HRT if no menopause symptoms?

[Clarissalarissa]

I've read on here that HRT provides protection against various medical conditions. So if you have gone through / are going through menopause, but have no symptoms at all, should you still take HRT? Or is there a downside that would outweigh the upside, or would the GP refuse to prescribe it anyway?

Watching with interest....I've wondered the same thing

I was offered HRT but I was only 38 - I think it depends on your age.

No. You can't use it as a prophylactic.
You have to have symptoms.

I agree with sprout, it depends on your age, your risk for osteoporosis and the time from your last period.

Periods aren't relevant to starting when starting HRT. I had missed 1 period when I started HRT at 43.

If your last period is many years ago and you are above 60, hrt is not considered safe. My periods were almost regular when I started hrt at 41.

Emerald In the UK the guidelines have changed re. age. Women over 60 can start HRT if they have symptoms, but they have to start on a very low dose and it has to be transdermal. This is in the NICE info and also from the BMS.

What you can't do is rock up to your 'average' GP at 55 , 5 years post meno, no symptoms and ask for HRT. No way.

But as 80% of women do have symptoms- some for 20+ years - you are lucky and rare not to.

If HRT provides protection against other serious problems, but women with no menopause symptoms aren't allowed HRT, are we actually that lucky?

I do wonder that too Clarissalarissa - sometimes it seems that HRT is being described as completely necessary for post menopausal women but then so few women actually take it and yet seem to live healthy lives.

I think I'm right in saying that other factors are more important in protecting against serious problems, and that minimising alcolhol, stopping smoking and not being obese are far more important, as are weight bearing exercises. And genetics!

So, I think it's all about risk vs benefit for those with symptoms, and no point in taking the risk if you have no symptoms.

Think you're very lucky to have no symptoms personally :)

Thanks Polly for replying! The guidelines are a bit different and more conservative in my country. The good point is that I can have hrt without the need for prescription.
The majority of gyns have doubts for any hormonal replacement in general but I personally think that things will change and hrt will be a preventative and anti-aging method in the future.
I made my decision to stay on it as long as possible, for a life maybe and that’s something that the most gyns disagree.
I’d like to ask your opinion for testosterone. I want it for my muscles. I have a hard CrossFit training almost daily but with not satisfying results. Testosterone is not allowed for use for meno in my country and my endo, after my pressure, suggests me DHEA (a “clever” drug that converts to estrogen or testosterone according the body needs) but with my own responsibility. Can I ask your opinion?

Hi Paris! I think that the absence of symptoms doesn’t mean that there isn’t any harm at heart and bones. Of course it’s better not to have symptoms but I think that hrt helps with well being in general and not only for the symptom’s relieving.

Emerald I think you might find this useful.

menopausedoctor.co.uk/wp-content/uploads/2016/09/Practical-implementation-tips-hormone-replacement-therapy.pdf

Nick Panay is one of the top meno drs in the UK- former chair of the BMS, contributed to the NICE guidelines. He's a good guy- very down to earth, balanced views, etc.

You will find the bit about 'starting HRT over age 60' at 7 of this report.

Testosterone- I know that Panay is fine about this for libido and is happy to offer. I don't know about DHEA but there are women on other forums who (I think) use it. I guess, do your research and see? Good on you for the cross fit- it's gruelling!

Thank you Polly! It’s sounds good and reassuring!

I think if you are not having symptoms it is probably wise to have a DEXA scan to make sure your bones are ok. You need to know if you are going to make it to 80 in good health.

A friend of mine found she was osteopaenic at 55, which is a stage where calcium in bones is lower than you would like but not yet osteoporosis. She was having trouble getting hrt for depressive mood and lack of energy but another GP has prescribed some for her now.

My endo said me yesterday “you are 42, you feel 25 and you want hormones for 25! No way! You always want more...” 😂

DEXA scans would only be advised after a risk analysis, looking at things like weight, alcohol intake, activity levels etc. I have no risk indications at all so would be a waste of resources to have a scan. I think it important to remember that most women don't use hrt, and we shouldn't panic women.

Paris- FWIW I had no risk factors at all except being petite. The FRAX score shows that in theory I am not at risk.

However, 12 years ago I paid for a DEXA scan out of interest (friend my age then had been diagnosed with osteopenia) and was horrified that I had severe osteopenia . In another year or so it would have been full osteoporosis in my hips. That was in my late 40s. Had I not known, I could be disabled now and taking medication that has serious side effects. I've spent 12 years working on improving my bones. IMO every woman should have a DEXA scan at 50-55 but of course this is not going to happen within the NHS.

www.qfracture.org/
www.sheffield.ac.uk/FRAX/tool.aspx

the two tools which are used.

Sounds an unusual case PP.

My friend probably would come up ok, especially on the afracture one. She does have a history of underweight, especially when she was younger.

Not unusual at all Paris. The tools are just that- tools. They aren't 100% accurate.

1 in 2 women over 50 have osteoporosis. Not unusual. Most aren't picked up till their 60s when they have a fracture. Osteopenia is the stage at which it's easier to stop the rot. You can lose up to 5% of your bone density each year for around 5 years after your last period.

Do you have a link for that PP? Sounds unlikely. Isn't it that half have low bone mass which may or may not cause a problem?

Found this www.iofbonehealth.org/facts-statistics

Osteoporosis is estimated to affect 200 million women worldwide - approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90

and this one
reverehealth.com/live-better/women-osteoporosis-need-know/
Caucasian women are most at risk for osteoporosis, along with older women. Twenty percent of Caucasian women over 50 are estimated to have osteoporosis. Caucasian women lose a third of their bone mineral density in their hip between ages 20 and 80, and over half of all Caucasian women over 50 have low bone mass, which can lead to osteoporosis.

nos.org.uk/media/1959/agenda-for-osteoporosis-england-final.pdf

That link doesn't say that 50% of women over 50 have osteoporis though, think you're overplaying the risk.

It says: 1 in 2 women and 1 in 5 men over the age of 50 will break a bone. I don't like that