Anyone choosing NOT to use HRT?

[WandaWomblesaurus73]

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

Daily mail link

Yes, a lot can go wrong and hormones essentially run our bodies. However, this article, is hardly unbiased. It is written by a woman who had health problems which HRT solved after a battle to get it. She is also writing a book on the subject. It just seem to be a very fashionable and current narrative. If we keep hearing about the women who were given HRT and it didn't do much good, made them feel worse or detrimentally affected their health would you be equally swayed?

Thing is people are influenced by their own decisions. They often select the data to support them after they have made them. So they feel validated. Research is affected by who, who interprets it, who will fund it and other societal beliefs and control systems.

At the end of the day it really is up to the individual. And health care needs to be just that, individual choice.

"what are these hormones essential for? Mostly for reproduction"

I can only assume that the discussion on cognitive decline and osteoporosis passed you by.

It's pretty clear that the benefits for bones is only clear for people who have early menopause

Which is also associated with a poor diet ..

Cognitive problems may well be correlated to hot flushes ... or people who have more of that symptom are more likely to suffer cognitive decline

Cause, effect and confounding factors

@CoteDAzur

"what are these hormones essential for? Mostly for reproduction"

I can only assume that the discussion on cognitive decline and osteoporosis passed you by.

No, I saw that. I meant in a broad sense, these hormones are 'essential' for reproduction. There may be other effects had on cognition, etc.

This was in response to someone saying oestrogen was 'essential'. Obviously not all women die or get osteoperosis post menopause. So it's not literally 'essential' to supplement with HRT, which was the apparent implication.

It’s a fact that bone density decreases by 1% a year post periods stopping.

Supplementing with hrt reduces that. Yes you might not get osteo if your bone density was amazing before that. Lots of osteo is never diagnosed.

Bone density decreases in men and women

Do you propose hrt for the men also ?

If you are at risk of osteoporosis then taking action is merited

Early menopause is a risk factor

Taking action because some people have problems and you might be one is way less clear to me

All medication has risks and side effects - it's a cost benefit analysis.

Do any countries have higher rates of using long term HRT does anyone know?

I have done some looking around and found this

‘This research supports the UK’s current prescribing guidance, which recommends taking HRT for no more than five years.‘

From here evidence.nihr.ac.uk/alert/research-shows-some-hrt-lower-risks-breast-cancer/

'It’s a fact that bone density decreases by 1% a year post periods stopping. '

It seems that there is a relatively rapid decrease post menopause which then slows

“We know bone loss begins 1 year before menopause and accelerates over the next 5 years, ” Ebeling, from Monash University, in Melbourne, Victoria, Australia, added in an email. “This study indicates some stabilization of bone loss thereafter with lesser effects of low estrogen levels on bone.”

“It probably means bone density does not need to be measured as frequently following the menopause transition and could be every 5 years, rather than every 2 years if there was concern about continuing bone loss.”

vighneshworld.com/health-news/new-study-changes-understanding-of-bone-loss-after-menopause/

And a reduction in bone density doesn't mean automatic osteoporosis.

'... there are important gaps in our knowledge of the effect of the menopause transition on the skeletal system. Although bone loss accelerates after menses cease (3,4,5), it is not clear either when bone loss begins or what the rates of bone loss are at various stages of the menopause transition. It is important to determine when bone loss accelerates so that women and their health care providers can make informed decisions regarding the appropriate time to screen for osteoporosis and to consider therapy to prevent bone loss. There is considerable variation in rates of bone loss among women, with some women experiencing rapid bone loss during the menopause transition and others experiencing little or no bone loss'

www.ncbi.nlm.nih.gov/pmc/articles/PMC2266953/

Most women will not get osteoporosis:

'Estimated number of individuals aged 50+ with osteoporosis in 2019

32 million (5.6% of the total European population aged +50)
♀ 25.5 million (22.1% of women aged +50)
♂ 6.5 million (6.6% of men aged +50)

(or 78% of women will not get osteoporosis).

www.osteoporosis.foundation/facts-statistics/key-statistic-for-europe

"Our bone density is built up in puberty and through our life until around the age of 30. At this stage it starts to reduce, with a more rapid decline at menopause. The biggest changes can be made in puberty, which is why it is important to encourage teenage girls to exercise and eat healthily. We then have a bigger deposit in our 'bone bank' so that, as we lose bone density, we hopefully do not fall into the osteoporosis range."

patient.info/news-and-features/how-can-you-prevent-osteoporosis-during-the-menopause

@anothersmahedmug

Bone density decreases in men and women

Do you propose hrt for the men also ?

If you are at risk of osteoporosis then taking action is merited

Early menopause is a risk factor

Taking action because some people have problems and you might be one is way less clear to me

All medication has risks and side effects - it's a cost benefit analysis.

Women get far more osteoporosis than men so not sure your point? Men are far less likely to die from it.

[quote ArabellaScott]'It’s a fact that bone density decreases by 1% a year post periods stopping. '

It seems that there is a relatively rapid decrease post menopause which then slows

“We know bone loss begins 1 year before menopause and accelerates over the next 5 years, ” Ebeling, from Monash University, in Melbourne, Victoria, Australia, added in an email. “This study indicates some stabilization of bone loss thereafter with lesser effects of low estrogen levels on bone.”

“It probably means bone density does not need to be measured as frequently following the menopause transition and could be every 5 years, rather than every 2 years if there was concern about continuing bone loss.”

vighneshworld.com/health-news/new-study-changes-understanding-of-bone-loss-after-menopause/

And a reduction in bone density doesn't mean automatic osteoporosis.

'... there are important gaps in our knowledge of the effect of the menopause transition on the skeletal system. Although bone loss accelerates after menses cease (3,4,5), it is not clear either when bone loss begins or what the rates of bone loss are at various stages of the menopause transition. It is important to determine when bone loss accelerates so that women and their health care providers can make informed decisions regarding the appropriate time to screen for osteoporosis and to consider therapy to prevent bone loss. There is considerable variation in rates of bone loss among women, with some women experiencing rapid bone loss during the menopause transition and others experiencing little or no bone loss'

www.ncbi.nlm.nih.gov/pmc/articles/PMC2266953/

Most women will not get osteoporosis:

'Estimated number of individuals aged 50+ with osteoporosis in 2019

32 million (5.6% of the total European population aged +50)
♀ 25.5 million (22.1% of women aged +50)
♂ 6.5 million (6.6% of men aged +50)

(or 78% of women will not get osteoporosis).

www.osteoporosis.foundation/facts-statistics/key-statistic-for-europe

"Our bone density is built up in puberty and through our life until around the age of 30. At this stage it starts to reduce, with a more rapid decline at menopause. The biggest changes can be made in puberty, which is why it is important to encourage teenage girls to exercise and eat healthily. We then have a bigger deposit in our 'bone bank' so that, as we lose bone density, we hopefully do not fall into the osteoporosis range."

patient.info/news-and-features/how-can-you-prevent-osteoporosis-during-the-menopause[/quote]
That is a lot of women who will get it? 22%?

Add in the ones who are on heart meds? Who have dementia?

More research needs to happen on preventative health care so it’s not just the preserve of the rich

I'm going to leave this link as a separate thread as it will disappear here, but it's a simple and factual summary of HRT by the Women's Health Concern organisation. (They are the patient-arm of the British Menopause Society.)

There is, sadly, a lot of mis-information on this thread, as well as posters asking questions, and for anyone who is unsure about HRT, it's better to stick to the medical facts.

HRT risks and benefits

The British Menopause Society has a very similar statement, which is here'

thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/

Also, just to correct a previous poster, (think it was @AnnabelleScott), I posted a link to the latest BMS report into menopause/HRT/ osteoporosis, a few posts back.

If you read that link there is a very detailed section on osteoporosis in the UK with stats. The figures for the UK are that 1:2 women over 50 will have a fracture and 1:3 of those women will be then diagnosed with osteoporosis. 100K pa will die in old age from complications resulting from a fracture of the hip or femur.

The BMS also states that HRT is the first line of choice of medication for women to prevent and treat osteo on women aged under 60, rather than the other alternative drugs.

You can be prescribed HRT for meno symptoms. If you also have a risk of osteo/heart disease then it might be wise to consider it to help your meno symptoms. Clearly, not all women need or want HRT. Menopause specialists, including those offering private appts, have lots of other cards up their sleeves to support that choice. They don't simply offer HRT.

Clearly, not all women need or want HRT.

Thanks, that is all I was trying to point out. If two thirds of women will not get osteoporosis or other longterm issues there is no reason to suggest all women should take HRT as a matter of course, which is what some posts seem to suggest. Many if not most women will not need it or the potential risks may outweigh potential benefits

Many if not most women will not need it or the potential risks may outweigh potential benefits

But you did read the link and see that for women under 60 , the benefits outweigh the risks.

On a population level, 1:3 women with osteoporosis is a huge number - I don't think there is any other disease that affects such a large percentage of women over 50.

A GP is not going to prescribe HRT as a preventative anyway for anything.

You'd only be prescribed it from a consultant (rheumatologist or gynaecologist) if you were referred for reasons of risk, fractures or family history.

for women under 60 , the benefits outweigh the risks.

All women?! Or those who are experiencing symptoms?

@ArabellaScott

for women under 60 , the benefits outweigh the risks.

All women?! Or those who are experiencing symptoms?

I'm struggling to know why this is confusing.

Read the link. :)

It's all there. It is in the context of women being given HRT for menopausal symptoms.

If women who have menopause symptoms that warrant using HRT, the benefits outweigh the risks.

You can't be prescribed HRT as a prophylactic (prevention) by a GP.

It's confusing because I am maybe taking your statements too literally! New to all of this and trying to parse out what is being suggested.

'HRT for symptoms, not for preventative' - seems reasonable.

Thanks for clarifying.

rambleonplease No, nobody ever suggested HRT. I was told I was lucky to have still been having periods at that age! Apparently, the chance of getting Osteoporosis is lower when you're still having periods.
I certainly didn't feel lucky. I'm just glad it's all over with.

Arabella I think HRT should be considered by anyone menopause under 50 , and strongly encouraged for anyone menopause under 45 even with no symptoms as that is a strong osteoporosis risk

@ArabellaScott

It's confusing because I am maybe taking your statements too literally! New to all of this and trying to parse out what is being suggested.

'HRT for symptoms, not for preventative' - seems reasonable.

Thanks for clarifying.

This is what I’m hearing and useful to have it clearly stated

I want to add that as we know from countless posts - symptoms might not show up in the way you expect!

It seems women think of symptoms as ‘hot flushes’ but it’s so much more than that. The symptoms might be osteo and by then it’s sadly very serious.

Pls don’t think this is a short year or two thing and then done. Plenty of good info out there so I hope it helps people new to this board.

You cannot be given HRT by your GP as a 'preventative' .It's not licensed for that unless you have had an early menopause or a hysterectomy.

You can be given it for peri and post meno symptoms.

What happens is that your GP ought to discuss your symptoms with you and offer your HRT if you ask for it and you have no listed contraindications.

If you are someone - for example- with many slight peri/ meno symptoms and could get by without HRT that's fine.

BUT at the same time, if you are small boned and petite, (one risk factor for osteo) or you have a family history of heart disease and bone loss, this could be a reason to use hrt alongside the need for it for your flushes etc.

If you are referred to a consultant, they are more able to prescribe off licence, as their professional status allows them more choice of treatment. This is why hrt can be given to prevent bone loss if you have some already, or are at a high risk, even if you have no meno symptoms.

You can also use HRT from some menopause consultants as a preventative treatment if you feel you want the heart and bone benefits. They are more qualified to judge if this is appropriate for you and they can prescribe when GPs can't.

I really suggest anyone who isn't sure on all of this reads the BMS and the WHC links.

I think the WHC also has a free helpline, if you want to know more about your own choices, or just have some questions. It's probably best to focus on your own needs, and seek the right advice for yourself.

I do find some of these posts very worrying as the misinformation might be accepted by others as fact. JinglingHellsBells posts factual information but seems to be targeted by others trying to shoot her down with nonsense.
No idea either why this thread has turned out to be a debate on osteoporosis. I thought there might be more interest in lack of oestrogen being responsible for vaginal atrophy, loss of libido etc and premature aging not to mention stress incontinence and prolapse all of which tend to be reported about 10 years after menopause.

@Esspee

I do find some of these posts very worrying as the misinformation might be accepted by others as fact. JinglingHellsBells posts factual information but seems to be targeted by others trying to shoot her down with nonsense. No idea either why this thread has turned out to be a debate on osteoporosis. I thought there might be more interest in lack of oestrogen being responsible for vaginal atrophy, loss of libido etc and premature aging not to mention stress incontinence and prolapse all of which tend to be reported about 10 years after menopause.

What specifically are you talking about as misinformation and nonsense?

Really women are just looking for non biased information in order to make the right decision for themselves. If there is misinformation and nonsense I'd like to know what it is.