Is starting HRT early really so bad?

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So last year at 43 I felt a bit rubbish, I was and am still having regular periods but was just feeling blah. Tired all the time, joints a bit sore, skin looked crap, deflated boobs etc. I saw the Davina documentry at the time and thought I might be in perimenopause. I decided to ask my GP for a trial of HRT, I had to push a bit to get it but in the end she let me have a trial. I really did feel better on it more energy, restless legs vanished, joints no longer sore, seemed to age backwards and boobs filled out. So I have stayed on it and fully intend to stay on HRT (Evoral Patches & Utrogestan) for as long as I can / forever.

I did discuss this with a friend of mine who has said I'm wrong to start using HRT so early or pre-emptively. She said I was using it as an anti-ageing treatment as opposed to treatment of menopausal symptoms.

I suspect that the earlier into perimenopause HRT the more robust the benefits are in terms of preserving things like bone, muscle and collagen and perhaps the risks could be greater as well but surely that is my choice? HRT is cleared for use in peri so why not use it if I want to and feel the benefit of it? I do look better on it and I like that but I'm not using it purely for cosmetic reasons. In my admittedly anecdotal experience women who do start it earlier and stay on it seem to age much slower, isn't that a good thing? Who wouldn't want to hold off old age and frailty?

Tiredness, sore joints and lack of energy are peri symptoms. That's a reason to try HRT.
Getting bigger boobs and better skin are a bonus perhaps but not a reason to use HRT!

Your GP has been quite 'generous' allowing it. At 43 they will usually do blood tests to check nothing else is causing symptoms.

I suspect that the earlier into perimenopause HRT the more robust the benefits are in terms of preserving things like bone, muscle and collagen and perhaps the risks could be greater as well but surely that is my choice?

At 43 your bones ought to be pretty good anyway if you have had a healthy lifestyle and diet and no family history of osteoporosis, or other risk factors. But only a DEXA scan will tell you.

Heart health is improved if hrt is taken within 10 years of the last period. so for many women that means they benefit even if they start in their early 60s.

The risks of hrt don't kick in until you reach average menopause age (51) as you are simply supplementing your own estrogen till then.

I can see that your friend might take a dim view of using hrt if you do bang on about having fuller boobs and better skin, rather than the good effects on your overall wellbeing. It all depends on how you 'sell it' to her!

The risks of hrt don't kick in until you reach average menopause age (51) as you are simply supplementing your own estrogen till then.

This is only true of younger women who have undergone a hysterectomy and thus gone into premature menopause. If you are not in peri-menopause and on HRT you already have estrogen in your body and adding HRT to that can cause an overage of it- estrogen is a primary carcinogen. That’s why even women in peri and menopause with wombs have to take combined HRT because the progesterone offsets the womb cancer risk of the estrogen.

So the cancer risks are definitely kicking in for OP, and if she’s not in peri, they will be a bit higher

Here is the Gov website:
www.gov.uk/drug-safety-update/hormone-replacement-therapy-hrt-further-information-on-the-known-increased-risk-of-breast-cancer-with-hrt-and-its-persistence-after-stopping

e.g, risks start increasing after use of HRT for one year. Risk of cancer after ten years of use is roughly double the risk after five years or use. Added risk can persist as long as ten years after stopping HRT.

It's not as simple as that @Discovereads
Many drs will not agree with you that estrogen is a carcinogen.

Yes, endometrial cancer can begin if the lining is not controlled and it happens to women not on hrt too.

Women who use estrogen only hrt have less breast cancer than women who have never used/ don't use HRT.

The science at the moment is pointing to the type of progestin in hrt that may contribute to cancer. (There is a lot online on this in research papers and in the BMS statements.)

Anyway...the OP is in peri as she has some of the symptoms.

@Discovereads That report has already been disputed by many breast cancer experts and the BMS issued a response at the time, trying to put it into context.

Just to put it very simply, the research used in the meta analysis was 20 years old, it included data from 2 big studies- the WHI and the MWS (both of which are now shown to be flawed) a lot of it not peer reviewed, BUT most importantly, was not based on the use of Utrogestan which is what most informed drs now prescribe. There were 58 women using it out of 100K!

bjgp.org/content/68/675/499

A recent meta-analysis has shown that taking oestrogens combined with natural MP is not associated with an increased risk of breast cancer for the first 5 years. For women taking HRT for >5 years, risk of breast cancer was lower when taking MP compared with taking a synthetic progestogen.

You also need to look at absolute figures for increased risk- not simply 'double'.
'Double' could mean 2 in a 1000 instead of 1.

She said I was using it as an anti-ageing treatment

Even on the statement alone, your friend is being ridiculous.

There's no such thing as 'anti-ageing treatments'. Sure we are sold this by the beauty industry. But actually there's nothing any of us can do to prevent ageing.

And as Jingling says, you have peri menopausal symptoms in any case.

@JinglingHellsBells
Women who use estrogen only hrt have less breast cancer than women who have never used/ don't use HRT.

If they are using the vaginal Oestrogen gels only or are women who’ve had hysterectomies so are on estrogen only HRT. You can’t use estrogen only HRT in any other circumstance.

Many drs will not agree with you that estrogen is a carcinogen.

Its a well accepted medical fact that unopposed estrogen is a carcinogen.
my.clevelandclinic.org/health/diseases/10312-estrogen-dependent-cancers

I could list hundreds of other links…but it’s a fact, not my opinion.

You also need to look at absolute figures for increased risk- not simply 'double'.
'Double' could mean 2 in a 1000 instead of 1.

I know that and that is why I linked the .gov webpage with the latest advice which has more detail for the OP.

My main point still stands that you were incorrect to say that the risks of HRT do not kick in until age 51. This is blatantly untrue no matter which studies you look at, no matter how old or recent. The risks of HRT start after taking it for one year and increase the longer you take it and persist for up to ten years after taking it. There is no “risk free” period of taking HRT prior to age 51 as you stated with the only exception being oestrogen vaginal gels which was not what the OP is taking and so thus irrelevant really to her situation.

Actually I’ve just seen you stated “less breast cancer” than never users of HRT. This was only found in one outlier study, all the other studies show no increase in risk which is not the same as lowering risk at all.

@Discovereads The issue of HRT and BC is very contentious and emotional obviously. It's often discussed here and opinions can run high. The paper/info you keep referring to has been heavily criticised. It has major flaws as already mentioned as pointed out by Prof Baum, breast specialist. A lot of the research included doesn't pass muster.

The Gov website is now out of date as the '10 year risk' timescale has been changed (already) to 2 years for micronised progesterone.

This is from Dr Heather Currie (MBE for menopause services) on Menopause Matters website (find it under Risks of HRT.)

Current opinion is that HRT taken for less than 5 years does not significantly increase the risk of breast cancer but studies have shown that after 5 years of use, there is an association with a small increased risk. Once HRT has been stopped, the risk returns back to baseline. This suggests that the use of HRT may promote the growth of breast cancer cells which are already present if HRT is taken for more than 5 years after the age of 50, in some women; there is no evidence that HRT causes breast cancer.

It seems very likely that different types of HRT are associated with different risk, estrogen appears to increase the risk very little while there appears to be a small increased risk of cancer promotion with long term use of estrogen combined with progestogen (combined HRT)

[See updated statements about micronised progesterone which show no added risk for 5 years at least.]

The NICE guideline on Diagnosis and Mangement of Menopause concluded that for every 1000 women aged 50 to 59, combined HRT may be associated with an extra 5 cases of breast cancer over 7.5 years, with no extra cases for women taking estrogen only

I've not read your link to the Cleveland clinic, but bear in mind that is US info, they don't use the same HRT as we do here and in Europe, and the WHI study is flawed and was dismissed years ago.

That is interesting about the risks of HRT. I did read about the increased risk of blocod clot or stroke increasing over the first year but then going back to normal thereafter. I think my other risk factors for cancer as low such the fact I have never smoked, never drank alcohol, am a life long vegetarian and have fairly low stress. I have been a bit overweight but as I have more energy, and better mood on HRT I've been better able to exercsie and have lost weight since starting it. There is no history of breast cancer in my family nor ovarian or womb cancer. I do think though that if I want to stay on it long term I'll need to ask for or pay privately for a uterine scan in future just to check the lining.

I think I am definetly in peri, my mum and her mum were post menopausal at 42 and unfortunetly my grandmother died of a heart attack before she was 50. My mum took HRT with no issue for 15 years and her health only started to decline after she stopped HRT, developing chronic, debilitating insomnia, hot flushes, osteoperosis etc. She is not on various medications which affect her overall health and especially her cognition.

I do appreciate the visual benefits of HRT like my boobs filling in again and my skin looking so great but I don't think I would take HRT just for those reasons alone. The main benefit was energy and a lot of niggling aches, pains, restless legs, mood issues all just went away after starting HRT. I suspect that even if I'm still producing hormones and having a natural cycle that I'll be menopausal earlier than the average age of 51 given my family history.

I suppose useful question might be that how do women who wish to use HRT long term reduce their risk of the cancers that HRT can be associated with, without stopping HRT?

@JinglingHellsBells At the time I spoke to the GP about the HRT I had done a lot of research and was well aware of risks etc so she felt I could make my own choice. I really felt the benefit of the HRT while doing the trial and so wanted to keep taking it and the doctor agreed I could. I've been on a a cyclical hrt since then so its hard to say if I am still ovulating or if my periods would have already stopped by now?

I did have to push a bit to get the utrogesten as where i am it wasn't first line but did get that after a few months. I'm on the estrogen only patches for now which I like as I can put them on and forget about them till they need changing, may be I'll do the gel as I get older or need more hormone?

I have a family male member who takes testosterone replacement therapy and he goes for regular blood tests and check ups to make sure he isn't having any harmful side effects. Not sure why that same system doesn't apply to women?

Nothing I posted contradicts Dr. Heather Currie at all.

“HRT taken for less than 5 years does not significantly increase risk of breast cancer”- I posted the info saying this risk starts to accrue after 1 year of use. There is no contradiction.

“Once HRT has been stopped, the risk returns back to baseline”.- yes and can take up to10yrs after stopping for the risk to return back to baseline. There is no contradiction.

“It seems very likely that different types of HRT are associated with different risk, estrogen appears to increase the risk very little while there appears to be a small increased risk of cancer promotion with long term use of estrogen combined with progestogen (combined HRT)”

Yes absolutely true it depends on the type of HRT how big or small the risk is, but keep in mind the only women using estrogen only HRT are women who have had a hysterectomy and so they do not generate any of their own estrogen in their system, but they do still produce progesterone. For these women, the HRT is merely replacing the estrogen that was lost, and their natural progesterone opposes it. For women who have a uterus and are in peri/meno both their estrogen and progesterone production are in decline (the symptoms are due to this natural decline not always being in sync). It’s why they cannot take unopposed estrogen…if they did their cancer risk would be even higher. It’s actually why HRT is combined for women with wombs…to lower the cancer risk of estrogen.

Again- your statement that there is no risk taking HRT before age 51 is what I objected to as it is patently untrue. And everything you have posted thus far contradicts you…the OP is 43 and started on HRT. By age 51 she will have been taking HRT for 8yrs…which absolutely does mean an increase in cancer risk.

We can post all day about how big or small that risk is currently thought to be, but all the evidence says there is some risk no matter when you start HRT. There is no risk free if taken before age 51 like you said.