Anyone choosing NOT to use HRT?

[WandaWomblesaurus73]

Does anyone feel that HRT isn't for them or feel happier without it?

@Newgirls

Marsha I think that’s too easy to dismiss. Women are bombarded with advertising and messages about being stoic, having natural births, my mum didn’t need hrt etc etc I doubt any of us are immune

Advertising is usually paid for by a company with a product to sell so not really re natural approach

Anyway it’s not that relevant to me as someone who feels ok, like pp, I want to focus in on non symptom related issues

[quote Esspee]**@bordermidgebite
The problem with older women, say over 60, is that once issues such as osteoporosis or prolapse arise they are past the window to start HRT whereas preventative treatment from perimenopause could have prevented it.[/quote]
Yes but we have limited evidence that for that group of women ( later menopause no symptoms) that hrt would have given a material benefit to their risk of those conditions Over and above other approaches to managing that risk .

I can't take much from population level studies unless factors such as genetics diet and exercise are controlled for

PP stated that someone was told that HRT would have prevented something - yet we know anecdotally that 100% certainty is not possible - and stating things as truth that patently are not weakens the argument and makes me think that other factors are at play / the harder the sell the more I back away

Research into woman's health should focus on more than just what medication can we devise

[quote JinglingHellsBells]@ArabellaScott The links you left to Menopause Matters have been on this forum many times and I left the same link just a few days ago.

The consultant running the site does indeed work for the NHS, but Menopause Matters website and the magazine she runs, is a private company. They make money from advertising on the site (like Mumsnet) and the magazine.

So I don't know if that sits well with you, bearing in mind you are sceptical of other doctors who have an element of private practice ('making money out of menopause.')[/quote]
I've not been on this forum before. Freely admit I don't know much about the subject, hence asking questions.

You seem pissed off with me, not quite sure why?

Looking at the health of women who live post menopause requires that you only compare outcomes with historic groups who also lived past menopause

unless you have reason to think that having high probability of dying in childbirth would correlate with poor post menopause outcomes

We don't know so we can't assume it is fine to remove such a large cohort. However even without that cohort where is the population pre 1900 where women in general could expect to survive into their 70s, 80s and 90s?.

Individual or historical stories are irrelevant to population level data.

I can’t help thinking @bordermidgebite that an osteoporosis double blind placebo trial for HRT would be unethical considering the overwhelming evidence that low oestrogen levels correlate with progressive osteoporosis.

I am bowing out as my tax has to be in by month end and this is procrastination on my part. I hope everyone finds the solution which suits them, both now and in their old age. The important thing is to be fully informed.

@bordermidgebite - this is a genuine question not a snippy reply ( I'm sorry but the written word sometimes comes across that way).

In the case of osteoporosis the major cause is oestrogen deficiency - would there be in reality any other way of mitigating a woman's risk for it beyond supplanting the deficient hormone ? I promise I mean this genuinely.

It is difficult to read the evidence and understand risks and benefits. For example we've seen repeatedly on this thread posters claim hrt may prevent vaginal prolapse (and Google agrees) yet studies like this claim the opposite. I don't know the ins and outs of the study but it is absolutely understandable why women are confused.

Genetics diet and weight bearing exercise all impact on bone health and strength

So someone on HRT with poor genetics diet and exercise May be more likely to get osteoporosis than their luckier counterpart who was not on HRT

What i don't know is the incremental benefit of HRT when other factors are controlled for

If my personal risk is tiny and HRT halved it, then I would prefer no HRT

If my risk was large , say 20% and HRT reduced that to 0.1% I might well change my mind

But I have to weigh it up against the fact that I am generally feeling happier in myself as my hormone levels are dropping ( but that is correlation not necessarily causation )

The British Menopause Society has a very clear statement on HRT and osteoporosis. They also have many other consensus statements and links to research on their site.

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

Prevention and treatment of osteoporosis in women
Summary

The British Menopause Society Council aims to aid health professionals to inform and advise women about post reproductive health. Osteoporosis affects 1 in 3 women. This guidance regarding oestrogen and non oestrogen based treatments for osteoporosis responds to the controversies about the benefits and risks of individual agents. Treatment choice should be based on up to date evidence based information and targeted to individual women’s needs.

Summary practice points

-HRT reduces the risk of both spine and hip as well as other osteoporotic fractures.

-Oestrogen remains the treatment of choice for osteoporosis prevention in menopausal women, and especially in those with premature ovarian insufficiency.

-Bisphosphonates are effective for treatment of established osteoporosis, reducing both spine and hip fractures.

-Bisphosphonates have a very long skeletal retention time and hence should be used with caution in younger postmenopausal women (e.g. those aged below 65 years).

-Denosumab is an effective treatment for reducing spine and hip fractures in osteoporotic women.

-Denosumab should be avoided in women with increased susceptibility to infections.

-There may be an increased risk of fractures after denosumab discontinuation.

-Provision of adequate dietary or supplemental calcium and vitamin D is a part of osteoporosis management

-The effects of calcium and vitamin D supplements alone on fracture reduction however, are contradictory and may depend on the study population

@bordermidgebite

Genetics diet and weight bearing exercise all impact on bone health and strength

So someone on HRT with poor genetics diet and exercise May be more likely to get osteoporosis than their luckier counterpart who was not on HRT

What i don't know is the incremental benefit of HRT when other factors are controlled for

If my personal risk is tiny and HRT halved it, then I would prefer no HRT

If my risk was large , say 20% and HRT reduced that to 0.1% I might well change my mind

But I have to weigh it up against the fact that I am generally feeling happier in myself as my hormone levels are dropping ( but that is correlation not necessarily causation )

There are a lot of links and posts here to NHS info.

Please- do step away from the NHS info sites. They are often out of date (they havent even updated the Covid info to include the Omicron symptoms yet, to the disgust of scientists ). They give a tip of the iceberg info.

'The consultant running the site does indeed work for the NHS, but Menopause Matters website and the magazine she runs, is a private company. They make money from advertising on the site (like Mumsnet) and the magazine.'

Money made from advertising will be peanuts as opposed to private clinics charging 300 quid or more for an initial consultation then unsurprisingly going on telly to tell everyone they need hrt.

@bordermidgebite thanks for taking the trouble to reply and also for not taking my query as snippiness.

I understand what you mean by incremental benefit.

I guess not everyone would be in possession of all the information to get a full picture of their personal risk ( ie for example I do weight bearing execrcise, I am slightly overweight but have a good diet- however my mother died young, but my maternal grandmother had fractures in her 70s - she's not alive so I don't know if osteoporosis).

NICE say that longer HRT does reduce risk of fragility fracture so I take that to mean that the evidence in favour for that particular risk is high.

My framework for deciding for me is therefore personal to me - ie I have found the symptom reducing benefits for my peri menopausal symptoms to be really good, I'm unsure what my osteoporosis overall risk is but I feel happy that I'm addition to symptom reduction it contributes to a decreased risk of it in my older years.

Of course your framework for a decision is totally individual to you

More info from the BMS.
if you find info out there confusing this is summary and is based on all the latest research.

BMS & WHC’s 2020 recommendations on hormone replacement therapy in menopausal women

Key points

All women should be able to access advice on how they can optimise their menopause transition and the years beyond.

There should be a holistic and individualised approach in assessing menopausal women, with particular reference to lifestyle advice, diet modification as well as discussion of the role of HRT.

The decision whether to take HRT, the dose of HRT used and the duration of its use should be made on an individualised basis after discussing the benefits and risks with each patient. This should be considered in the context of the overall benefits obtained from using HRT including symptom control and improving quality of life as well as considering the bone and cardiovascular benefits associated with HRT use.

The HRT dosage, regimen and duration should be individualised, with annual evaluation of advantages and disadvantages.

Transdermal administration of estradiol is unlikely to increase the risk of venous thrombosis or stroke above that in non-users and is associated with a lower risk compared with oral administration of estradiol. The transdermal route should therefore be considered as the first choice route of estradiol administration in women with risk factors.

Evidence from large observational studies and case-controlled studies suggests that micronised progesterone and dydrogesterone are unlikely to increase the risk of venous thrombosis and are associated with a lower risk of breast cancer compared to that noted with oral progestogens.

The potential benefits of bioidentical hormone therapy can be achieved using conventionally licensed products, without having to resort to unregulated compounded varieties from specialist pharmacies.

Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.

HRT prescribed before the age of 60 has a favourable benefit/risk profile.

HRT initiated before the age of 60 or within 10 years of the menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality.

If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of estradiol administration. Evidence from the Cochrane data-analysis as well as that from the long-term follow-up data of the WHI showed no increase in cardiovascular events, cardiovascular mortality or all-cause mortality in women who initiated HRT more than 10 years after the menopause.

Women with POI and early menopause should be encouraged to use HRT at least until the average age of the menopause.

HRT and the combined contraceptive pill would both be suitable options for hormone replacement in women with POI. However, HRT may result in a more favourable improvement in bone density and cardiovascular markers compared with the combined contraceptive pill.

Border absolutely agree. Every women does what her body needs. The post I quoted was implying those of us who need it are wasting doctors time. And I've never said none of us cope. And definitely never implied we should all take it regardless.

@JaniieJones

'The consultant running the site does indeed work for the NHS, but Menopause Matters website and the magazine she runs, is a private company. They make money from advertising on the site (like Mumsnet) and the magazine.'

Money made from advertising will be peanuts as opposed to private clinics charging 300 quid or more for an initial consultation then unsurprisingly going on telly to tell everyone they need hrt.

Making money from a site doesn’t necessarily mean you are not impartial - just that you cover a particular topic. Whoever uses you for advertising is likely to want the target market not that you promote one view on biased basis

Oth going into a clinic is already moving towards a solution on offer. The answer is unlikely to be you don’t need anything

Out of all the posts the ones re osteoporosis are the ones that are making me thinking about something I don’t feel I need atm

Treatment of choice

For something I don't have and have no indication beyond " it's common" ( 1 in 3 post menopause women I think are affected )

2/3 won't get it

No one in my family had had it

Friend who has it were on HRT

Men also get it ( 1 in 3 cases )

It is a personal choice , it reduces risk but can't eliminate it , just because you are find hrt useful and makes you happier does not mean everyone else will be the same

Given we know diet and exercise are important for more than bone health , how come the focus on HRT as the solution ?

'Out of all the posts the ones re osteoporosis are the ones that are making me thinking about something I don’t feel I need atm'

Yes it does seem to be something that isn't in any doubt. Thing is fractures and treatment cost the NHS millions, I don't understand why, if the benefits really do outweigh the risks, that the CMO, PHE, Department of health etc aren't all actively encouraging women to take hrt to take the pressure off the NHS if nothing else.

@JaniieJones

'Out of all the posts the ones re osteoporosis are the ones that are making me thinking about something I don’t feel I need atm'

Yes it does seem to be something that isn't in any doubt. Thing is fractures and treatment cost the NHS millions, I don't understand why, if the benefits really do outweigh the risks, that the CMO, PHE, Department of health etc aren't all actively encouraging women to take hrt to take the pressure off the NHS if nothing else.

I’ve just been thinking this too and it does make me question it

The cost later on is high enough that if there is an easy prevention why is it not used

For clarity @bordermidgebite in case you meant me - I have been consistent in all my posts on saying that is my decision and I am not suggesting what anyone else should decide. I've said it repeatedly

@missfliss - indeed there is a mixture of responses from thoughtful , personal to evangelical, sorry if I appeared to be sniping at everyone

[quote missfliss]@bordermidgebite - this is a genuine question not a snippy reply ( I'm sorry but the written word sometimes comes across that way).

In the case of osteoporosis the major cause is oestrogen deficiency - would there be in reality any other way of mitigating a woman's risk for it beyond supplanting the deficient hormone ? I promise I mean this genuinely.

[/quote]
Yes I think people think osteo and bone health is all about calcium.

Oestrogen is so important to our health not just fertility.

Women really are left to flounder about with bits of knowledge. I hope this discussion at least gives people food for thought and new areas to read about.

@bordermidgebite

Treatment of choice

For something I don't have and have no indication beyond " it's common" ( 1 in 3 post menopause women I think are affected )

2/3 won't get it

No one in my family had had it

Friend who has it were on HRT

Men also get it ( 1 in 3 cases )

It is a personal choice , it reduces risk but can't eliminate it , just because you are find hrt useful and makes you happier does not mean everyone else will be the same

Given we know diet and exercise are important for more than bone health , how come the focus on HRT as the solution ?

Diet and exercise very important yes of course.

But they can’t give you the oestrogen your bones, skin, membranes and brain need.

Not at all @bordermidgebite and Thankyou for your posts

@JaniieJones

'Out of all the posts the ones re osteoporosis are the ones that are making me thinking about something I don’t feel I need atm'

Yes it does seem to be something that isn't in any doubt. Thing is fractures and treatment cost the NHS millions, I don't understand why, if the benefits really do outweigh the risks, that the CMO, PHE, Department of health etc aren't all actively encouraging women to take hrt to take the pressure off the NHS if nothing else.

Yes i agree. Maybe when covid is under control more investment will happen in preventative health. Though the Tory government will be more in favour of private clinics…

I'm on kliovance hrt - it's changed my life, my sanity, my sleep, no bleeding, just feel normal again.