Myths about HRT

[PollyPerky]

I'm so fed up with the rubbish treatment being dished out to women by GPs who are not up to speed. There is a HUGE contrast between what they are offering and the treatments offered by menopause consultants.

These are the facts according to NICE

It's a mutual decision between patient and dr- drs give the facts, women make the choice as informed adults!

HRT can be started in peri and continue indefinitely- up to the day you die if that's what you want and have no serious health issues that make it dangerous.

There is NO cut off point and NO age limit. (Starting for the first time over 60 is more risky so a lower dose is advised.)

Post meno HRT does not have to be the continuous type if women are intolerant to progestogens. Sequential can be used instead.

Patches and gel are safer than pills re. blood clots and should be the choice for older women.

Vaginal estrogen creams do not carry any risks, and can be used with systemic HRT as well.

Anti depressants are not to be used instead of HRT unless HRT is dangerous for the woman OR she has a clinical diagnosis of depression that is not linked to hormones.

Thanks that's very helpful

And that not only are you never 'too young' for HRT, but that the earlier you begin peri-menopause the more important it is that you take HRT to protect your bone density.

Yes !

Peri meno under 45 is classed as premature menopause so HRT is essential right up to 52-ish at least regardless of symptoms which may not be troublesome.

Also conditions like these:

high blood pressure
a mother with breast cancer
a mother with heart disease

are not valid reasons to be refused HRT.

Only 5% of breast cancer is hereditary. The rest is random or lifestyle related.

They may not be a reason to be refused HRT, but they may be valid reasons why some women are reluctant to take it.

Reasons, or misunderstandings of the true risks? Everyone has a choice and that's as it ought to be, but medical decisions ought to be based on science not prejudice or misinformation.

Really? There should be no scope at all for women's preferences, concerns or views?

They should just do whatever the latest 'science' tells them, despite the fact that 'scientific' views are always changing.

I disagree. Prescription of medication should be more thoughtful than that.

Christina why are you looking to start an argument? My initial post was with the aim to be helpful, because many women are ruling out or being denied treatment options. If you read my post above, it says 'Everyone has a choice'. Not sure how that can be clearer!

I don't know why you have put 'science' in inverted commas. Science and research is all we have, or you are then in the realms of 'belief' and 'myths'. Yes, new research can change our views, but unless you have a crystal ball, we have to work on what we know now.

It's impossible to look back over the history of medicine and not be agast at what catastrophic prescriptions have been 'scientific' proved to be effective at the time.

As you say, research is all we have and the current thinking and guidelines will inevitably change.

It's sensible to exercise a degree of caution about the latest medical guidelines, especially in the context of the commercial opportunities than pharmaceuticals offer.

You are right Christina. Equally, in the future, we will look back at how many people were denied treatment that has been shown subsequently to be life saving (think of old ladies with bent, humped backs/ broken vertebra as a result of lack of hormonal treatment.)

In my first post on this thread, it says 'It's a mutual decision between patient and dr- drs give the facts, women make the choice as informed adults!'

You are clearly sceptical about HRT which is your choice.
I've read pretty much everything out there on it, talked to my consultant about research and decided what's best for me with my medical history and risks factors.

I don't think anyone takes anything- whether it's bought from a health food store or via a pharmacist- without doing some thinking on risks/ benefits. Some of the biggest and most profitable companies are those flogging vitamins and supplements (Imperial Tobacco used to own a huge sector of the vitamin industry- they all exist to make money.)

Too many people base their decision on the myths and knowledge of earlier years. For example, that you have to stop taking HRT after a certain number of years. Or that you have to do exactly what the doctor says. Or that the doctor knows everything. In an ideal world the doctor would know everything, bang up-to-date. But doctors are just as human as their patients, with the potential for prejudices and over-confident ignorance, too. It is our responsibility to be full partners in our health and well-being, to inform ourselves and make decisions from a point of knowledge, not half-truths and ignorance.

Yes!

The thing is, most GPs get something like half a day's training on meno at med school (if they turn up and aren't hung over!) Unless they are interested in it, or go on courses provided by the BMS, they rely on a quick shufty at new headlines and press releases of research.

The BMS (chaired by Heather Currie who runs Menopause Matters) is fully aware of the dire state of most GPs lack of knowledge, hence their courses .

I'd never go to a GP for something with as many options as HRT unless they had a real interest and training in it. Read far too many terrible tales of poor and even dangerous treatment.

Of course GPs aren't experts in everything - the clue is in the name.

But it's highly offensive to say that med students 'don't turn up to lectures' because they're hung over.

People don't get a med degree that way.

Haha! You clearly don't know anything about student life
Both my Dcs were at uni with med students. The tales I could tell you! I can assure you they miss lectures due to being hungover and worse.

Um, I think I do!

well in that case why make statements that simply aren't true?
My DCs shared houses with med students and with drs. If you want to believe that undergrad medical students don't drink, don't get hung over and never miss lectures, carry on with those thoughts. :)

And if you want to continue to believe that medical students don't take their future jobs seriously, then maybe the specialist consultants that you cite aren't as objective and reliable as you would like to believe .

You're coming over as a bit silly now, sounding a bit desperate to have the last word. Not going to be drawn into trading insults. Have a lovely weekend.

Well I agree Polly.
I had breast cancer at 26 ovaries out at 46 (preventative) and was initially told absolutely no HRT.
After seeing a specialist who then liased with my other specialist it was decided it was far not beneficial for me to have HRT than not.
I'd already been suffering from no sleep, anxiety, inability to concentrate at work and zero sex drive.
I have young kids so really needed to stay on my game.
It's been a minor miracle and the long term benefits are huge.

I'm with you OP. I had premature menopause caused by earlier chemotherapy. Peri started at 29, but took years for periods to stop completely. I had years of being dismissed by GPs. Blood tests showed I was through Meno age 36. Now at 42 I'm on the pill and will be until mid 50s.

I still get judgemental comments about not managing it "naturally".

Why is it only things that affect women that we're supposed to not use modern medicine for? Childbirth, controlling periods, menopause, even mental health problems which disproportionately affect women.

No one ever bragged about not needing pain relief when they had a tooth out, or managing it naturally when they break their leg.

That's really interesting Ledkr and Donald.
My consultant told me recently that some oncologists are happy for some women who've had BC to use HRT, especially micronised progesterone instead of synthetic progestogens. There is this strong theory at the moment that it's not oestrogen that causes BC but the synergy between it and synthetic progestogens (in some women.)

I certainly agree with the pp that it is an area that is under researched and like you I had to do a lot of reading up myself.

I think for those of us with early Meno or cancer in our history it's harder because I felt at 29 that it was a medical problem, but the GP treated it as a timing issue!

I would like to add to my previous post though that I apologise if I sounded like I was dismissive of anyone who doesn't want hrt for any reason. Not everyone needs it, and not everyone wants it.

I just agree with the OP that everyone should make a balanced decision without the weight of years of being told it's all in women's heads influencing them.

My mother has a dowagers hump and very bad osteoporosis. She had an early menopause at 42 and was on HRT for 10 years. She is 73 now. Would it have been better for her if she had stayed on HRT? She is hypothyroid too.

I am 43 and peri as my cycles are more and more sporadic after being like clockwork for most of my life. I don't want to end up like my mum!

Thank you Polly. Excellent info

Wish I'd been started on HRT sooner

@pollyperky - really interesting, have you any info about hrt and hemiplegic migraine and stroke? When I first had hemiplegic migraine around 15 yes ago I was told I'd never be able to have hrt. It's not an issue yet (40) but something i'm keeping an eye on.

Museumum I don't know anything about that type of migraine and HRT, but I do know that 'ordinary' migraine is not an issue re HRT. (I get migraines but not too often and was told it was a non-issue.) The risk of blood clots is with HRT in tablet form as they have a slightly higher risk of blood clots / stroke. (But tiny nevertheless.) Women who have any raised risk are advised to use topical oestrogen (patches and gel.) This is in the NICE guidelines but it's fairly standard practice. (I've never used pill form.)

Tone my personal opinion is that your mum came off HRT too soon. As she had an early meno, the HRT she used was only supplementing her bones until the age of average meno (52.) She ought to have had a DEXA scan then and decided whether it was worth using HRT for longer, depending on her scan results. Ideally she should have had DEXA scans every 2-3 years to monitor her bones.
I suggest you ask for a DEXA scan in your late 40s or sooner as you have a hereditary risk. SEe your GP.