If HRT protects later health in most women, why aren’t we all offered it, regardless of symptoms?

[Fullyhuman]

I’ve no unbearable symptoms as yet, in early menopause, and am learning about HRT, but am confused by this. Why would only women with symptoms need their later health protecting (heart disease, osteoporosis)?

There is so much misinformation about HRT it’s unreal. People still think it causes blood clots. It doesn’t- not the new gels and patches. Louise Newson is amazing and her website and videos on you tube should be watched by all.

I totally agree with you.

It’s due to the misogyny of the health service.

Good question, OP. Following.

It does come with risks eg breast cancer, ovarian cancer....need to weigh up risk/benefits for the individual

Because HRT DOES come with additional risks linked to cancer. There are not huge risks, especially in its own, but certainly becomes more so if the person has co-morbidities.

It therefore comes down to risk factors and risks benefits.

In my case, history of sting bones and I am very physically active so not worried about osteoporosis. My heart is supposedly that of a 20 year old according to the cardiologist, low resting heart rate, low blood pressure, and in excellent aerobic health.

I however have history of breast cancer under 40 in the family. Despite that ai was prepared to take it if it sorted my symptoms, but would be silly to do so otherwise (as it is, I felt worse on it anyway!).

I've just read up a little more and might invest in a consultation with the Louise Newson on clinic. I think getting a prescription/advice from an expert on menopause could make more sense than convincing my GP to take an interest. HRT in my case would be for preventative health reasons. I seem to be over the worst symptoms of brain fog, rage, anxiety and insomniy. I'm doing well with nutrition, exercise and vitamin D these days.
I'd be interested in hearing anyone's experience with going private.

d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/454/Breast%20Cancer%20and%20HRT%20v21-02.pdf

This is informative. Lots of other similar fact sheets on the website-

www.menopausedoctor.co.uk/

@dontdisturbmenow

Because HRT DOES come with additional risks linked to cancer. There are not huge risks, especially in its own, but certainly becomes more so if the person has co-morbidities.

It therefore comes down to risk factors and risks benefits.

In my case, history of sting bones and I am very physically active so not worried about osteoporosis. My heart is supposedly that of a 20 year old according to the cardiologist, low resting heart rate, low blood pressure, and in excellent aerobic health.

I however have history of breast cancer under 40 in the family. Despite that ai was prepared to take it if it sorted my symptoms, but would be silly to do so otherwise (as it is, I felt worse on it anyway!).

I went privately to the Newson clinic and it has changed my life. I am 41 and am in early menopause due to many autoimmune conditions. My GP was reluctant to prescribe HRT because I am on so many medications already but Newson health started me on it and I find it helps so much (I have oestrogel and utrogestan and the mini pill).

Sorry I have mis quoted the wrong person. I was replying to the poster asking about going private! Oops.

HRT does come with a slightly increased risk of some cancers and blood clots/dvt. This is a fact.
However, it also seems to have protective qualities wrt heart and bone health of needed before age 51.
So...if you have a family history of osteoporosis or heart disease then the slight cancer or clot risk is probably worth it.
But I would not touch HRT if I or a family member had hormone receptive cancers or vascular disease.
I cannot take HRT. I wish I could. But it causes a severe and rare type of migraine which greatly increases my risk of stroke. I also react quite badly to the patches. (Contact dermatitis).
It is what it is. I had to stop taking hormonal contraception for the same reason.
HRT is not the magic bullet for every woman and it does have risks, as with ANY medication.
Assess your personal risk.
Good luck.

@Bagelsandbrie - thanks. It helps to hear other perspectives.

£££ the nhs cuts costs wherever it can. In the US for example you pay a fortune in insurance and co pays but you get the best medical care.

@DDIJ

For those who have been to Newson clinic, do you keep going there or can you do a one off visit? What do you do about repeat prescriptions? I was prescribed by the menopause clinic at the hospital then the GP took me off it. I won't get back to the menopause clinic unless the GP re-refers me.

I had an appointment and then they prescribed the HRT privately for 3 months however after this I was able to continue the same items via prescription on the NHS and I probably could have done this initially if I had waited for the Newsons letter to reach the GP, however I was desperate to start and didn’t mind paying so paid. After this it’s completely up to you whether you want to keep having follow up appointments with the Newson or whether you’re happy to continue under your GP. I choose to have follow ups with the Newson every 6 months because I have so many specialists involved with my care (NHS - rheumatologist, endocrinologist and asthma specialists etc) and find having a recognised, qualified menopause specialist is useful for me to speak to with regards to how the HRT is affecting my other meds or vice versa. It’s up to the individual. My first appointment and the meds cost me £400 ish I think (this was some time ago) and follow ups cost me about £200 every 6 months. I understand I am lucky to be able to afford this and not everyone can. Everyone should have access to the same standard of HRT advice on the nhs.

OP my biggest health risk without HRT is that I will walk off a bridge one night. Sorting my hormonal mood crashes is worth a small increased risk of breast cancer to me.

It's about understanding your own risk factors and accepting the trade off. The problem with the NHS is that many, many GPs aren't up to speed in their meno training and base their assessment of HRT's risk factors on the older types of med. Our understanding changes all the time and - actually - the menopause world is quite fast moving.

Louise Newson is a shero for her work, but then I also saw a GP Registrar at my local surgery (that's someone just finishing their GP training) and she was incredibly knowledgeable and supportive. If you have a choice of docs at your surgery, pick the youngest would be my recommendation, as ageist as that may be.

HRT does come with a slightly increased risk of some cancers and blood clots/dvt. This is a fact. However, it also seems to have protective qualities wrt heart and bone health of needed before age 51.

@Bee0808 The only risks of blood clots is with Pill form and it's far, far less than the Pill (BCP). Most women now use transdermal estrogen which does not increase clotting.

It protects the heart if used before age 60. This is because between 50-60 women's risk of heart disease increases to the same as men's (due to loss of estrogen.) Using estrogen keeps the arteries supple and it also slows down/ prevents build up of plaque by changing the lipid profile in blood.

One in three women get osteoporosis and up to 100K die a year from complications of a fall/ break in older age.

The International Menopause Society published a report about health in midlife. It stopped short of saying that women should use HRT regardless of symptoms, but did say it was on balance very beneficial and women using it had better health in old age and less mortality.

This is an excellent podcast with Nick Panay (one of a handful of really good meno consultants in the UK) and if you listen to it , right at the end, there is a question about whether women with no symptoms could /should HRT and he says yes.

lizearlewellbeing.com/podcasts-videos/podcast/making-sense-of-hrt-nick-panay/ You need to click on the Spotify link to listen.

Of course it's a personal choice about HRT. Some women never need it or want to use it, That's fine.

I don't agree it's about misogyny in the NHS but I do think that many GPs can't be bothered to learn about menopause and HRT. The cost of HRT is very cheap at retail cost and it's a lot cheaper than repairing broken bones or treating heart attacks. But the UK doesn't bother with preventative medicine.

Just to clarify what I said in the previous post.

N Panay on the podcast says that if a woman goes to him and asks for HRT (and she has no symptoms but wants to protect her health), he would give her HRT (assuming no big contraindications) as long as she was well-informed of the small risks.

The big difference between the experts and some GPs is that the experts allow women to make their own choices if they are aware of risks v benefits.

Also, there is no absolute definitive proof that HRT causes breast cancer (this is on a factsheet by Dr Louise Newson.)

The research says it may or it may not. What it says on Menopause Matters website (again written by an meno consultant) is that some types of HRT may promote the growth of an existing cancer, but there is no causal relationship with HRT.

It comes down to choice over what you want to do.

@JinglingHellsBells

Just to clarify what I said in the previous post.

N Panay on the podcast says that if a woman goes to him and asks for HRT (and she has no symptoms but wants to protect her health), he would give her HRT (assuming no big contraindications) as long as she was well-informed of the small risks.

The big difference between the experts and some GPs is that the experts allow women to make their own choices if they are aware of risks v benefits.

Also, there is no absolute definitive proof that HRT causes breast cancer (this is on a factsheet by Dr Louise Newson.)

The research says it may or it may not. What it says on Menopause Matters website (again written by an meno consultant) is that some types of HRT may promote the growth of an existing cancer, but there is no causal relationship with HRT.

It comes down to choice over what you want to do.

You are looking at very limited evidence ..... just a basic google of ‘google scholar’ for recent evidence based literature brings up hundreds of articles which show a link between growth of cancer and hrt use ( not just existing cancer) .....of course it comes down to choice..... but people may want to do a bit more research than you appear to have done

Op I think it will become more the norm as time goes on.

Kitkat you are talking rubbish.

If people are worried about breast cancer they should 1. stop drinking alcohol 2. reduce weight to ‘normal’ bmi. Yet hrt gets all the clicks 🤷‍♀️

OP

Agree. The fact that women are 3 x more likely to get alziemers than men is down to low oestrogen. That’s a devastating way to live your last years.

@Kitkat151 How do you know which evidence I am looking at?

I am quoting medical research which includes everything you would find on google scholar.

This is from Menopause Matters. Dr Currie who has written this is a consultant gynaecologist.

Current opinion is that HRT taken for less than 5 years does not significantly increase the risk of breast cancer but studies have shown that after 5 years of use, there is an association with a small increased risk. Once HRT has been stopped, the risk returns back to baseline. This suggests that the use of HRT may promote the growth of breast cancer cells which are already present if HRT is taken for more than 5 years after the age of 50, in some women; there is no evidence that HRT causes breast cancer

It seems very likely that different types of HRT are associated with different risk, estrogen alone does not appear to increase the risk while there appears to be a small increased risk of cancer promotion with long term use of estrogen combined with progestogen (combined HRT)

The NICE guideline on Diagnosis and Mangement of Menopause concluded that for every 1000 women aged 50 to 59, combined HRT may be associated with an extra 5 cases of breast cancer over 7.5 years, with no extra cases for women taking estrogen only

So...that it MAY cause 5 more cases in 1000 women in a timescale of 7.5 years.

I will post the info on Dr Newson's site later which is not her own words, but from many research papers.

@Kitkat151 Are you menopausal and considering using HRT? If so, you may find these links and quotes helpful.

The first post I left was a summary of the information on medical sites (which obviously include all current research.)

This is a fact sheet on HRT and cancer . The 4th pg from the end, includes the lines that there is no proof HRT causes or doesn't cause cancer.

d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/454/Breast%20Cancer%20and%20HRT%20v21-02.pdf

This is a really good diagram showing risks of other lifestyle factors which are known to be high-risk for breast cancer. Look at the numbers for being overweight or drinking.

www.menopausematters.co.uk/risks.php

Hope this helps if you are looking at what to do for yourself.

Also, there is no absolute definitive proof that HRT causes breast cancer
There is definitive evidence, as one can refer to 'evidence' in science that it DOES increase the risk of breast cancer, by a small amount, less than obesity does, but denying that it is there is helping no-one.

Personally, unless hrt made a real improvement to my symptoms, I'd rather not take any additional risks at all.

Osteoporosis is sadly very much an outcome of our generation not doing enough exercise. It is a real problem in later life and associated risk of falls, but dexa scans will pick up patients at risk and medication other than hrt is available. I'm surprised that not all women are offered dexa scans every few years just like mammograms or cervical screenings. They are quite cheap.

I had one at 46 due to being in peri and will have another one next year, but I'm not too worried as my results were excellent last time and I'm very active.

Dontdisturb,
I completely agree with what you say . I also found that HRT created some other symptoms of its own . I prefer to take no medication . HRT is medication , no matter how 'natural' the source, you are taking a steroid. If a dr asks if you are on any medication , would you not mention HRT?
Clearly we all have our own opinions and Hellsbells is firmly pro HRT. As is each and every dr she quotes. Other drs do not agree that HRT should be so strongly promoted. The NICE guidelines are carefully worded - very much about balance and restraint .
I suspect pharmaceutical companies are very frustrated at the continued low uptake of HRT.

Clearly we all have our own opinions and Hellsbells is firmly pro HRT.

@dizzyandbusy I am quoting from NICE, a consultant gynaecologist, (Dr Currie) a GP with a specialist meno clinic (Dr Newson) and the International Menopause Society (Nick Panay, on the committee and an eminent world-class researcher and gynaecologist.)

but denying that it is there is helping no-one

@dontdisturbmenow Do you think you are missing the point? The statements left here are not mine. They are medical statements from doctors and NICE. Please will you stop making this about me?

It's becoming a form of bullying to constantly pick on me when I am copying and pasting factual info from accredited medical sources.

It's your choice what you choose to do. HRT didn't work for you. That's fine. But it would be good if you would not make personal comments and try to censor posters giving factual , medical information.