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)?

In response to the original OP: If HRT protects later health in most women, why aren’t we all offered it, regardless of symptoms?

As someone who is already post-menopausal at 45 and very much intends to stay on HRT for as long as possible, I have thought about this a lot over the years, particularly as I had to battle to get HRT in the first place.

I think the answer is simply that most GPs are not up to date with current HRT information, and many are still holding much outdated knowledge. It is worth remembering that during their training, menopause is covered briefly, and it is rare to find a GP with a keen interest in it/who keeps up on new research. In my experience, many GPs think menopause is something that happens to older women, and it is when your periods have stopped completely, so if you're still having periods, they won't offer HRT. And, sadly, again in my experience, many older male GPs think menopause is something that women should just deal with, something I have had said to me on several occasions.

In some instances, GPs aren't informed enough to even prescribe the right HRT anyway, and why there should be more specialist menopause clinics. Menopause is a very real issue, and should be taken seriously and treated by specialists who know what they are doing. It is scandalous really that over half the population will go through menopause at some point, either naturally or due to surgery, and there isn't more funding, research or a focused approach by the NHS for all women to tap into and be helped by. This should be part of the discourse too.

Lastly, I feel strongly that regrettably, medicine and healthcare is geared more towards men. While I do not want to say it is a simple case of misogyny, there is a general lack of interest in women's health as a whole. I genuinely believe if men went through menopause, things would be very different.

why there should be more specialist menopause clinics
I fully agree. And training available for not medical staff that could provide these clinics supervised by the clinician.

These clinics should not be about hrt only, but also consider other medical and non medical alternatives. Treatments that also focus in one specific issue rather than all as many women struggle with only one or two menopausal issues and need help with these specifically.

@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!

How do you know this stage will pass? - it didnt for my mother and she went back onto HRT ( after she was taken off by her DR after the scare of a few years ago) she went back on it at 70 and feels so much better, her symptoms are well managed. She is fit and healthy, eats amazingly well, has a personal trainer 3 x per week, does pilates and she did these things before going back onto HRT. The difficult stage didnt 'pass' and doesnt for many. The fact that you feel great is brilliant for YOU. So in the same way you are suggesting that Jingling is making sweeping statements so are you.

Kingfisher
Of course I can't speak for your mother .
We are all generalising to some extent . Similarly , your mothers experience is not relevant for others .
I am merely trying to balance the argument . The fact is , for the majority of women the worst of the menopause symptoms do pass. Some have no symptoms at all!

@dizzyandbusy
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 .

It's not about ME. I don't care if you think I am 'right' or not. I'm quoting science -based information from NICE and world menopause experts.

Your point is actually untrue. The risks and benefits are not finely balanced. That's your opinion. The evidence shows that for women aged up to 60 (at least) the benefits outweigh risks. You can read all of this on the British Menopause Society website.

eg the risk of breast cancer is 5 more women (on the old types) in 1000 over 7 years. That is a risk of 0.5% divided by 7 years, per woman, which is tiny and applies to the type of HRT not used a lot now (old research.)

If you read the quote from Dr Currie (and I know most other meno experts concur with this) it is that HRT does not cause cancer but promotes the growth of an existing cancer.

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!

Again, this is all about you. It's hardly factual or statistical. The facts are that up to 20% of women have ongoing meno symptoms for up to 15, 20 or more years. My mother still has hot flushes into her late 80s.
I could name 3 menopause experts who have said they have women in their 80s and 90s still using HRT because they have symptoms otherwise.

You clearly have your own mindset on this so I suspect however many stats I list, or who I quote, however reputable they are , you will still throw it back at me and say it is my 'opinion'.

It's funny how the posters here who are wary of HRT / don't want it rely on their opinions or personal experience, but ignore all the science and the evidence, thereby cause alarm amongst women trying to make an informed choice.

We are all generalising to some extent

LOL .
Scientific facts are not 'generalisations'.

What we have here are a few posters who are anti HRT for whatever reason and want to make out their opinions are based on fact.

@dizzyandbusy

Kingfisher Of course I can't speak for your mother . We are all generalising to some extent . Similarly , your mothers experience is not relevant for others . I am merely trying to balance the argument . The fact is , for the majority of women the worst of the menopause symptoms do pass. Some have no symptoms at all!

I am merely trying to balance the argument . The fact is , for the majority of women the worst of the menopause symptoms do pass. Some have no symptoms at all!

And some will have every symptoms going.

I believe this is at the root of it all - the very simple fact that no two women will experience menopause in the exactly same way is why we aren't all offered HRT regardless and why there is such an erratic approach/lack of knowledge among GPs in general.

*I'm quoting science -based information from NICE and world menopause experts"
No, you are quoting selected science based-inforaation, from selected experts that that always goes in favour of hrt.

What we can concluded from this thread is that clinicians need to start listening to INDIVIDUALS because one characteristic of the menopause is that unlike many disorders patients seek treatment for, the menopause is extremely individual.in it's manifestation.

Debating one research against another, one expert from another, trying to justify that the Menopause is best treated one way or another us totally counter-productive.

This is why I'm still struggling with it and why I don't trust clinicians any longer. I don't want a lecture on hrt, or herbal remedies or whatever else.

I want to be listened to, in great detail so that my treatment options are based on the specificity of MY menopause not what X expert has said based in their specific research.

*Scientific facts are not 'generalisations

A good scientist never talk of facts, but of research outcomes, very very different!

What we have here are a few posters who are anti HRT for whatever reason and want to make out their opinions are based on fact
Who is any hrt? Staring that her is not risks-less and doesn't work for everyone doesn't make you anti-hrt. Only in the mind if those who think hrt is the cure to the menopause.

@dontdisturbmenow

*I'm quoting science -based information from NICE and world menopause experts" No, you are quoting selected science based-inforaation, from selected experts that that always goes in favour of hrt.

What we can concluded from this thread is that clinicians need to start listening to INDIVIDUALS because one characteristic of the menopause is that unlike many disorders patients seek treatment for, the menopause is extremely individual.in it's manifestation.

Debating one research against another, one expert from another, trying to justify that the Menopause is best treated one way or another us totally counter-productive.

This is why I'm still struggling with it and why I don't trust clinicians any longer. I don't want a lecture on hrt, or herbal remedies or whatever else.

I want to be listened to, in great detail so that my treatment options are based on the specificity of MY menopause not what X expert has said based in their specific research.

Excellently put.

I want to be listened to, in great detail so that my treatment options are based on the specificity of MY menopause not what X expert has said based in their specific research

The main issue I had was that none of the GPs I saw listened to what I was saying to them. They just saw me as someone whose symptoms had to match a list exactly, and for me to fit to their guidelines. When my body did not respond in the expected way, they washed their hands of me.

At no point did I ever want to or even think I would have to seek out private treatment, but I was forced to because of the lack of duty of care from various GPs. My private specialist listens to me, and she actually cares about my wellbeing. This is priceless, and should be standard for everyone.

@dontdisturbmenow

*I'm quoting science -based information from NICE and world menopause experts" No, you are quoting selected science based-inforaation, from selected experts that that always goes in favour of hrt.

What we can concluded from this thread is that clinicians need to start listening to INDIVIDUALS because one characteristic of the menopause is that unlike many disorders patients seek treatment for, the menopause is extremely individual.in it's manifestation.

Debating one research against another, one expert from another, trying to justify that the Menopause is best treated one way or another us totally counter-productive.

This is why I'm still struggling with it and why I don't trust clinicians any longer. I don't want a lecture on hrt, or herbal remedies or whatever else.

I want to be listened to, in great detail so that my treatment options are based on the specificity of MY menopause not what X expert has said based in their specific research.

You have summed up how I felt too dontdisturb. I tried HRT , found it gave some new symptoms , didn't relieve all of the old ones , found the rabbit hole of constantly changing cancer advice re HRT a pain to keep up with. And Hellsbells you are certainly persistent in your defence of HRT , I'll give you that . But I'm from a family of drs and scientists ( not one myself as is probably clear ) and the one thing they do agree on is when people start stating things are 'scientific facts' be very wary. There is no such thing . Medicine in particular changes constantly . I never did find the educated listener dontdisturb , I just gave taking nothing a chance . I felt better and better as time went on . I'm afraid I can't quote a scientific study to support me Hellsbells, you'll find there aren't many studies done on people who don't take medication. No money in it .

Because there are other medications that can prevent osteoporosis, if that is what you mean.

@dontdisturbmenow

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.

True. GPs would be reluctant to prescribe hrt for women who drink a lot or who are ‘obese’

@dizzyandbusy

Kingfisher Of course I can't speak for your mother . We are all generalising to some extent . Similarly , your mothers experience is not relevant for others . I am merely trying to balance the argument . The fact is , for the majority of women the worst of the menopause symptoms do pass. Some have no symptoms at all!

Yes symptoms like flushes etc do pass. But the underlying damage to heart, brain/mental and bone health lasts for years.

I wondered about asking my GP earlier this year. I started getting hot flushes at 49 and no periods for 6-8 months. Luckily at the moment it has all started up again, but clearly I am at the start of it all, and at some point I will have to think about it - I don't know whether to do so sooner or wait til symptoms become very difficult to manage in any other way. I was coping OK with that level of hot flushes, though they were very annoying.

My biggest concern is dementia; I have a huge family history of it, really really prevalent. The evidence I've seen for HRT and demetia is mixed - some research seems to say it can be preventative, whilst others say that it actually increases the risk. I don't think my GP will be up enough on the studies to be able to talk through the differences between them and what the most recent results indicate, but maybe a specialist would.

I take it for prevention for a very specific condition that I have that research shows affects women less if they are on HRT. I had to do all the research myself though, my consultant for that condition knew nothing about it at all and said no one had ever asked him before about the menopause. I could only be prescribed for current symptoms, not because evidence suggested it could save my life though. IME the knowledge of the medical profession about the impact of the menopause is abysmal bearing in mind the many conditions that start to affect us in our 40s and 50s.

The cause(s) of dementia are still very much unknown. As you say, many research, mainly undertaken by drug companies, but no research yet has come up with an undebatable list of risk factors.

I'm reading an I retesting join in the matter 'the end if Alzheimer's Programme by Dr Dale Bredesden. His view is that the reason why there is still no cure is because the disease is the results of many unbalances. Oestrogen is one of them, but 'them' is about 50 different factors, so only one part contributor amongst others.

It's an interesting book. Even experts have different views, so indeed, we can't expect a GP to provide us with reliable guidance on this subject.

Dementia is a huge one - I’ve read about links to low protein/veggie diets too so we need to be making sure we get good protein-rich diets from whatever source we choose. Oestrogen ‘fuels’ some normal cell growth so low oestrogen linked with all sorts of issues. I agree a gp prob won’t be able to help much but I hope a specialist can.

No, you are quoting selected science based-inforaation, from selected experts that that always goes in favour of hrt.

This is getting beyond madness @dontdisturbmenow and @dizzyandbusy.

You genuinely want to dismiss the entire committee of the British Menopause Society and the International Menopause Society as me 'being selective' in what I post?

And yet you have not posted any single piece of evidence to show that HRT has far bigger side effects than those stated by NICE etc?

How you have nerve to post that the BMS (it's a group of consultants) and the IMS (ditto but worldwide) are being selective in their statements, is truly shocking.

It's really sad- and doing a disservice to women who ask here for information- that you feel the need to dispute the statements of all these experts, when someone started what was a sensible discussion, asking for information. And that you think you know better.

Hellsbells, you'll find there aren't many studies done on people who don't take medication. No money in it .

@dizzyandbusy There are plenty of cases of women in poor health who have not used HRT when it would have benefited them.

Ironically, the drugs for osteoporosis are more of a money maker for drug companies than HRT which is dirt cheap.

I asked you many times over this thread to stop pointing the finger at me and making out these are my opinions. if this low-level bullying and attempts to stop me posting facts continue, I will report those posts. It's not right to hound one poster or make it personal.

Also, there is no absolute definitive proof that HRT causes breast cancer (this is on a factsheet by Dr Louise Newson.)
Your use of wording says it all. Absolute definitive proof? No, there isn't, just as there is no definitive absolute proof that hrt is harmless.

There is reliable evidence that shows that hrt has a positive effect on the risk of osteoporosis (amongst other things) just as there is reliable evidence that hrt increases the risk of breast cancer.

Science is never black or white. It never refers to facts or proof.

And yet you have not posted any single piece of evidence to show that HRT has far bigger side effects than those stated by NICE etc?
Why would I? I'm not debating against NICE or other bodies you mentioned. NICE is not saying that there is zero increased risk of cancer. I'm not arguing that hrt has more risks than benefits, just that it does have SOME risks and for some women, these will not outweigh the benefits, if any.

It's you who seem to be determined to defy the notion that there are any risks at all. Why?

if this low-level bullying and attempts to stop me posting facts continue, I will report those posts. It's not right to hound one poster or make it personal
I agree with you, but you might want to consider your own behaviour as you have made very personal attacks to others, including myself recently and the tone of your posts was much more hostile.

I have said many times that your posts here are invaluable here as your knowledge of hrt is incomparable.

The issue is your general refusal to want to acknowledge that it is not be all end all treatment for everyone.

Jingling is a huge asset to these threads - pls stay!

To reply to the OP again.

Some more thoughts on why hrt isn’t more prescribed that might be more productive!

1. Women after 50 didn’t work as much as now. We can’t afford brain fog etc any more

1. Social media etc we now talk about the symptoms and share info than ever before

1. There was ‘shame’ talking about no longer being fertile, older, or whatever so women didn’t talk about it so clearly and so widespread.

1. Women need men less. So we are happier to say out loud that we are no longer fertile and are in a dif stage of life. It’s a fascinating cultural shift really!

Thank you all, I’ve nothing intelligent to add but am reading avidly.