Starting HRT years after menopause?

[Shedbuilder]

I'm 62. I had a relatively easy menopause and apart from the very occasional hot flush I seem to be out the other side. I thought I could live well enough with the after-effects, which for me have been thinning hair and dry skin.

Unfortunately now the lack of oestrogen is really starting to bite. I've developed vaginal atrophy and practically anything I do — using soap, riding a bike — let alone sexual contact leads to extreme discomfort and bleeding. My urethra is affected: despite being properly hydrated and infection free, it's often very painful to pee and I have minute traces of blood in my pee fairly frequently. My GP seems unconcerned and has recommended I just moisturise down below several times a day using a petro-chemical-based moisturiser.

I asked about HRT and she shrugged and said 'It's a bit late now, isn't it?' She's young and I find her ageist: it's as if she thinks a woman over 60 should just be grateful to still be alive. I have a busy, active life and need to continue working for the foreseeable future.

For the last three months I've been using a recommended natural oestrogen cream with no discernible effect. In recent days, after trying to have sex (yes, we used loads of lube) I'm very sore again.

Is it possible to start HRT at this stage of things? What can I expect? It's clear that my GP surgery isn't taking me seriously so I'll need to go private. How do I find a good private physician who specialises in this issue?

Your GP is utterly negligent not to give you Ovestin or vagifem (local oestrogen for atrophy). Have you not asked for that? You should not need to go privately. Can you not speak to another GP?

Guidance on HRT use over 60 included here: thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/

They also have a find a specialist search tool: thebms.org.uk/find-a-menopause-specialist/

Thank you very much. I'll brace myself to go back to the GP with a specific request for Ovestan or similar. I'm fortunate enough to have reasonable health so don't seek help often so I don't know what to expect or what's reasonable or not reasonable. I try not to bother them necessarily but always end up feeling as if I'm wasting their time.

I've been seen three times regarding this issue in the last 18 months. First time (in person) because of blood in my urine, second time (FaceTime) because of terrible soreness, third time (FaceTime) to ask whether there was nothing more helpful than mosturisers. Each time I've had sighing and 'Well, I'm afraid this is what happens when women get older.' The third time she made the point that there's a pandemic and ended the conversation with an eye-roll and a 'Well what do you want me to do?' I said I didn't know: I'd consulted her because she was supposed to know things I didn't.

All the reading I've done indicates that standard HRT isn't a good idea. Let's hope topical oestrogen creams work. [Shifting uncomfortably on my chair: sore today!] Thanks.

Yes, the vagifem/ovestin should be given to you without question - there is loads of evidence for its use in vaginal atrophy and recurrent UTIs. You may need to use it every day for a week or more before reducing the frequency. Someone else on here will know more.
If you wanted HRT at 60+ then I believe you may well need to see a specialist (NHS or private).

This is helpful. Topical oestrogen can be used daily for up to three weeks before reducing frequency:
www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Gynaecology/6647-1-Atrophic-vaginitis-genitourinary-syndrome-of-the-menopause-GSM.pdf

This Urogynaecologist is also very helpful: twitter.com/jfitzgeraldmd/status/1415837133269606409?s=21

Application for UTI prevention: twitter.com/jfitzgeraldmd/status/1415877321865809920?s=21

The info from @SparklingLime I great @Shedbuilder

Start with vaginal estrogen which is given to women into their 90s.

If you need more than that, you can have systemic HRT.
You would start on a low dose of a transdermal types like patches or gel.

You don't need to see a specialist for that- your own GP (if they are clued up on it) can offer you what you'd need.

Thanks. I'll try another GP. There are three at my surgery and I tend to try and see a woman if I can but I might have done better with a man.

It does seem clear that you need to do your research and turn up at the appointment knowing what you want before you consult a doctor.

Following with a lot of interest as beginning to get similar issues and want to be armed before first GP consult. Just a question - vagifem/ovestin is topical right? ie you apply it like a cream or is it more a pessary, every day? Also do topical estrogens have any effect on bone density?

Sparkling Lime, thank you so much. I'd never had a UTI or bladder problems in my life until the last 18 months and now I seem to be living with an almost permanent low-level issue. I see that Dr Fitzgerald recommends it for permanent use. Off to make an appointment now.

I can only imagine the state I would be in without Vagifem, my friend in her 90's still uses it. I also use relplens. You must get it.

This is appalling op, your go is so ignorant and I would suggest negligent. Systemic hrt is of course something to be started only after lots of research and discussion but vaginal topical oestrogen cream has absolutely no risks.

Surely any menopausal woman presenting with issues associated with vaginal atrophy including urinary issues should be a started on topical oestrogen straightway. I would suggest to your eye rolling GP you are surprised she doesn't seem to know this.

If you get no joy from your gp surgery then look up your nearest menopause clinic. You will need to pay initially but they can liaise with your GP to provide the prescription once you are diagnosed. I got fobbed off at GP for being too young (early 40s fgs) but local menopause clinic diagnosed me immediately.

A colleague of mine is being put on it by her orthopaedic surgeon at 62 for her bones, so no you’re not too old.

Thank you. I think perhaps the fact that this has blown up during Covid has affected attitudes. I get the feeling that unless you're at death's door they prefer you not to bother them.

But yes, JaniieJones, now I've learned a bit more I'm feeling pretty furious at that 'What do you want me to do?' comment. Why on earth didn't she at least mention topical oestrogen treatments? Are they trying to save money? I know GP practices are essentially private businesses. It's cheaper to jot down the name of a moisturiser I can buy over the counter than start prescribing oestrogen cream.

I developed vaginal atrophy and went to see one of our GPs (male) about it. He put me straight onto Vagifem - just twice a week as I'm approaching 60 and my atrophy was mild (dryness, itching and a bit sore now and then). His view was there is a possible solution so let's try it and see what happens.

The difference is amazing. The soreness has stopped, the itching has stopped. The dryness has reduced big time. When I tried to get the pessary tube in first time it was sore. Now it's easy.

Oddly enough my brain seems to be firing up quicker too - the last few years I've almost felt in a 'fog' sometimes especially when I've had to think on my feet. Now I just seem to be able to find the words or get the name of the item I'm looking for into my head quicker. Not sure if that's coincidence or not.

Definitely see a different GP. There are solutions out there and it does no harm to at least try them.

thank you for posting this OP - I am going to approach my GP now and see if I can get some help

I tried and was refused.
I’m trying again on Monday as I’m feeling desperate.

It makes you wonder if men get fobbed off when they go about ageing problems 🤔

I just checked out Replens, which my GP didn't even mention. At least that has the virtue of appearing to be free of petroleum-based ingredients. The moisturiser that my GP advised me to use in my vaginal area comes complete with a warning about not standing close to naked flames and not smoking or standing near a fire when using it or when wearing clothing that may have dried lotion on it. Since when did applying something flammable to your delicate vaginal area sound like a good idea? I'm furious that this might have been dealt with easily 18 months ago.

Really pleased to think that this might have been informative for other women. Here's hoping we can all get the solution we need.

@Marcipex

I tried and was refused. I’m trying again on Monday as I’m feeling desperate.

You were refused vagifem, @marciplex?

@oviraptor21

Following with a lot of interest as beginning to get similar issues and want to be armed before first GP consult. Just a question - vagifem/ovestin is topical right? ie you apply it like a cream or is it more a pessary, every day? Also do topical estrogens have any effect on bone density?

Vagifem is a pessary, @oviraptor21, a small pill in a plastic applicator. Ovestin is a cream so can be applied to the urethral opening if needed as described in the link above.

No effect on bone density, you’d need full on HRT for that.