Help needed to decide on HRT please!

[Nickersnackersnockers]

I am getting more confused by the day!

I visited a friend just starting on HRT. She is starting it to reduce potential problems and combat symptoms that may or may not be attributed to the menopause at the moment. I have looked into it as i have a couple of issues that also may or may not be attributed to the menopause. For instance, my memory is poor, I have lost interest in things and apathy. I don't have hot flushes or night sweats or any other typical symptoms.

My friend has started HRT to reduce the chances of heart disease, osteoporosis, diabetes in the future.

So I rang the gp who said yes you qualify after asking the most basic of questions, sent me information and told me to message him when I've decided which one I want! He recommended I consider SSRI'S as there are less risks involved but how would they help combat osteoporosis plus I'm not even depressed?!

Can anyone please offer any wisdom to help me out of this dilemma! Does anyone else take HRT with few or no symptoms. Davina says only 1 in 10 of us take it anyway.

The gel is good, while others prefer the patch

I’m sure someone will come along with more expertise than me but I have quite mild symptoms (no hot flushes or insomnia) but have gone on HRT at 45 partly because of the protective long term benefits. Effectively I think the risk of not taking it is higher than my risk of taking it. But it really is a personal choice.

I don’t think the number of women taking it has a bearing on anything as it can be quite hard to get hold of (and women are nervous anyway) following scare stories emanating from a long discredited study in 2002.

I think SSRIs are antidepressants so obviously not HRT. HRT is estrogen (gel or patch) and progesterone (needed if you still have a womb to prevent risk of uterine cancer). Because we have estrogen receptors in different parts of our bodies, balancing hormones can help with low mood. Don’t know why anyone without low mood/depression would take antidepressants as I’m sure they come with risks/side effects of their own.

Thank you for your replies. I'm particularly interested in women taking it purely for the future benefits which seems to fit with you table. The doc was really up for it when I expected resistance. Which made me suspicious he wasn't doing his job properly!

Yes he did offer anti depressants but I don't see how that would help. I think it was if i was worried about the risks associated with H R T.

I will go with patches and pill if i go for it

If I could turn back the clock to 13 years ago when I reached menopause, I would be asking my doctor for HRT without a shadow of a doubt!

It's too late for me to start now. I'm 63 and have advanced osteoporosis and worry every day that the next time I slip and fall, or the next time I have a bad cough or sneeze too hard or turn over in bed I could fracture my spine.

I hugely regret not having asked for HRT when I was 50. I had an uneventful menopause, with just the usual symptoms (hot flushes, night sweats etc) and didn't feel they needed medicating.

Don't make the same mistake that I made, OP. If you're deemed suitable for HRT then I would strongly advise that you take it, especially if you have any other risk factors for osteoporosis (such as a low BMI; taking oral steroids; coeliac disease or other absorption problems; a parent with osteoporosis; parent has broken a hip).

Definitely go for HRT!! I started menopause in my late 40s with severe effects (foggy brain, hot flushes every 30 min day and night, etc) and then had a hysterectomy.
I've been on HRT for nearly a decade (different ones depending if it was before or after the hysterectomy) and they are fabulous!
GPs in general don't get menopause and they over prescribe anti depressants when women need HRT of some form.
My gynaecologist prescribed it and he said more women should have them.

SSRIs can have a part to play in managing menopause. If you are depressed (and menopause can be a major life-change) then SSRIs alongside HRT can help. Alternatively, a low dose of SSRI can work wonders for hot flushes if you are not taking HRT. But it does not have any effect on any other aspect of menopause, nor the protective of HRT.

Do either of these apply to you?

BTW, an alternative to trans-dermal oestrogen and oral progesterone is continuous TD oestrogen with a Mirena IUD for continuous progesterone. Less to remember, lower dose of drugs for your liver to process, no bleeding, and contraception.

My gynaecologist also said that in general patches are better as the pills might affect the liver.

Wow thanks so much everyone!

I do have a low mood sometimes but i have put that down to losing my dog who was the love of my life. But i am not depressed. More a can't be arsed kind of attitude.

80's mum so kind of you to share your story and sorry that has happened. I'm 58 though so is that too late to have any benefit?

I had patches first then moved to gel, I much prefer the gel, I find it more convenient and easier to put into a daily routine and am not worrying about patches falling off or patches of sticky residue being left on my thigh. The gel is so easy.

Are there any more benefits to gel lady

@Dilbertian

SSRIs can have a part to play in managing menopause. If you are depressed (and menopause can be a major life-change) then SSRIs alongside HRT can help. Alternatively, a low dose of SSRI can work wonders for hot flushes if you are not taking HRT. But it does not have any effect on any other aspect of menopause, nor the protective of HRT.

Do either of these apply to you?

BTW, an alternative to trans-dermal oestrogen and oral progesterone is continuous TD oestrogen with a Mirena IUD for continuous progesterone. Less to remember, lower dose of drugs for your liver to process, no bleeding, and contraception.

@Dilbertian The Nice guidance on menopause ( sticky post top of this forum) said in 2015 that SSRIs are not first line treatment for low mood in menopause and should not be used.

The comment you made about them helping hot flushes only applies to women who cannot use hrt for medical reasons such as breast cancer etc. (Again, all in the Nice guidance.)

They come with their own side effects and that's why Nice says don't use unless no other options fit.

The Nice guidance is HRT as first line therapy.

Avoid ssri’s unless you have specific mental health concerns-in fact, avoid a go that suggests ssri’s as a first line response to menopause!

I started oestrogen gel and progesterone pills about two month ago, with no specific meno symptoms; I ‘just’ felt dried up -skin and sexually- and brain foggy and FILLED with rage a lot of the time. My joints aches to the point I wondered if I have arthritis or similar as I struggled to get downstairs. My hot flushes finished a year or so ago.
I now feel ten years younger, my skin is not scaly, my joints move properly and I am no longer a screaming banshee most of the time

“Avoid a GP who suggests..”

*The Nice guidance on menopause ( sticky post top of this forum) said in 2015 that SSRIs are not first line treatment for low mood in menopause and should not be used.

The comment you made about them helping hot flushes only applies to women who cannot use hrt for medical reasons such as breast cancer etc.*

I'm not getting the tone here. I hope you are confirming that what I said is in keeping with NICE guidelines, rather than saying I gave bad advice.

@ladygindiva

I had patches first then moved to gel, I much prefer the gel, I find it more convenient and easier to put into a daily routine and am not worrying about patches falling off or patches of sticky residue being left on my thigh. The gel is so easy.

Agree. Even better would be an implant, like the contraceptive one .

SSRIs are not prescribed for menopausal low mood unless the woman has a previous history of depression (not linked to hormonal change.) This is in the Nice guidance.

Use of SSRis (or drugs for high BP)for hot flushes is limited only to women who cannot use estrogen. They are not an option for women who can use HRT.

(Nice guidance on vasomotor symptoms)

Implants are not often given as they cannot be removed easily if they are not tolerated.

My mother has osteoporosis, so I'm on HRT. I didn't have many other symptoms, but I slept really really badly, and didn't realise that's a menopausal symptom. I have transdermal gel oestrogen and Utrogestan at night for progesterone. I can now sleep 7 or 8 hours straight and feel amazing!

Gel or patches are best for oestrogen, because they are transdermal they avoid the liver and I believe there is a lower risk of clot.

My menopause started abruptly when I was 40 and my periods completely stopped overnight. GP completely disinterested, just said it is a natural process and there was nothing they can do for me. Was put off HRT with talk of massively increased risk of breast cancer and "how would I feel about breaking it to my kids WHEN I got breast cancer."

I didn't get on to HRT until I was 50 when I saw a gynae consultant who was horrified I hadn't been put on HRT ten years before as it was standard procedure to put those with early (before age 55) or premature (before age 40) menopause on HRT to protect against osteoporosis and heart disease. Studies show no extra risk of breast cancer in those on HRT who start it before average age of menopause of 55 compared to women who start menopause at age 55 and don't take HRT.

Subsequently sent for bone density scan and was found to have osteopenia ( precursor to osteoporosis), now on high dose cut D and calcium to try to control deterioration but very scared about what will happen when I get older. No sign of heart disease yet but the worry is there.

OP, especially if you are below 55, HRT is very important to protect bones and heart. Even if you are 55 and older the breast cancer increased risk is small and the protective benefits still probably outweigh those risks.

I'm 58 have i left it too late to start?

Experts say it’s never too late

Louise Newson’s menopause doctor website has everything you need

I’ve been on Evorel Sequi patches for 3 years and never looked back. When there was a supply issue a while ago I couldn’t get them and my symptoms came back. When I got hold of them again they stopped.

I take HRT mainly to prevent osteoporosis, as my mother has it.
I had some issues with my joints and my orgasm went AWOL, but other than that no symptoms and my periods had stopped completely. Never had a hot flush.

Joints now fine, orgasm returned and hoping to not get osteoporosis.

I'm using SSRI because I'm going through surgical menopause and can't have estrogen, that is where it's more commonly used. Get yourself some good old HRT if you can!

Thanks so much to all of you i have requested hrt from the gp

Thanks for the points to the Newson Website. I shall be digesting later at Wine o clock ⏰😌

@Nickersnackersnockers

Are there any more benefits to gel lady

The gel is better for adjusting your dose, if youre on a patch you need a whole new prescription whereas on gel you simply increase or decrease the amount you take should you be on the wrong dose.