HRT age 51 post menopause ?

[kissmelittleass]

Periods stopped at age 48 in October 2016 , had some light spotting very occasionally but not often until August 2018 and absolutely nothing since so presume I am post menopause?
Doctor doesn't seem to know anything and basically says carry on as you are you don't need HRT and so I've never thought no more about it until recently.
This was because a gynaecologist consultant at my hospital got a bit annoyed that I wasn't on HRT and told me to speak to my doctor as I would need it for bone and heart health.
My bone density is low but my doctor last year just told me to put some weight on.
Anyway I now obviously with lockdown and actually isolation can not see a doctor until this pandemic is over so who knows when that will be!
My question is mainly is it too late to take HRT at 51 if I've been period free for a good while?
Anything I could take until I see the doctor which is going to be a long time yet!

Out of interest, why didn't the gynae who advised HRT not prescribe it themselves?
Was it a meno-related issue that sent you to them?
What prompted a DEXA scan for your bones? How low are they- do you know your T score, for example?

Sorry for all the questions!

You can take HRT at any age but ideally, to get the benefits to your heart and bones, within 10 years of a last period. This is clear medical advice and you can find it on all specialist meno type websites. They call it the 'window of opportunity'.

Gaining weight is a rather odd thing to suggest unless your BMI is very low. Weight gain post menopause is a risk factor for breast cancer (if you become very overweight).

Why would your dr suggest it?

It's true that women who are petite tend to be more at risk from osteoporosis, but that doesn't mean they have to get overweight- just a sensible BMI ideally between 18.5 -25.

Being heavier now won't help your bones.

Have a look at the Royal Osteoporosis Society website for advice.

If your GP is hopeless over HRT it would be worth seeing a consultant, privately to get your HRT.

Brisk walking an help your bones. As can a vitamin supplement. You don’t need to go on hrt if you don’t feel you need it for any other reason.

Brisk walking alone is rarely enough to reverse low bone density. It helps of course but resistance exercise is more beneficial. The ROS society website has all this information.

Vitamin D is helpful but this is the advice for all people in the UK to take it over the winter months.
On its own it won't reverse loss of bone.

(I have personal experience of this, as well as having researched and written about it for my work.)

Walking and Vit D can help prevent bone loss initially, but when it's there and someone has had a diagnosis, they are not enough.

Post menopause, we can lose up to 5% bone a year for a few years (it falls very fast.) This is hormonal and nothing natural can replace bone that fast- it's like trying to fill the bath with the plug out.

It's really important to catch this fall off before it gets worse as it's then much harder to increase bones.

OP all very good advice from @JinglingHellsBells. I would maybe take some time during lockdown to arm yourself with knowledge. Dr Louise Newson's website is very good with evidence based recommendations
www.menopausedoctor.co.uk
and her podcasts are great too. Start listening to them on your daily walk.

@JinglingHellsBells To answer some of your questions
The gynaecologist consultant I saw was not about a menopause matter, I was there to get results and he asked if I was on HRT and went on to say I needed to see my doctor to discuss it as in thirty years time I'd be glad I took it for bone and heart health.

I didn't have a dexa scan, I saw a private dietitian as requested by my doctor as I'd lost some weight. The dietitian used a scale to measure muscle bmi etc and she said my bone density was low and I was underweight but not massively so I don't think.
My BMI was 18.5 and my weight was 49.5 kg, my height is 5ft 5.
Since then (a year ago) I can feel I have put a little weight on as my jeans are more snug! I don't own a scales so can't check!

Posted too soon! I take Vitamin D daily 1000iu for the last fifteen months as my vitamin D was low at 25.
Thanks everyone for the good advice and links which I will have plenty of time to check out!!!

The dietitian did say that putting weight on would help my bones actually, forgot to add that!

@kissmelittleass Thanks for answering! To be honest, the scales that were used do not assess bone density accurately. The only way to assess bones is a DEXA scan.

I was diagnosed with quite severe bone loss in my late 40s, long before menopause at 53. (I'd chosen to have a scan privately as part of wellbeing tests.) My bones are now pretty normal but after a lot of hard work (changes to my diet, HRT for menopause symptoms, and exercise.)

Since then, I've had dexa scans every 3 years.

I am also a writer and the topic is one I've researched and written about for national publications, obviously with input from medical experts.

Your next step ought to be a referral from your GP for a dexa scan.

You can also arrange these privately.

Adding weigh will put more stress on your bones as they respond to impact and 'load'.

However, it's unlikely you will make a huge difference simply by adding weight and that's not terribly healthy anyway beyond a certain point.

No one can 'cure' low bone density by adding weight or taking Vit D.
Research shows that only women over 65 benefit (bone wise) from Vit D supplements (although we all need enough Vit D anyway.)

You do need at least 1000mgs calcium a day ideally through food but with an added supplement if needed.

One thing you ought to do is resistance exercises for your hips and spine. The ROS used to have a selection of books showing which exercises work for this. Or you can find it online. Some of the exercises need ankle weights or dumb bells (for wrists and arms.)

But the most important thing is to get a proper scan and find out what's going on.

Let's be honest, at 51, you are unlikely to help your bones simply by putting weight on. You need to increase your muscle mass by doing load-bearing exercise at the gym. (Currently impossible). You can gerry-rig weights with tins, etc, which can help. (Lots of youtube videos to help.) I would DEFINITELY recommend seeing a Gynae re HRT when lockdown is over. Not only will it help bones, but assuming you have no other comorbidities, it's long-term benefits also include cardiovascular function (despite dodgy American 80's studies which have been disproved.), psychological well-being, skin & hair tone, etc.... I have been using oestrogen gel for nearly two years and don't want to give it up ever. (I'm 48 this year.). My bone density hasn't improved, but hasn't worsened. I haven't exactly done much to help it, though. (yet)

I agree @justilou1

The weight idea @kissmelittleass is controversial.

There used to be an idea that women over 9st were not at risk from osteoporosis as they had enough weight to 'load' their bones, day to day.

However, more recent research has disputed this. It showed that overweight women were just as likely if not more likely to get osteoporosis (for quite complicated reasons linked to having high body fat ).

This research paper covers some of the discussions.

www.ncbi.nlm.nih.gov/pmc/articles/PMC3139535/

The introduction says this:
The belief that obesity is protective against osteoporosis has recently come into question. The latest epidemiologic and clinical studies have shown that a high level of fat mass might be a risk factor for osteoporosis and fragility fractures. Further, increasing evidence seems to indicate that different components of the metabolic syndrome, ie, hypertension, increased triglycerides, reduced high-density lipoprotein cholesterol, are also potential risk factors for the development of low bone mineral density and osteoporosis. This review considers both the older and more recent data in the literature in order to evaluate further the relationship between fat tissue and bone tissue.

@JinglingHellsBells @justilou1 Thank you for such great advice!
I will be looking into things suggested and doing quite a bit of reading I think!
My muscle mass was very good apparently.
I'm not in the U.K. so would be a lot harder to get referrals to a gynaecologist etc here as in meaning there would be a extremely long wait on a public list could be up to two years and is going to be a lot harder after this crisis I imagine!
Private would not be an option as I spent so much money on private health care and now we have lost our jobs like everyone else!!
My GP can prescribe HRT for me I'm sure, but as in original post who knows when I can get in to see her and discuss it!
I will reading everything suggested though, thanks!

I’m 50 and been fully menopausal since 47. I recently queried their home thing as DM has osteoporosis, the GO did a quick questionnaire which showed I’m high risk due to my history so I’ve been referred for a Dexa scan which has obviously been delayed for now. Definitely worth pursuing imo.

@Inforthelonghaul Hi, assuming if a person goes for a Dexa scan and results show low bone density what would be the treatment as such?

I'm long past the menopuse, about 10 years now and have always taken oestrogen only HRT (Kliovance) for that very reason.
It's great stuff.

@kissmelittleass as far as I know the treatment would be long term HRT which I’ve not bothered with before as any symptoms were manageable.

@kissmelittleass Trreatment really depends on how bad your bones are.

There is a sliding scale of low bone density from just below normal ( osteopenia) to full blown osteoporosis.

When you had the assessment by the dietitian, it wasn't accurate. It would only measure your relative percentages of fat, muscle and bone. The measurement for bone would be your total bone mineral content ( I assume.) It would not show if your hips, spine or any of part of your skeleton was high or low density. A DEXA scan only measures density in the hips (it's actually the top of the thigh where it joins the pelvis) and lower spine.

Smaller, thinner women tend to have less mineral bone content anyway compared to a bigger heavily built woman but it doesn't mean always they have osteoporosis.

I don't understand why your gynae did not offer you hrt- it seems negligent. If he saw a need, surely he should have taken control of your situation?

(The monitoring of bones is by my gynae.)

The treatment varies. For women under 60 it's often HRT especially if the loss is not huge. For worse bones where there is very bad osteoporosis, the treatment can be other drugs but these are for women who tend to be older and they do have some side effects and a limited time use.

To build and maintain bone density using hrt it's necessary to keep going with it for around 10 years.

@madcatladyforever Kliovance is not estrogen-only, it's a combined pill of estrogen and a progestin. Just saying for your benefit and anyone reading.

Hi OP... I am in Australia, and Women’s Health is my special interest and area of study. (Peri/Menopause and Post-Menopausal Health is my passion and I intend to work in this area.) I don’t think there is enough attention paid to this as a specific health demographic which affects our health and psychosocial well-being as we age.

@kissmelittleass The figure you gave for your BMI is incorrect based on your height and weight. (I checked out of interest as my weight is around the same but I am shorter.)

Your BMI on those figures is 17.4.
That is underweight.

Out of interest why were you seeing a dietitian? Have you had food allergies or an eating disorder or a digestive illness?

All of these can affect bones.

Good quality food and plenty of calcium is vital for bones.

Have a good read of all the info on the Royal Osteo Society website which has info on diet, exercises, diagnosis, and treatments.

@JinglingHellsBells I have no idea but dietitian said my BMI was 18.5 and was good, muscle mass good, Just that I was slightly underweight and low bone density according to her calculations on her scale?!
I do in fact have a lot of digestive issues for years now but that wasn't the reason I was seeing her, my doctor referred my as I was concerned about slight weight loss at the time. Infact the dietitian couldn't advise me really as she said my diet was very good and healthy enough as a near vegan.
Thanks to everyone for answering!

@kissmelittleass Might be worth asking for an investigation for coeliac disease. Lots of adults are not diagnosed till late in life- think the average age is 40.

Coeliac is a risk for osteoporosis as the gut can't absorb a lot of minerals and that can include calcium.

I'd suggest you see your GP and discuss unless it's already ruled out.

Good luck- looks like you have a lot to think about to get to the bottom of what might be going on.

@JinglingHellsBells Thanks again! The dietitian I saw arranged for me to have a blood test for coeliac straight after the consultation with her and it came back as negative.

Glad you’re not coeliac, although it raises other questions about the weight loss. Stress? (Who isn’t stressed atm?) Irritable bowel? Crohn’s? Do you have other inflammatory symptoms? Do you have any other signs that you might be suffering from nutritional deficit or malabsorption? (Fatty or greasy stools, hair thinning or bald spots, unusually dry, thin skin, bruising, pale skin? Yellow eyes?) Any of these things need to be discussed with your GP also. Btw, don’t start taking multivitamins or any supplements before you see your GP. They will probably want to run some blood tests and supplements can affect the results - especially things like fish oil and bioten, believe it or not. If you do normally take them, stop for a week or so before the blood tests. (Vit D is ok, but let them know when you have the test.)

My understanding is that blood tests can give false negatives and false positives for coeliac. The only guaranteed way is a biopsy of the gut. There is a lot of info on the coeliac support charity website on this @kissmelittleass.

If you are almost vegan, where is your calcium coming from?

We need to eat a lot of pulses, green veg and dried fruit to get anywhere near the 1000mgs a day which post-meno women need.
You can find info on calcium content of foods on the ROS website.

I went dairy-free for a number of years as it seemed to make my eczema flare, but looking back I think it may have contributed to osteopenia, even though I did supplement at times.

Basically, you need to get a bone density scan then decide what to do.

It's serious- 1 in 2 women over 50 have osteoporosis and it's a disabling condition long term.