Bit confused about HRT - had an appt today which didn't help

[KatyMac]

I'm 50 and I am in (had?) surgical menopause - ovaries gone, uterus still here

The nurse had never heard of that before, and it effects which HRT I have; but she wasn't sure how

I suggested a DEXA scan to check if I am at risk of oestoporosis & she said I didn't need one - I offered to pay privately but she still said no - preventing oestoporsis would be a main reason to take HRT

I got Vagifem which I was thinking about pre-op for bladder/dryness so that's a good start

But I'm now confused - if I'm not currently having symptoms of menopause (hot flushes/night sweats - what else is there?) is there any benefit from having HRT now or should I wait to see if symptoms arrive?

Well I'm confused too! I answered your question on the Women's Health forum 2 weeks ago. You said you were getting HRT in 2 weeks. Why isn't your consultant or GP following this up with you- it's not a nurse's job to manage this after a major operation like removal of ovaries.

You mean the nurse had never heard of surgical menopause? Some nurse!

The odds are that if you were not menopausal before the op, the symptoms will kick in sooner or later.

If not, that's rare.

Re your DEXA scan. You can pay for this but not at an NHS hospital. If you want a DEXA scan you need to find a private hospital near you where they offer this but you may need a referral letter from your GP or you may not. You would have to shop around- google dexa scans and your location.

The thing is, at 50 you are average age for meno anyway. No one is going to give you HRT now as prevention for osteo unless you have risk factors or have some evidence you already have low bone density, because it's not like you had your ovaries taken out at 35 or 40. HRT is usually given to women who lose ovarian function before the age of 50 to prevent bone loss and heart disease.

I just don't understand why none of this has been talked about with you before your operation, which is a major one, and I think you need to contact the surgeon's PA and ask questions/ follow up appt with them, not on forum.

Queen you are having a go at me when I'm not well and confused

No HRT wasn't discussed before except as an abstract - you might/prob will need it we will sort it out

It wasn't sorted out on the ward or when I phoned the consultant after I was released

I asked for a GP appt and got a nurse appt - the nurse hadn't given HRT to anyone who was 50 without ovaries and with a uterus

I am really glad your medics were proactive or you were assertive enough to get what you knew you needed - I'm not

The consultants secretary has said everything will be dealt with at the follow up appt at the end of nov

I am trying to find out what I need or want and I am riding it hard; maybe because I'm not at my best

I like hearing about people's actual experience of medications rather than a vague description from someone looking up on their notes (from a course) what might be best for someone in my situation

I'm not happy with yesterday's appt and I will be making a new one with someone I have more of a relationship with but I'd rather go in with more knowledge

Katy no one is 'having a go at you' and sorry if it came over that way.

I was confused because what you wrote didn't tie in with other posts. You said you had an appt in 2 weeks ( ie now ) to discuss your HRT When you spoke about the nurse, you didn't say it was at your GPs and I assumed it was a hospital appt as a follow-up to the surgery. A nurse is not qualified to deal with your issue.

I don't think there are any answers to what you are asking . Most women on these forums who have had a surgical menopause need HRT and they seem to have symptoms kick in very quickly- in days. Others may have no symptoms except low mood or emotional stuff going on. Others may have symptoms that come in a few weeks. On your other thread you did have replies from women saying this.

If you are not having symptoms then you don't need HRT. If they start, then ask to see your GP again.

You might get more help from a support group for women who have had a hysterectomy- even though you have had your ovaries removed. It's called Hystersisters.

I'm sorry maybe I'm overreacting; I'm not ungrateful but you seem to have a very different relationship with HCP than I do

I saw the consultant 3 times each for less than 3/4 minutes once just after a horrific biopsy, once pre-surgery when she told me she would glue me together if I needed the bigger surgery (when she ignored me saying I have allergies to some adhesives) and when I was coming round from the surgery.

I do have a low mood but there is as much chance of that being SAD/post-op or a manifestation of my CFS/FM

I will see someone again at the surgery and ask more questions - I had a heel scan 2/3 yrs ago and she was amazed at how good my bones were considering I am dairy free

I am relatively pro-active with my health but my main successes have come when I abandoned the NHS and gone off piste! (Vit D/B12)

OK I found my bone density score from Nov 16 and it was Tscore -1.5 & -1.6

Which I don't think is too bad - I wonder if I should check it again? I'm not sure 2 years is long enough to register any difference - but it was a heel check not a Dexa

DEXA scans are done very 2- 3 years.
Both your scores were below normal and show osteopenia. Between 1.0 and 0.-1 is normal.

-1.6 is heading in the wrong direction so you need a reassessment.

From -0.1 to -2.5 is osteopenia. Below -2.5 is osteoporosis.

How come they allowed you to have it done or did you pay?
Heel scans are not accurate as they need to scan your pelvis and spine.

I paid for a heel check

Chat to the GP I guess

At GPs must be strong and assertive!

OK Dexa scan results (I haven't had the official report yet)

Spine T=3 Z=3.3
Hips T=1.4/1.7 Z=1.9/2.2

So I think I am doing pretty well

Glad you have had it done. When you say it's not 'official' yet, who told you the results or have you had a print-out?

I've never heard of a Z score going up to 3.

Are you sure these figures are + and not -?

If so, that's good and means something you have been doing has raised your minus T scores which were -1.6 up to positives in the years since you had your last scan.

I have a print out & the lady explained but said the Consultant would send me & the GP a report

For the spine the graph showed a range of -5 to 4 & for the hips -5 to 3

I was well within the green band for all three (hips were shown on one graph) my left is worse than my right but I do have a problem left hip

I fee very relieved who knows which supplement or exercie did it but I'm not stopping any of them (or at least I'll be back exercisinging once I have managed walking properly again)

Actually it brings in to question the accuracy of the heel scanners - which are known to be less accurate....however that is a LOT of less accuracy!

I've never ever had both hips scanned and I've had 5 scans over 16 years. They only do one side- this is a top London hospital.

Any 'problem' you have with a hip would not show on a scan because osteoporosis is not something that anyone can feel unless their spine fractures.

Well they said most place only did one hip but that this was new who knows??

The left is is malformed and has oestoarthritis so gets 'used' less I am very right footed!

I'd attach my scans but DD is away and she is the one that blocks out data/names and addresses!!

I found this but I don't understand it

what sort of place did you have it done at out of interest?

You got a bargain- I pay twice what you did and paid your price 16 years ago! :)

Nuffield private hospital in ipswich

I self- referred, was seen 'next working day (phoned on friday appt today) got my report and paid on my way out

Consultant report to follow - but radiographer said although he is the dexa specialist she couldn't see any problems (other than my mis-shaped hip and a slight curvature in my spine which I also knew about)

Terrified about tomorrow tho' I'm supplementing B12 and D at higher levels than the gp will approve of so I've printed out all my research form 3/4 years ago to take with me

And that along with telling her about a CFS attack is making me nervous!

It's really unusual for you to have a Z score of 3! :) That means you are 3 deviations above the norm for a 50 yr old! Have you got a history of athletic activity or similar???

Is that for the spine? She implied it was average

Dunno I'll ask the gp

Mind you - this is the radiographer - the consultant may say something different

I have had ME/CFS for over 20 years so no athletic past AT ALL!!! And I was the most unsporty child anyone ever met hiding in the bushes reading instead of rounders

I wonder if I got someone else's results

average would be +1.

Normal is from -0.1 to +1.0

Anything above +1.00 is considered above average.

I've never seen anything showing +3.

I'm confused looking at your graph! There are 3 lines on the chart. The bottom line is in the red zone- osteoporosis - and the middle line is bordering normal/ osteopenia. But the text above it gives you a T score of 3 and 1.4

But I am in the green? That has to be good?

There are 4 pages - if you pm me your email address I'll scan and send the whole thing

I'm banking on green being good - but I could be in cloud cuckoo land