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 ?

Was out with friends and if the 5 of us 3 were on hrt. Reasons varied:

• bad hot flushes and no sleep for two
• me for arthritis (seems to be helping with pain)

Personally I would prefer not to be on it as I hate the faff. But, if there is a reason you should consider it. I don't notice anything else positive - no change in mood etc ... I thought I was sleeping better but that has stopped but that might be related to hot weather.

That is correct @MrsPelligrinoPetrichor

The reason that the 5 year 'rule' has reared its head again is as a result of the Lancet report in 2019.

That report showed an increase in BC that corresponded to over 5 years.

The data in that meta analysis has been heavily criticised by many menopause experts.

It was OLD research, two of the biggest studies included have been shown to be flawed (the WHI and the Million Women) and the number of women included in the report who use micronised progesterone was 58.

Thanks, I’m seriously thinking about a DEXA scan. Just had private thyroid test as feeling mine’s been sub optimal for a while but never picked up on routine NHS tests. Never heard a DEXA scan until I started reading posts on here! You’re right, the information is out there, just maybe not as easily accessible as it might be.

There is an excellent ZOE video on YouTube. m.youtube.com/watch?v=k2Sga8ggNbo
When she was 50 my mum slipped over and her hip broke, she was put on HRT and told to remain on it for life. She moved a couple of years later and her new GP refused to keep her on HRT as it was the height of the breast cancer fears. 25 years later mum is in constant pain and has her quality of life hugely impacted because a her spine has been eroded by osteoporosis. I'm in my late 40's and am a year into HRT I plan to stay on it long term. I have over 20 great aunts, aunts or female cousins that are 60+ there are zero cases of breast cancer (our cancer rate over all as a family is remarkably low) but half a dozen with osteoporosis. For me it's a 'no brainer' my cancer risk is very low so a tiny increase in risk leaves me at below average risk anyway. I would like to see women better informed and able to access what ever course of treatment (or none) they decide is best for them. For me I wouldn't touch the anti-depressants that are often touted as the alternative to HRT firstly because they wouldn't protect my bones and secondly because I have seen friends suffer awful side effects but I wouldn't want to deny them to other women. I'm certainly not seeking eternal youth (I have embraced the gray and have never considered Botox or fillers). As far as I'm concerned being old is infinitely preferable to the alternative.

'It was OLD research, two of the biggest studies included have been shown to be flawed (the WHI and the Million Women) and the number of women included in the report who use micronised progesterone was 58.'

Yes and it is reassuring that micronised progesterone may not have the same risk but we need clinical studies. Didn't you say your hcp prescribes cyclical rather than continously as continuous even using micronised has a higher bc risk?

So again yes HRT of course alleviates unpleasant issues re hormone depletion and we should all use it if needed but there are serious, albeit small, cancer risks and until we have evidence re micronised then women should be aware and and not be told cancer risks have been disproven or 'that was the old kind' or worse 'it protects against dementia'.

I don't want to take it because it's extracted from mares' urine. The mares are continually impregnated to produce the hormones. I find it abominable what we do to animals for our own benefit.

Isn't that the old stuff,I thought we'd moved on from that now?

No it isn't. Micronised hrt is all natural stuff. I don't think the mares urine stuff is prescribed in the UK anymore.

You do realise that’s a load of outdated nonsense??!! My Mum was taking that crap in the 1980s/90s. Modern HRT has nothing to do with horses!

faq.iapmd.org/en/articles/3971383-does-hrt-come-from-horses-urine-what-hrt-is-suitable-for-vegans

@AllAboutMargot no it's not anymore HRT and horses

Hi @JaniieJones Have you watched the Youtube videos with Prof Nick Panay and Diane (#makemenopausematter)

Here it is
menopausesupport.co.uk/?page_id=16456

He also does a 1hr interview with Liz Earle on her Wellbeing site.

The reason I've linked is that he covers the topic of more research into micronised progesterone along with the limitations of the current research.

He says it is very unlikely that there will be any research into micronised progesterone owing to funding and he may try going to the WHO for financial support. He also covers, in some detail, risks v benefits, length of time on HRT and the age of some of his patients.

I was told over 10 years ago by my consultant that it's the progestin part of HRT (the older types) that may promote BC, not estrogen. It's been known for many years as women on estrogen-only have less BC than women not on HRT.

And the stats show that sequential has a lower risk as the breasts are allowed a 'break' from continuous progestin (keep in mind this was all based on the older types.)

www.ncbi.nlm.nih.gov/pmc/articles/PMC4960754/ see 'Discussion'

To put is it simply, @JaniieJones (!) if you are near 50 now, you are probably never going to know the answer to what you want to know.

Long term research would require trials lasting at least 10 years with maybe 10 years of follow up.

They would also require women (in menopause) to be given micronised progesterone, or a placebo, or another progestin.

That's why all the data so far has been retrospective.

It's very frustrating but for the foreseeable future, it's a case of making a choice on the data that's out there, not wishing for something definitive, as it's not going to be there for a very long time.

'I was told over 10 years ago by my consultant that it's the progestin part of HRT (the older types) that may promote BC, not estrogen. It's been known for many years as women on estrogen-only have less BC than women not on HRT.
And the stats show that sequential has a lower risk as the breasts are allowed a 'break' from continuous progestin (keep in mind this was all based on the older types.)'

Yes I knew it was the progestin part that increased risk of bc I just hadn't ever read papers stating continuous was a higher risk than sequential. It's crazy isn't it, the amount of women post meno automatically started on continuous without being told sequential is actually safer!

Would a Mirena coil count as continuous progesterone, or is it such a small dose that it doesn’t count ?
I thought I’d read that progesterone in a coil keeps the lining of the uterus thinner, reducing your chance of uterine cancer.

So is there anyone on here who is totally symptom free but takes HRT for the protective measures in the future

I have tried 3 types of conti HRT and they have made me feel so rotten I have come off them because I feel so well when not on HRT.

I have had 2 DEXA scans one in 2013 and one in 2021 and both show my bones are fine.

I could keep trying different regimes but getting fed up with trying to be honest.

I run and swim alot but HRT makes me feel so rough I can't do either.

I’m more confused than ever! If I went in HRT it would purely be for the protective effects. I spoke to my doctor who is the Alzheimer’s lead for my county, he was perfectly happy to prescribe me HRT as a preventative measure for bone loss but he was absolutely adamant that there is no proof that it protects against Alzheimer’s and is very annoyed that this is now being claimed as absolute fact when it is not.

If only 15% of eligible women are on HRT surely we are heading for an absolute health crisis in the not too distant future of women who don’t take HRT of heart disease, osteoporosis, and according to some reports Alzheimer’s, is it inevitable we will get all these diseases due to not taking HRT? if that is the case then why are women not automatically advised to go on it, surely it would save the NHS billions in the long term?

@JaniieJones The stats about sequential v continuous are in the Lancet paper if you dig around into it (and bear in mind again that it's almost all about the synthetic progestins.) The supposed difference is about 1.3% fewer cases on sequential compared to continuous so not a massive amount but worth considering.

I was advised that the use of a progestin/ progesterone should be minimal- enough to control the endometrium.

In the first days of using HRT it was estrogen-only ( 1940s and beyond) and this caused around 20% endometrial hyperplasia, some of which were cancerous.

So they had to add progestins. The downside of that was a higher risk of BC.

@LadyVictoriaSponge HRT is not licensed for prevention (on the NHS) UNLESS they have a risk or osteoporosis/heart disease, due to early menopause through surgery or POI.

But menopause specialists who also work privately will usually prescribe it if a woman asks for it, taking on board the small risks.

There is no proof [yet] it will prevent dementia, but at the same time it's been shown not to make dementia more likely.

I don't think it's right to take HRT just to prevent dementia, partly as lifestyle measures are a huge part of avoiding dementia.

There is already a crisis with osteoporosis, but no one talks about it.

This is from the ROS and discusses the gender gap of women's health being ignored.

Osteoporosis affects 1:2 women /

Craig Jones, Chief Executive of the Royal Osteoporosis Society said:
A credible Women’s Health Strategy needs to include a serious plan for tackling the public health crisis of osteoporosis, which sits near the top of the list of life-limiting conditions which disproportionately affect women. A full half of women over 50 will suffer osteoporosis, with as many people dying from fracture-related causes as from lung cancer and diabetes.

Despite this, the UK has fallen way behind, with widespread injustice caused by under-diagnosis and under-treatment in the NHS. If government puts a tiny fraction of its £2bn spend on hip fractures every year into early intervention, we can transform the quality of later life for women in this country

We hope the Women’s Health Strategy will show it is serious about tackling the culture of passivity and defeatism that has characterised the fight against osteoporosis for far too long

@Afterfire @BarrelOfOtters2 @JaniieJones

I'm happy to be corrected if what you all say is accurate.

Also on the dementia front, the OP’s choice of sertraline instead of hrt for mood does have an increased risk of forms of dementia including Alzheimer’s. And none of the protective benefits.

That is the role (to keep womb lining thin) of progesterone in HRT as far as I understand it, whether you are taking a progestin form in the coil or apatch or the body identical format Utrogeston. A woman that has had their womb removed wouldnt generally be prescribed the progesterone element.

Doesn't this 100% prove how misconceptions about things like HRT can take on a life of their own and outlive the actual facts by decades!

'The stats about sequential v continuous are in the Lancet paper if you dig around into it (and bear in mind again that it's almost all about the synthetic progestins.) The supposed difference is about 1.3% fewer cases on sequential compared to continuous so not a massive amount but worth considering.'

Interesting but then there's www.womens-health-concern.org/help-and-advice/factsheets/hrt/#:~:text=Forms%20of%20hormone%20replacement%20that,more%20so%20than%20sequential%20HRT. (Can't verify where their stats come from) where it states continuous may be safer re endo cancer than sequential! So the choice seems to be continuous with a higher bc risks or sequential with a higher endometrium cancer risk. Though obviously if private that risk is mitigated with readily available scans.

It's no wonder women are confused.

@folly115 if you don't have any symptoms and your Dexa scan is fine why are you wanting to try hrt? You may well not end up crippled with osteoporosis, many women aren't. If you do revisit it ask for oestrogel as you can control doses so up a pump or lower a pump depending how you feel. Many women feel nauseous and jittery on too much oestrogen and also ask for utrogestan and use it vaginally, less side effects that way.

'Also on the dementia front, the OP’s choice of sertraline instead of hrt for mood does have an increased risk of forms of dementia including Alzheimer’s. And none of the protective benefits.'

Blimey i didn't know that. I don't take ADs but don't something like 1 in 6 take them? That's a big national dementia risk.

Thank you @JinglingHellsBells that does explain why it’s not prescribed as a matter of course, I didn’t realise it wasn’t licensed for preventative for normal age menopause. Those figures for osteoporosis are shocking and quite sobering and it’s appalling women are not informed more, the only that seems to be at the forefront of women’s health is breast cancer which we are bombarded with in most media outlets, never hear about osteoporosis at all.