Thanks to Mumsnet and the women who urged me to take HRT

[PhyllisDietrichson]

I've just come out of a period of depression. I went through years of: self doubt, self-blame, worry, anxiety, low mood, chronic insomnia and intense day sweats. I experienced funny smells after peeing, no libido, wanting to hide and huge weight gain. My girlfriends tell me they've experienced part, or all of the above and more. I've sat there with a poor friend whilst they've sobbed into their cuppa telling me, 'I don't know what's wrong, I feel as if my friends don't like me anymore, I feel alone and sad, I've gone off sex' etc etc, so many friends have had a really horrible time too.

My question is why did no-one suggest we were not going mad, but that it was all a result of the peri-menopause and the menopause?

I'd ended up on anti-depressants and sleeping pills, had a breakdown and quit my career. I had all sorts of counselling, I lost contact with friends and felt so rotten for so long. In fact I was a different person; and I lost myself for 6 years. No wonder they call it 'The Change'.

Then I finally got HRT. I went and asked for it after chats with other women on Mumsnet who've gone through this. Those little pills have changed my life: The sweats have gone, I'm far happier and sleep better. I'm not anxious or sad. That strange feeling of doom and persecution has gone as has the need to blame myself and others for being ''crap" all the time. I don't need to hide away or feel isolated. I've started going out more and to enjoy my friends again. I've joined a weight loss class and have started light running with a group so the weight's slowly coming off.

It seems strange that during those dark years when I was seeking help through mental-health route, no doctor ever asked me how the peri-menopause was, or tried me on HRT when I presented with these symptoms. Why not? Don't they know?

Why are women being fobbed off with the sticking plaster of anti-depressants? It's not dealing with the hormonal imbalance, it's masking it. I know it sounds incredible that these symptoms were all down to lack of hormones, but that really is my experience. All of those horrilble years could have been avoided, if I'd been seen earlier by a doctor who understands that not all weepy middle-aged women are actually mentally ill. I do appreciate that HRT is not for everyone for all sorts of health reasons, but it sure has helped me to feel my old again. I am so very grateful to the women who frequent these pages who urged me to get HRT, and I thank you

It seems we are all fobbed off with the cheap option first. Either AD's or pills when we really need the more expensive patches.

It's easier to give ADs & come back in 7 weeks then up the dose if they are not helping, than investigate, look for a hormonal reason or offer talking therapy. The sign of the times so it is good there a places for people to get advice from people who have experiences.

There is no type of HRT that is expensive compared to other drugs. I pay for my own as it's a private prescription from a consultant (not NHS). It costs me about £15 a month RRP which is much the same as the NHS cost of £8 x 2 which you;d pay for 2 separate items (unless a combined pill.)

The difference between cheap and more expensive HRT is a few pounds a month.

I don't know what the rule is now in the NHS but years ago (think it changed recently) you used to be able to ask an NHS GP to give you a private script to save you money if the meds were cheaper to buy than the cost of the prescription. I think this has been pahsed out (maybe because the NHS is better off by the full prescription charge being paid!)

I suffered the whole range of menopause symptoms for 9 years. I had refused HRT because I thought it would make me gain weight.
It was only when I went to the doctor because I felt so awful I wanted to die that I considered HRT.
I feel so different now and definitely don’t want to die.
Women’s hour had a whole week this week about the menopause if you want more information.

You are more likely to gain weight without HRT! It means you will still have the body shape of a pre-menopausal woman (without all the fat going on the belly) and HRT is shown to lower the risk of diabetes and thickened arteries. Weight gain post meno is not to do with HRT- it's eating too much without allowing for a midlife change in metabolism, lack of activity, alcohol, etc. Some women think HRT= weight gain but they'd stil be gaining weight post meno without HRT unless they adjusted food intake and upped exercise.

Well done for getting the HRT OP! Be warned though, you may have to fight to keep it. I have hassle from my GP practice once every 6 to 12 months when they call me in and tell me they are stopping it. The dozy nurse even tried to scare me by telling me it caused heart problems and osteoporosis. I had to google on my phone and show her it was actually the opposite. Even the GP tried to tell me it caused heart problems!

I have joined an online patient forum and through that I've found a private menopause specialist who I will go to if my GP starts his shenanigans when I go again.

Polly, I meant the cost to the NHS, not me. The tablets I was out on cost the NHS £4 pm, the patches cost the NHS £35 pm. This was told to me directly by the 2nd GP I saw.

I knew exactly what you meant :)
The cost of pills and patches is here....

menopausematters.co.uk/perimeno.php

The cost of Femoston for example is just over £5 a month.
The cost of patches is between £11- £13.
Not sure why your GP was quoting £35!

The night sky I’ve had exactly the same. My go wants to wean me off ‘that stuff’. I’m changing my GP.

Loaf Not wishing to be controversial but I work for the NHS and hear that "cheap shit" comment regularly so am probably being oversensitive but...

The NHS has a duty to be as cost-effective as possible (stewardship of public funds and all that) so has to try the cheaper medications first as they work for the majority of patients. They are all tested, approved and regulated so there is so such thing as cheap shit, just some things that suit some patients and not others. If GPs gave everybody the more costly alternatives without working through the options the sheer numbers of patients would mean the NHS would be even more cash strapped than it is at present
Sorry, lecture over!

Polly GPs have been advised they should not give private scripts from NHS consultations so a normal consultation will result in an NHS prescription and, a private script only if the patient sees the doctor privately. The majority of patients go off the idea of private scripts once they are told they would have to pay for their consultation!

It'd be interesting Loaf to know how much a GP would charge for a consultation for a private script! Might be worth it for some women to get what they want!

The point about 'cheap shit' is that often it's cheap for a reason.
All pill form HRT carries a higher risk of blood clots. Patches and gel are safer.
Estrogen that is CEE is liable to give more side effects either not serious but just a nuisance or more serious like blood clots and maybe even cancer.

Apart from HRT some Drs are now told to prescribe the cheapest statins even though again, they are shown to have more incidences of side effects and risks. (One of my parents was changed due to cost, to one considered inferior in trials.)

Sorry that was for Ivor ! :)

Ivor it might be worth trying HRT, it's not immediate but after a month you'll know if it's working and 'worth it'.

Hi Ivor! Many docs believe that hrt has more risks than benefits. I have been told that hrt causes heart problems after a few months of use and that I will develop a very strong addiction to it, like heroine. I don't know what to believe, I only know that my life was a nightmare before.

. I have been told that hrt causes heart problems after a few months of use and that I will develop a very strong addiction to it, like heroine

Really? what was that Dr on? .

That is complete and utter bollocks. Whoever told you that should be struck off!

I can't believe you were told that,, but you did say you are not in the UK.

Read this www.bmj.com/press-releases/2012/10/10/hrt-taken-10-years-significantly-reduces-risk-heart-failure-and-heart-atta

I totally agree. Got nowhere with the gp- am mid forties. Asked to try hrt and gp first said ‘you are too young’ and then sat staring at the computer screen saying ‘ there are so many types it’s bewildering’! So she referred me to a gynaecologist. Appointment came through for 6 months time! Went private and within days of starting the hrt am finally sleeping again after weeks of being awake all night feeling anxious as well as lots of other symptoms. It is amazing!! Why do some gps know so little aboout hrt? The menopause is hardly a rare condition.....

Polly, he is a GP ( pathologist) and he works privately. He said that if I was her daughter, he would try to keep me away from this stuff. His opinion was that when we mess with Mother Nature, that will kill us later. He said that my body knows better and that maybe my early meno was a way to protect me from a breast cancer in the future! I said really? So why you suggest me antipressants? Maybe Mother Nature wants to kill myself!

Polly I don't know where your parents are but NICE guidance is to give atorvastatin which, until a few years ago, was only used for patients who failed to respond or had side-effects to others as it was too expensive but the cost has fallen so that is used first line now.

My point is that every medication the NHS uses is tested by clinical trials, licensed by the MHRA and evaluated by NICE so nothing used here is really shit. There will always be some medications that are more effective than others, some that are cheaper/more expensive than others and what suits who can be very variable but, in this country, we do not use cheap shit.

Emerald I have heard one doctor argue that women should not face 1/3 of their lives hormone deprived but heard others claim they think the risks are higher than worth it. This is why I don't know. If my symptoms are not horrendous, should I take any risk to remedy them? (although I think DH would like to see my libido again sometime!)

Ivor I do worry seriously not only because of my symptoms but for the long term consequences for my health due to the lack of estrogen. I feel that I have to follow my instinct and to give my body what it needs. I think that I prefer the quality of life for sure. Maybe hrt will be a must for every woman in the future!

Ivor I'm sorry to continue to disagree but with regard to HRT, all is not equal regarding risks. You cannot argue with the NICE guidelines which say that transdermal HRT has less risk of blood clots (as an example). Some GPs may wish to disregard this in the basis that a women has no increased risk factors, but the point is they are not giving the sort of HRT with the least risk. And the cost to the NHS is minimal. Only 10% of women use HRT anyway.

Emerald he's talking nonsense. You need to find another dr. Seriously.

My weight has stabilized on HRT. In fact I lost a bit probably because I have more energy ergo, I do a lot more.

Patches were a total fail for me. Dont know why but my body couldnt absorb them through my butt and I seem to do just fine on quite a low dose that hasn't needed any tweaking.

I waited 3 months for an urgent gynae appointment, which is just not on but my consultant was wonderful. So understanding, informed and supportive. It is strange why there seems to be so many ill informed doctors. Apathetic response to women;s very real problems is not new though in the bigger scheme of things.

I think there ought to be some sort of menopause service like for cervical smears and mammograms. YOu hit your mid 40s and you get an invite for a bit of a chat with other women and a gynae professional talks you through menopause and what you want to do. How to go about it.
It is part and parcel of women's health so why not make it interactive rather than an assault course to be endured?

That's interesting Polly, I'll have another look at NICE and the guidelines as we are using the flowcharts for prescribing

when you say we Ivor, are you a GP?

I think it's a shame that for example, I'm given the safest HRT around because a) I see a brilliant consultant who is an expert and b) I pay for my own meds. (which incidentally cost no more per month than 2 x NHS scripts for 2 items.)

It's not the best policy that women are being given other types of HRT when the difference is a few pounds. In terms of drug costs, this is peanuts.

I think you need to consider the small print of this (whatever your role is.) Yes, most women will be fine on tablet types of HRT for 2-5 years. But the risks of blood clots increase with age if tablets are used. As does the risk with women who are overweight, smokers etc.

Larger doses of the hormones are needed with tablets because so much is lost in digestion and tablets do affect blood lipids (negatively.)

Again, this is not to say that tablet form HRT is a complete no-no. Many women prefer the ease of taking a tablet to fiddling around the patches, gel and having a Mirena fitted, or having to manage their own progestogen each month as a separate item.

But if we're talking about what is best rather than what is just 'effective' , cheapest doesn't cut it.

This is from NICE

1.5 Long-term benefits and risks of hormone replacement therapy
Venous thromboembolism
1.5.1 Explain to women that:

the risk of venous thromboembolism (VTE) is increased by oral HRT compared with baseline population risk

the risk of VTE associated with HRT is greater for oral than transdermal preparations

the risk associated with transdermal HRT given at standard therapeutic doses is no greater than baseline population risk.

1.5.2 Consider transdermal rather than oral HRT for menopausal women who are at increased risk of VTE, including those with a BMI over 30 kg/m2.

1.5.3 Consider referring menopausal women at high risk of VTE (for example, those with a strong family history of VTE or a hereditary thrombophilia) to a haematologist for assessment before considering HRT.

This is also from Prof Studd who sent this letter to his patients (posted by one of them on another meno forum.)

The correct HRT

The most obvious fact is that we should avoid any oral therapy whether it is the logical oestradiol, which is the hormone produced by women naturally, or the ridiculous collection of preparations containing horse-oestrogens such as Premarin Premique Prempro etc. Oestradiol should be given transdermally as this route avoids the first pass liver stimulation of clotting factors with oral oestrogens which lead to the probable increase in deep vein thrombosis, heart attacks and stroke with oral oestrogens whether it is the oral contraceptive pill or HRT.

This is really interesting reading. I have only just turned 44 and I had a baby 18 months ago (IVF but own eggs). Recently I have been feeling very anxious and self-doubting, plagued by thoughts of what an awful person I feel I was in my teens and twenties.

My own Mum had HRT in the eighties after going pretty crazy for a while, but she’d had a hysterectomy when she was younger than me. It really helped her.

Leilaniii did you have HRT and IVF at the same time? I ask because a little part of me would like a second baby.