attitudes to hrt - people desperate to avoid it?

[CharityShopChic]

I am 50 this year and so many of my friends are on HRT. I started using patches in January and have seen a huge improvement in my anxiety, sleeping and furious temper.

I am in another online group with people of all ages, although tending to the 40+. Comment made in the Facebook group yesterday about hot flushes and how if the national grid could harness menopausal flushes the energy prices would half. Lots of chat about how awful flushes and other symptoms are. I commented that they should give HRT a try and the patches for me have been life changing.

Nearly everyone in the menopausal age bracket was oooooh no, that's not for me, I'm trying to manage without it, i'm hoping to avoid it etc etc.

What is going on here? I haven't come across this attitude in real life, that succumbing to HRT is some sort of failure? And that it's best to power through without , even if you feel crap? Or are they all just menopause-bonkers?

@hihellohihello I think you posted earlier about exercise and bone strength?

It is certainly true that exercise helps build bone. However, if you were to talk to an osteoporosis consultant, or read the research on bone loss/menopause, you'd find that exercise alone is not enough to build bone at the rate it is lost post-menopause.

Sadly, it's one of those myths that crops up here and in other health discussions.

There is an expert - Dr John Stevenson- who has a 5 min video on the British Menopause Society website (it's a bit hard to find- it's under Education/ TV) but he explains clearly why exercise is not enough.

Bone loss post menopause is multi-factorial, and depends on frame size, weight, diet, and genetics, as well as estrogen levels pre-menopause. Some are under women's control but many are not.

I think you'd find the video link helpful as well as reading medical research papers, if it's something that interests you.

@CharityShopChic, if HRT were a person I’d snog her.

That little sticker of happiness has improved lives immeasurably. I have a good sex life again, I no longer want to kill everyone, I can weather my teen daughter’s hormonal outbursts without it descending into an argument. I’m calmer, the insomnia improved (still get the hot flushes though) and my joint pain has reduced.

All that from a little square patch on my hip.

Not helpful @JinglingHellsBells HRT isn't really an option for me having had breast cancer with a family history on both sides of various types of cancer. No osteoporosis as far as I know,

So not something I care to pursue or waste time worrying over. Having had cancer I recognise how precious time is.

Didn't mean to be too critical there @JinglingHellsBells but it is worth remembering how health decisions rarely are free from our emotions and sometimes it feels as if people just sling conflicting bits of research at each like weapons.

[quote SpiderVersed]@CharityShopChic, if HRT were a person I’d snog her.

That little sticker of happiness has improved lives immeasurably. I have a good sex life again, I no longer want to kill everyone, I can weather my teen daughter’s hormonal outbursts without it descending into an argument. I’m calmer, the insomnia improved (still get the hot flushes though) and my joint pain has reduced.

All that from a little square patch on my hip.[/quote]
🙌

Average life expectancy is brought down by things like infant mortality. It is an average, not a norm.

Osteoporosis is also common in thin women, but I don't see anyone who is a size 8 in their later years acknowledging that as a risk factor; and the figures I've seen for prevalence of osteoporosis are not a flat 1:2, as said above, but 1 in 4 women over 75, and elsewhere 1 in 2 over 60 have an osteoporotic fracture, and elsewhere 1 in 5 over 65 have signs in their neck and femur; presumably every country does their own research and has their own percentages...

Women should be free to make up their own minds about their need for HRT, but it is clear from every menopause thread I have ever read on MN that an astonishing number of women remain completely uninformed about their own body and its ageing processes.

I tried HRT after my hysterectomy but stopped after my sex drive went through the roof for my late dp's sake so he could get some sleep & not have to put up with my demands. I haven't used patch since I was 48, never had a hot flush or anything.

I assume there is no moderation of these boards?
I’ve read some nonsense on here but HRT is not a drug?? Someone actually said that upthread

I know they will say they ‘misspoke’
Call it a replacement all you like . It’s a drug . It’s linked to cancer and other illnesses which is why you are monitored while on it.

' assume there is no moderation of these boards?'

There is moderation yes. Click on 'report' on any comment you think is misinformation, explain why and it may be deleted.

Newgirls

MrsSkylerWhite
Newgirls

The NICE guidelines say that GPs should not prescribe anti depressants for peri/meno pause. The reasoning is that they can help with symptoms but don’t tackle the cause - which is falling/fluctuating oestrogen.“

In that case, I’m very glad mine went against them. Should I have just tolerated it?
Just be aware that perhaps your gp wasn’t right? The NICE guidelines are meant to be followed by GPs“

Doesn’t bother me. Her prescription means I can sleep/not worry about water running down my face multiple times each day 🤷‍♀️

I thought GPs could prescribe anti depressants for menopause anyway? The after breast cancer formation booklet said that if you were struggling with menopausal symptoms they could prescribe them, as I recall, because HRT is unsuitable after breast cancer. There is still help if you have problems and cannot tolerate HRT.

I don't know, personally, as thankfully my symptoms have been comparatively mild - a few warm flushes and drier more sensitive skin. However I do a lot of exercise now and lost all my excess body fat so I don't know whether that has a bearing on things.

But it's important to point out GPs still can help. Lots of women get breast cancer / have other health issues which means they cannot tolerate HRT. It is cruel to paint a picture of crippling health problems for the rest of their lives and inaccurate- just for the sake of justifying personal use of HRT.

Average life expectancy is brought down by things like infant mortality. It is an average, not a norm

That's a good point, @milkyaqua. I believe that the actuarial data is quite complex for life expectancy in the archaeological and historical records because of the very rates of infant mortality in some eras and the incomplete data sets.

Often a more useful figure is the average age at death of women (and men) who survived childhood.

In terms of evolutionary theory, the idea is still knocking around that women can and do live past the end of their fertile years for some considerable time because there is a evolutionary 'fitness' to them carrying out a collaborative role in the wider family group, helping to keep infants safe. In other words, 'grandma duties'. (I don't mind the theory per se; but I do dislike the sex-stereotyped language and assumptions often use when it's discussed in pop science media.)

Interesting discussion OP.

I was in the "will never have HRT" camp as I don't like to take "unneeded" medication, if I can do it naturally.

I was a child of a nurse in the 70's who was dismayed over the amount of penicillin that was handed out like smarties back in the day.

Anyway I didn't even take the contraceptive pill, and used a Dutch Cap (prob non PC to call it that now). Do they even use Dutch Caps now?

Sorry I digress again! So went though all my menopause naturally. However about 5 years later I woke up like an old woman, couldn't walk straight and was exhausted.

Assumed it was hormone related, and after a couple of weeks feeling 90 years old phoned GP to talk about HRT. Couldn't get an appointment on the phone for 6 weeks.

So I read up more about HRT, started a couple of threads here and read more about the benefits.

There was 2 main reasons for my decision to go on HRT, one a clinical study I read said it made you look prettier. I tried to find a link for this post but can't find it! I know vain and pathetic, but who cares ;)

And two, a poster on here said something like well you're only replacing a hormone that you were making naturally anyway. Which made complete sense to me!

By the time the GP phoned my aches and pains had gone away, but decided to go ahead with the HRT anyway.

I can say outwardly, it appears not to have the slightest bit of difference, sexually or mood wise or even health wise. And I'm definitely not any more attractive! :)

However have decided to keep on for my poor old bones!!

I only read the first post but this is why I am refusing HRT:

I cannot even use the pill without getting migraines every single day of the week. I have even ended in hospital with them. They stopped a week after taking the pill, whatever pill I was taking.

My doctor suggested getting a Mirena coil to control my heavy bleeding in the last years. The heavy bleeding did not stop but in the 2 months I had the coil I was in a state of constant rage, the outcome of it is that I handed notice at work and almost finished a long term relationship. Even though I was sure it was the Mirena, the gynaecologist didn’t pay attention to it even when is a possible side effect and refused to remove it. The issue ended when I threatened her to remove it myself if she didn’t do it herself. I was back to my normal calm self in two weeks.

I am refusing HRT because I am afraid of the above repeating and also because I don’t trust my GP to be well informed to prescribe the right combination of HRT or to hear me and adapt it if things go wrong. In fact, my GP service is so crowded that it is almost impossible to get an appointment unless you are prepared to ring them every morning for weeks on end.

@Novella4 I think it may have been my post where I referred to HRT as replacement rather than 'drugs'. It was in reply to a poster who said she didn't want to be 'on drugs' for years.

Mumsnet has already a disclaimer on health forums that they cannot vouch for the qualifications of anyone posting.

It's mainly in the UK that HRT is prescribed, as in some countries in Europe it's available over the counter, with no prescription. (Spain is one country.)

I agree there is a lot of misinformation on this thread.

There is still an ongoing debate on this, with many experts saying they think HRT may accelerate an existing cancer, but there is no proof of cause-effect. (If you are interested, this is on Menopause Matters, on the HRT Risks page.)

You can see in this table, that many lifestyle behaviours have a much greater risks than HRT. Namely alcohol and being overweight.

www.menopausematters.co.uk/pdf/Understanding%20Risk%20of%20Breast%20Cancer.pdf

The monitoring you refer to is no more than for any prescribed medication- legally, it's an annual review.

Some women may be asked to do a BP reading, but not if they use transdermal estrogen which doesn't raise BP.

I don't dispute there are some small risks, for some women, but equally, drs will tell you there are also risks for some women in not using it.

I'm reading Oestrogen Matters as it was £7 on Amazon - bloody amazing book and enraging.

I'd advise all to read it if worried about taking hrt.

@TheBigDilemma Can't advise about your GP and getting an appt etc, or their knowledge of HRT.

BUT it might help (in case you start suffering with severe symptoms and reconsider) to read around HRT v The Pill.
Although they are both hormonal treatments, there is no comparison.

HRT is made from plants nowadays (yams) and the estrogen is the same as your own (molecular structure.)

It's 1/5th the dose of most Pills( which are made into a synthetic estrogen not like our own.)

There are many types of progestin available, and the Mirena is coated with a synthetic type.

If you are concerned about lack of knowledge by your GP, one way to help deal with this is to read around the topic and ask for the type of HRT you want to try.

There are also menopause gynae consultants who work privately if that is an option.

[quote JinglingHellsBells]@TheBigDilemma Can't advise about your GP and getting an appt etc, or their knowledge of HRT.

BUT it might help (in case you start suffering with severe symptoms and reconsider) to read around HRT v The Pill.
Although they are both hormonal treatments, there is no comparison.

HRT is made from plants nowadays (yams) and the estrogen is the same as your own (molecular structure.)

It's 1/5th the dose of most Pills( which are made into a synthetic estrogen not like our own.)

There are many types of progestin available, and the Mirena is coated with a synthetic type.

If you are concerned about lack of knowledge by your GP, one way to help deal with this is to read around the topic and ask for the type of HRT you want to try.

There are also menopause gynae consultants who work privately if that is an option.[/quote]
Thanks for that! If you know of any good private one could you PM me their details? Thank you

'You can see in this table, that many lifestyle behaviours have a much greater risks than HRT. Namely alcohol and being overweight.'

I always find this a strange comparison as we don't say drinking everyday or being overweight is ok. People are told of the associated risks constantly and encouraged not to drink excessively and advised not to be obese/overweight.

Imo if women are fully informed and accept the risks of HRT that is of course fine. If the effects of depleted oestrogen are impacting their life so much that they are struggling again then yes fine but what some people should stop doing is minimising the known risks and stop overegging the benefits.

We don't know if hrt protects against dementia (it is often stated as fact on this board that it does) NICE guidelines confirm it is not known www.nice.org.uk/guidance/ng23/ifp/chapter/benefits-and-risks-of-hrt and we know it only prevents against osteoporosis for as long as it's taken and many take for the shortest time

If this all changes in the future and body identical hrt is proven not to increase the risk of cancer and if it is found to protect against dementia great but at the moment the evidence seems to be contradictory so women should of course be aware of that and have every right to be cautious.

@JaniieJones
I don't think anyone has mentioned dementia here. It' s something you do keep mentioning, but I know that many doctors do believe it's protective when HRT is started before 60. One could ask why women suffer most from dementia and the obvious answer is there is a hormonal link.

The info on bone health is not as clear cut as you make out. There is also other evidence that bone density may last a lot longer than first assumed, even when HRT is stopped. The NHS is always very slow in responding to new research and what you find on their sites, and even NICE, can be limited.

And, what's important to understand, is that (for example) using HRT to the age of 70, that woman will have far more bone than if she'd not used HRT. So although her bones may decline over her next 15 years (or more) they will not be as fragile as if she'd never used HRT and she may never have a hip fracture.

It's easy to underestimate the impact of osteo on older women.

Many older women are disabled or lose their independence after falls and fractures, needing to go into care. Even a wrist fracture can mean they can't drive anymore and lose their independence.

'I don't think anyone has mentioned dementia here.'

It is stated on many threads on here that hrt protects against dementia. I know and you know this has not been proven.

I'm pro HRT with the caveat there are of course risks but if women are happy to take the risks then great but we mustn't minimise and make sweeping statements about uneducated GPs or crippled 70 yr olds who should've take hrt but didn't. Again, not on this thread but the often common theme.

@JaniieJones Thought I'd share something that you keep mentioning.

You often make the point about new research that may prove something.

I've been told by my consultant that there are no new major research trials underway (on HRT) and that even if they were, the timescale would be at least 20 years. The lack of research is partly financial- HRT is dirt cheap to produce and there is no benefit in pharma carrying out costly trials.

This does make it hard for women, but at the moment, we all have to go on what evidence is there - some of it contradictory- and make the best choices we can based on our own personal risk factors and circumstances.

'I've been told by my consultant that there are no new major research trials underway (on HRT) and that even if they were, the timescale would be at least 20 years. '

Disappointing and puzzling isn't it. If there was something that could save the NHS millions in the prevention of osteoporosis and the ensuing operations, lengthy hospital stays and recuperation plus the massive drain on the NHS regarding dementia care then you'd really think they'd have chucked everything at hrt research (as the disastrous whi research was now 20yrs ago) to prove how safe and vital it is for long term health.

I’m still generally undecided and did go to a check up recently but obviously it wasn’t covered.

My main question is if no symptom relief benefit, is it still beneficial in any way?

Not sure if that can be answered so I’ll probably skirt round this with a scan at some point

And also is there still a five year limit in guidance

the massive drain on the NHS regarding dementia care then you'd really think they'd have chucked everything at hrt research

Not sure I understand this @JaniieJones

The NHS doesn't fund research as far as I know.
Pharma companies do, research universities do, the MRC (medical research council) and sometimes charities.