Does HRT simply delay the menopause? Help me explain this to a colleague

[trumpisaflump]

Hi. My work colleague/friend is in her mid fifties and is struggling with a few menopausal symptoms. Namely insomnia and hot flushes (they look really severe so I feel awful for her). She took HRT for two years when she was around 50 and she said it worked wonderfully for both these symptoms and she felt fantastic on it. Her GP advised her to stop HRT after two years as HRT simply delayed the menopause and the symptoms she had would return no matter how long she stayed in HRT for.
I think my friend should go back to her GP to discuss going back in HRT and I don't think the advice is correct that HRT simply delays the symptoms of menopause. However I'm kind of struggling to understand why if menopause symptoms are due to a lack of oestrogen, once the oestrogen in HRT is removed (ie when you stop HRT) why don't the symptoms return?
Sorry if I'm not making myself clear! I've woken up early and I'm typing this in the dark!

I think the idea is that the symptoms will be less severe when you stop HRT? I'm gradually withdrawing mine after being in it for 6 years and the symptoms are returning but in a much more manageable form.

@funmummy48 thanks for that. I think I'm trying to get my head round 'why' though. Why are the symptoms less severe as time goes on? I've had a good search online but can't really find out.

Is it just because the menopause “tails off”? Does your body get used to having less oestrogen? My symptoms came in quite suddenly and insomnia was my biggest issue. By slowly reducing my HRT, I’m reducing the oestrogen much more gradually which is less of a shock to my system. Someone with some medical knowledge needs to come along and explain it all!

Grrrrrr posts like this annoy me!

First, there is not time limit to using HRT ( NICE and British Menopause Society guidance.) Your friend can use it till she's 90 (or for life.)

Secondly, it's not down to her GP to stop it unless there are serious medical reasons ( cancer, heart attack, blood clot.)

NICE states it has to be a joint decision / choice with the woman's preferences taken into account.

So her GP is way out of order and behaving in a way they shouldn't.

As for delaying the menopause- what poppycock! You can't delay menopause because your body runs out of eggs whether you use HRT or not.

'Menopause' means no more periods ( as in no more eggs.)

Many women find HRT eases the symptoms during the transition from peri to post meno when hormones are all over the place.

Some women find they have no symptoms when they stop.

Other women find their symptoms come back but not to severe.

Other women find their symptoms are just as bad so they decide to use hrt long term ( or for life.)

The point is, it is supposed to be the woman's choice once she has made clear she understands the risks with hrt.

The decision is supposed to be based on her informed choice.

You might like to listen to the podcast with consultant Nick Panay which I linked to about 12 threads down- he talks about his patients in their 80s and 90s still on it and the idea that he would happily give hrt to women with no symptoms if they want to use it for long term benefits ( heart, bones and brain.)

Hellsbells

Could I just point out that ‘ delaying menopause’ is often shorthand for ‘delaying the symptoms of menopause’ and I’m sure that is what both the gp and the poster meant.
It is perfectly correct that when women stop taking hrt their symptoms frequently return. As they are older these symptoms may be even harder to cope with at that stage

Could I just point out that ‘ delaying menopause’ is often shorthand for ‘delaying the symptoms of menopause’ and I’m sure that is what both the gp and the poster meant.

Well, a medical person ought to be precise. Some drs and also women do seem to think it delays it .

I’m coming off HRT through my own choice. I have family in Australia so the slightly increased risk of DVT is a bit of a concern whilst I’m using HRT. Also, my patches have been very hard to get hold of recently so I’ve eked them out by reducing my dose. If I go back to my original symptoms at the level that they were out, then I’d happily take HRT again. 😁

@funmummy48 You might find it helpful to know there is no increased risks of blood clots with transdermal HRT ( this is clearly explained on lots of medical sites- Dr Louise Newson's is a good one.) The risk is no higher than your own baseline risk. It's only tablet form that has a slight increased risk. www.dailymail.co.uk/health/article-5095793/Menopause-treatment-anti-ageing-says-expert.html

Yes I think my friend and her GP were thinking HRT simply delays the symptoms of menopause. When I tried to convince her this wasn't correct I struggled a bit. If the effects of menopause are due to lack of oestrogen, surely when exogenous oestrogen is withdrawn you will experience menopausal symptoms again?
Her GP stopped her HRT although my friend has no medical history of risks. I'm trying to get her to go back to her GP.

Oh and I'm about to go on a dog walk so I'm definitely listen to that podcast when I'm out! Thanks for that.

@trumpisaflump My meno consultant says the menopause is in 2 parts- short(er) and long term symptoms/consequences.

A
Shorter - flushes and sweats, mood swings etc. These can last for anywhere from 2 to 30+ years (yes, some women never ever get rid of them.) For most women they are the result of a drop in estrogen but it's gradual and most (but not all) women find their body adjusts eventually.

B
Longer term - this includes loss of bone density, heart disease, pelvic and genital issues ( prolapse, leaking, vaginal atrophy) possible dementia, and joint pain.

Some women choose (note- choose) to use HRT for 20+ years to avoid B. Some also have flushes into their 80s and want to stay on HRT for those reasons.

The guidance now is if women are informed of the risks, and accept them, they can use HRT for life.

Your friend needs another GP- can't see how the same one is going to understand the latest guidance if they are so out of touch.

Oh...I thought the DVT risk applied to patches as well as tablets! Ah well, I’ll still stick to reducing my dose as at least my last 2 packs of patches will last longer. I had to phone around for almost an hour to find anywhere that had them. 😳

I'm not sure if I am right but I explain it to myself as it's the FLUCTUATIONS in the amount of oestrogen not the absence of it? Don't know about progesterone as I don't need that.

Thanks @EvaHarknessRose and @JinglingHellsBells that makes sense! And I found that podcast really informative too. Thanks for sharing.

I’ve elected to ease into the menopause instead of waiting to crash into it. I started BHRT about six months ago with a private clinic (Marion Gluck affiliated) and am 44. I’ve not heard one good story from my friends about menopause so I decided I was going to try my hardest to avoid the shittier symptoms.

Perk for me was short cycles, really heavy bleeding over one day, panic attacks in my sleep, no libido. I now sleep much much better, libido is slightly improved but we’ve just tweaked my meds so we’ll see on that, cycles slightly longer.

It’s a work in progress and I plan on being on it for the rest of my life (or as long as I can afford it). I think it’s an absolute scandal that HRT is so difficult to access currently. If it were a male issue they would see it as something to be corrected and all of them would automatically go on medication from 48 or something.

Hope your friend can get back to the doctor and get s prescription she can fill!

*Peri for me

I have been using HRT for over 10 years. I have twice attempted to reduce the dose and both times the symptoms have returned with a vengeance. I have no intentions of trying again, although I have moved from oral to patches, because I do several long haul flights NZ-UK each year.