What next?

[Unicornshorn]

I'm 46 and although was having regular periods they were shorter alongside terrible headaches every 7ish days, joint pain, feeling down and feeling hot in the night. My GP was reluctant to put me on HRT and suggested I start with the mini pill as this might be enough to stop the hormone fluctuations and therefore the headaches. This was about 9 months ago. The headaches did stop but in the last month they are back quite regularly, today is particularly bad alongside cramps and some bleeding. I no longer have regular periods but quite frequent spells of bleeding. I also feel quite detached from everything, in some ways less anxious but I have little interest in seeing friends or family a lot of the time and can feel quite down. Im now wondering if I do actually need to try HRT as the pill alone is not enough/ is making things worse. My gran died of breast cancer and my Mum was on Tamoxifen for many years as a preventative measure as she has a lot of breast lumps (all benign so far). I know that views on HRT and breast cancer have changed, but it is a worry and I still see conflicting information out there. I don't think I can go on like this I feel old, tired, can't concentrate a lot of the time, have an intolerance of others and just feel fed up. Getting a GP appointment isn't easy at my surgery and I found the last one pretty useless but i don't want to go private unless I have to. Does this sound like I need HRT?!

I appreciate it's so hard for you. I'd be really worried in your situation about HRT.
As you say, there are conflicting views and also research.

On balance, it appears that micronised progesterone is safe for up to 5 years, as the progesterone part of HRT.

British Menopause and International Menopause Society report

journals.sagepub.com/doi/full/10.1177/2053369120957514#:~:text=In%20summary%2C%20results%20from%20the,small%20increased%20breast%20cancer%20risk.

-HRT regimens that included estrogen and a progestogen other than micronised progesterone or dydrogesterone had a slightly elevated breast cancer risk with short-term use up to five years (HR 1.70; 95% CI 1.50–1.91) and with long-term use for more than five years (HR 2.02; 95% CI 1.81–2.26). A slight ongoing increase (HR 1.36; 95% CI 1.13–1.64) was also noted following discontinuation of HRT in this group.

-In summary, results from the E3N French cohort study suggest:
Estrogens combined with micronised progesterone do not increase breast cancer risk for up to five years of use.

-Estrogens with oral micronised progesterone for >5 years were associated with a small increased breast cancer risk.

Given your family history, I'd suggest you see a menopause specialist privately . They will give you time (usually up to an hour) to discuss all the physical and emotional sides of this.

It's around £300 for an appt but worth every penny if you can afford it.

Thank you for this, that's really useful information- it's such a minefield. The GP did say that HRT could only be for 5 years (I think in the general sense) and that was part of the reason she didn't want me to start "too early". However I'm now at the point where it's affecting my quality of life so I think that's right about a private appointment. I'll do some research into that. Thanks again for your help it's appreciated.

The GP did say that HRT could only be for 5 years (I think in the general sense) and that was part of the reason she didn't want me to start "too early"

A GP who is confused. Following the Lancet report (which has been heavily criticised anyway by other experts), which showed an increase in BC after 5 years, (on some types of HRT) some drs have interpreted this as meaning there should be a 5 year limit.

There is refuted by both NICE and the British Menopause Society who say no limit on time on HRT. It's an individual choice based on your own risk/ benefit profile.

It's worth bearing in mind that almost all the research into HRT has been retrospective and is 20 years old. Very few of the research studies were on micronised progesterone.

Menopause experts, like Mr Nick Panay, are trying to get a new double-blind trial funded to research micronised progesterone. At the moment the funding is not there - he mentioned in an interview about approaching the WHO for funding.

I know this doesn't help you just at the moment, but I'm mentioning it to show there are big gaps in knowledge on the safety or risks of HRT used now , rather than types used 20 years ago.

Thanks again for this, I'm currently researching private specialists, it is so apparent that many GP's are not at all up to date with all this. The only thing I was unsure about is whether I will then have to pay privately for HRT or will I be able to access it on the NHS? I'm not sure if there can be challenges with this. Thanks again.