Trying to decide re HRT

[tass1960]

I am 55 and haven't had a period for 2 and a half years. I had made the decision not to take HRT and just try and muddle through. I was managing fine until I started getting vaginal dryness - I have been prescribed estriol 0.01%l but don't really know if it's working since my libido has all but disappeared and am a bit scared to try and be intimate anyway. My memory is non existent. The only other problem is more recent - my body feels like it's been battered - my shoulders, elbows, hands, knees, ankles, feet and back are almost constantly aching - I have just realised that this could be down to menopause.

Am considering speaking to my GP and I suppose my question is has anyone started HRT after struggling along without it and if so did it help? Does it help with the atrophy and dies it help with the aching body and memory? I would also be interested to know what type is best - am thinking I would prefer a transdermal type but would be interested to hear opinions on this too.

You might find i t useful to have a read of the Menopause Matters website and look at the pros and cons etc on HRT on the site.

Unless you have serious medical risks that mean you can't use HRT then what's your reasons for avoiding it?

The advice on HRT is that it is best started soon after the menopause. This reduces risks and gives the most benefits. For women who are 10 years post meno then the risks are higher and you have to start on a low dose.

1:4 women need local HRT (vaginally) as well as systemic HRT.

Many of us using transdermal use gel for the oestrogen and natural progesterone for the other part of it. Transdermal is much safer re. blood clots- no extra risk.

I've only ever used gel- recommended by my consultant- and been on it for 7 years. I've no intention of stopping unless there is a reason to.

Hope this helps- it's bit of a learning curve on HRT if you've not used it before, but there's a lot of info out there if you want to google and find it - research papers etc.

I went to the GP a few months ago as I had started a new relationship post divorce/menopause and was suffering from vaginal dryness. I was prescribed Vagifem and it's fantastic. The dryness has gone and I don't need to go for a wee nearly as often which has the unexpected side effect of better sleep. If my relationship doesn't last I have no intention of stopping it.

Thank you for replies.

I made the decision not to take HRT probably mostly through ignorance. I just assumed I would eventually have to through it all when I stopped taking it. I now know this isn't necessarily the case .

I miss being intimate with my husband (he does too but is very good about it). I want my libido back, I want to be able to have sex without being in pain, I want to stop aching constantly and I want my memory back. Not much to ask for !!

Am going on holiday on Saturday but am going to have a read at the website suggested and see my GP when I get back. Kinda wish I had sorted it before this then we might have had a proper holiday ...

It's best to deal with how you are now and what may help, rather than presuming how things might be 5 or 10 years ahead. Even now there is no time limit on the use of HRT if you're healthy enough to use it and starting over 60 is riskier- some drs wouldn't prescribe then but most specialists would , with care.

There are new developments happening all the time- some consultants have researched and trialled very low dose HRT- a quarter of the normal dose- and believe this may be one way for women to go long term. So we never know what the other options might be in a few years time!

It's also important to know that HRT doesn't just deal with the more 'minor' symptoms like flushes etc but can have a positive long term benefit on almost every part of the body.
My mum asked to try HRT when she reached 60-ish and her dr said it was too late. She'd had terrible flushes and sweats for years. She's now a healthy 80+ but still suffers from insomnia (started at menopause) and flushes. Some of her friends who have sadly died had illnesses that were clearly linked to low oestrogen- anxiety, 'nerves' as they liked to call it, osteoporosis, heart disease , bone and joint problems - most of which are a result of being oestrogen-deficient.

Have a good holiday!

Thank you so much Polly for your very informative replies. I have made an appointment to see my GP when I get back.

I agree that I should be dealing with this as it is now and having read some great stuff I really can't wait to get started. If I remember I will report back.

Hi I'm in same situation as OP and have looked at Menopause Matters website. I just wondered whether anyone could advise me which transdermal route people find most effective.

I had no periods for over a year, then had 2 two months apart and the last one which only lasted a day 2 months ago.

I have been trying to avoid HRT too (listened to too much media hype perhaps) but now am exhausted due to night sweats and waking up, anxious and depressed so have made an appointment to see my GP again tomorrow.

I have been researching the various options and would prefer transdermal route & will need progestogen too.

What is best way to go please? I'm very confused!

It's really a personal choice. There are patches or gel for Oestrogen but only tablets for progesterone if you want a 'natural' type of progesterone.

As you might be fully menopausal - 12 months with no period- you are best to start on a sequi regime which will give you a mock period each month. Doing it this way will help you to see how you react to each hormone as they are used cyclically rather than 2 every day.

Some people like patches but I've never used them; don't like the idea or look of a constant meno reminder! They come in various doses. With gel you can alter the dose but stick with each dose for at least 2-3 weeks to see how you get on. The idea is to use enough to stop your symptoms.

With progesterone, the 'natural one' is Utrogestan. This may have less risk with breast cancer- the stats are looking that way. You can only take it at bedtime because it can make you slightly dizzy and dopey! Most women use it for 12-15 days a month.

The other synthetic progesterone is Norethisterone which is used as 5mgs for 12-15 days a month.

It's really up to you which you get on with best. I used Noreth for 5 years but as I wanted to carry on longer term, I have now switched to Utrogestan.

Oh just another thought for you. Many GPs don't like prescribing gel- not sure why- think they just aren't aware of how it's used. Ditto for Utrogestan - you may have to ask / tell them. I get mine from a consultant so have had no problems because they suggested it first anyway.

Thank you PollyPerky. I've been researching on Menopause Matters site for hours now & am thinking oestrogel & utrogestan but then I've read that the dosage for utrogestan is quite often too high for people with unpleasant side effects, I'd night sweats & feeling wired at night.

I then looked at Femoston - going away from transdermal route but again what works for one doesn't work for someone else.

I guess I just have to decide & see how it goes. Had no idea this HRT business was going to be so complicated!

Good that you have had a read Nat. One thing to bear in mind- posts on forums tend to be made by people having problems and looking for help. There will be lots of women on all kinds of HRT who are doing just fine and don't join a forum; posts on forums can tend to be negative at times because those posters want to offload, understandably. I use a relatively high dose of Utro- 200mgs a night- and for the majority of the time I feel no effects at all. Occasionally I might feel a bit hot for a night or two, but the progesterone course for me is 10 days - not long to put up with fairly minor side effects. I'd try not to look for problems because the mind is very powerful.

Yes that's true Polly. Although there is a lot of helpful informed advice too! One last question re Utrogestan is how are you taking it? I understand there are capsules which people seem to react to more, or vaginal pessaries which seem cause fewer side effects.

I see from your earlier post you used Norethisterone for 5 years which appears to be a smaller dose than Utrogestan - would it be worth me going for something like this first and then going along the Utrogestan route at a later date?

Thank you - any advice gratefully received.

I agree there is a lot of helpful advice, yes. But women who are doing fine don't tend to join a forum specifically for meno. (Mnet is a bit different because you can 'talk' on all kinds of forums here!)
I take Utro orally. I know some women use it vaginally. This was suggested to me as an option by my consultant but for various reasons it may not suit me so i don't do it that way.
Norethisterone can have side effects too - I used to feel quite PMS-ish on it sometimes- so they all have a downside. I think it depends on how much you want to avoid synthetic drugs which seem linked to more serious risks longer term, but not in the short term.

Thank you again Polly. I will chat to GP this morning and see what we can work out.

Well you were quite right Polly, the GP who wasn't actually the one I had booked to see was bemused at both gel & Utrogestan. I explained what the progesterone part was & was told they would look into to it to see if it could be prescribed. She actually said "we prescribe tablets or patches" in a way that left little doubt that I was being a nuisance asking for something different.

I am hoping that when my doctor returns that he will be more open-minded about it as the GP this morning wrote everything down & said he'd be in touch. I really didn't feel I was getting any advice which I would expect from a GP which is really frustrating. I said to her that this method of HRT seemed to be more & more popular but was told that doesn't necessarily make it right!!

That is disappointing. :(

I think all you can do is 'insist' it is mainstream, just another form of transdermal, and has been used in the UK for a long time- especially by gynae consultants who know about these things.

It's no more expensive than pills or patches so unless there is a medical reason (which there won't be) not to prescribe it then you can ask for your preference.

Lots of interesting chat - am glad I asked now - seeing my GP on Wednesday and will report back ...

Quick update: I saw my GP on Wednesday but because I have quite severe breast pain though no lumps she would prefer to let that settle down and if it doesn't refer me to a breast clinic before prescribing HRT - had lots of bloods done and should get results at the end of this week I also have under active thyroid so she wants to check where I am with that since last time this was checked was 3 years ago. I will come back when I have some progress.

Hi Tass,
I was the same as you and believed all the hype written in papers re HRT until I went to see both a back specialist and a menopause specialist.
Told me that most older women end up in hospitals due to falls. They cannot recover because of weak bones caused by lack of estrogens. Their quality of life is severely impaired.

Anyway, I had a bone scan , bloods done and ovarian scan. My bone scan showed osteoporosis in my left hip and osteopenia in the rest! All due to lack of estrogens. My risks of having a broken hip are far greater than having breast cancer. I am now on gel (pump) and ustrogetan. I was lucky to be below 60 ..

Can't you insist for your GP to refer you to a menopause specialist?
As quoted above, I have found Menopause Matters forum fantastic.

Natfrenchie:
My protocole is three gel pumps per day and 100mg tablets Utrogestan x 7 days per calendar month.
I read that it is also possible to have a type of coil fitted instead of taking progesterone tablets (cannot remember the name).

Mirena coil can be used for the progesterone component of HRT.

Please don't ignore the fact that with the combined oestrogen/ progesterone treatment there is a greater risk of breast cancer (see NICE guidance). I went on it 3.5 years ago due to horrid night sweats and my GP said it would keep me younger longer. I was feeling great and waxed lyrical about HRT. Had a mastectomy last week and have five months of chemo to follow. And the sweats are back.

Really sorry to hear about your cancer Wild. I hope you are okay.

I think all women using HRT worry about the risks but for some, quality of life is important especially if symptoms last for decades. We are all at risk everyday whether as a pedestrian, cyclist or in the car- 10 people a day die in car crashes in the UK.

This is a really good video from Dr Currie- approx 35. mins in , she talks about risks and how it's now thought that HRT promotes the growth of existing cancer cells, but doesn't cause cancer.

www.menopausematters.co.uk/podcasts.php#hc-vid-three

There are also differences between the different types of progestogens and cancer- some have a higher risk than others. I won't use synthetic progestogens on a daily basis as they are linked to a higher risk.
Some of use Utrogestan (natural progesterone) - a huge long term study in France shows no increased risk of breast cancer with this type of hormone.
www.ncbi.nlm.nih.gov/pmc/articles/PMC1974841/

Hello,
Wild , I am very sorry to hear from your breast cancer. I hope all goes well. We are all very worried about this dreadful disease.

In my case, I was told that I would most probably get a hip fracture within 5 years which would affect my quality if life in a very big way.

I agree with Pollyperky, there are risks everywhere. Each woman is different and needs to discuss the risks with a medical professional .

I think that Pollyperky is referring to the same study?
www.virginiahopkinstestkits.com/bioidenticalbreastcancer.html

Yes, that's the same report Lico.

I'd hate to give the impression to anyone thinking about using HRT that I am blase about the risks. I think almost daily if I am going took back one day and 'blame' HRT if I ever get something serious from using it.
But all I can say is that consultant who is very very good, tells me there are risks using it (albeit very small) and risks in not using it. My personal risk factors and family history show I'd benefit from using it so I've had to balance that against other risks. It's never black and white or an easy choice, but all I can do is try to cancel out some of the risks by making other lifestyle changes- being a healthy weight, not drinking, keeping active etc, which are all big risks factors for illnesses.

Seen my GP this morning and left the surgery in tears - was so excited at the idea of getting started on HRT and getting my life back. But not today. The bloods she ordered have come back with abnormal liver results - she didn't appear worried but said could I come back and get bloods repeated later today (oh for the days when GPs could take a blood sample) so I don't think she isn't unconcerned. She saw how upset I was and said it would probably be OK and she had the prescription in front of her - she then checked my blood pressure and it was raised (175/93) - so because of that together with the liver anomalies no prescription for me today. She is going to arrange a liver scan and hopefully it is gall stones (no symptoms) and if it is that we can get started . If not gall stones God knows what's going on. So gutted right now.