So HRT

[oldschooloon]

Yes ? .... Or no . Thoughts please ?

I've been taking Femseven sequi for almost 6 years now. Its been brilliant, but all the stats seem to show that the breast cancer risk increases after this long and at my age. Very difficult decision whether to stop but the medical papers seem unequivocal about this sadly...

Perhaps but it's a risk not an absolute. It doesn't mean you will get cancer. You can offset the risk by being more active, not drinking and eating healthily. Equally there are risks in NOT using HRT- heart disease, osteoporosis and higher risk of bowel cancer. And not all types of HRT are equal in risk. Some types such as natural progesterone are thought to have a lower risk compared to synthetic progestogens.

Its tough isnt it - however you look at it, even if you are slim, eat healthily and exercise, HRT will still increase an individual's chance of getting breast cancer. I agree entirely about the benefits, but I wish it was a more straightforward decision.

No that's not the case.

Have a look at this.
menopausematters.co.uk/pdf/Understanding%20Risk%20of%20Breast%20Cancer.pdf

If you look at how you can reduce your risk, you can reduce it more than the number of added cases of BC.

4 more cases for women on HRT.
7 fewer cases if you do more than 2.5 hrs exercise. So that means still 3 fewer cases for women on HRT who exercise.

And if you read the blog on Menopause Matters by Dr Currie the latest thinking is HRT might accelerate existing tiny tumours, but not cause them.

Mmm I've seen that before, but I'm not sure it really makes the decision any easier. So say I reduce my personal risk to a 16 in 1000 women by exercising (which I do), that's great, I am at less risk than the general population. If I take combined HRT, I am then upping my risk again by 4 so back up to 20 in 1000. That means for me, my personal risk of BC is higher than if I didnt take HRT, even though it is lower than the average person. Does that make sense?

No it doesn't make sense because...
the 23 :1000 women will include women who are:
-obese
-drink more than 2 units a day
-smoke
-are inactive
-have a genetic history

as well as some women who do none of these.
That's why is out of those 23 women some took exercise the number would fall to 16: 1000.

This explains it very well.

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

Your own personal risk is what counts. This includes age of first period, age of first pregnancy, genetic history, ethnicity, and lifestyle.

It also matters which type of HRT you use because they are not all equal in terms of risk. There may be very significant differences.

There are no more deaths from BC in women who are using HRT compared with women not using it. There are more deaths annually from osteoporosis than breast cancer. And the same for heart disease (in women.)

And as I posted before, the theory now is that HRT may promote growth but not cause cancer. That's a very different scenario.

Everyone has to make up their own mind.
Everything has a risk.
You have to weigh up your own risk factors and your risks of not using HRT alongside quality of life.

I think we might be at cross purposes Polly. Say my personal risk starts out at 16 in 1000 thanks to my lifestyle etc. If I then take HRT what I think those stats say is that my personal risk would then increase. Am I reading it wrong? Its a really difficult decision.

Elleste Duet has helped me a lot with the flushes and sweats. Downside is horrendous period pain, like when I was a teen. It seems the lesser of the two evils though.
Joint pain has been helped my high dose Omega 3 fish oils every day.

How do you know your risk is 1:16? (That's a risk of 1.6 women in 100, or 1.6%.)

You can't know your risk. You can only guess at your baseline risk.

If your baseline risk is 1.6% the going by your calculation it would rise to 2%.

So in 100 women, 2 might get BC compared to 1.6. That is an increase in risk of 0.4%.
It's tiny.

Your risk of osteoporosis is 1:3 so 33%. May be as high as 1:2 so 50%. You are more likely to die on old age from complications of osteoporosis than BC from HRT.

Have you considered other risks of everyday life which we all take without thinking? Your risk of dying in a car accident is possibly higher. But do you stop using a car?

It depends on how bad your symptoms are and what quality of life you would have without HRT.

I didnt say I know my personal risk - thats why it was phrased as 'say' my personal risk is...

Not sure what car driving has to do with it - having worked in Theatres for many years I'm only too aware of the risks of driving! I know you are very pro-HRT for you , but for some of us, particularly those of us who have had people around us die of breast cancer, the increased risk of this bastard disease that HRT brings is something to include in our own risk:benefit assessment. Not being remotely argumentative by the way, just saying that it isnt clear cut for me, or for some others. Even the experts dont agree, or may change opinions based on newer studies as is often the case in Medicine.

With respect, you don't know who I know or have lost through BC.
Please don't jump to conclusions.

I'm struggling to see the connection between theatres and driving! The point is that driving long distances often is more likely to risk your life than dying from HRT.

I am not blase about BC. Far from it. However, I've had many chats about it with my consultant who knows far more than you or I on it. He is treating women who have had BC, along with their oncologists, with HRT.

I am 'pro' HRT because I believe- as do many consultants- that it gives better quality of life for me with a tiny risk. I am using a regime that is supposedly lowest risk of all. I don't feel totally 'safe' but I have other medical issues that would most likely be worse without HRT.

Going by your stats, out of 100 women using HRT long term, maybe 2 will get BC (but not necessarily die from it- the risk of dying is no greater than women not using it.)
That means 98 women will use HRT long term and be fine.

We can't have a crystal ball into the future; you have to do what is best for you and if that means not wanting to have any added risk of BC then HRT 's not for you.

(You can by the way do a very general online screening for BC risk by entering certain factors.)

I've had my GP appointment yesterday after chucking the nasty white pills down the loo.

Speaking with my GP, whom asked me if I liked to try anything else, I said no.

He said that the medical benefits of HRT are good, but that as I have overall good general health, putting me through misery of trying to find a suitable HRT will counteract my wellbeing.

So, advice is to exercise daily, (I do) even if just a stomp through a muddy field with my dog, ensure I eat healthily and have a bone density scan to ensure no bone thinning.

My mother did not take HRT, she braved the storm for a while and as I entered peri-menopause at 36, I am left with night sweats whigh I can manage and live with.

I'm not anti-HRT. I just don't feel it works for me. I have not taken BC pill for 20 years as I was sterilised at 29 years old. I'm relieved at the thought of being period-free again after 5 weeks of flooding taking the little fuckers.

If it all gets too much for you sometime, consider HRT in a form that is not pills. They really aren't the best or the safest and are pretty 'old fashioned' in terms of HRT.
The other thing to think about is that HRT is not just for the relief of short term 'minor' symptoms. Bones, heart, bladder, pelvic floor and joints all need oestrogen to function well in your 60s , 70s and beyond.

My mum didn't have HRT. She asked her GP for it when she was 60-ish and he said she was too old to try it (this was 30 years ago- things have changed.) She 'weathered the storm'- but WHAT a storm; still having flushes and symptoms in her 80s. It doesn't ever stop for some women.

Hi Polly,

TY for your response.

I will consider non-oral HRT if I feel I'm not managing any symptoms. Over the last two weeks Ice felt tonnes better than I did throughout the 10 weeks I was taking Kliofem.

Granted, the hot flushes at night have come back but we've managed to get through those and to be honest, I can live with it. I have done for 12 years periodically.

Being period-free for me is utter bliss. I had years of cramping, flooding and it made my life hell.

I'm low risk for cardiac disease and providing my bone density is not thinning, I'm going to manage with diet & exercise and reduce my caffeine intake. I'm not a big drinker these days. (Spent majority of my 30s drunk) my blood pressure is a good 110/70 so I'm on track.

I could have tried alternative HRT, but I can't deal with the breakthrough bleeding after the recent spate of it on Kliofem. I'm not prepared to risk work again as while my employer was understanding (I've not had sick leave for 6 years) I'm leading a project that needs my attention.

That may all sound first world problems with work, but my work is very important to me. While I was going through the HRT stage, my performance dropped to below 40%. In the current climate of jobs, I'm not prepared to risk my livelihood for the sake of hoping that some extra medical benefits might be helpful to me. Weighing up this against suffering again during a test period of further HRT is odds on against me winning this one.

My GP is not concerned and neither am I that I have chosen this route.

My MiL is 82. She still has hot flushes. She's had three rounds of cancer and has never taken HRT. She's a warrior.

My mother died at 69. Of heart disease. She smoked like a navi for years. HRT would not have prevented this from happening.

I hear you :)!

One thing to consider...Kliofem is AFAIK, conti HRT.. so 2 hormones daily. Breakthrough bleeding during the first 3-6 months is common. It may be the case that if you are not truly post meno, the progestogen part of Kliofem is not enough to keep the lining in check hence the bleeding.

You can always use sequi HRT at any age (most GPs don't seem to push this very hard or even know about it.) I'm over 60 and still use sequi because I didn't get on with conti when I experimented. Ok, the bleed is a PITA and I hate the first day of it, but the upside for you would be you would get a regular bleed every few weeks. Some of us are- under consultants- on long cycle with means a bleed only every 6-8 weeks.

That's interesting, Polly.

How would not truly being post-menopausal be identified?

My GP has confirmed I am post-menopausal. My periods ceased in July 2015. Up until February 2017, (2 weeks after starting Kliofem) I'd not had even a spot of blood, a cramp or a headache. Night sweats were about all I'd suffered.

I see what you're saying about the sequi HRT, but I wouldn't want a bleed every few weeks. For the sake of taking HRT. When I'm in good health overall. If the time comes that my bones are thinning, that I'm suffering with something due to the lack of oestrogen, then with the advice of the GP, I'd consider something.

One thing I'm hearing you on, is that a lot of women are content even into their 60s that a bleed every few weeks is not a problem. However, for me I see that as a forced menstrual bleed. I'm willing to be educated on this. I guess what I'm trying to say is, I'm of the mind where I can't imagine any woman being happy about having periods when nature dictates that our bodies stop shedding.

I have detested monthly periods since the age of 14. I'm ecstatic I no longer have to suffer the bastards.

However, for me I see that as a forced menstrual bleed. I'm willing to be educated on this. I guess what I'm trying to say is, I'm of the mind where I can't imagine any woman being happy about having periods when nature dictates that our bodies stop shedding

But you - or other women- would be happy to use oestrogen and progestogens at a time when nature dictates we aren't producing
them naturally? :)

1. Combined HRT (which could also be seen as 'forced' because the only time we'd produce 2 hormones simultaneously is when pregnant and not during the majority of our fertile life) or

1. mimic a natural cycle - and the way to do this is by using progestogens every few weeks. I'm sure you know why- the progestogens oppose the effects of oestrogen on the uterine lining and when the 10-14 day progestogen course is stopped, a withdrawal bleed occurs.

If you are using oestrogen - when nature dictates we are too old to have those levels!!! - then we need to prevent it causing hyperplasia- and that's what progestogens do (either daily as you had with Kliofem, or mimicking a cycle.)

I personally would rather be on a more natural regime of a cycle than an unnatural regime of 2 hormones daily. The reason I have been advised to do so is that it thought to lessen the risk of cancer which appears to be caused by using too much synthetic progestogens.

I can only speak for myself. One of the reasons why I couldn't live with the thought of bleeding for weeks after reading and hearing HRT was fantastic. It is. It's just not for me.

I've read and heard anti and pro HRT women. I think there's valid arguments on both sides. I like that my GP is patient-led and is switched on to health in women whom choose to not to take HRT. Just as much as he is on Women whom take HRT.

It's just not for me at this time in my life. I don't see any medical benefits for me at this time. It may well have been in my peri-menopause stage. However, that wasn't explored as most of this time was spent dealing with heavy periods that knocked me sideways.

It's interesting hearing pros and cons of HRT.

TY Polly.

If you don't feel any need for it, then there is no point.

But for anyone else reading who thinks bleeding is 'uncontrollable' the obvious- and gold standard option- is the Mirena coil and a separate transdermal oestrogen. Miran means no bleeding at all and no tablets to t ake.