Bone protection

[BlackInk]

Hello

I'm 45, and my periods stopped out of the blue about 3 years ago. I've tried a few different forms of HRT - FemSeven, Everol Conti and Tibolone but none of them have helped with my symptoms - which aren't typical of Menopause and I'm pretty sure they're something else.

Meno consultant told me I need to be on HRT to protect from osteoporosis if nothing else.

Is there anything I can take to protect my bones, but without all the hormones of HRT?

I spoke to her about using the contraceptive pill instead of HRT but she wasn't keen as it's been so long since I had a period.

Many Thanks
BI

What are your symptoms that HRT has not helped with?

It's not just your bones,it's also your heart and brain.

I don't know why you can't have the Pill unless you have risks? Some women use Qlaira for an early meno.

You can use HRT within 10 years a final period, safely, so unsure why same doesn't apply to the Pill even though it's a higher dose of hormones.

For your bones you can do exercise and eat enough calcium.

Have a look at the Royal Osteoporosis Society website.

Weight lifting is great for improving bone density, and a lot of fun as well.

Thank you @JinglingHellsBells

I don't think I'm at particular risk from HRT or the Pill. None of my symptoms eased at all though with HRT, and drs don't really seem to think it's meno related - they think I'm imagining it all as far as I can tell! Exhaustion like you wouldn't believe, horrible stomach issues, weird neurological things, no libido, low mood and general anxiety... I also have low B12, but drs don't think that's to blame either.

I've had lots of tests, but low B12 (and lots of other bloods only just in range) is the only things showing up - dr doesn't think that's the cause either.

I'm at a bit of a loss really. I don't feel it's hormonal at heart, so just want to take as little medication as is sensible.

BI

Exhaustion like you wouldn't believe, horrible stomach issues, weird neurological things, no libido, low mood and general anxiety..

Sounds like typical meno to me!

One thing to consider....looks as if all the HRT you have tried was the continuous type ( 2 hormones daily.)

My suggestion is you avoid that sort and try sequential. ( estrogen every day, progestins 12 days a month.)

Tibolone is a special type of HRT so exclude that.
The others contain the progestin Norethisterone. This is known to affect mood and it kind of 'negates' the good effects of estrogen.

You ought to try estrogen gel ( you can easily alter the dose yourself from 1 pump daily up to 4) and micronised progesterone for 10-12 days every calendar month.
If you are very intolerant to it, you can reduce to every 6-8 weeks under medical supervision (only.)

Using continuous HRT from the word go is not a good idea because you can't get the dose right of the estrogen because it's being masked by the progestin.

ps HRT at your age is not actually medication. It's 'supplementation' for what you ought to have naturally till you are early 50s.

It IS a serious risk to be without estrogen for almost 10 years prematurely and you'd be silly to underestimate that even with a healthy lifestyle.

Get a dexa- scan to establish your baseline bone health/calcium need. This should include advice on diet/supplements as needed for your individual case. It should also feed back to your gp. Based on my own experience there is going to be an epidemic of osteoporosis soon

Thank you @JinglingHellsBells and @Dora26 ... I'm seeing a meno consultant in a couple of weeks so will ask her about sequential HRT and estrogen gel.

I don't know what I can do though if GP and meno consultant are saying my symptoms aren't typical of menopause or B12 deficiency.

I've had a look at the NHS requirements for a dexa scan referral and it looks as though I might fit periods stopped age 42, some osteoarthritis in my hands and am slightly underweight. Will ask meno consultant if they can refer me or ask my GP to.

BI

Based on my own experience there is going to be an epidemic of osteoporosis soon

There already is although women don't hear about it.

More women die from complications of osteoporosis than cancer incl breast cancer.

1:2 women over 50 have low bone density. Sadly it's not often picked up till they are in their 60s or 70s and break a bone then have to take other drugs for it which have terrible side effects.

You can pay for a DEXA scan yourself- you don't have to do it via the NHS.

I had mt first in my late 40s. If I'd not had one I'd be severely osteoporotic now. Thankfully I took steps to correct my bone density over the next 12 years. I didn't have an early menopause either- was 53.

I too had horrible neurogical symptoms as the worse part of the menopause. Pins and needles, tinnitus, dizziness, shakes, balance issues, tremors, fainting.I felt very poorly for about 3 years.

I was sent for a head MRI all fine, all blood results ok but one specific one that is linked with B12 deficiency even though these came back normal.

My GP didn't think it had anything to do with it so I decided to self inject myself. I started with every other day for 2 weeks which I did three times in two months. After that, I did once a week for about 2 more months and since then about once a month.

I have now almost completely free of these symptoms and I don't know how much was due to hormones and how much B12 deficiency although my gut feeling is telling me it was a combination of both.

Like you, her did nothing to help, as a matter it made me feel much worse both times I tried. Different regimes. HRT just doesn't work for everyone.

I started peri at 42, fully meno at 48. My GP agreed to sent me for a dexa scan where I showed to have excellent results. This is likely to be due to running, cycling and walking I do every week and have done for years. HRT helps with low bone density but it doesn't mean that anyone with an early menopause will end up with osteoporosis. You should definitely be tested though.

Speaking from experience, I second: getting a Dexa scan, paying for it privately if need be and (regardless of the results/start today) doing loads of weight bearing exercise (walking counts but cycling doesn't) and getting sufficient calcium in your diet. It is much better to get the calcium from food eg dairy etc rather than from supplements. Be careful not to go over-the-top on your intake of calcium, though, as that can cause heart problems. The joys of getting older.

By the way, my BMI was fairly low and I was advised to put on a bit of weight.

. HRT helps with low bone density but it doesn't mean that anyone with an early menopause will end up with osteoporosis.

Yes that is true and similarly and women with NO risk factors develop it too.

Too MUCH exercise can be bad - women athletes often find their periods stop due to over-exercising and although they are getting impact on their bones, they are so low in estrogen (and often very slim) that they still develop osteoporosis.

The important thing is to have your bones monitored long term. Once very 3 years is recommended.

That's good advice. Dexa scans are not very expensive.

The exhaustion is also typical of thyroid issues and low b12. You should get your results printed so you know your levels. If you've tried hrt and were still exhausted, your gp should check other causes. I know from my own experience, it can take years to be diagnosed...the levels have quite a big range.

Also second dexa scan. I asked for one at 45 and it showed the start of osteoporosis which as now been reversed with diet, exercise and hrt.

Thank you all. I will definitely ask my meno consultant / GP about referral for a bone scan, and if they can't do it will look into getting it done privately.

I've had basic thyroid tests and they all came back normal. B12 was low. The range in my area is 180 plus. Over a 2 year period mine was 168, 160 and then 122. My GP didn't flag it until it fell to 122, then gave me 5 loading injections in November. I then had to wait 6 months and had B12 retested recently. Result was 208 and GP said that's now normal and my symptoms are unconnected / psychological.

My ferritin is always lowish (around 17 or 18) regardless of whether I'm taking supplements. Everything else tested has come back within normal range, but several things very low in range.

I have severe osteoporosis. I wish I had had the chance to get HRT.
My sister is on it and she is still leaping around like a spring chicken.
Regardless of menpause symptoms, preventing ostroporosis is well worth it.

As women, we are generally on message about breast cancer but osteoporosis seems to go under the radar may be because it is seen as something that affects "old people".

The message needs to get out that you need to have an adequate intake of calcium in your diet throughout life and that women must take special care when pregnant, as the baby is drawing on their reserves. Once the body has taken calcium out of your teeth, it cannot be replaced. No wonder so many women reach our age and wonder why their teeth are falling to bits. If their teeth are falling to bits, what about their bones?

Interesting reading,
I've just had a bone density scan and it shows borderline osteopenia. I'm 43 and perimenopause. Been told to take vit d and walk lots.

Did you get the scan on the NHS @MummaPl ? If so, can I ask what criteria you met to be referred for it?

I have arthritis and saw a private menopause specialist who suggested I should so my GP agreed it.

Ah, thank you. I'm seeing an NHS menopause consultant and I have arthritis in my fingers, so maybe I stand a chance of getting one!

Having arthritis is not a reason to get a DEXA scan.
Arthritis is caused by wear and tear. It's very different from loss of bone density.

The reasons for a DEXA scan are

-family history of osteoporosis
-early menopause ( before 45 though some say 47)
-a fracture to your ankle, hip, arm, leg or spine from a slight fall (might show low bone density already)
-long term use of steroids
-eating disorder causing irregular periods over many years
-infrequent periods for years and years

You come under the early menopause category :)

This is from the NHS website @JinglingHellsBells ... so might help my cause even if not strictly accurate?

I can't understand why you aren't having b12 injections regularly. Did they find the cause? Having the loading dose is generally just the start. It raises your b12 so it skews further testing. Sounds like they are waiting til it drops below the bottom of the range again...