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)?

@dontdisturbmenow

This is from Louise Newson's site and this is the relevant part of the conclusion of this paper Yet the NHS website and Breast Cancer UK say differently. Why would that be?

The nhs website is woefully out of date on all sorts of things sadly

@Queenie24

I was told 2 years ago I was perimenopauseal but as I was under 40 there was nothing they could do. Well I've now been back to the doctors as issue have continued to get worse. Hormone levels are normal but the doctors still say its perimenopause. I was told there were 2 options anti depressants or HRT. The doctor wanted to go antidepressants route as my mum died from ovarian cancer and apparently HRT increased chances of this. Well I said no to antidepressants as I'm not depressed so it looks like it will be the HRT route . However, now my husband and sister have both said not to go on HRT as I will be on it for ever and I should try natural options first? I'm 40 and now so confused.

You can take it for a short time if you like it doesn’t have to be for life. It should be reviewed regularly and new products etc appear all the time.

Sorry you are going through all that

'Your numbers are wrong. It’s harmful to spread misinformation.'

From the nhs website. One extra case per 50, this does indeed equate to 10/500 or 100 in 5000.

www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/

I agree it is harmful and wrong to spread misinformation. The stats should not be constantly dismissed on this board,

No, not everyone is able to cope without help and I'm a big advocate of exercise, diet, topical treatments. Not taking hormones.

@GetOffYourHighHorse

'Your numbers are wrong. It’s harmful to spread misinformation.'

From the nhs website. One extra case per 50, this does indeed equate to 10/500 or 100 in 5000.

www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/

I agree it is harmful and wrong to spread misinformation. The stats should not be constantly dismissed on this board,

No, not everyone is able to cope without help and I'm a big advocate of exercise, diet, topical treatments. Not taking hormones.

More recent research (links on this thread already) and info I was given from my GP says different figures. 1 in 200 extra cases if you still have periods and take it for under 5 years.

What a mess it all is. Women deserve up to date and consistent information.

Diet and exercise don’t cure all and as many have said here they have tried. It might do for some but not for all. If people don’t like the hormone products that are avail let’s campaign for better and better rather than this weird ‘shaming’ or criticism that seems to me to be anti feminist and anti choice

@JinglingHellsBells

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.

@JinglingHellsBells I've seen your posts on every HRT thread, it's clear you are very pro HRT. It doesn't mean that everyone who disagrees is wrong. Scientists and doctors disagree.

I am post menopause. I had awful symptoms for about three years but none since. I avoided HRT (I am not overweight and don't drink). I got breast cancer anyway.

In hindsight I'm glad I didn't take HRT as I would have felt the cancer might have been avoidable even if it wasn't.

@Newgirls “Diet and exercise don’t cure all and as many have said here they have tried. It might do for some but not for all. If people don’t like the hormone products that are avail let’s campaign for better and better rather than this weird ‘shaming’ or criticism that seems to me to be anti feminist and anti choice”

Yes! Totally agree... and let’s bear in mind that NHS resources are (understandably) stretched and information about HRT/risks may not be up to date. Thankfully, other information sources are available.

This is from Louise Newson's site and this is the relevant part of the conclusion of this paper. It clearly says that after 5 decades there is no absolute proof that HRT caused BC.

That was in 2018. Today, in 2020, we know that there is a definite link between HRT and BC:
doi.org/10.1136/bmj.m3873
“This study has produced new generalisable estimates of the increased risks of breast cancer associated with use of different hormone replacement preparations in the UK. The levels of risks varied between types of HRT, with higher risks for combined treatments and for longer duration of use.”

So the Newson website is definitely out of date.

@Newgirls and @GetOffYourHighHorse

You’re both right. It can be 1 in 50 or 1 in 200, depending on your age and which type of HRT you are using. The NHS website says in full:
“Women who take HRT for more than 1 year have a higher risk of breast cancer than women who never use HRT. The risk is linked to all types of HRT except vaginal oestrogen.

For women in their 40s and 50s who take HRT for 5 years there would be:

1 extra case for every 200 women taking oestrogen-only HRT
1 extra case for every 70 women taking cyclical HRT
1 extra case for every 50 women taking continuous HRT
The number of extra cases is thought to double among women who take these types of HRT for 10 years.

Research shows that the increased risk of breast cancer falls after you stop taking HRT, but some increased risk remains for more than 10 years compared to women who have never used HRT.

If you take it for less than 1 year, there is little or no increased risk of breast cancer.

Because of the risk of breast cancer, it's especially important to attend all your breast cancer screening appointments if you're taking HRT.”

So, let’s not be quick to call it outdated. The issue I think is people throwing out statistics that are not with their complete context.

'What a mess it all is. Women deserve up to date and consistent information. Diet and exercise don’t cure all and as many have said here they have tried. It might do for some but not for all. If people don’t like the hormone products that are avail let’s campaign for better and better rather than this weird ‘shaming’ or criticism that seems to me to be anti feminist and anti choice'

Absolutely agree, we deserve consistent definitive information. I am actually very pro choice i just see so often on this board the bc risks are minimised.

I don't want to shame anyone just imo whatever challenges the menopause presents women with, the tests, treatment and recovery from cancer are a million times worse. @Juo sadly had this anyway , it would be absolutely horrific to be diagnosed if we knew we had taken meds to increase the risk.

[quote PlanDeRaccordement]**@Newgirls* and @GetOffYourHighHorse*

You’re both right. It can be 1 in 50 or 1 in 200, depending on your age and which type of HRT you are using. The NHS website says in full:
“Women who take HRT for more than 1 year have a higher risk of breast cancer than women who never use HRT. The risk is linked to all types of HRT except vaginal oestrogen.

For women in their 40s and 50s who take HRT for 5 years there would be:

1 extra case for every 200 women taking oestrogen-only HRT
1 extra case for every 70 women taking cyclical HRT
1 extra case for every 50 women taking continuous HRT
The number of extra cases is thought to double among women who take these types of HRT for 10 years.

Research shows that the increased risk of breast cancer falls after you stop taking HRT, but some increased risk remains for more than 10 years compared to women who have never used HRT.

If you take it for less than 1 year, there is little or no increased risk of breast cancer.

Because of the risk of breast cancer, it's especially important to attend all your breast cancer screening appointments if you're taking HRT.”

So, let’s not be quick to call it outdated. The issue I think is people throwing out statistics that are not with their complete context.[/quote]
Yes that’s very useful thanks.

I was told one thing based on me. And that will be true of other women. It really is a case of we need to be individuals in this and read as much as pos. Some GPS are very out of date, and may websites are. It could all be better and with all this interest let’s hope it will be 👍

My personal bugbear is women being diagnosed with depression and being given meds for that when it is wrong for them (NICE guidelines). So more info around this subject will hopefully avoid that.

Exercise will help with mood and sleep problems, topical oestrogen will help with vaginal atrophy, a healthy diet will help with energy levels

If only it was this simple.

Try exercising or sleeping with hot flushes every 60 seconds. Try exercising or even trying to go about your day-to-day life when you've had less than 45 minutes of sleep across the whole night.

No amount of healthy diet will help with energy levels when you're getting little to no sleep. What can happen instead is that your cortisol levels will rise which will make getting to sleep even more difficult.

@Newgirls

My personal bugbear is women being diagnosed with depression and being given meds for that when it is wrong for them (NICE guidelines). So more info around this subject will hopefully avoid that.

Yes!

@Queenie24

Sorry you're not having an easy time of it. You should be treated according to symptoms, rather than hormone levels. Also, there is no reason for you to be on HRT forever, so for now, I would put that worry out of your mind and insist on being sent to a menopause clinic as anti-depressants aren't the answer, and won't protect you from osteoporosis.

@CamMakan

In case this helps others, I started HRT (estrogel and utrogestan) a few weeks ago. HRT was not a decision taken lightly. My mother had breast cancer following early menopause/HRT in her 40s; she recovered and went on to have bowel cancer in her 60s (from which she also recovered!) so I went to see a senior consultant breast surgeon first. His view was “premature menopause, as is the case with your mother, significantly reduces the risk of breast cancer. However, HRT simply normalises this and it is unlikely that your mother’s breast cancer was caused by her HRT.” He also told me that there is a slight increase in risk taking HRT compared to the general population, but also that weight, level of activity and alcohol consumption increase risk anyway. I work hard to keep fit and eat well, and it is an incentive to keep that up. Personally, I feel a million times better, taking HRT. I was struggling with insomnia, memory loss, aching joints, night sweats, rage and apathy. I feel human again. It’s thanks to people like my enlightened GP, my breast cancer consultant, *@JinglingHellsBells*, Louise Newson and her website, and others, that those of us who need and want to take HRT have knowledge of the options, and can seize back our lives during and after perimenopause.

I forgot to add in my earlier post: the consultant also mentioned that the risk of bowel cancer is thought to be reduced by HRT. Also, knowing of the slight risk of breast cancer, this is more likely to be identified earlier, at a (generally) more treatable stage. Just some extra factors to consider.

Yes lots of exercise when you have poor sleep and heart palpitations is not great advice!

I think jinglinghellsbells is taking a break from this thread and who can blame her! I for one have found her links and ideas helpful. The debate around this whole subject shows how much more research and education needs to happen. And surely not bully away people who really just want to help other women.

I am learning so much from this thread and am very grateful.

'Yes lots of exercise when you have poor sleep and heart palpitations is not great advice!'

If someone has heart palpitations they should have medical investigations and treatment if needed. If it is anxiety related then exercise even walking briskly for an hour a day will help. Exercise will of course help with sleep. Google dopamine and endorphins.

Cammakan, so your specialist said exact what some of us keep raising here, that HRT is a very good option for the treatment of the menopause, but does come with some slight increase risk in breast cancer, something that Jingle is trying hard to discredit.

@GetOffYourHighHorse

'Yes lots of exercise when you have poor sleep and heart palpitations is not great advice!'

If someone has heart palpitations they should have medical investigations and treatment if needed. If it is anxiety related then exercise even walking briskly for an hour a day will help. Exercise will of course help with sleep. Google dopamine and endorphins.

You really do not seem to grasp that anxiety and sleep issues are often related to menopause, and no amount exercise is not going to help.

Melatonin which is essential for sleep, production of which lessens as we age, particularly during menopause.

If exercise worked for you, then that is wonderful, but for many, it won't.

The exhaustion and bone ache has put paid to proper exercising.

@RaindropsSplashRainbows

The exhaustion and bone ache has put paid to proper exercising.

This! The pain in my hips and the exhaustion from lack of sleep meant I could barely function. And I was taking a lot of supplements and prior to surgical menopause pretty fit. The relief from my estrogel is amazing (prescription signed off by my breast cancer oncologist as he said that for me, as I’m late 30s, the effects of no oestrogen will be debilitating long term). Obviously there are risks, but the benefits need to be considered too, and these are often passed off as a natural process and women should put up and shut up. I also find it sad that people think breast cancer is somehow avoidable and this implies the woman’s fault if she’s taken HRT. I had breast cancer in my 20s, no family history, no smoking, fit and healthy and I didn’t drink to excess. It’s not your fault if you take HRT, and if you didn’t you could still have got it anyway. There are awful long term risk factors from reduced estrogen - heart health and osteoporosis are just two. People should consider the pros and cons for them and not be made to feel like shit whichever option they take.

@dontdisturbmenow

Cammakan, so your specialist said exact what some of us keep raising here, that HRT is a very good option for the treatment of the menopause, but does come with some slight increase risk in breast cancer, something that Jingle is trying hard to discredit.

No she hasn’t said that - the posts I read from jingling were more nuanced than that. Weirdly personal post and not in the spirit of what the OP was asking about.

Absolutely ^^

The tone of some of these posts is very ‘it’s your fault if you get ill you didn’t do enough yoga or eat plant-based etc’

All those things are great but cancer isn’t that easy to avoid sadly.