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 polly. I'll be sure to check properly rather than rely on my gp when the time comes.

Thank you Polly

Here is a link from menopause matters om myths about HRT. On the Home page of MM there is a link to articles in the Guardian on menopause and this is one of the links

www.womenshealthadvice.co.uk/menopause/10-hrt-myths-that-every-woman-should-know

It's written by a dr and covers most of the points discussed on this thread.

The way Myth 4 is worded is a bit misleading though, given the results of the study published last summer.

www.theguardian.com/society/2016/aug/23/combined-hrt-increases-breast-cancer-risk-nearly-300

This article is very balanced though.

Not sure how it's misleading at all. 'Myth 4' says that being overweight or drinking 2 units a day increases the risk of breast cancer more than HRT. This is fact.

Even the research scientists say that the risk is 2.7% higher (than women not on HRT) but then amend further down the article to 1.7%.

You have to look at the absolute figures- not the percentage increase.
If a woman's risk is 2 in 1000, a 2.7% increase is just over 5:1000. A 1.7% increase is less than that.

The other thing is that the consensus is that HRT may stimulate existing cancer cells but not cause normal cells to become cancerous.

wwwmenopausematters.blogspot.co.uk/2016/04/hrt-and-breast-cancer.html

The conclusion from these two points is that combined HRT may, in a small number of women, stimulate the growth of cancer cells which are already present, rather than cause breast cells to turn into cancer, and the natural history of disease for each woman is not altered.

It's misleading because it deliberately says .'..all types of HRT.... Increased breast cancer risk', when it's not a myth that combined HRT increases risk, while oestrogen only doesn't appear to, based on current knowledge.

It's poor sub editing, or an oversight by the author, or some subs have changed the headline and made a mistake.

The features were commissioned by another media company in association with the Guardian, in a big drive to publicise the menopause.
The Dr who wrote it may have been misquoted once the subs got to it.
If it bothers you, might be worth contacting the Guardian so they can correct it online.

It only bothers me in the context of posts about the 'myths about menopause' and its attempt to suggest that it's a myth that the combined HRT pill carries increased risk of breast cancer, when it's actually fact.

I don't think it was poor subbing - I think it's a deliberate attempt to sidestep and downplay the facts, as much as they are known at this point in time.

But in that case the headline for myth 4 'is correct. Not all HRT causes breast cancer. Oestrogen-only HRT doesn't cause any extra cases. That's well known. some women will use oestrogen only HRT.
Sorry- not quite sure now what your point is.
It's not misleading in any way.

The headline says there is a risk of BC with all kinds of HRT. That's a myth. There isn't.

Thanks for posting this Polly ,
I mentioned HRT when I was with GP as I have been completely exhausted and wondered if it was connected to menopause.
I am having blood tests check thyroid etc but when I go back if all's well I was going to discuss HRT again.
I have high BP controlled on ramipril and also h/o stroke in family.
I want a wonder cure for my complete exhaustion/lethargy ,zilch sex drive ,aching body , poor memory ..I feel 90 and am only 54.

I have always thought i would be refused HRT

Thanks for posting this. I started hrt at 43 on combined as I was peri. Have since changed to no bleed type. GP advised me I would only be on it until around 50-52, I don't want to stop it as I feel so much better both physically and mentally. I now feel informed enough to demand my right to continue it in a few years when I reach that age, instead of dreading being forced to stop.

My mother has recently been diagnosed with breast cancer, which she says her doctor says was probably due to her HRT.

I assumed that meant I couldn't have it (I'm 49 so a decision probably isn't too many years away) But if a mother with breast cancer isn't a risk factor does that mean it is still something on the table for me ?

This is really informative thank you.

I'm 44, peri (confirmed by bloods), periods stopped last April nothing since, nada. My doctor advised I have HRT after a random conversation about aches and stiffness in my wrists and fingers in the last few months.

I used to have high BP (3 pregnancies induced, first one pre eclampsia) and was on Atenolol for 3 years after 3rd pregnancy. Not on anything at the moment but there is maternal strokes/BP in family.
My Mum is dead against HRT and doesn't want me to have it.

This is a real mine field, I'm just about struggling with coming to terms being menopausal let alone the rest of it

Sorry to hear about your mum online.
My consultant gets very 'frustrated' when they hear of other drs saying 'HRT caused your breast cancer' because their view is it's impossible to prove that. Breast cancer is caused by all sorts of factors, not least being overweight (main factor), sedentary lifestyle, alcohol , age and other things.
95% of breast cancer is not hereditary.
I've been told that it's only an issue if there are two close family members who have had it at a young age (ie before 45-50).

I think if I was worried by family history I'd go for annual mammograms once on HRT and use a type of HRT that was least risky (there is a variation in risk between the progestogens .)

Strokes and high BP are not relevant in young women (under 60) whether there is a family history or not. Again, these are often lifestyle related so whatever our mums or grans did is not necessarily going to apply to use, especially no we know so much more about how to avoid these things, through better healthier diets and exercise. (My own gran had a heart attack at 60 and a stroke at 80 but she was overweight and inactive.) There is also a lot of evidence that HRT started soon in peri helps improve the arteries and lowers the risk of CHD.

High BP should be treated anyway and the advice is to use topical HRT not pills, which is not linked to blood clots.

Polly

Mum is obese. She has struggled with her weight since she was a teenager. As far as as know, nobody else in the family has had breast cancer, let alone at a young age. My father died last year of brain cancer, but he is the only other case of cancer in the family that I know of.

With two parents with cancer in a single year, in their very early 70s.... I've more or less sunk into a "I'm doomed" sort of position anyway. So might as well enjoy the benefits of HRT in what feels like the not very many years left.

Really glad you posted this thread. I'm going to do some reading and digging. I live in a very rural corner of Italy and our few GPs tend to be very old school and not that up to date in the latest research. Going to have to get myself up to speed on my own and decide mostly based on that when the time comes. Although if it's better to start in the peri-menopause... the time might already be here. My periods are still here, same regularity, but they only last a couple of days now.

I do think you have to totally disregard your mum and dad's cancer. All of us will probably have one parent who has either cancer or heart disease. I think the stats are that 1:3 gets cancer, 1:3 heart disease / stroke and 1: 3other illnesses.

We could all get knocked over by the proverbial bus tomorrow, so worrying about what might get you when you are 70 or 80 is not relevant imo!

I do think you have to totally disregard your mum and dad's cancer

Rationally I had with dad's. The chances are his job caused the brain cancer. Emotionally, particularly since mum got diagnosed just months later, it's less clear cut, cos emotions go around being all ... emotional and irrational. I think it will take a little while to clear the "I'm doomed, DOOOOMED I tell you !" feeling from my head.

But it was really helpful to hear that mum's cancer is 't likely to be a clear cut case of HRT and I can't take it. Full Stop. No Arguement.

So thank you. I will look into it and try to work out how to get tested to see what point I am at, and what my options are.

I don't want it to sound as if I'm dismissing your worries. I'd be the same in your shoes. However, if HRT 'gave' women cancer, there would be many, many more cases of it. As it stands, some types of HRT are more risky than others. You can offset the risk by having a healthy lifestyle. Women who are overweight, drink and use HRT are adding 3 risk factors. No one will ever know which of those was responsible for cancer, or if it was the synergy between 2 or 3 factors.

There is an online tool for working out your breast cancer risk (don't have a link but it's not hard to find with google) and seeing how you fit within the population for your age etc.