Need links to good info on HRT

[crabb]

I'm going back to see my gynae on Monday and need to be better read about HRT before I see him. Could someone post some links to recent, quality, evidence-based research , particularly relating to HRT in 60+ year olds?

I get the feeling from my GP and gynae that HRT should only be used for as short a period as possible due to risk factors. I do have a higher risk of heart disease (type 2 diabetes, hypertension, hypercholesterolaemia, all well controlled) so I don't want to be foolish, but isn't there evidence out there for benefits to longer and older HRT?

I'm 59 and have been on a couple of different drugs: had a Mirena for menorrhagia during perimenopause but it fell out, was on Premarin for a while in conjunction with the Mirena (but it's very possible I was took the Premarin for about 12 months without the Mirena as not sure when it fell out). Went without HRT for a few months, hot flushes were debilitating, started Livial - did wonderful things for my libido but did not completely cease the hot flushes. I also spotted during the 9 months on it. I've been off it for 5 weeks on Gynae advice as he wanted to see where I was at without HRT - spotting has disappeared, and no withdrawal bleed as he predicted, but hot flushes and tingling feet back with a vengeance. He also got me to have an X-ray to see whether the Mirena had migrated - it's nowhere to be seen so confirms the falling out/flushed out theory.

Anyway, sorry for the long history. I'm not sure what he will recommend next. Last visit he mentioned a hysteroscopy as I have an enlarging (but not huge) fibroid. I want the hot flushes controlled (and would rather like to get my Libido back with the Livial, it was almost miraculous ), but would like to have a better handle on up-to-date info before talking to him, and would be grateful for any links you could send my way.

It depends on what you mean by 'evidence based'. There are numerous scientific papers but these are possibly too complex to read thru and take into an appt. The bottom line is that if you are still having symptoms, the benefits and risks of HRT at 60-70 are equal. Have a look at the website Menopause Matters. Go to Treatments/ HRT/ Risks/ Benefits etc and also read the Home page Blogs by Dr Currie.

If you are in the UK all you need to do is read and maybe print off the NICE guidelines on menopause, and also read the statements by the British Menopause Society and the International Menopause Society paper on women's health in midlife (all of these online- just google) which state that there is no upper age limit for HRT.

In the NICE guidelines - you will need to read the full guidelines- it says that transdermal HRT does not increase risk of blood clots or heart disease. Research in Denmark into CVD and osteoporosis showed women on HRT had healthier hearts (again- google- I don't have time to link to all these papers).
There is also some research which shows HRT reduces risk of diabetes.

Livial (Tibolone) is a complex steroid not usual HRT. The bonus is it doesn't thicken the womb lining. I think (check this out) it's more risky for heart disease.

Are you doing all the l ifestyle stuff for your diabetes and high BP? Are you overweight? If so it's important you tackle these and not just see HRT as the answer.

I was hoping you'd come along, Polly 😊
Thanks for that, you've given me good reading material for the weekend. I'm in Australia but will look at NICE guidelines anyway. Re lifestyle stuff, am tackling, slow progress.