HRT refused after only 6 months use

[Lunaballoon]

I’ve just had an HRT review after being on Evorel Conti for six months and basically the GP refused to give me a new prescription saying she’d never heard of HRT as a preventative treatment for osteoporosis. A different GP in the practice had agreed to put me on HRT in the first place because of a family history of osteoporosis.

The second GP is insisting I have a Dexa scan and will only consider treatment with Bisphosphonates if necessary. Where do I go from here? I’m pretty sure the scan will be fine now, but surely any bone protection from HRT needs to build up over time?

HRT is licensed for osteoporosis in women who can't take other drugs like bisphosphonates. It is suitable for women with advanced osteopenia but not usually given as a preventative - so she's right about that.

There is some debate about this- bisphosphonates are not to be used for prevention either!They are for women with established osteoporosis and can only be used for 5 years max, because they actually stop bone turnover and simply glue together old bone which is then dead, and they can have severe side effects. There is also some controversy around them because they stop new bone growing and can actually cause fractures. There was some research published on this last year- micro fractures in thigh bones due to bisphos.

You need to have your DEXA scan and take it from there. If you have any menopause symptoms you can have HRT for those and the benefit to your bones is a bonus. Have you?

Thanks for replying Polly. I will have the scan and all being well my bones should be healthy. I’m 58 and my mum didn’t develop osteoporosis until she was in her 70s.

I’ve felt good since starting on HRT - stable mood, sleeping much better, no waking with palpitations, although I still have vaginal atrophy/dryness.

Even if there’s no immediate risk of osteoporosis, I don’t understand why HRT should be withdrawn after only six months. I understood that five years would be a more typical limit.

It is my understanding that HRT does protect against bone loss. My gp is happy for me to have HRT but can't give me a dexa scan as I have not broken a bone yet.
I will stay on it for as long as possible

That’s interesting Munchy. My GP is insisting on a scan even though I consider my risk to be several years down the line.

Luna- I'll send you a PM about this off forum.

You might find it helpful to read the National Osteoporosis Society (NOS) website which covers all of this.

Make sure you get the UK site and not the US one which has a similar name.

Your mum's osteo at 70-ish is not that relevant; 1:3 women have osteop by the age of 50+. I think probably most 70 yr olds have it even if it's not diagnosed till they have a fracture.

HRT is not licensed for prevention of osteoporosis.

Munch- that's bizarre. It's simply about the cost. Only scanning after a break? How totally mad. what good is a scan then after the horse has bolted.

I have scans every 2- 3 years because I had severe osteopenia in my late 40s. I pay for them. You can have a DEXA scan privately if you can afford to pay. Waiting to find out after a break when you'd be in serious trouble doesn't make sense.

This is the link you need from the NOS

nos.org.uk/about-osteoporosis/treating-osteoporosis/osteoporosis-drugs/hormone-replacement-therapy-hrt-for-women-and-osteoporosis/
Extract below:

Until the early 1990s, HRT was the only treatment for osteoporosis. Since then other drug treatments for osteoporosis such as the bisphosphonates and denosumab have been developed and licenced. The publication of two large clinical studies on HRT in 2002 and 2003 raised concerns about the potential risks associated with HRT, resulting in a significant reduction in its use. These studies were the Women’s Health Initiative (WHI) in the USA, and the Million Women study (MWS) in the UK.

After more than a decade, there is still much discussion among specialists about the conclusions of these studies as both provided evidence for the benefits and risks associated with HRT. The initial reluctance to use HRT is now more balanced, with HRT being used in early menopause and in younger women with conditions affecting hormone levels up to the age of 50. It is also sometimes used in women between 50 and 60 with a high fracture risk, particularly if they also have menopausal symptoms that need treatment.

Have already looked into having A scan privately, just need to get a referral from the GP next time I see her, want to keep bones as healthy as poss, partly because I had a fairly young meno at 46 and I fall over more often than the average person!