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)?

Cancer is a risk. Women with oestrogen receptor positive history can’t use it.
Doubling or even quadrupling risk of VTE (dependent on study) would exclude many and put others off. It rules out women with obesity.
Possibly increased risk of stroke.

There are benefits, but many of those benefits can be achieved far more cost effectively by women helping themselves.

• Weight bearing exercise taken regularly reduces osteoporosis risks.
• Exercise sufficiently reduces hormonal surges and thus symptoms of menopause.
• Likewise controlling blood sugar reduces unwanted symptoms.

I think the idea iPod medication rather than lifestyle changes is an easy win but not the best solution, necessarily. We shouldn’t be creating a pill for everything culture for all sorts of reasons. The menopause is a normal biological phase and should be sold as such.

Not IPOD medication, clearly. The idea OF medication....

I think the thing is we need to move towards seeing HRT as something replacing something that women are deficient in - in the same way if someone has a thyroid deficiency we prescribe thyroxine. If someone has Addison’s disease (as I do) we prescribe steroids, because otherwise that person will be deficient. Why is this not considered to be the case with oestrogen, particularly with women in early menopause who would normally be bountiful in oestrogen for potentially another 20 years or so? This is why the risks related to HRT are practically non existent for younger women taking it - it’s just replacing something that should be there anyway. We need to start thinking this way.

Hellsbells my point was that the drs you select to quote are pro HRT.
Not all drs are pro HRT , there remains a lot of debate. The NICE guidelines are carefully worded and restrained , as I mentioned.I remember a lot of heated debate when the current guidelines were published and some accusations flying about of pharmaceutical companies having too close an interest.

Bagels I think the answer to your question is that menopause isn't a disease. Its a normal process .
The change in hormone levels may cause problems for some but if treatment is needed there will be a range of options as was mentioned below

Cancer is a risk. Women with oestrogen receptor positive history can’t use it.

Untrue in some cases. If you go to the website of Dr Louise Newson, she has interviews with women using it post- cancer and an interview with a Professor of breast cancer who prescribes it.

The lifetime risk of BC for all women is 1 in 8. Using some forms of HRT will possibly raise it by 5 cases per 1000 women over a 7 year period.

Doubling or even quadrupling risk of VTE (dependent on study) would exclude many and put others off. It rules out women with obesity. Possibly increased risk of stroke

NICE guidelines - There is no risk of stroke or DVT with transdermal HRT. Most women use this now or have the choice to do so.

And as before...NOT my opinion. Medical stats.

There are many factors that affect bone density., including what you are born with (your frame and weight.)
It's far more complex than just doing exercise. Exercise helps, but on its own it is not enough to build bone lost. Many female athletes get osteoporosis by over-training which reduces their estrogen levels.

@JinglingHellsBells

A year it so ago was a programme about the menopause on the BBC that many posters watched and then commented on here.

You acknowledged at the time what experts were demonstrating, that hrt does increase the risks of cancer by something like 5 per 100 compared to those not on hrt, which was indeed lower than obesity to give perspective.

You didn't deny then that this increase existed albeit, indeed small. So why are you saying the increased risks don't exist now?

www.bmj.com/content/371/bmj.m3873
The study above, published in bmj last year shows the risk mainly attributed to combined hrt, but it still acknowledges some increased risk, risk that will be deemed insignificant compared to the benefit it provides to many, but this thread is about asking to be prescribed it regardless of symptoms and it is fair that readers should know that it does come with increased risk of developing breast cancer.

I'm not picking on you, just on the fact that as it's been picked up by some posters, you refuse to acknowledge that hrt has benefits AND risks.

@dizzyandbusy These are the most eminent drs in the UK/ world. I am not selecting certain drs.

Nick Panay is a world leader in menopause research as well as a practising gynaecologist in a London NHS hospital and Vice Chair of the IMS. I am sure that readers here would be happy to read other points of view and other stats if you an offer them, but not just your views on this.

And they are not 'pro' HRT. You're missing the point. They are reporting on the science. It would be unethical for them to bring their own opinions into science. Every single dr I've spoken to about HRT says women must make up their own minds. BUT they need to know the facts. When I post here, I include stats . Some posters don't appear to like that :)
C'est la vie!

@dontdisturbmenow Have you read the stats in my previous post, taken from NICE?

It was 5 women in 1000 (possibly, it depends on the type of progesterone used) over 7 years. That is hugely different from 5 in 100!

I'm sorry but you are choosing to muddy the waters by suggesting I've posted things I've not.

The link to the info on Dr Newson's page, for example, is taken from a large research paper. It's not actually her opinion, (I've read the paper myself). Here it is again. The important part is in bold. Note it says there is no absolute proof HRT causes BC - it may or may not. (And if it does, it's a tiny amount.)

FROM DR LOUISE NEWSON'S FACT SHEET ON HRT AND CANCER
The increased risk is related to the type of progestogen in the HRT.

Taking micronised progesterone (the body
identical progesterone) is not associated with an increased risk of breast cancer, for the first five years of taking it.

After five years, the risk of breast cancer is very low and seems to be lower than the risk for a woman taking the older types of progestogen.

Even for women taking the older types of progestogen, the risk is very low.

A recent review of all the research studies concluded that current scientific evidence (for older types of progestogen) does not confirm, or dispute that taking HRT causes breast cancer.

The level of increased risk of breast cancer, with the older types of combined HRT, is similar to the level of risk of breast cancer that any women has if they are overweight or drink around two glasses of wine a day.

In addition, there is no evidence that shows there is an increased risk of death from breast cancer, in women who take HRT.

If you have a strong family history of breast cancer, or have had breast cancer yourself in the past, you might
still be able to take some types of HRT.
___

@dontdisturbmenow I have never said there were no risks. I have left information as above which says that there may or may not be risks.

The statements from the BMS and the IMS say that for most women up to 60, the benefits outweigh the risks.

FGS will people stop saying these are my opinions! I'm quoting other people!

Hellsbells did you state once on here that you are a health journalist?
You clearly have spent a lot of time on the topic of HRT.
You are right , I don't have a list of references stored that I can refer to right now.
The references you promote don't make you 'right'. They are general and always hedged with ' the woman must balance the risks' The use of medication for menopause is a fine balance between benefit and risk .
All I want to point out to readers is that the difficult stage does pass, not taking any HRT means you don't have to worry about the risks of HRT. I don't take any HRT medication and I feel great!

@dontdisturbmenow

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.

Load bearing exercise does help improve osteoporosis in legs and hips etc. Doesn’t help wrists etc so press ups etc can help there.

Most of the treatment for it is oestrogen based so it’s a case of when you take it really. If you have a history of osteo in your family then it’s worth being informed on the benefits of hrt rather than dismissing it. Trusts to anyone reading this btw not just in reply.

@LemonRoses

Cancer is a risk. Women with oestrogen receptor positive history can’t use it. Doubling or even quadrupling risk of VTE (dependent on study) would exclude many and put others off. It rules out women with obesity. Possibly increased risk of stroke.

There are benefits, but many of those benefits can be achieved far more cost effectively by women helping themselves.

• Weight bearing exercise taken regularly reduces osteoporosis risks.
• Exercise sufficiently reduces hormonal surges and thus symptoms of menopause.
• Likewise controlling blood sugar reduces unwanted symptoms.

I think the idea iPod medication rather than lifestyle changes is an easy win but not the best solution, necessarily. We shouldn’t be creating a pill for everything culture for all sorts of reasons. The menopause is a normal biological phase and should be sold as such.

I am a runner, slim, eat a very healthy diet, never smoke, rarely drink alcohol. I still got heart palpitations and other symptoms of low oestrogen. Lifestyle stuff helps of course and we should do it anyway but it doesn’t fix this for everyone.

@dizzyandbusy

Hellsbells did you state once on here that you are a health journalist? You clearly have spent a lot of time on the topic of HRT. You are right , I don't have a list of references stored that I can refer to right now. The references you promote don't make you 'right'. They are general and always hedged with ' the woman must balance the risks' The use of medication for menopause is a fine balance between benefit and risk . All I want to point out to readers is that the difficult stage does pass, not taking any HRT means you don't have to worry about the risks of HRT. I don't take any HRT medication and I feel great!

I’m sorry but pls quote references if you come on here to dispute? I find it anti feminist to be honest for posters to spread possible disinformation. By all mean share medical information it’s all welcome but not stuff plucked out of thin air that might worry people.

@Bagelsandbrie

I think the thing is we need to move towards seeing HRT as something replacing something that women are deficient in - in the same way if someone has a thyroid deficiency we prescribe thyroxine. If someone has Addison’s disease (as I do) we prescribe steroids, because otherwise that person will be deficient. Why is this not considered to be the case with oestrogen, particularly with women in early menopause who would normally be bountiful in oestrogen for potentially another 20 years or so? This is why the risks related to HRT are practically non existent for younger women taking it - it’s just replacing something that should be there anyway. We need to start thinking this way.

Concur with this absolutely. It is worrying the number of women who think of HRT as 'medication' when it isn't at all. To repeat, HRT is NOT medication.

There are hormone receptors in every single cell in our bodies, and if the balance of hormones is disrupted or deficient in anyway, our cells and our bodies will not function properly.

@dizzyandbusy

Bagels I think the answer to your question is that menopause isn't a disease. Its a normal process . The change in hormone levels may cause problems for some but if treatment is needed there will be a range of options as was mentioned below

Early menopause is not a natural event, even if it occurs “naturally”. I am in early menopause due to a pituitary tumour and without oestrogen (and progesterone) my long term health would suffer. I already take prescribed calcium supplements due to confirmed bone density issues. Due to lupus and my other disabilities I cannot exercise more than a daily walk. I have tried. I am on long term high rate disability benefits, I am very disabled by my conditions. Not everyone can exercise and do things to improve their bone strength and why should they when HRT can help with this if these things are difficult?

Lots of very young women go through early menopause in their teens due to cancer treatment. They take HRT.

It’s not just for older women.

It may be a natural event for older women but for younger women particularly going without oestrogen is anything but natural.

And older women should be able to make a proper assessment of their own personal risks and whether they’d like to take it and currently I don’t think there is enough positive media and information about it out there for women to do this.

Due to medical treatment I had suppressed estrogen as a younger woman and honestly it was massive the very quick drop in my cognitive abilities and mental well-being which very quickly recovered once my estrogen levels weren’t suppressed. For that reason alone I would be very keen to take HRT when I get to that point.

Yes 5 in 1000 indeed,left a zero out.

I have never said there were no risks
No, what you do is go in and in about the benefits and never ever mention the risks, hence providing in imbalance views.

This is why posters have to come and bring them up.

This thread is asking why not all women are being prescribed hrt since it has so many benefits. The obvious response is to to mention that it also comes with some risks.

Most of the treatment for it is oestrogen based so it’s a case of when you take it really. If you have a history of osteo in your family then it’s worth being informed on the benefits of hrt rather than dismissing it
Point where I've dismissed it? I wouldn't because I believe hrt is an amazing treatment helping many women. Just not for ALL women and not without any risks.

In terms osteoporosis, I also do a hiit class 3 times a week which involves pushups and other weight bearing exercises, bit it's a good point to raise that it's not just about legs and hips.

Of course , that is all absolutely true.
Under the age of 51 I think it is, of course , HRT is necessary .

I was only referring to the extended use of HRT past usual menopause age

Bagels good post.

It’s about information. Yes. So many gps are prescribing things like anti depressants for peri symptoms that NICE had to give clear advice on this. The more women know what’s happening in their bodies the better.

The level of increased risk of breast cancer, with the older types of combined HRT, is similar to the level of risk of breast cancer that any women has if they are overweight or drink around two glasses of wine a day
And many menopausal women are overweight and drinking too much, so already putting themselves at risk, hence why it is important for them to know that taking hrt MIGHT increase their risk even more.

Of course , that is all absolutely true.
Under the age of 51 I think it is, of course , HRT is necessary
No, not necessary. Maybe more potential benefits than risks but not necessary. Women didn't all due of osteoporosis before hrt became available.

In my family, I have my 75 year old mum, menopaused at 47, never taken get, excellent bone density. She is and always was active.

My MIL, in her 80s, on her since starting the menopause at 52, still on it!, was diagnosed with osteoporosis in her late 70s. Neither have had breast cancer.

We can talk of statistics and risks on a large scale, it doesn't mean that individual will respond one way or the other.

It's a real eye opener when you look at the statistics for increased risk of breast cancer due to HRT compared to alcohol. Some women are very reluctant to take HRT because of the cancer risk, but they're often not prepared to give up the wine despite it posing a much greater risk.

I agree.
It shouldn't be presented as ' alcohol is a greater risk than HRT'
It should be presented as ' do you drink ? If yes HRT will compound the cancer risk .
Are you overweight ? If yes , HRT will compound the risk .

@MyDcAreMarvel

£££ 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.

No you don’t get the “best medical care” in the US. I have lived in US for 4yrs and U.K. for 2yrs and then 5yrs, rest of my life in France and I’d rate the medical care I had in the US as the absolute worst. And I had exceptional medical insurance. It was the “gold plated” HMO variety, which is almost nonexistent today because it doesn’t make as much profit as the usual types of insurance.