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)?

@Fullyhuman If you want to read the BMS consensus statement on HRT this came out this month. I hope it helps. I know this thread got a bit heated, but if you get past that, there are some facts amongst it all :)

hebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/

thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/

Trying again! :)

There's something weird about HRT that makes people blinkered evangelical about it. Evangelism rings huge alarm bells, giant red flags for me. You evangelists are insanely undermining your pet cause.

For me it's a lot like debate around statins. The benefits are obviously being exaggerated and the risks-under stated, by people with vested interests.

I don't care what individuals choose. I hope people find a comfortable way forward whatever drug they take or don't take.

@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 56 and have "suffered" from menopause for the last 5 years. I didn't want to take HRT and went down the natural route. Exercise, nutrition and supplements. I'm slim, exercise daily and don't drink. There was NOTHING more I could have done "naturally", however I think I'm ready to throw in the towel and try HRT.

I've got the most horrendously stiff body, I ache like an old old woman and think it may be due to low oestrogen.

So yes you were lucky to get through it unscathed but it's not just because you did it healthily. So be honest I'm pretty devastated I may have to go on HRT, I never even went on the contraceptive pile, I used a Dutch cap.

But I can't carry on being like this. :(

Laeta - your gp will prob recommend you try 1-3 months so you can see if it’s for you without some huge commitment if that helps. Also some women use it for a short time 1-3 years depending on their age and situation so it doesn’t have to be forever if that concerns you.

@dontdisturbmenow If you read my posts- especially those from Sunday round about 2 pm - I said very categorically that it's a personal choice. I quoted Dr Newson and then linked to her own website to the factsheet.

I also referred to the BMS where they say benefits outweigh risks for women up to 60.

It's also no 'evangelical' to link to the BMS and IMS statements.

I think- reading my own posts here- they are accurate and balanced.
I have said many times in this thread that it's a personal choice.

I have never said all women should use HRT but I did say that the IMS and Nick Panay were in favour of women using HRT for long term health benefits if they were informed of th e small risks.
I'm really struggling to understand the accusations from you and another poster who want to accuse me of being totally pro HRT when in fact I'm not giving a personal opinion, but quoting other experts (and they are not selective! I could have listed other experts who are far far more evangelical about HRT and also research papers that show no links at all with breast cancer.)

That's all I have to say on this.

It's just a shame that it's turned into a bun fight for the same old reasons.

@Laeta You just have to try it and see how you feel. Like you I had done everything I could in terms of lifestyle before I went onto HRT, well past peri meno. I never intended to or thought I'd use hrt.

I was advised that the risks were small, that symptoms like lack of sleep are very detrimental to health (making us more prone to weight gain and reduced immune system) and I also had other personal health risks which made HRT more advisable. I was told that some women never get rid of flushes etc (my consultant told me he had women who had suffered for 30+ years.)

Some women- the lucky 25%- get away with no or some symptoms for a few years. Others don't and there is no knowing how long the symptoms can last.

I hope you get on okay whatever you decide.

@yeOldeTrout

There's something weird about HRT that makes people blinkered evangelical about it. Evangelism rings huge alarm bells, giant red flags for me. You evangelists are insanely undermining your pet cause.

For me it's a lot like debate around statins. The benefits are obviously being exaggerated and the risks-under stated, by people with vested interests.

I don't care what individuals choose. I hope people find a comfortable way forward whatever drug they take or don't take.

Spot on trout .

When I said I felt very well post menopause and non medicated I certainly wasn't intending to boast or make anyone feel lesser. I merely wanted to give some hope to those still in the midst of the storm - for many the storm does pass . There some of us who actually feel better than they have for years now that all the hormonal ups and downs have stopped . You don't hear much about that side of it do you ?

@yeOldeTrout

There's something weird about HRT that makes people blinkered evangelical about it. Evangelism rings huge alarm bells, giant red flags for me. You evangelists are insanely undermining your pet cause.

For me it's a lot like debate around statins. The benefits are obviously being exaggerated and the risks-under stated, by people with vested interests.

I don't care what individuals choose. I hope people find a comfortable way forward whatever drug they take or don't take.

If something had changed your life immeasurably, wouldn't you be evangelical about it?

However, I also understand that not everyone will choose the HRT route and they have absolutely that right to do so - I would never belittle others choices or try to change their minds, (although that said, I am always surprised by the number of women who choose to struggle through perimenopause with symptoms that can easily be tamed and stopped with HRT). But as I said, that is their choice and I respect that.

@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’m afraid exercise alone does not reduce hormonal surges in all women. I am a fit, regular exerciser. I mean HIIT, weights, aerobics, etc, at least four times a week. I am slim and eat well. No way could I manage my hormonal changes without HRT.

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

It's very condescending to suggest that women can 'help themselves' if only they would 'do a bit more'. It implies women are too stupid or lazy to a) know that lifestyles matter and b)have not tried it already.

Also, HRT is not really classed as medication or using it is 'medicating' . It's a 'replacement' treatment. Yes, in the UK it's prescription-only but in some parts of europe it's bought over the counter.

Lots of dangerous drugs are bought over the counter in other countries .

You are really stretching credulity now .
HRT is a hormonal ( steroid ) medication .

‘Evangelical’ is the sort of word used to shut women down. To stop them speaking.

It prob suits some people for women to feel rough, not sleep enough, step back on work commitments. It’s like the debate around the contraceptive pill all those years ago. Women know your place!

There is another view .

Keep women on medication , keep the profits for the drug companies rolling in.

Interesting point you make on work though . We do need to keep as many people in work as possible for as long as possible . Hmm

@dizzyandbusy

There is another view .

Keep women on medication , keep the profits for the drug companies rolling in.

My grandma was on heart meds for years - it’s prob more a case of what drugs you take and when 🤷‍♀️

@dizzyandbusy

Interesting point you make on work though . We do need to keep as many people in work as possible for as long as possible . Hmm

Yes let lovely women all stop work at 48 and be tied to men 😳

There are some really odd comments here. No facts or figures to back them up.

meds
The biggest portions of the NHS budget are spent on drugs for chronic conditions. These are CVD, diabetes (£Billions) and drugs for arthritis and osteoporosis.

All of this are preventable in women, or reduced risk, with HRT.

The cost of HRT is tiny.
Drug companies make practically nothing from HRT. This is also why they don't fund research into HRT on the whole, because unlike something like the common cold, or heart disease, there is not a lot of money to be made from producing new hormonal treatments for women over 50. The current use of HRT is 10-15% of women.

some of the biggest and most profitable companies are those selling vitamins and supplements. Many of them touted as remedies for menopause yet research shows most are ineffective.

The women who are being medicated are the thousands being given antidepressants, wrongly, when they ought to have estrogen. This is a scandal ,and if you want to appreciate the problem do some googling. NICE has, thankfully, told GPs to stop using ADs as a first line treatment for peri and meno women, but too many women are addicted to them or can't find a dr to offer better alternatives.

@dizzyandbusy Estrogen is not a steroid.

I think- reading my own posts here- they are accurate and balanced.
I have said many times in this thread that it's a personal choice
But without mentioning the actual risks and actually downgrading them. How can this be balanced?

Saying that her is fantastic, recommended by X, y, and z expert, pointing in details the benefits but never mentioning the risks and actually saying that they have not been demonstrated can't be referred as balanced view. This is what is missing from your detailed and well informed posts, that and your seeming refusal to accept that it doesn't work for every peri or menopausal women.

@Laeta, poor you, you need to give it a go. If it works for you, it can change your life for good.

As for healthy lifestyle overcoming the symptoms, I would think it certainly helps, but like others, I couldn't do anything more. I walk on average 100,000 steps a week, do not drink any alcohol or caffeine, eat healthily (albeit a bit too much as I'm always hungry), have no stress in my life, follow all guidance for a healthy sleep and still I can't sleep, when despite Avery stressful life for many years before, it was the one thing I could rely on. HRT did nothing at all to make me sleep better, and came with other unpleasant effects. Poor leep is the only outcome I struggle with.

@dizzyandbusy Steroid- not in the sense you imply. As most people think.

Not that it's relevant in any way to the OP's first question

The biggest portions of the NHS budget are spent on drugs for chronic conditions. These are CVD, diabetes (£Billions) and drugs for arthritis and osteoporosis. All of this are preventable in women, or reduced risk, with HRT
Really, HRT prevents diabetes...

Diabetes is the the most expensive condition in the UK. 80% is type 2 and preventable. The best prevention is keeping fit and a good weight. That's a much more efficient treatment for it and even cheaper than HRT, without increased risk of cancer.

Why not promote healthy lifestyles rather than HRT?

@dontdisturbmenow I have never said HRT is fantastic. maybe you and I can carry on this debate off forum if you feel so strongly as you are really side lining the debate and making it personal- as you always do on this forum.

Why not promote healthy lifestyles rather than HRT?

I do!

But equally, do you not want women to know that HRT reduces the risks of diabetes- that it's in the list of conditions it helps prevent, by changing the lipids and various other factors?

Or are you unwilling to have facts posted?

Do you think that your posts are coming over as trying to censor what anyone says if it's showing the benefits of HRT? Honestly, it's getting laughable.

I personally like this article from Oxford, which I found to be genuinely impartial.

www.ox.ac.uk/research/hrt-safe-use-menopause-what-science-says-0