Anyone choosing NOT to use HRT?

[WandaWomblesaurus73]

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

How would I identify a bona fide "menopause specialist" - as opposed to, I dunno, a fake one? A bogus or amateur one? What are the definitive indicators and when one is a "menopause specialist" what does that mean? Does a "menopause specialist" always have more accurate comments & answers than people who are not a "menopause specialist" ?

I have many 'general ignorance' (to quote QI) stories about HRT. At my last Rheumatology appointment, the doctor I saw told me that HRT had no preventative effect whatsoever against osteoporosis.

He also didn't know how to use the ultrasound scanner.

If he hadn't been wearing ID and dragged another doctor in, I'd have thought he might be one of those whackjob imposters. But no, he actually thinks my HRT (transdermal, oestrogen only, started at 57) is useless. And this was only a few weeks ago. In Rheumatology.

@eyeseeyou

Particularly for preventative measures.

But these are not straightforward since no one is a fortune teller. There are complexities regarding individual human bodies which need to be taken into consideration when deciding upon individual medical interventions. Added to which genetic tendencies are just that, the study of epigenetics and gene expression illustrates this.

But if someone has a health problem, or is worried, I agree, help and information should be freely available.

That's why I'm a strong advocate for bodily autonomy and against anything that erodes this.

I’m not really coming at it from this angle.

More an understanding of why it’s not part of public health messaging.

The vaccine programme is a good example of mass simple communication for a complex range of situations, it also doesn’t mean it’s not a choice.

I’m not worried that’s the issue, and that means unless I read a thread on mn it’s likely I wouldn’t take HRT at all.

If there are clear links to osteoporosis that in the end cost the NHS why wouldn’t it be beneficial for a direct line of communication to happen so I know this?

I do have an appointment next week for late 40 year olds generally so maybe there will be what I want and the messaging is this. I’ll ask about it but given story about HCP below in pp I’d rather it not be left up to individual HCP views, but based on consolidated data, analysis and messaging.

Wow I've just caught up with all the posts and it's all fascinating. I know so little about menopause and in a meeting yesterday so many of the women there said they knew nothing either and we were all just sitting there in ignorance and then enlightenment. This thread is case in point. I did send a bunch of them to Mumsnet and Gransnet to do some reading!

If there are clear links to osteoporosis that in the end cost the NHS why wouldn’t it be beneficial for a direct line of communication to happen so I know this?

Because the NHS is only concerned with treating problems when they happen, not preventative medicine.

IMO it's completely irrational to have mass screening of women for certain illnesses, but not others that cost more to fix.

There is practically no preventative health screening here but it's the tale of women's health being bottom of the pile.

They are public health experts and more than able to analyse data and give their professional opinion on risks and benefits.

This has already been done by the British and International Menopause Societies. That what they do.

Because the NHS is only concerned with treating problems when they happen, not preventative medicine.

Not always - folic acid, vitamin d, vitamin k are preventative and not on individual level

@JinglingHellsBells

They are public health experts and more than able to analyse data and give their professional opinion on risks and benefits.

This has already been done by the British and International Menopause Societies. That what they do.

And yet it stops there

Why?

If the cost benefit is as you say

@JinglingHellsBells hmmm lipid lowering drugs, anti hypertensives to name but 2 of many measures that practice health prevention. I doubt clinically HRT is justified for all women as our risks will be different. My mother age 87, never had HRT, never developed osteoporosis. Nothing is inevitable and risk is not the same for all.

I'm 50 and periods seem to have stopped finally. I'm wondering whether to go on it. I don't seem to have symptoms except for hair thinning at the moment. I've got very dry skin around my eyes/eczema but not sure if it's related

Those of you want proof that estrogen improves bone health- it's on the statement by the BMS which I posted.

The BMS is a serious ,medical body. They look at all the research, headed up by some great global scientists, and they use that as part of their consensus statements.

If you are not happy with that statement, then you can google using search terms and find out for yourself. Lots of research papers are online, free and fully accessible.

You can find research papers that show bone density increase in the spine and hips, how much per cent per year, on what dose of estrogen, etc etc.

[quote rambleonplease]@JinglingHellsBells hmmm lipid lowering drugs, anti hypertensives to name but 2 of many measures that practice health prevention. I doubt clinically HRT is justified for all women as our risks will be different. My mother age 87, never had HRT, never developed osteoporosis. Nothing is inevitable and risk is not the same for all. [/quote]
Who has said that all women should have HRT?

It's not, never has been, and won't be. It depends on the individual risk.

And it's not good discussing this without the knowledge of your own bones. Get a bone scan!

And the jury is very much still out on statins. Yes, some people are on them but medical opinion is divided . BP drugs are given if high BP exists, not as prophylactics.

@MarshaBradyo Are we talking about the same thing- DEXA scans?

I don't know the answer to why the NHS isn't proactive. But I guess it's because it's how they work. It's in their DNA- fix a problem when it happens, not before it happens. The whole system needs turning on its head so that diseases can be prevented, not just treated.

It's the same with their approach to obesity.

'Because the NHS is only concerned with treating problems when they happen, not preventative medicine'

With respect, nonsense. Smoking cessation advice, breastfeeding advice, obesity advice, reducing alcohol advice. All advice regarding preventing future problems.

We shouldn't have to Google BMS, this stuff should be widely available and actively pushed if the evidence is robust. I posted upthread a link to a study that states hrt actually increased the prevalence of prolapse in post menopausal women. Actually contradicting other studies, so none of this is clear.

As I have said why on earth don't DofH and PHE advocate hrt if we allegedly have 100k deaths a year that could be prevented?!

@JinglingHellsBells
Yes the research is varied with statins. But hypertension causes many cardiovascular diseases so treating it is preventative. These examples were merely given as you claimed the NHS was not interested in practising preventive medicine.

Folic acid in pregnancy.
Immunisations
Dieticians from the NHS
Treatment for obesity
Smoking cessation supports/ patches.

Bone scan for me, I am 49 have no need for a bone scan just yet.

I'd question if it's the fault of the NHS or the wider health industry

We do get mammograms , bowel screening , sounds like there is a case for bone screening also

I'll volunteer for a trial !

This thread has seemed very pro HRT at times so I assumed that

If you mean scans should be routinely offered - and that’s it, rather than go straight to HRT then fine by me. I’d welcome that as part of preventative care like mammograms and smears

I did look up BMS but it seems to be directed to HCP

The British Menopause Society (BMS), established in 1989, educates, informs and guides Healthcare professionals on menopause and all aspects of post reproductive health. This is achieved through an annual programme of lectures, conferences, meetings, exhibitions and our interactive website.

I think this is why the posts below don’t resonate as much, whereas the one they link to menopause matters is for women so is easier

The reason I am evangelical - particularly about testosterone - is that not a lot of people know that low libido is something that is easily solved - so I want to shout it from the rooftops.

I think that there is something about older women saying that they want to enjoy sex - or GOD FORBID - saying they are happy with the way they look - that people think unseemly. KNOW YOUR PLACE WOMAN

Because the NHS is only concerned with treating problems when they happen, not preventative medicine.

Not always - folic acid, vitamin d, vitamin k are preventative and not on individual level

But the NHS doesn't fund folic acid and Vit D.
You only need to look at the state of NHS dentistry to see how the NHS feels about preventative medicine.
Health screening for a lot of issues has come about because of charities campaigning and raising public awareness, which is still on going for example endometriosis. The NHS left to its own devices with its current funding issues is often just firefighting.

It's not not everyone has those same problems !

@MarshaBradyo

The BMS is a valuable source of info.

This is top of the list of their latest initiatives

It's THE PLAN TO IMPROVE WOMEN'S POST REPRODUCTIVE HEALTH and they want the NHS to step up.
It's a feature linked to on their Home page.

News
The BMS recommendations to the DHSC have now been published online in Post Reproductive Health Journal
10 January 2022
The British Menopause Society (BMS) recommendations to the DHSC’s call for evidence to inform the development of the Women’s Health Strategy have now been published online in Post Reproductive Health Journal.

The BMS response was specific to menopause and post reproductive health and included recommendations in relation to all six core themes included in the call for evidence assessing the different areas of women’s health. This was accompanied by an Editorial, ‘Women’s Health Strategy: Time to have women’s voices at the top of the agenda’ by BMS Chairman Haitham Hamoda and BMS CEO Sara Moger.

The full BMS response and Editorial can be accessed through the following links:

Women’s Health Strategy: Time to have women’s voices at the top of the agenda

Developing the Women’s health strategy: The British Menopause Society’s recommendations to the department of health and social care’s call for evidence

Here is what they say. Bone health is actually mentioned at the bottom of the first page.

journals.sagepub.com/doi/pdf/10.1177/20533691211064037

I never went down the HRT route.

I had lots of peri/meno symptoms but they never all came at once. So I'd get a new symptom it would last a few months, and then it would sort of fade away another one would come along to take its place. Several of my friends took the HRT route, but I never quite got to the point where I felt I needed to.

I was fortunate in that flaxseed oil worked wonders for hot flushes (a friend tried it and it was useless for her) but within a week of starting taken it my hot flushes noticeably reduced to a level that was manageable. Coincidence, placebo effect, who knows, but it seemed to do the job for me personally.

Now I'm through and out the other side HRT free, and doing great. I look and feel better than I have in years.

I have two friends of similar age who are same as me, went through it cold turkey so to speak, while others swear by their HRT.

@SusannaQueen folic acid for pregnant women which is when it is used as a preventative measure is available on prescription. Vitamin D is also for people with a vitamin D deficiency, my DH has his on prescription from his GP.

Yes much of the NHS is firefighting I should know I'm a medic, but that's a whole other thread of which there have been many!

@SusannaQueen

Because the NHS is only concerned with treating problems when they happen, not preventative medicine.

Not always - folic acid, vitamin d, vitamin k are preventative and not on individual level

But the NHS doesn't fund folic acid and Vit D.
You only need to look at the state of NHS dentistry to see how the NHS feels about preventative medicine.
Health screening for a lot of issues has come about because of charities campaigning and raising public awareness, which is still on going for example endometriosis. The NHS left to its own devices with its current funding issues is often just firefighting.

I did get a free vitamin d card last time, for a newborn, just saw it in the drawer actually - not means tested

Folic acid - can you get it in any way by free prescription?

And I’ll start with advice at least and clear messaging. Who knows maybe I’ll get it next week at appointment

Immunisations are preventative too and vitamin k injection after birth

It’s not the case NHS doesn’t do prevention on public scale

It's a really promising document as it addresses everything being discussed here and was published 3 day ago! How exciting! :)

Read pages 3 and 4, and look at their ideas for all women to have a really thorough MOT at 45, and make them aware of everything that they can do to improve their health.

There are also stats there on osteoporosis, which confirm a lot of what I posted earlier.

Do read it as it's great to see something like this actually out there, at last!