
As I say I feel I can cope at the moment but I don't want to be storing up problems for later on if I fly solo now.

llijkk
What I meant to say was that where depression and anxiety are part of the peri menopause- and someone hasn't had these before- then they are not a 'mental health' issue in the way we normally regard chronic mental health issues that have no hormonal connection. I suppose another way to look at it is if a man has low testosterone and depression was one symptom, he'd be treated with testosterone rather than ADs. But for some reason, some women are offered ADs not hormones.

I'm interested to know where you've read about women who have had worse psychological problems after coming off HRT- where would we / you find that information? There is no need to come off HRT at '58+' if it's preventing long term problems.

Margo Have a read of the www.menopausematters.co.uk website on the Prescribed Alternatives to HRT ( left hand side of Home page.) You will see that the effects of the SSREs are listed there and also the side effects.

If you feel ADs are a good alternative can you explain why- out of interest, please?

where you've read about women who have had worse psychological problems after coming off HRT

Try here, symptoms returned "in a tidal wave, particularly the panic/anxiety",

and here, "We are getting a lot of queries from women who have been taken off HRT by their doctor or have decided to do it themselves and are finding things really tough."

and here, "plagued with hot flushes and pins and needles in the fingers. I can find plenty of guidance on the menopause and why to/ not to use HRT, but nothing offering information on what happens when you stop HRT! Help!"

Some ADs have good evidence for effectiveness in hot flushes. I'm sure you know this as you seem well informed. See PubMed.

"Some women are surprised that their symptoms get worse when they stop HRT. And that the symptoms are worse than they were before they started HRT. One major reason is usually because of the “rebound effect” that is a common response to prescription drugs. The second major reason is that women may be taking less care of themselves now than they were before. The third reason is that once the estrogen receptors have been primed they need to be supported in other ways."

lljkk I think we are discussing 2 different issues. I thought originally you were saying that when women came off HRT their symptoms were worse- implying that HRT made them worse.
Yes, of course, many women's symptoms come back when they stop HRT. There are two points here: is it worth improving quality of life for some time (with HRT) than not improving it at all. And is there any need to come off it? Many consultants now- and this is discussed in a recent statement by the British Menopause Society ( on their website) are happy for women to stay on HRT indefinitely as long as there are no increased risks that outweigh the benefits she's getting. it's erroneous to think it always has to be stopped. Some GPs are doing this but they are not up to date.

If a woman chooses to come off it then yes, symptoms may return and then there may be other things like weak phytoestrogens that may help some women. I know someone of 74 who took HRT for 20 years came off it for 6 months, felt dreadful, couldn't function, and is now back on it.

When women come off it they have to do so gradually over 6 months, and at the same time try supplements which may help.

My mum is late 80s and has never got rid of her hot flushes - I was told by a consultant that some women don't - about 10-20%.

It's all a personal choice and there is no one-size fits all.

Margo yes, I ADs provide benefits for hot flushes. Menopause Matters info ( below) they are used primarily with women who have had breast cancer. They can also cause some of the problems women have with menopause already- insomnia, etc.

SSRI DRUGS (Selective Serotonin Reuptake Inhibitors). This is a class of anti-depressant drugs which seem to work on the "thermostat" receptor as well as neurotransmitters. Examples are Venlafaxine, Fluoxetine, and Paroxetine. They have been studied and widely used effectively for reducing flushes in women who have had breast cancer [Ref 11 and Ref 28] . Care should be taken however, if Tamoxifen is being taken as part of the treatment for breast cancer since studies have shown that some SSRIs may interfere with the action of Tamoxifen. Venlafaxine seems to be less likely to have this effect and so is the preferred option in this situation. The dose of SSRIs can be started low and increased gradually to minimize side effects. A greater reduction in hot flushes is seen at higher doses but the side effects such as nausea, dizziness, problems with sleeping, agitation and confusion may be worse.

lljkk No it's not just a 'rebound' effect - it's because oestrogen levels have fallen to an all time low over a number of years.
Many of the sites you have linked to ( not MM forum) are commercial sites that are promoting products for alternatives to HRT .

I guess we can agree that it's good that there are lots of different products that seem to help.

I'm 53 and definitely menopausal. Really don't want to take HRT - my godmother (an ENT consultant) is convinced it caused her breast cancer - and she is a very intelligent, informed, sensible woman now in her 70s. I always think (as I did in my worst pregnancy/small baby moments) 'what do women in Africa do?'. OK, maybe many suffer in silence, but I've always preferred the idea of just getting on with it. I started taking Menopace several years ago when I was peri-menopausal and have also been wearing a Ladycare magnet for a few weeks to help with hot flushes. (See other threads for people who love/hate/are very suspicious of this, but I say even if it's a placebo, do what works). Also just started with evening primrose oil and magnesium because a friend said it helped her sleep. I am a bit insomniac at the moment, but have other worries causing that. Finally I do exercise regularly. So as you can see I've thrown everything at it and something must be working because I feel pretty good most of the time.

It's great mrsmoo that you have found something that works.
But it is early days. I started on HRT later than your age now and was convinced I'd 'managed' without nothing.
It might be worth you looking at the video I posted -by the IMS consultant on menopause. It gives a balanced and up to date view of what is what, as well as describing the types of HRT which are considered 'breast safe'. HRT has moved on a lot since I expect your godmother took it.
Most women are not aware that drinking alcohol daily or being slightly overweight gives a higher risk re. breast cancer that HRT and the video talks about all of that.
Hope you continue to feel well.

My mother is 86 and still takes a small dose of HRT every other day. She has been taking it for over 35 years! The doctor tried to persuade her to stop years ago, but she pointed out that she has no contra-indications health-wise, or family history of related problems, and she is firmly convinced it protects her against osteoporosis.

I started using Evorel Conti (50mg) patches 4 months ago and it has transformed my life - I'm 54 and my periods stopped 4 years ago. I had awful hourly hot flushes, with accompanying nausea and faintness, and night sweats which destroyed my sleep and drove DH into the spare room. I did a fair bit of research beforehand, opted for the patches as the safest delivery method, and was able to argue the toss with my GP after a locum intially prescribed me something totally inappropriate for a post-menopausal woman .

I have some side effects - I get skin irritation from the patches and slightly odd mood-swings: it's a bit like having someone else's PMT . But frankly, I feel I've got my life back, mostly. Now if someone could just please locate my libido?...........