Would you take HRT when you have no menopause adverse issues?

[PilatesPeach]

My last period was 8 years ago. I had one bad year with sweats, flushes, aching joints and some anxiety but I feel really well as I am. I am a normal weight, I run, do weights, yoga and pilates. I sleep well. Am happy enough. I take a daily sage tablet which means no flushes and my hair and skin is good. Some vaginal dryness but can use some lubricant for sex. My GP recommends that I start HRT for the preventative benefits - he says it will prevent osteoporosis. reduce stroke and heart disease risk by around a third, eliminate brain fog (I don't actually have this anyway). He says I may have some bleeding on it which would really bother me as I have none currently and don't want to start that again and that I may find my breasts are sore/swollen which again I never had when I had my periods.

I am loathe to start something when I feel fine. Any advice please? thanks so much

In a similar position to you in that I have no classic menopausal symptoms but I do have osteoarthritis and risk of osteoporosis so am thinking I should explore with GP in the next couple of weeks.

In lots of ways I feel better post menopausal than I did as a younger woman. I used to get terrible PMT and brain fog. So, I am not 100% convinced but I thought I would try it and see what happens.

This is so interesting.

Most of the posts/ threads here are from women trying to get HRT and their GPs are refusing, for various reasons.

There are very few GPs who are willing to prescribe HRT as a preventative. I replied to a poster earlier today as she asked if she should use HRT if she had no symptoms (now or in the future.) I replied she'd be very lucky to find a GP willing to do that although most meno specialists would.

You won't get bleeding on HRT if you use a no-bleed type which many women post-meno do. You may get spotting for a few weeks /months until it settles down. (Read about how 'continuous combined HRT works.)

The sore breasts etc- not really- I've never had that (many years on HRT) and it's usually dose-related. You'd start on a very low dose.

You don't have to do what your dr suggests, but you do need to consider your risk factors. Ideally, IMO, all women ought to have a bone density scan at 55 and see how they are- that can make the HRT decision easier. You won't get this on the NHS unless there is hereditary osteo in your family but you can 'buy' a private one.

Your dr is right about the heart and stroke benefits but these only work if you start HRT within 10 years of your last period.

It's worth thinking about vaginal estrogen which is not HRT, but is far better than lube- lube is just that and it doesn't change the cause of the dryness.

Me. I'm mildly skeptical on those claimed HRT benefits. At least I think they are exaggerated. I'd like to see one of those person graphics, like "5 cases of severe osteoporosis" prevented among 1000 women who take HRT at least 5 years: or whatever the actual risk reduction statistic is.

NICE says that some forms of HRT raise risk of stroke, (same said by Stroke assoc). No effect on stroke risk if gels/ patches.

same NICE link says no effect on heart disease risk & BHF also only says HRT doesn't raise risk of heart disease rather than saying it reduces that risk.

I'm the same as you, OP, and I wouldn't take HRT if there was no immediate, obvious, clinical requirement. I am on oestrogen vaginal pessaries for a little local problem, but I don't see the need to take it as a preventative measure. My bone density is very high, my mind clear and I certainly don't want bleeding or sore breasts again.

I’m on it, but was told by the doctor it is only indicated for symptom control and for a short time only when I explained there was a strong family history of opteoporosis. Thankfully I had bad hot flushes so I was “allowed” to have it. I’ll be fighting tooth and nail to stay on it long term.
It’s so refreshing to hear that doctors are finally realising the benefits.

I do. My mother has osteoporosis so I requested it as a preventative and my GP prescribed without bother.

No I probably wouldn't. I was peri and then diagnosed with breast cancer. My meds flung me straight into menopause and it's been ok quite honestly. I had a few months of feeling a bit shit, terrible sleep and awful hot flushes but it's gone now. If I were that far down the line, then no I wouldn't bother. Also, had I not had cancer, I would still have waited to see how I coped before taking HRT. It's not awful for everybody.

And osteoporosis is really nasty, women die from it. And the drugs to treat it aren't well tolerated by many.

My GP is totally in favour of HRT for all females and is male interestingly. I feel with all my exercise plus daily dog walking I am helping keep my bone density good compared to those who do none. He told me he felt this way since he was a trainee GP over 20 years ago!

Interested too

I have one symptom I reckon so trying to decide

@lljkk There is loads of info on the benefits of estrogen on bone loss. It's not a case of it being exaggerated. It's licensed for the treatment and prevention of women with osteoporosis, under 60. It's tolerated far better than many of the alternatives for bone loss.

You might like to listen to the experts on these quick video interviews as they cover both bone loss and heart disease.

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

Prof John Stevenson, endocrinologist, discusses both at the bottom of the list of interviews.

I'm the same. 52, a year since last period. Never felt better but interested in the health benefits and also because I've heard it's good for the skin and helps retain a youthful shape. (Yes, i know its vain, but it matters to me.) I had an appointment last week and told GP exactly what I've said here, including the vanity things, which she agreed with! She was very keen. Went through a long list of symptoms so varied I couldn't not agree to having some of them (migraine and aching joints) and immediately prescribed patches. They're still sitting in the bathroom cabinet as everytime I go to start them I panic at the thought of the side effects.

My DM had osteoporosis
I'm on hrt for that and skin/other body benefits
If they try to stop it, I'll just get it privately

@PilatesPeach the thing about vaginal atrophy is it is not just about during sex so a bit of lube at the time doesn't cut it. It is what happens to your vaginal and urology area through lack of hormones. Google vaginal atrophy but don't look at the pics unless you have a strong stomach.

My GP recommends that I start HRT for the preventative benefits - he says it will prevent osteoporosis

If OP's GP said that then the GP exaggerated the claim of benefit by implying the benefit is certain. There are women on HRT who get osteoporosis. HRT doesn't always prevent osteoporosis. So that would be an exaggerated claim by GP.

British OS says that HRT "can help" to prevent osteoporosis. Not that it's guaranteed protection.

NOS says that HRT has a role to play, and that role needs to be clarified.

Thanks everyone it is so hard to make a decision when I feel great currently! I really do not want any bleeding or spotting or tender breasts or weight gain - I know it is not certain I would get them though. I always hear the benefits of weight bearing exercise in terms of bone density and am always doing this - my job is in fitness and my hobbies too.
I will look at the vaginal atrophy thank you.

I’ve not had HRT and 8 years since last period. Doctors never said anything to me? Not been and asked as I’ve only had hot flashes in the first few years occasionally and some insomnia

can heart disease, stroke & osteoporosis be controlled by diet and exercise? Are there alternatives to HRT that would have the same level of effect?

This is very interesting to me as it's something I've thought about recently. I have sailed through meno with no obs symptoms at all so don't take any meds ( the Dr was astounded I'm 57 and don't have any regular prescriptions for anything ) . I've been wondering if I should take something as a preventative but don't really want to take something ' incase ' iyswim

I’m surprised your GP is pushing this. Your lifestyle suggests you are already minimising your risks of osteoporosis and cardiovascular disease, so it would be interesting to understand what he thinks the additional benefit would be, compared with the risk of side effects from the HRT. All drugs have risks and side effects.

@lljkk I can see that you are sceptical about the benefits of osteo and HRT. I'm not sure why? It's licensed for both the treatment and prevention of osteo. If you spend time researching this topic, all the info is there. (I have- for 15 years- as I was on the brink of osteoporosis, and have since had advice from bone consultants.)

One of the biggest misunderstandings is that if you walk enough your bones will be fine. This is not so. Walking is a low impact exercise and in itself doesn't do much for bones.

If anyone is doubting the role of HRT in helping bones and thinking diet and exercise are enough, read this.

www.johnstevenson.org.uk/osteoporosis.html He has written numerous papers on osteoporosis all of which are online.

Quote from the link above

Treatment
Diet and exercise alone are not able to prevent or treat osteoporosis
Most treatments for osteoporosis are with drugs that reduce bone breakdown, and hence prevent bone loss. When such drugs are first given, there is often a gain in bone mass, because the reduction in bone breakdown exceeds that in formation, and thus a “positive” bone balance exists for some months or even years. There are now some drugs which primarily increase bone formation rather than just reducing breakdown.

Hormone replacement therapy (HRT) prevents bone breakdown, and may also increase bone formation to some extent. It is very effective in preventing the development of osteoporosis and fractures in postmenopausal women. It is usually given to those identified as being at increased risk, and is as safe and effective as any other currently available treatment (see Menopause and HRT section). It can also be used for the treatment of osteoporosis in women who already have the disease. It does not have the same long term adverse effects as the bisphosphonates and other drugs (see below)

Not me, but a friend went on it for the same reason. She is extremely fit and exercises daily, in addition to having an active job.

Why medicate if you don’t need it? But I don’t think a bunch of unqualified people on MN can answer your question-challenge your GP. But if you don’t want it, don’t have it.

This is interesting to me as I'm wondering about osteoporosis. I'm only just starting menopause - have occasional periods, symptoms not bad.

But the NHS seems very proactive in trying to prevent it, in my recent experience - I had a fracture recently, and before I'd had the follow ups I was expecting from the fracture clinic, specialist, physio etc, some of which I'm still waiting for, I had a call from the liaison clinic to book me in for a bone density scan. It was first thing the morning after I'd left the ED in fact. The scan itself won't be for a while, but they were certainly hot on contacting people who might need it.

So I wonder if I will then also have any hormone tests or discussion of menopause and HRT as part of that, depending on the findings of the scan.

Did you miss the bit where OP said she is a runner? It is well established that regular weight-bearing exercise helps maintain bone density.