Just had my annual " why don't you come off HRT " lecture from my GP - how to handle this ?

[VivaMiltonKeynes]

Yesterday I had a phone call from my GP doctor and it is the usual "lecture " that you seem to get at this practice every year .
For background I was on HRT for 4 years then came off at my previous NHS doctor's request . It was horrible - total resumption of the symptoms I had - feeling as if living in a sauna, aches and pains in hips , inability to sleep . I therefore went privately to a menopause specialist also an NHS Consultant in Contraception and Reproductive Health who put me back on HRT and referred me back to the NHS . I came off in 2015 when I had a total hysterectomy and the aftermath was even worse . The Gynae consultant said there was no reason I could not go back on and now on Oestrogel . I feel great on this .I only take one pump a day. Joined this GP surgery a year ago and had the lecture on joining then this review yesterday - she wants me to come off it . She referred to a greater increase of likelihood of stroke . She asked me what my "plan" was and I said to her that my private specialist had said there is no need to come off ever . She seemed to go very quiet at times and seemed unsure of how to handle someone saying they didn't want to . In the end I agreed to take one pump every other day and she is going to call back in 3 months and see how I am getting on . I am pissed off with myself that I even agreed to this . After the call I reviewed the NICE and NHS guidelines and they specifically say there is NO or little increased risk if you are using the gel . I know all about the positive benefits. Firstly I don't think this is fair - that women have to be subjected to this whereas a man can be prescribed Viagra for years and never be questioned on it .Secondly how do I tackle this with this GP ? Just tell her I want to stay on and refer to the guidelines ? Sorry this is so long but trying to cover all details. Thanks for any input.

@Ahwig

I tried to manage my symptoms with herbal stuff from well known health shop and it worked for a while then stopped working so I went to see my gp and asked about hrt. My appointment was with a male doctor who said I had 2 choices either to go on hrt or just cope. I replied that I had been trying the “just cope “method and now I needed help. He said he would prefer not to prescribe hrt. I said in a slightly light hearted way there speaks a man who has never had these debilitating symptoms . His reply was rather bizarrely yes but a man who had a mother that went through the menopause. Needless to say that didn’t work for me and I left the surgery with the prescription and have not looked back since

WTAF he had a mother that went through the menopause?!?! And why on earth does that factor into the discussion!

[quote PlanDeRaccordement]@JinglingHellsBells
Estrogen only HRT is safe. Women using it have LESS breast cancer than all women in the population who are NOT using HRT!

This is not accurate. Women using estrogen only HRT are more likely to develop breast cancer than women using no HRT.

The Lancet results also mean: (a) of 70 women taking estrogen plus intermit- tent progestogen, we would expect 5 rather than 4 cases of breast cancer; (b) of 200 women taking estrogen only, we would expect 14 rather than 13 cases.

thebms.org.uk/wp-content/uploads/2020/01/HRT-and-breast-cancer-risk-should-women-be-worried.pdf[/quote]
@PlanDeRaccordement

That article in the Lancet has been criticised by some of the best cancer experts in the world. It is the ONLY publication that has found a link between using estrogen only and BC compared to all the other studies.

And even if there is a risk it is miniscule and outweighed by the benefits to heart, bone and brain. (Not my words- those of experts who know more than we do!)

www.menopausedoctor.co.uk/menopause/breast-cancer-risks-from-hrt-by-leading-breast-cancer-specialist-professor-michael-baum

www.newsonhealth.co.uk/news/leading-breast-cancer-specialist-professor-michael-baum-responds-to-irresponsible-reporting

www.menopausematters.co.uk/risks.php

Compare the red and the green dots on the graph- women not using hrt, women on estrogen-only.

I make no comment as to whether HRT is worth taking on balance or not. I only took issue with your inaccurate statement that women on estrogen only HRT had less cancer than women on no HRT. This is plainly not true. And the link I provided was not to the lancet study but to the BMJ critique that quantifies exactly what the extra risk is. It is small but it does in fact exist. Your statement would mislead women who need the facts when making their own judgement as to the risks versus benefits of HRT.

It is the ONLY publication that has found a link between using estrogen only and BC compared to all the other studies.

That’s also not true. Earlier studies in fact resulted in a higher breast cancer risk estimate than the more recent studies. Estrogen only HRT is lower risk than combined HRT, but every study has shown all types of HRT increase breast cancer risk.

I intend to stay on HRT forever (I have late menopause issues). I asked to be referred to Nick Panay’s clinic when my GP (female) said I should come off it.
Personally I’ve always found male GPs way more sympathetic and helpful than female ones, and actively choose to see them.

www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk. Has a good summary
“Does HRT increase the risk of breast cancer?
The risk of breast cancer increases for postmenopausal women using any type of HRT. But it is biggest for those using combined HRT, which has the hormones oestrogen and progestogen.

Risk is also higher in those who use HRT for more than 5 years. For these people, the risk remains increased for at least 10 years after they stop using it.

Does HRT increase the risk of endometrial (womb) cancer?
The risk of womb cancer differs depending on the type of HRT.

Oestrogen-only HRT increases the risk of womb cancer. The longer this type of HRT is used, the larger the risk. So, oestrogen-only HRT is usually only offered to those who have had their womb removed (a hysterectomy) as they have no risk of womb cancer to begin with. Adding the hormone progestogen can reduce womb cancer risk for those taking HRT. But combined treatment causes the greatest increase in risk of breast cancer. So, it’s important to talk to your doctor about the benefits and risks of HRT for you.

Tibolone, another medication that can help with uncomfortable menopausal symptoms, has also been found to increase the risk of womb cancer.

Does HRT increase the risk of ovarian cancer?
Using oestrogen-only or combined HRT increases risk of ovarian cancer. But when HRT is stopped, risk starts to go back down over time.”

@PlanDeRaccordement

It is the ONLY publication that has found a link between using estrogen only and BC compared to all the other studies.

That’s also not true. Earlier studies in fact resulted in a higher breast cancer risk estimate than the more recent studies. Estrogen only HRT is lower risk than combined HRT, but every study has shown all types of HRT increase breast cancer risk.

@PlanDeRaccordement

The links I left if you have read them show a different side to it.

The Lancet report has (and I am repeating myself here) been criticised by experts far more qualified than either you or me. I have listed several sources but maybe you didn't read them?

One of the main drawbacks of that report- which included published and unpublished data from 25 years ago (unpublished means it was not peer reviewed so may be inaccurate.)

It also did not have any data on the most modern types of HRT- including micronised progesterone - which is now thought to be much safer re. breast cancer as shown by large trials in France (the KEEPs study and another one in Denmark.)

I'm sorry but every study has NOT shown a higher risk with estrogen-only. The link from Menopause Matters which is also on the WHC (Women's Health Concern, part of the BMS) shows research with the exact opposite.

Please come back with links showing a higher risk with estrogen-only and I'm happy to discuss.

And it is very important to put any risk into context of quality of life and benefits to other parts of the body. That applies to every single medicine- risk v benefit.

You’re changing your story. First you said the lancet study was only study to show a link between estrogen only HRT and breast cancer ever, now you’re saying there are a few studies that show no link. I think you need to provide links to these studies that show no link between estrogen only HRT and breast cancer.

And I’m sorry, but cancer research U.K. is a more reliable source than the fringe ones you have listed.

I followed your link to the menopause matters website and the “research” you have said showing the “exact opposite” is not research but two sources that are news articles from 2007 and 2015. Your data is out of date.

@PlanDeRaccordement I'm not going to reply to a few quotes without seeing the sources.

I have been reading and researching this for over 12 years as a health writer for Patient as well as other publications and in order to do that, interview UK experts.

The info from Cancer Research is not without its critics. I am fully aware of what they say. What you are not appreciating is that there is a lot of divided opinion between experts and you need to look more deeply rather than grabbing headline statements that do not look at the detail.

I will reiterate that the data does not include the most modern types of HRT and therefore is not accurate. Any HRT expert will tell you that.

If you listen to or read the opinion of Michael Baum, he explains that the new research shows- even if it's accurate- an increased risk of something around 0.03% per woman.

lizearlewellbeing.com/podcast-s4e6/

Go to the final bullet point of this podcast and it's really interesting to hear him discuss the stats.

2015 is the latest data.

The links are not fringe sources. You can't have read them.

I am not saying different things. Do you understand what the Lancet study was? From what you have said, I don't think you do understand what it did- it wasn't a 'study' it was a compilation of old and new data going back decades much of which was never peer reviewed.

You can't possibly have read or listened to the links I've quoted in the time between your posts so maybe do that?

I'm not going to continue posting because for anyone reading I've left loads of valuable links.

If you think Michael Baum is a fringe source you need to research him. He's THE leading expert on BC and treatment in the UK

A lot of Cancer Research statements are overviews. They also have their own researchers (I won't name names but can) who are disagreed with by other researchers and who work is not actually considered that good and one particular study they did for CR has been torn apart as inaccurate.

Anyway, nice to chat to you on it all.

Have a good day and stay safe :)

Here is the 2019 meta-analysis study done on all published and unpublished scientific studies on the link between HRT and breast cancer from 1992 to 2018.
“ for women of average weight in developed countries, 5 years of MHT, starting at age 50 years, would increase breast cancer incidence at ages 50-69 years by about one in every 50 users of oestrogen plus daily progestagen preparations; one in every 70 users of oestrogen plus intermittent progestagen preparations; and one in every 200 users of oestrogen-only preparations. The corresponding excesses from 10 years of MHT would be about twice as great”
pubmed.ncbi.nlm.nih.gov/31474332/

This is in line with most recent study in the BMJ from October 2020
“Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases BMJ 2020; 371 doi: doi.org/10.1136/bmj.m3873 (Published 28 October 2020) Cite this as: BMJ 2020;371:m3873

*Compared with never use, in recent users (

My GP practice is one of those staffed by part-time GPs with a system where you just have to phone on the day & hope you can see a doctor so when I had early menopause with horrible side effects I saw several different doctors over an 18month period & they were all young & scarily ignorant on menopause issues & whatever they recommended had little effect. When I saw one scrolling through a massive list of drugs available it did seem that it was just pot luck what I was prescribed. Luckily I finally saw an older female doctor who cheerfully told me that the practice had a womens' health specialist (who had been there for several years). Once I had got an appointment with the specialist everything changed & I have been fine since. I have a family history of osteoporosis & have been advised that continuing with HRT does help with that, but I have also been told that my weight is a big issue with regards to cancer risk. I am very active, waist less than half height, BMI fine etc, but if I let my weight creep up then I'm told the cancer risk goes up so much that I would need to seriously reconsider continuing with HRT.

Readers are free to follow both your links and mine. That’s the whole point of informed choice isn’t it? And I agree you should stop trying to defend your untrue statements: “2015 is the latest data.” being the most recent.

The biggest reversible causes of cancer are smoking and being fat .
Last time I spoke to my GP he asked if I’d ever tried coming off HRT to which I replied ‘ no and currently I’ve no intention of ever doing so ‘ - stick to your guns OP and good luck . All things in life carry risks but it’s a matter for every individual , given accurate information , to decide what path they wish to take .

@VivaMiltonKeynes

Sadly she is a young female GP .

Blimey that doesn’t inspire me with confidence!

One gp at my practice told me I’m couldn’t go on hrt because of a previous health issue, so I just made an appointment with another one and told her I wanted to go on it and was prepared to take the risk of any issues. I’m on hrt gel and it’s honestly been life changing for the better.

@Djangor3725

My GP practice is one of those staffed by part-time GPs with a system where you just have to phone on the day & hope you can see a doctor so when I had early menopause with horrible side effects I saw several different doctors over an 18month period & they were all young & scarily ignorant on menopause issues & whatever they recommended had little effect. When I saw one scrolling through a massive list of drugs available it did seem that it was just pot luck what I was prescribed. Luckily I finally saw an older female doctor who cheerfully told me that the practice had a womens' health specialist (who had been there for several years). Once I had got an appointment with the specialist everything changed & I have been fine since. I have a family history of osteoporosis & have been advised that continuing with HRT does help with that, but I have also been told that my weight is a big issue with regards to cancer risk. I am very active, waist less than half height, BMI fine etc, but if I let my weight creep up then I'm told the cancer risk goes up so much that I would need to seriously reconsider continuing with HRT.

Sadly I am in a small village and we also have this system of part time doctors - most female , young and with young kids ( from their Bios ) . I probably therefore harbour some unfair thoughts about how up to date they are with all of this .The care I have had from this surgery is pretty awful overall compared to my previous surgery in a town .Of course Covid has added to the complications and they operate these E consults . I recognise that the NHS is struggling right now but the doctor that called me yesterday is not even on the Team at the surgery ! I imagine they are outsourcing some of this . Anyway thanks for all your replies and in January ( if possible) I am going to book to see privately the doctor I originally saw in 2015 and discuss it all again with her . She is actually a well known Consultant for the area I live in and has established her own Menopause Consultancy now .

When all these young female GP’s are ‘ wrinkled old prunes ‘ like me - well not like me actually they will most likely be gagging for oestrogen .

OP I think a complaint to the practice manager might be in order. You have made it clear twice now that you are aware of the options and risks and your choice is to continue with the treatment. I would be putting that in writing to the practice manager and asking that they confirm that your wishes will be respected.

@PlanDeRaccordement One final try in the hope you might be a little more open to the other opinions of experts out there!

I don't need to read the BMJ report. I read it the day it came out.
I have already pointed out why other medical experts don't agree with it.

I have tried (and failed :)) to point you in the direction of other experts who point to the limitations of that data.

I can only reiterate that all those studies are indeed a meta analysis which includes both robust AND non-robust data. So they are not all double-blind controlled trials using the same HRT.

It has LONG been known than the progesterone element of HRT is the implicating hormone in HRT. The recent BMJ report says nothing new.

However, it is the only report yet to show that estrogen-only hrt increases BC risk. And there are many experts who refute the data and how they are interpreted.

Have you listened to the podcast with Michael Baum?

I really suggest you do before you post again because he is an expert and I am quoting him and others.

You might also like to look at the book Estrogen Matters by Avron Bluming who is a US cancer expert who disputes any link between HRT and cancer.

IF there is a connection between estrogen and cancer, it is minute and less than 1% per woman. Listen to the Michael Baum podcast 'double a tiny number is still a tiny number'.

And the research appears to show estrogen may fuel an existing cancer not cause it.

As another poster has said, smoking, being overweight, drinking 2 units a day and being sedentary all carry a MUCH higher risk of BC than the very worst case scenario of HRT.

OP “ Firstly I don't think this is fair - that women have to be subjected to this whereas a man can be prescribed Viagra for years and never be questioned on it .”

I would mention this.

Also send a copy of NICE guidelines to the doctor.