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)?

'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.'

Of course I grasp it. However exercise or at least daily significant activity will improve sleep and anxiety whatever the cause of the anxiety.

If someone was depressed would you just suggest meds, not certain life-style changes which are evidence based to produce natural hormones that affect mood and sleep?

Look, take hrt if you like, just do so knowing you increase the risk of bc no matter how small that risk may be.

@GetOffYourHighHorse

'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.'

Of course I grasp it. However exercise or at least daily significant activity will improve sleep and anxiety whatever the cause of the anxiety.

If someone was depressed would you just suggest meds, not certain life-style changes which are evidence based to produce natural hormones that affect mood and sleep?

Look, take hrt if you like, just do so knowing you increase the risk of bc no matter how small that risk may be.

It’s context. The risk is negligible for many. We should focus more on the risk of alcohol and being overweight which is far more likely in the UK. Being overweight increases your risk of some cancers by 25%! I hope the anti hrt-ers raise awareness of that as much?

I'm afraid you are rather tripping over your own feet here .

HRT will be added to the risks of being overweight / drinking etc

As I pointed out earlier in the thread :

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

Being overweight increases your risk of some cancers by 25%! I hope the anti hrt-ers raise awareness of that as much?

Ha. I’m not anti HRT myself and I don’t think it’s nice to accuse people stating what actual medical cancer risks there are which might be higher or lower depending on the individual. We’ve talked mostly about breast cancer but some HRTs can also increase ovarian and womb cancer for some women as well. Your throwing in other causes of cancer is a bit of what aboutery to my mind. Might as well have said smoking causes cancer, why aren’t you antiHRT people banging on about smokers too?

@dizzyandbusy

I'm afraid you are rather tripping over your own feet here .

HRT will be added to the risks of being overweight / drinking etc

As I pointed out earlier in the thread :

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

In addition, the BMJ 2020 study did take into account comorbidities like alcohol, weight, lifestyle factors, etc and actually adjusted the HRT cancer risks accordingly.

“Odds ratios for HRT types, adjusted for personal characteristics, smoking status, alcohol consumption, comorbidities, family history, and other prescribed drugs.”
doi.org/10.1136/bmj.m3873

So you can safely count on the risks reported in this study are just from HRT and not wonder oh, maybe it’s because the women studied smoked, were overweight, drank like fish, had a family history of breast cancer ....that has all been accounted for:

“Overall, 33 703 (34%) women with a diagnosis of breast cancer and 134 391 (31%) controls had used HRT prior to one year before the index date. Compared with never use, in recent users (

note that the numbers of extra cases are per 10,000 woman years, not women. So that’s the # of extra cases you’d see every year* for 10,000 women.

To get your personal risk in terms of number of extra cases per 10,000, you’d have to multiply that extra cases number by the #yrs left you intend to take HRT. If you’ve had HRT, you use the past user figure and multiply that by years left of your life expectancy.

So a 38yr old woman on oestrogen-progestogen would be in the 9 extra cases per 10,000 woman years category. This hypothetical women intends to take HRT until she is 50. So her additional risk is 12 x 9 or 108 in 10,000 women.

So fast forward and she is now 55 and stopped her oestrogen-progestogen HRT five years ago, luckily no cancer. Her remaining elevated risk is now her life expectancy x 2 cases extra per 10,000 woman years. She probably has life expectancy of 86. So 31 x 2 = her personal risk is an extra 62 cases in 10,000 women (living to 86).

• the odds risks are easy to decipher. 1.99 means your risk is almost doubled for example. Now, don’t panic because the initial BC risk from HRT is small...so doubling something teeny tiny, is still tiny.

@dizzyandbusy

I'm afraid you are rather tripping over your own feet here .

HRT will be added to the risks of being overweight / drinking etc

As I pointed out earlier in the thread :

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

Not comparable at all. Alcohol is 25% more linked with breast cancer. Whatever fig you apply to hrt risk from zero to 1% it isn’t in the same league

It’s not whataboutery - there is so much misinformation and spin about this it needs raising.

I know people who say they wouldn’t take hrt because of the cancer risk yet they’d happily drink loads. We can be very selective in our ‘risks’ and not always logical

This is such an active thread, which is great because HRT still isn't discussed openly enough in my opinion!
HRT should be an informed choice for all women and that still is not the case.You really have to do your own research to decide if it's the tight choice for you & often then fight to get it too. Thank goodness NICE have finally updated guidance to say women are allowed to make an informed choice ..baby steps and all that!

Referring to the original question though..due to the fact aging has now been reclassified as a disease and not an inevitably, I suspect in 10 years or so hrt or a new improved form thereof will indeed be a recommendation for those wanting to improve healthspan.

Healthspan! That’s the word, isn’t it!

Yes my confusion is, are there two strands of reasons why women should consider HRT:

1. symptoms of menopause
2. the personal balance of risks/benefits may be weighted towards HRT for an enhanced ‘healthspan’.

I read Perimenopause Power by Maisie Hill and she writes both of the benefits (& risks) of HRT and of keeping an open mind as you try lifestyle changes first, that you may move on to HRT if your symptoms don’t resolve. But the benefits she describes sound - for some women - less risky to their ‘healthspan’ than going without it, yet that option - HRT in the absence of bad symptoms - is not covered. Idk if it’s even an option on the NHS?

HRT in the absence of bad symptoms - is not covered. Idk if it’s even an option on the NHS

I have a cardiovascular condition that research seems to suggest has better outcomes on HRT (including lower mortality rates) but I can't be prescribed it for that reason, I have to have symptoms now. I have been very anxious though (as you would be if you had a condition that could kill you) so that's a symptom!

@TabbyStar how stressful for you! So do you have prescription for it now?

I have a fantastic GP who is menopause lead for the county and HRT has changed my life . She talk a frankly about sex and the menopause and it's was really helpful to my relationship. The protective effects to my bone density, cognition and heart health are a bonus .

@TabbyStar how stressful for you! So do you have prescription for it now?

I do, basically the prescribing nurse said something along the lines of "I can't prescribe it for your condition but if you tell me you have symptoms such as anxiety or hot flushes I can prescribe it". To be fair I do feel much more anxious in general. I think it's appalling though that I have to read medical journals because my consultant for my condition knows nothing about the menopause - you would have thought that they would bearing in mind the effect of the withdrawal of estrogen on the cardiovascular system and that it's a condition that disproportionately impacts women between 50 and 60 - and the nurse can't prescribe it either for that.

“ my consultant for my condition knows nothing about the menopause - you would have thought that they would bearing in mind the effect of the withdrawal of estrogen on the cardiovascular system and that it's a condition that disproportionately impacts women between 50 and 60”

That’s shocking.

I got no support and had a terrible time with menopause. There is a strong history of breast cancer in my family. I don't know if this is the reason I was not offered HRT. In my experience GPs and higher are useless when it comes to both menopause and thyroid health, both issues are in the main womens. Is that a coincidence that treatment is so scant? In the end I went through utter hell. My menopause symptoms are now subsided but it took about 3 years.My husband was my only support , for some reason my friends just didn't want to talk about it or brushed it off.I don't bother with doctors unless I absolutely have to. My GP is sympathetic, but I find further up the tree is where the difficulty lies. It's like anywhere else good doctors and others that make me wonder.

So many stories about lack of support and actual training in peri/meno with GPs. There is campaigning happening which is why we are all talking about it but it’s woefully late for so many.

@Newgirls

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.

Exactly.

We all do things that have an element of risk because they make our lives easier / give us enjoyment or pleasure. Getting in a car, eating chocolate, eating red meat (increases risk of bowel cancer in certain studies), using cosmetics (chemicals) blah blah blah. Sure we could all live in the woods and eat berries and never do anything but what kind of life is that? I think we’re all so worried about death we’ve forgotten it’s important to live.

I have a strong history of bowel cancer in my family - there is no genetic link been proved (I’ve been tested) so I do try and watch what I eat to some extent but I could do all that for the next 40 years and I still might have got it anyway and if I did eat a bacon sandwich everyday it might not have made a difference anyway.

Hrt is somewhat similar really. If it improves your life then go for it. You can always stop it if it doesn’t and if it does and even if it does have a small associated risk maybe it’s worth it to have some quality of life? And embrace the benefits too.

Yes @Newgirls. JHB is obviously not going to give her expert and knowledgable, wise, wise and kind advice and pointers/map/papers for people to do their own research anymore and why would she?

Ok for me, I benifited from it, as others did, hugely. But I am so sorry for women who will sadly miss out.

I am relieved the NICE guidelines have at least been reinstated at the top of this thread. They seem to have disappeared for a while. (I could be mistaken)

@Bagelsandbrie Exactly this.

@BillieSpain

Yes *@Newgirls*. JHB is obviously not going to give her expert and knowledgable, wise, wise and kind advice and pointers/map/papers for people to do their own research anymore and why would she?

Ok for me, I benifited from it, as others did, hugely. But I am so sorry for women who will sadly miss out.

I am relieved the NICE guidelines have at least been reinstated at the top of this thread. They seem to have disappeared for a while. (I could be mistaken)

I'm thinking (hoping) she may come back on future threads.

I hope so too, as things change all the time and she has professional insight into the latest research.

But I wouldn't blame her for steering well clear of the personal attacks.

Yes bagels - so true about red meat and so many other ‘risks’

I think the HRT and alcohol/weight thing is like people being scared about getting on planes but not thinking twice about getting in a car. It’s not logical or based in evidence.

@Newgirls

Yes bagels - so true about red meat and so many other ‘risks’

I think the HRT and alcohol/weight thing is like people being scared about getting on planes but not thinking twice about getting in a car. It’s not logical or based in evidence.

Yes. 100 per cent this.