Am I an absolute no-no for HRT?

[CurlyhairedAssassin]

I'm 48 and am pretty sure I'm peri menopausal. Irregular periods, non-existent libdo & more difficult to orgasm etc (It's ruined my sex life and put a pressure on my marriage), low mood, terrible anxiety, I wake shouting in the middle of the night, all anxious. I just don't feel myself at all. I've not long changed jobs to something fairly low level and on paper it should be enjoyable. Lovely working environment, I like my colleagues and other people I come in contact with, rewarding etc. I have no other worries in life, everything's good. But I have a constant lack of confidence, that I'm just not good enough etc. I worry over EVERY. LITTLE. THING. But on the cycles i do have a "kind of" period, I notice that there are a couple of days where I feel human and capable again.

Not sure I get actual hot flushes yet, although I do seem to wake up some nights a bit sweaty.

I do think I'd be a good candidate for HRT for these reasons. BUT......

I have a strong family history of breast cancer (although tests have proved no BRCA1 or 2 genetic cause).

I have a strong family history of blood clots (3 relatives have had DVTs and PEs). I myself have had a VTE (but in a shallow vein, not a deep vein).

Blood pressure is borderline high.

I haven't bothered asking my GP about the possibilities of normal oral HRT as I assume that would be a downright NO. But what about the patch? Do my issues mean I can't even have that? I've been taking Menopace and Vitamin D and it helps somewhat but I feel things are getting beyond what can be helped with supplements.

Anyone else in the same position?

Oh yeah, and as well as the libido through the floor, I've got issues with vaginal dryness too. When all this first started that was probably the main symptom and I did raise it with the GP. All she prescribed was a vaginal moisturiser/lubricant. Can't remember the name of it now but it was probably not much better than KY jelly to be honest. It didn't help. I need something "stronger" and more long-lasting.

Due to my risks I was referred to the specialist where we discussed the risks and I chose to go ahead.

Strong family history means 2 1st degree relatives ( mum and sister) with BC at an early age ( ie not 80s.)

Anything else is not considered relevant.

CVD is helped by HRT as long as it is transdermal and not tablets.

(estrogen helps prevent plaque in the arteries.)

You may find your GP doesn't even ask about your family history.

and in any case you need vaginal estrogen- called Vagifem or Ovestin. Insist you get it!

@JinglingHellsBells

Strong family history means 2 1st degree relatives ( mum and sister) with BC at an early age ( ie not 80s.)

Anything else is not considered relevant.

CVD is helped by HRT as long as it is transdermal and not tablets.

(estrogen helps prevent plaque in the arteries.)

You may find your GP doesn't even ask about your family history.

Well it's my mum and 2 of her sisters, all of whom had it before menopause. My mum has actually had BC twice, each unrelated to the other (different types). I wouldn't call that a weak family history personally. And neither do the doctors - my sister and I were both referred to the genetic clinic (hence us finding out that there is no risk for us from the BRA1 & 2 gene, although we were told that's not to say there isn't another genetic link they're just not aware of yet). My sister is younger than me, we were only teens when the generation above experienced all the issues, and both of us have been hyper aware of problems to watch for ever since (baseline mammograms years ago etc)

So you reckon I could get patches and vaginal oestrogen?

Hmm now.. that is a difficult choice to make. I would also not call that a weak genetic link but I suppose whatever predisposition your female relatives have might not be hormone linked.

Transdermal and topicals might be the way to go?

Fair enough- I wasn't aware of who it was from your post.

Vaginal estrogen is no problem- everyone can use it even women who had have BC.

There is an eminent breast consultant who says that unless you have the BRAC gene you could probably use it.

thebms.org.uk/publications/bms-tv/

There are also women who have had BC who have resumed HRT.
Google Kirsty Lang and Liz Earle podcast.

It's a hard choice and it depends how much you are suffering.

The latest research (you can find this on various medical websites) says that they now think estrogen may accelerate the growth of a cancer, but not cause it.

For reasons like yours, I can't have HRT - my (v good) GP asked me to rate which symptoms were the most difficult. Somewhat to my suprise when I actually analysed it, anxiety came marginally above the hot flushes. I was prescribed a low dose Venlaflaxine which is an anti-depressant that is thought to help with hot flushes. I think it has definitely helped with the anxiety and since I forgot to take my pills away with me on a short break, it also helps (but not eliminates) the hot flushes with me.

I have high risk family history of early nreast cancer and previous blod clots and have been put on hrt due to early menopause but i do worry about it.

Hmm....thanks, everyone. Food for thought. I will have a read of the resources you link to, Jingling. I haven't watched the Davina programme yet so will do that too, so I can ask to see my GP armed with as much info as poss.

For the libido issue you might benefit from Testosterone... you can have a blood test to check your current level

I would definitely ask for topical oestrogen soon to help with the dryness, even if you take some time to think about HRT. From all I've read, it helps to tackle vaginal symptoms sooner rather than later.