Is it the norm to be on HRT ?

[sweatyannie]

Managed to get through the menopause without too many issues. Exception being very heavy periods but got that sorted.

I never sought HRT or was offered it by GP but I am now struggling with weight issues especially around the tummy etc. that may be for a number of issues (calories in - calories out)

I seem to be surrounded by women friends , colleagues who are on HRT.

Am I the only one ?

I'm 62 and stopped periods about 8 years ago. Never considered HRT but now I am - I sleep badly, have anxiety and am forgetful. I'm hoping to get a prescription this week after delays for blood tests. Fingers crossed I feel more relaxed. If not I'll give up again but want to give it 6 months.

I think it will increasingly become the norm. For too long, HRT has been seen as unilaterally risky, and our sexist society has also not supported women with medical choices. When women properly weigh up the risks and benefits many will want it.

Is 5 years on HRT enough to protect against osteoporosis etc in the future? I’m only taking it for current difficulties really, I hadn’t considered further ahead. Jinglehellsbells made an interesting post about menopause symptoms falling into the more immediate 5 years category then there’s different symptoms/issues 10 years onwards. I was wondering about coming off it, I’ve been on it almost 4 years but it’s private treatment which uses a compounded HRT cream. I’m a bit better informed about this now and how BMS doesn’t approve it so my other option is to try switch to NHS treatment but I was put off by lack of availability plus having to possibly trial a new regimen when what I’m currently taking does make me feel well. It’s expensive though. 😢 I wish there was a shed load more info out there on all this so it was easier to make informed choices. I imagine to get protection from osteoporosis, dementia etc you need to be on HRT long term but I dunno? 🤷‍♀️

@Fififizz in the article they suggest being on it for 10 years. There's info on the Menopause matters website on osteoperosis, there are other things you can tae too. www.menopausematters.co.uk/benefit.php

Me too !

Oh and a page just on osteoperosis
www.menopausematters.co.uk/osteoporosis.php

I find it interesting that you will medicalise feelings by taking sertraline, a drug with multiple side effects and difficulties to cease taking, but won’t replace a naturally occurring substance in your body as that medicalises menopause. Horses for courses, but I rejected the sertraline because I didn’t want my emotions artificially clipped but am a fan of keeping my sparrow bones as strong as possible.

Thank you. I’ll have a good read.

Women have been scared of taking oestrogen for too long. They’ll replace thyroxine and other hormones they’re deficient in but they won’t replace oestrogen -one of the most natural hormones we have as a woman! We need to start thinking of menopause- particularly early menopause- as a deficiency like any other.

@Fififizz ”nature” didn’t “intend” (think about that, a concept can’t have an intention!) for women to live to menopausal age.

@Fififizz No, 5 years is not enough especially when you started before the average age of menopause. Bone loss is up to 5% a year for 5 years immediately after menopause.

There is some controversy over what happens to bones when HRT is stopped. It used to be thought that the benefit was lost quite quickly but now they think it might not be.

I know a LOT about this both from personal experience ( DEXA scans for years and advised by the best rheumatologist in the UK) and have friends with early menopause (and NO symptoms!) who now have osteoporosis and are on treatment, and I've written about it for the media.

Basically, at your age, no, 5 years is nowhere near enough estrogen replacement.

I wish there was a shed load more info out there on all this so it was easier to make informed choices.

@Fififizz There is. You just need to read it!

The Royal Osteoporosis Society is a good place to start.

You should also seriously look into getting a DEXA scan (which will cost less than the compounded private HRT.)

That will give you a baseline of where your bones are now.

I am almost 56, still have my regular periods and only experience flushes once or twice a month. I am not taking any HRT.

I'm 4 years post meno. Never taken HRT. I never got on with the pill and hated the pmt/heavy boob/hormone feeling so wanted to avoid that for sure.
Only meno symptoms that have been a pain were the night sweats. Positives, my spotty skin is now fabulous and no longer spotty. I have not gained any weight and bizarrely seem to have lost a bit of body fat and can see more muscle definition. My hair is ok, no hair loss yet. I am more confident & tend to tell people what I actually think these days (not sure that's a good thing).
Overall menopause without HRT has been fine.

'Women have been scared of taking oestrogen for too long. They’ll replace thyroxine and other hormones they’re deficient in but they won’t replace oestrogen'

Thyroxine doesn't have serious, albeit small , associated cancer risks though. It is the cancer risk which is the deterrent not taken medication.

The bone protection is only for as long as taken and theories it may last longer aren't really what people would go on. Clinical research and proven evidence should guide women.

I am very pro hrt as long as women are fully informed and not based on Davina style claims that it 'prevents against dementia' when this hasn't ever been proven.

But the point is that most, if not all, of the various cancer risks associated with HRT have been disproved or shown to have been completely blown out of proportion.

There are risks with any medication but women are still happy to take the vast majority of them whereas for some reason oestrogen seems to cause an insane amount of fear disproportionate to the risks involved. Why?

I am 41 and in early menopause due to autoimmune issues. I am on HRT because a normal person my age would still have oestrogen. I am simply replacing what my body should have. I can see it’s a little different if someone is 60/70/80 and of course you have to weigh up the risks vs benefits at that age but there are lots of younger women who would really benefit from taking HRT.

Absolutely agree.
Thyroxine and antidepressants don’t come with an increased cancer risk, as far as I know.
I’ve recently been prescribed the gel and vaginal pessaries, and I was shocked at the amount of increased cancer warnings for both that I read on the info leaflet.

'But the point is that most, if not all, of the various cancer risks associated with HRT have been disproved'

They haven't. Risks are small but present. As I say I'm pro hrt if women are fully informed but posters on this board often minimise risks and make claims based on their own theories regarding dementia and bone health. If women take it great i have family and friends who do and the miserable effects of hormone depletion have been massively alleviated, but for example people on here claim it can be taken for life when guidelines suggest 5yrs as risks increase after that, that has been proven. We either take notice of evidence and guidelines or we don't.

I don't think NICE guidelines suggest 5 years, do they? I thought it was as long as the woman wanted? I thought the 5 year thing was old advice.

I do agree with what you’re saying. I have just last week had a consultation with an NHS menopause specialist who has literally said the same thing as you - that it is safe for someone like me (aged 41) to take HRT up until the age of about 52 ish as generally that’s the age most women go through menopause, so until then the risks are almost non existent as I’m replacing hormones I should have. But beyond that it’s a bit more muddled. Risks do increase the longer people are on it. It doesn’t mean people shouldn’t take it and of course you have to weigh up risks vs benefits but it’s very complex to make these decisions.

I have a very complex medical history - lupus, Addison’s, asthma, pituitary issues, sjorgens, kidney issues, etc etc. I take 25 medications a day. I’m under 4 different specialists. Originally I saw someone at the Newson Health clinic privately to discuss HRT as I was told I had stopped producing any oestrogen at all and the NHS waiting list was 2 years at that point. Newson health started me on HRT but I wasn’t entirely confident they understood my health issues and how it all fitted together. I ended up stopping the HRT after a while and waiting for the NHS consultant as at least they had access to all my various medical specialists and information.

I think there’s a bit of a divide at the moment between private specialists who are bordering evangelical about HRT and those in the NHS who are more cautious. And of course there are lots of GPs who are quite frankly ignorant who seem to think prescribing anti depressants for an oestrogen deficiency is good practice….!

If the cancer risks associated with various forms of HRT have been overstated then the first thing that needs to change is the leaflets inside the drugs themselves.

I had a consultation with nhs gynae yesterday. I’m 54, been peri menopausal for about 10/12 years. Been on hrt for about 8 years. It changed my life. Reduced anxiety, insomnia, night sweats, and helped my libido. I was failing at work and my marriage was struggling before.

we discussed pros and cons and weighed up quality of life and no hesitation of continuing hrt but moving to Mirena and oestrogen gel. The quantity of hormones is tiny.

I hate to feel people are struggling with symptoms and not taking hormones that, in very small quantities, could be life changing.

The risks of HRT (comparing it to using thyroxine or anti depressants) - most of the research showing risks of breast cancer was done using the old types of HRT (mainly conjugated estrogen + synthetic progestins.

Women have to weigh up their own lifestyle, risks, family history of CVD, bone health, etc.

If you want to hear experts google Prof Nick Panay / Diane Danzebrink/ Youtube for a series of interviews. Nick Panay heads up the NHS meno clinic in London (and is also a researcher into HRT and all menopause treatments.) He's an expert on early menopause (POI) and treatment of women who have complex menopause symptoms.

Please remember when quoting stats that the risks of an increase after 5 years are based mainly on the older types of HRT.

The advice at the moment is that micronised progesterone is safe for 5 years at least. Research on longer timescales has been done on a couple of studies in Europe and showed no statistically increased risk, longer term.

What is important is to accept there may be a very small risk (Panay quotes less than 1 extra case of BC per 1000 women per year on the old data), but there are also risks to some women of not using HRT.

Anyone with a family history of CVD or osteoporosis, or existing bone loss, may be willing to trade off the small risks of HRT to prevent other disease.

'I think there’s a bit of a divide at the moment between private specialists who are bordering evangelical about HRT and those in the NHS who are more cautious'

Yes it is no wonder women are cautious when the private Drs are on TV programmes all the time pushing hrt but nhs Drs are more cautious. The narrative seems to be nhs GPs are rubbish and ill informed but I don't know any Dr who wouldn't want what is best for their patient, unfortunately nhs time constraints mean they can't accommodate weekly check ups to tweak doses which many women do seem to have problems with.

'I don't think NICE guidelines suggest 5 years, do they? I thought it was as long as the woman wanted? I thought the 5 year thing was old advice.'

Yes women can take it as long as they like but it has been proven risks increase after 5 yrs, yes with the old type of hrt but we don't have much info for the new varieties.

Ah right, thanks .