Problems HRT didn't fix for you

[lljkk]

I'll be called GF but I'm just curious, honest. It's good to be informed, right(?)

Did you have any ageing or menopause-linked problems that HRT utterly didn't fix, even if HRT helped in other ways?

What problems were they and what if any other fixes did you try, was there a solution in the end?

The libido and painful sex are a downside and I am now consulting with some new hormone specialists regarding this.

You need to use topical estrogen for up to 6 months to see any real improvement of vaginal atrophy. Then, you need to use it twice or 3 x a week forever. If you stop, it comes back, if you don't give it long enough, it won't improve. If you aren't using vaginal estrogen, it's unlikely that it will get better just by taking the Pill. Give it a go!

Queen thanks! Yes, there is a fair amount of evidence that HRT (as distinct from BCP's) can make stress incontinence worse too (which is what I have). I did 2 f*** years of pelvic floor everything and none of it worked. I did more yoga and kegel exercises than every last Kardashian put together, I spent hours, weeks and months hooked up to a stupid computer with things inside of me doing exercises along to a computer program resulting in a yeast infection or UTI almost every time I went and I tried creams and poking and prodding from doctors both sides of the pond. No one at that time felt that I was operation material and many of them (particularly the male ones) seemed to think I should just live with it (ie just wear diapers...by the way, I can't even wear a pad for my period without getting thrush). When my dm's obgyn in California suggested the pill, I just burst into tears. I saw Panay a week later in the UK (just coincidence that the referral that I had waited a year for came through then) and he suggested the exact same thing.

My most recent OBGYN suggested an operation and referred me to a urologist who laughed (I am not exaggerating) and said that it probably wasn't warranted and that I should just live with it. I am now waiting to see a (female) urogynocologist (who knew there was such a thing!!!) for a more expert opinion.

I am an American who lived in the UK for 7 years (and had both my dc's there) and now live back in the USA.

I tried the topical estrogen, but it doesn't seem to do the trick for me and in fact seems to irritate me more. I am now looking into sbhg and testosterone levels and how those can be tweaked (as the BCP's mess with them).
For me the HRT really became untenable when I had to switch from the patch estradiol to the pill as I developed a skin allergy to the patch. HRT has a much lower level of hormones than the BCP.
By the way, there is a new NPR (national public radio) Podcast called Bodies that is all about this. I found it (the first episode) to be very interesting.

It's shocking you have received this non- treatment. I had a repair in my late 30s. In the UK, no dr would say you had to use pads unless you were planning on having more children or you were very overweight which may limit the success of the operation as weight puts pressure on the pelvic floor. You'd be offered a ring pessary in the meantime to hold the bladder in the right place.

I'd really try to persuade you to give Ovestin or Vagifem another go. I have used ovestin for 12 years. I know what you mean about irritation but I found this was short-lived. By that I mean it irritated me for a few weeks but after that once the tissues were plumped up more, it settled down.

It isn't an overnight cure- you need to keep going for months if you have severe VA. You might even need more help with something ike dilators if your vag has shrunk, which it will through lack of estrogen and 'use'!

I hope you get some help.

After a life time of treatment resistant thrush, l finally got rid of it.

Then as intercourse was really painful because of atrophy l was given vaginal pesseryes. All good

First time l had sexafter using the less rise the thrush came back.....

Unfortunately, Queen the "non-treatment" I had was a combined effort of my UK NHS doctors and my USA doctors. I did live in London in a poor neighborhood with a severe shortage of doctors, so was definitely getting the NHS at its worst....(including foot surgery where the anesthetic wore off halfway through the surgery because the hospital had "run out" and exh who was checked out of ER with 50 stitches in his arm and no painkillers because the hospital had "run out" on a Friday afternoon (and no it wasn't Xmas and yes, it was during regular business hours). But I'm just appalled that almost 20 years later and it's still happening (both here and in the UK).

Queen are you a medical professional (or scientist)? You seem so knowledgeable about these things, in a very professional way.

Some of my work is as a medical writer and I speak to all the consultants including Panay and I do research in order to write.

But I'm just appalled that almost 20 years later and it's still happening (both here and in the UK).

In the UK you'd be treated for bladder leakage but you would have to wait for surgery. You;d be referred for physio first. If you saw Panay 20 years ago (not sure if that is the right time frame) the CCP would be the right treatment for someone in their early 40s.

There is a an ongoing thread on this site on the general health forum about prolapse and surgery/ treatment- might be worth looking at if you've not seen it?

To go back to the original post, HRT fixed my hot flushes, insomnia, night sweats and bladder frequency (to an extent.) It's also helped my bone density (along with other lifestyle changes.)

HRT is not a panacea. If your life was crap in some ways before HRT, and not connected to hormones, HRT isn't going to fix those issues. It's not realistic to expect it to change things that are not a result of falling estrogen.

I found some systematic reviews. HRT ...
often stops hot flushes (by 77%, but keep in mind that anti-depressants reduced hot blushes by 65%).

HRT doesn't reduce CVD risk (may increase it, actually).

Vaginal atrophy: Favoured taking HRT but Data too limited to be conclusive, only up to 12 weeks, only handful for each outcome, no assessment for publication bias.

Cognition: No effect.

Reduction in fractures Yes benefit, but not for age 60+, and not proven for women otherwise at highest risk of osteoporosis.

I'm aware the older articles (like the fractures one) might be discussing discontinued forms of HRT.

I thought I found a review other day about sleep problems... that said that HRT helped a lot with sleep problems for women who have hot flushes, but didn't make a difference for women without HFs.

There's high withdrawal rate in placebo arms of HRT RCTs (lack of placebo helping with HFs). High attrition causes problems when testing for effects.

I think the OP asked for women's experiences, not research proving or disproving things? .
The papers are a little out of date and there are others showing the opposite.
www.bmj.com/press-releases/2012/10/10/hrt-taken-10-years-significantly-reduces-risk-heart-failure-and-heart-atta

This is one of the best by the IMS www.imsociety.org/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf

You cannot really use a small study done in Korea (the one on vaginal atrophy) with the large studies done in the West. (I don't think this thread is about picking random research papers when in the UK the treatment for VA is pretty clear.) In the UK, Nick Panay is one of the best gynae consultants and researchers- there are others- have a look at his website and papers on it.

SofiaAmes, I know nothing about this issues you are suffering with. I am on HRT and works well for me. But...I think it is a bit silly anyone going on too much about the risks of BCP if it is really helping you.

I have Bipolar and every drug I take - I am heavily medicated - has huge risks attached and horrible side effects. But most psychiatrists advocate them for those with severe mental illness - even when side effects greatly affect the quality of our lives. I have made the decision that it is better for me to take them. But I am sure they carry far greater health risks than the BCP on an otherwise fit 50 something year old.

My patch stopped my flushes and restless legs which where Keeping me awake every night. For that alone they are worth there weight in gold.

@friendlyflicka I couldn't agree with you more!!! My teenage ds is bipolar and takes serious medications which help keep him alive. We have gone through a variety of medications and worked through the side effects and risks to find the one that works for him. That's the part of medicine that overworked doctors don't really do these days (or maybe ever) because they just don't have the time. This is where the internet is a godsend. We can share experiences on a website like this and understand all the possibilities where a single doctor that we get referred to might not have the expertise and/or time to offer. I don't expect my doctors to know everything out there or the latest research, but I do expect them to listen when I present them with good solid research and information. (It helps that my father is a very well known scientist who is a bit of a hero in the medical world, so I drop his name whenever possible.)
Queen thanks for that last article...I missed it in my last round of research.

Another thing that hasn't been mentioned here, is Vitamin D. Adequate vitamin d levels are necessary for many of our bodily functions, including weight control and mood. Everyone (especially if you are in the gloomy UK and/or either cover up or have dark skin) should have their Vitamin D levels checked and probably most of you should be supplementing.

The most important takeaway is the medicine (and in this case MHT - as Panay calls it) is very very individual and should be approached as such.

Hrt has been amazing for me but it has not cured my hormonal insomnia.

lljkk As far as I can remember HRT fixed all problems I had which were due to menopause. Initially libido was not fixed by standard HRT, and muscular aches and pains, and exhuastion after exercise began to appear - so after a few years I got some testosterone - and these seem to be much improved. Some changes are to be expected due to ageing but it can be difficult sometimes to work out what is due to hormonal deficiency and therefore potentially fixable!

Just to add to the list of papers for those who are sceptical - in addition to the ones that QueenoftheNights has listed and the International Menopause Society. Try the British Menopause Society, Women's Health Concern, North American Menopause Society and RCOG. No point in picking out random studies - these societies and organisations regularly trawl the literature, reveiw the findings and come up with recommendations so we don't have to

Here are a few more including some on alternatives to HRT:

BMS and Women’s Health Concern 2016
The British Menopause Society & Women’s Health Concern 2016 recommendations on hormone replacement therapy in menopausal women Hamoda et al ( incl Panay)
journals.sagepub.com/doi/full/10.1177/2053369116680501

North American Menopause Society
The 2017 hormone therapy position statement of The North American Menopause Society
www.menopause.org/docs/default-source/2017/nams-2017-hormone-therapy-position-statement.pdf

International Menopause Society

Prevention of diseases after menopause Climacteric 2014 Lobo et al

www.imsociety.org/downloads/world_menopause_day_2014/white_paper/wmd_white_paper_english.pdf

Alternatives to HRT

Consensus statement for non-hormonal-based treatments for menopausal symptoms Woyka 2017
journals.sagepub.com/doi/full/10.1177/2053369117711646?hootPostID=6690d93930a10b86869c48433ab506e7

RCOG - alternatives
Alternatives to HRT for the Management of Symptoms of the Menopause Scientific Impact Paper 2010

www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_6.pdf

@aroundtheworldandback Trollope is very good for insomnia. Or pretty much any book read on a Kindle Paperwhite (this is important because it's not a blue light and also doesn't require you to turn on the room light to read).