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?

Going through the menopause I started getting 2 or 3 UTIs a year (I had never previously had one), which I was given antibiotics for. After a few years of this, I then had 3 episodes in the space of a couple of months and saw one of the women doctors of a similar age at our GP practice. She discussed with me how the drop in oestrogen at menopause affects the vagina and urinary tract and prescribed Vagifem - topical oestrogen. It has been a life-changer and I have not had a single infection since (two and a half years now) and have been much more comfortable. It really has been such a simple solution! Good luck OP, I hope you will be able to get some help soon. (Btw I am 60 now).

@SparklingLime no, I was refused anything stronger. I’ve got Vagifem but it does nothing like enough.

[quote Marcipex]@SparklingLime no, I was refused anything stronger. I’ve got Vagifem but it does nothing like enough.[/quote]
Ah, OK. Have you got the NICE guidelines? Plus BMS statement linked above?

Here: www.mumsnet.com/Talk/menopause/3150778-NICE-Menopause-guidelines-for-information

@SparklingLime thanks for the link.
I don’t know what to say any more. I actually can hardly sit down for pain.

That’s miserable. How have you been using it? Ovestin may be better?

Dr Nighat on This Morning (Wednesday I think this week) talked through what the standard treatment should be for vaginal atrophy, oestrogen suppositories daily then twice a week, off the top of my head. definitely go back and ask for it.

@Marcipex you might have Lichens as well as atrophy. I had intense pain for 14 months, realised I had Ls and was prescribed dermovate. Has helped immensely along with the vagifem and ovestin.

Eek @Tootsey11

More positive info re UTIs and local oestrogen from a urologist: twitter.com/ashleygwinter/status/1453890993070039041?s=21

Thanks for the link SparklingLime, the article in the medical journal was really interesting. It's shocking that this was being written about some 30 years ago, and yet menopausal women are still struggling to get a simple and effective treatment for this common condition.

Absolutely, @Boiledeggandtoast. Something that could be publicised more on mumsnet.

@Boiledeggandtoast

Thanks for the link SparklingLime, the article in the medical journal was really interesting. It's shocking that this was being written about some 30 years ago, and yet menopausal women are still struggling to get a simple and effective treatment for this common condition.

It is appalling and even more so the op had to put up with an uppity gp making her feel like she was a nuisance.

All menopausal women presenting with genitourinary urinary problems should be prescribed topical vaginal oestrogen. I really hope the op goes to her snotty gp and ask why on earth she isn't up to to speed with this very basic stuff.

I think you should complain / mention your GP's attitude to the practice manager at your GP clinic... it's just not on really.

For a private specialist, have a look on the BMS (British Menopause Society) website for a list of accredited specialists in your area. It isn't too late to start on HRT, but individual circumstances need to be taken into account if over 10 years since your last period. Louise Newson has plenty of information on her balance menopause website & app, including women who have started HRT later in life (I think her oldest client starting HRT was 90!) . As others have said, you should at least be able to start local oestrogen such as Vagifem. This is a link to starting HRT in post menopause. nh-clinic-website.s3-eu-west-1.amazonaws.com/uploads/2021/07/Starting-or-continuing-HRT-after-the-menopause-v21-02.pdf

I am 63, almost 14 years past menopause and I am just about to start taking HRT for the first time. I've been thinking about doing this for the past few months and hadn't expected my GP to agree to prescribe it for me, but she did!
I'm going to be on Evorel patches plus micronised progesterone.

If I don't experience any adverse side effects, I expect to continue taking it for the rest of my life.

There's an excellent Facebook group - details below. Lots of info in the files section.