Have I been on the wrong dose of HRT for a decade?

[Choux]

I have been on HRT over a decade after being diagnosed with early menopause in my late 30s. Since hitting 51 the GP has suggested I come off it but I'm nervous about that as my life feels v stressful currently (elderly parents, work, pandemic restrictions making life less enjoyable). I came on here to find some evidence to support me staying on it when I request my next prescription in a few weeks.

But having seen another thread about younger people needing strong HRT I'm now worried as I think I have only ever been on regular HRT and I never attended a menopause clinic. I started off on Premique 0.625 / 5mg and am now on Kliovance 1 / 0.5mg. Should I have been on something stronger due to my age (youth!)?

I didn't have any real menopause symptoms other than missing periods when diagnosed and the HRT I took didn't cause any side effects so never really researched this. But as part of the follow up into my early menopause I had a Dexa scan and was told I was osteopenic so am now concerned I may not have kept my bones strong if on the wrong HRT dose.

Should I request another Dexa scan?

Lots to answer here!

1. Your GP is totally wrong and out of touch about you coming off HRT. There is no time limit on using hrt and you can stay on it for life. Many women don't even start using it till their 50s. The time you have used it doesn't count in terms of risks anyway as you were only replacing what you ought to have had.

The length of time you can use hrt (forever if you want) is YOUR choice unless there are strong medical reasons not to. This is in the NICE guidance and the British Menopause Society consensus statements. (all online.)

Also, HRT is now prescribed as the first line of treatment for women under 60 with osteopenia.

2 Dexa scans are supposed to be done every 2-3 years. How long ago was your last one? The reason for every 2-3 years is to monitor your bones and increase your HRT dose if applicable. You need to push for another scan and again, your Dr isn't up to speed if they have not done this.

The dose you were on was okay, as it helped you not to have any symptoms. But you do need to investigate your bone density sooner rather than later.

HTH.

two links for you. 1st one says use hrt to prevent osteoporosis in prem menopause.

thebms.org.uk/publications/consensus-statements/prevention-and-treatment-of-osteoporosis-in-women/

2nd one- half way down the page, no arbitrary limits on duration of using hrt.

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

Your dr needs to give you very sound, medical reasons why they think you should stop.

@JinglingHellsBells thanks so much for the fast and detailed reply!

I've not had a Dexa scan for over a decade so will follow that up with the GP. I had already decided I was not coming off it and the person from the practice I spoke to six months ago (when I had to agree to chat again in six months in order to get my repeat prescription) said they would not force me to come off it but I needed to be aware of the risks.

I belong to a multi GP practice with several nurses etc so I don't actually know what type of practitioner I had the telephone consultation with. I don't think she was a GP though.

The risks are minute and they don't even start until the age you are now. Most drs however would put you on transdermal HRT (patches or gel) and as it's safer re blood clots.

It's a disgrace you have had no Dexa scan for 10 years.

I'm sending you a PM.

Thanks - I've read it. I will be making a GP appt on Monday.

I think my score at age c40 was either -1.3 or -1.7. This fact sheet has a sobering diagram that shows that those scores at 40 look likely to slip down into osteoporosis by 75.

theros.org.uk/media/womm0us0/ros-c-bone-density-scanning-and-osteoporosis-fact-sheet-december-2018.pdf

Try not to worry until you have had your scan. The hrt you are using will have helped so you could be okay.

1 in 3 women over 50 have osteoporosis, but it's usually never diagnosed until they have a fracture. The best thing is to monitor it and take action if needed.

OP my GP wouldn't agree to me having a Dexa scan, so I got one done privately in London. It was about £150 and well worth it

Just had a telephone consultation with a doctor (not my doctor but since I only get this HRT and never use the practice otherwise I didn't know who my dr was)

It felt like she was following a script to get me off it - 10 yrs on it now, increased risks of breast cancer, you won't know if having symptoms until you come off it etc.

I interrupted and said no risk so far as have been replacing the hormones I should have had naturally, i have done some research and it has protected my bones, heart etc and I want that to continue esp as told am osteopaenic.

She mentioned not having my blood pressure or weight which I gave her (94/66 and 171lbs), supply issues with HRT (not Kliovance so far I said)

Result is she is giving me another 6 months prescription (ami going to have this chat every 6 months now?), no repeat Dexa scan as not severe enough to warrant it. At age 40 my t scores were spine -1.7 and hip -1.3.

I am due a BUPA health check through work so will get them to give me a Dexa even if I pay. Hopefully that will help my case to stay on HRT come next spring.

Thanks @JinglingHellsBells as your info helped me feel confident against 'the script'!

@Choux I really suggest you push your dr for a Dexa scan.
A T score of -1.7 10 years ago needs following up.
Usually they are done very 3 years. I have a few friends with that kind of score and they are having scans every 3 years.
HRT will help but you still need it monitored. You might need 2mgs dose as you had an early menopause. It's quite negligent of her to ignore this.
I'd see another dr or even pay for one if that's possible.