HRT Questions

[HRTorNot]

Also posted in chat but moveed it here.

NC'd. I'm 41 and probably about to be diagnised with premature ovarian failure. My periods have been hit and miss since about age 38, and tailing off to one or two a year for the last 2-3 years. Last period was end of jan/beginning of feb. 4 early MC.

The Gynaecologist has recommended HRT until about age 50. My GP has asked for a mammogram before she prescribes it. I have a blood test on monday to check my thyroid, autoimmune markers etc.

But, other than slight dryness and lack of libido, I have no other symptoms. I know HRT protects your heart and bones, but I've had a bone densitity scan and a more in-depth one for younger people and my bones are fine.

We would like to try IVF but the gynaecologist said we'd need an egg doner. I had an internal ultrasound the other day to check my ovaries and they are in atrophy. So I don't know where we would get with IVF. We Will need to wait for our house to sell before doing anything and she said if we are going to do it, its needs to be sooner rather than later so we don't have time to mess around. Which we knew anyway. She said take the HRT and then if we do IVF, they will adjust everything so taking it won't affect that.

But what will HRT do? I know nothing about it other than there's a breast cancer link. Its hard to speak to the doctors in depth because we have to wear the FFP2 masks still here.

Apparently it will it bring back periods? Why on earth would I want to do that with no chance of getting pregnant? Fuck that noise.

Once I start taking it, what will happen if I stop? Am I commiting to it for the next ten years? What will happen while I'm finding the right dosage?

I was reading something the other day that said once you are 12 months without a period, you are classed as postmenopausal, so is this it for symptoms? Or have I got the worst to come? I have no idea whether I've got all the awful symptoms that women talk about, to come or whether I'm nearly out the other side. If so, do I need the HRT?

I would like my libido back as its non existent atm, and why I originally went to the GP over this anyway. I really could never have it again and just sort myself out occasionally, which is so unlike 'me' and its not really what I want. Plus a sexless marriage isn't fair to my husband. Would the HRT even fix that?

I know there are issues with getting HRT prescribed in the UK, but I have health cover here and can ask the GP for what I want - if I research it and find out what I want - and probably get whatever I ask for prescribed. I don't know what the cover is for prescriptions and how much it is if I have to pay for them.

So, would you take it and is it likely to help me?

It's really sad how little you have been told, despite seeing a consultant and your own GP.

Sorry if my post sounds a bit 'lecture-y' but you've asked a lot and I'm trying to get it down asap for you!

You will find it helpful to read the website of The Daisy Network. This is a UK support group for women with POI and is led by the UK gynaecologists for POI (working from the Chelsea and Westminster hospital, London.)

www.daisynetwork.org/about-poi/signs-and-symptoms/

www.daisynetwork.org/about-poi/poi-guidelines/

Your GP ought to do what your consultant advises. You do need blood tests to confirm POI and an ultrasound but assume the consultant ordered/ did this?

You do not need a mammogram before HRT. There is no directives for this from NICE so you need to tell your GP that.

There are no issues getting HRT prescribed in the UK for POI- it's medically advised by NICE. It is prescribed whether or not you have meno symptoms.

Using HRT is necessary to prevent bone loss. In the first few years after periods stop, women can lose 30% of their bone density. This means you would be at a very high risk of osteoporosis in your late 40s or 50s, and also there is strong evidence that heart disease occurs more in women with early menopause.

The advice is you use it to age 50 at least. If your periods have stopped, for a year or maybe less, you can use a type that does not cause a bleed.

You most definitely do need HRT and the risks of breast cancer do not apply to women under 50 as you are just replacing what hormones you ought to have.

You may also be given testosterone to help with libido.

The prescription charges are the same as for any meds and most women get 3 months at a time.

It's likely that you will soon experience other symptoms or possibly that you already have some other symptoms and you are not aware they are related (for example I kept getting electric/static shocks and I didn't know that that was a symptom).

I would ask for localised oestrogen also to help with the dryness.

I intend to stay on HRT for the rest of my life. Doctors tend to mention 5 years and 10 years according to what they learned at university.

Gold standard HRT is known as body identical because it is identical chemically to the hormones your own body produces, unlike the contraceptive pill or Mirena coil though many women find the Mirena coil fantastic. Oestrogen comes in transdermal patches/gels/spray and progesterone (micronised) comes as a capsule which can be taken orally or vaginally. Only oral progesterone provides the full benefits. Taking HRT is more similar to taking Vitamin D or B12 if you were deficient in these than using the contraceptive pill.

www.balance-menopause.com/ has lots of information.

I'm sorry you're going through all of this. ❤

Thank you, that's very informative.

I was deficient in b12 and vit.d so take those daily already.

I imagine the gp will go through it in further depth after the blood test and mammogram results are back. She actually specialises in menopause according to the website.

@Apileofballyhoo Good points ! but did you mean to say that only oral progesterone was effective? I've been told the opposite (with regard to Utrogestan) that it's absorbed better when placed right next to the cervix.

@CourtneeLuv Are you the OP or another poster asking the same?

@CourtneeLuv You do not need a mammogram (unless you have symptoms). Your GP is incorrect. Can you imagine the queue if every woman asking for HRT was made to have one?

Same poster, name change fail.

I'm not in the UK and have health cover. A mammogram is included in the yearly check up anyway and the gp just wants me to do it before prescribing. A bone density scan is also included so I'll get one of those each year too. And all relevant blood tests. 70€ a month.

Hi to be clear hrt is two hormones that replace yours that allows your cycle to continue.

The oestrogen will boost your remaining eggs to be matured and released. It's prescribed for ladies ttc because it does exactly this.

There is no additional breast cancer risk with the oestrogen gels.
The only key raised risk is uterine cancer because just like your own oestrogen it causes your lining to grow.

This is why you have to also take the progesterone...this triggers you to shed your womb lining and have a period.

In fact your fertility is boosted and the guidance leaflet states clearly that you must continue to use contraception.

So hrt does not reduce your fertility but by 40 your egg reserve is usually exsausted and atrophied ovaries are a big sign that it may be to late.

Good luck On your journey

Ah, I see @CourtneeLuv . A lot of what I posted isn't relevant to you as you are not in the UK. Having private cover overseas is clearly very different and you are able to access a lot that is rationed or not done in the UK.

Yes, I'm very lucky from what little I've read on here. We had to take the health cover to get residency but have kept it because its definitely worth it. We'd pay more than it costs in tax and NI if we were still back home.

Thank you for that explanation @babasghost.

You are very welcome. It's a shame Drs don't take the time to explain.
Good luck lovely

How soon will you get the mammogram?

Would you ask the GP why the mammogram before a prescription is possible? I don't understand why have a mammogram before prescribing. I mean, you're having mammograms annually already, if I understand your system correctly. You'd be very unlucky to have grown a cancer A) at your age & B) since scan last year and you'll have the next scan very soon so could stop the HRT when mammogram found a problem.

Are you not worried about the radiation from an annual bone density scan and annual mammograms? Someone your age with known good bone density would not be recommended to have another such scan for at least 15 years.

The mammogram will be this week or next, I have to ring to book an appointment. This mammogram will be this year's annual check one. I won't have another.

I assumed she wanted to do it because of the risk between hrt and breast cancer that I'd heard about. She didn't say why.

I assumed she'd go through all the hrt options once the blood test and mammogram results are back and I'd be ready to start them.

I didn't know there were radiation risks? Surely the risks would be the same if I needed multiple x-rays through the year? So far this year I could have had my foot x-rayed twice, each elbow, and my ankle. I usually damage an ankle once or twice a year, at least.

I've had one mammogram, last year. The hospital said there was something they couldn't see properly and should have further investigation so I had an ultrasound and they said there was nothing there.

I also would have thought a mammogram at this age is an unnecessary risk.

@JinglingHellsBells progesterone plays a role in many female cells throughout the body but if it's taken vaginally it won't reach those cells. It plays a role creating new bone and also is beginning to be recognised in breast protection. Better sleep and less anxiety are also reasons to take it though I find that it's when my oestrogen is low I can't sleep and am anxious. Also it is important for the immune system, I don't know if this is by itself as such or because it prevents oestrogen dominance. I'm only going by articles I've read but it makes sense to me to take it orally. We have two hormones we lose (3 if you count testosterone but afaik that's later on) so I feel if I'm replacing oestrogen throughout my body I should replace progesterone too. I think there will be a lot more research done on it. At the moment I believe recommendations are beginning to change from 100mg a night continuous to 200mg a night continuous for post menopausal women.

I have never seen the thing of it being more effective for womb protection taken vaginally but it could be true, I don't know. I assume it has to be effective taken orally or orally wouldn't be an option, whether it reaches the womb quicker or something I don't know. Maybe for endometriosis it would be important to take vaginally to reach that area first?

@Apileofballyhoo Could you leave a link to all of that please?

What you have posted is contrary to everything my specialist says, so I'm keen to see the info you have found.

It's well established that progestogens are the 'bad' hormone re. breast cancer, (because women on estrogen-only HRT do not have an increase in b cancer) although natural progesterone is thought to be neutral.

There are a lot of studies on serum levels of progesterone when it's used either orally or vaginally. Certainly, for endometrial protection, it's best used vaginally and this is what I've been advised to do. It also removes the bad side effects as it doesn't pass through the liver, so no side effects like mood swings, tiredness, etc.

I did read some things about bone health a while back and it seemed inconclusive and promoted mainly by 'alternative' medical sites, or very small studies, but really happy to read anything you have. The estrogen dominance idea is a myth and was started mainly by the late Dr J Lee who sold progesterone cream - which doesn't work for endometrial protection.

Women who no longer ovulate have no progesterone in their body for the rest of their lives so I can't see how the immune system protection can be accounted for.

Do leave links if you can!

That's a good point, what are the side effects of hrt? Everyone is different but what have people on here experienced?

I suppose the benefits outweigh the side effects, but do they, if I don't really have any horrible symptoms?

Googling now.

www.cemcor.ca/resources/does-taking-progesterone-alone-or-estrogen-increase-women%E2%80%99s-risk-breast-cancer

@JinglingHellsBells here is one link anyway. I might have to put links on separate posts as I'm on my phone and copying and pasting into different tabs sometimes doesn't work if I do more than one.

www.bmj.com/content/367/bmj.l5928/rr-3

Thanks @Apileofballyhoo I've read both of those previously.

I was hoping you might show something that said progesterone was useful in building bone density. I did find one paper on it, but it did say it wasn't fully conclusive. I think it looked mainly at MPA which is a high risk progestin re. BC.

There is also some conflicting evidence on whether MP is best absorbed vaginally or orally. My consultant trains other drs ( was doing this way before Dr Newson and she thinks he's marvellous!) and he advises vaginal use for the endometrium.

Menopause Matters website - lots of useful info.

And the forum - www.menopausematters.co.uk/forum/ - my go-to place for anything meno related.

CourtneeLuv, did you actually have any broken bones any of the recent times your ankle was xrayed? Did you strongly suspect it was broken? Do you have osteoporosis, is that why your ankle keeps breaking?

Yeah, sorry to say, but of course every xray carries a small risk of encouraging a cancer mutation and you really shouldn't have any xray without clear benefit in that moment that it's a necessary diagnosis tool. The risk that xrays carry in encouraging cancers is cumulative: one xray a year not so bad, but 10 xrays would be 10x the possible risk.

Anyone recall the episode of 24 hours in A&E, when the consultant is hesitating about some xray-imaging-method for a patient. Patient is a child & the child would (by virtue of being young) have more years for the xray to end up having caused harm. It is something doctors are supposed to consider.

Are you not worried about the radiation from an annual bone density scan and annual mammograms? Someone your age with known good bone density would not be recommended to have another such scan for at least 15 years.

The radiation is very small. @lljkk In many other countries like the US and France an annual mammogram is the norm , but it's a personal choice over what to do.

The link that you left from the American site was about women aged over 65.
It says that the bone loss in that age group was very slow, so a woman of 65 with 'good' bones could feel reassured for another 10-15 years.

Up to 30% of bone loss occurs within 3-5 years of the menopause. This can be enough in a lot of women to cause osteoporosis, because some women are at risk already, maybe due to family history, or medications, or just by being small framed.

1:2 women over 50 break a bone due to osteoporosis, and 1:2 women end up with osteoporosis. Shocking, really.

DEXA scans are done every 2 to 3 years depending on circumstances. Bone density beyond the first few years post meno can be slow to increase (using meds and exercise) so an annual scan is too much unless someone has had a break in that time.

I don't know if I've ever broken anything, I think I have but I've never been and had x-rays. I meant I could have had that many x-rays this year. If I'd gone to hospital.

I dont know why I get so many buggered ankles but I can fall over and sprain my ankle standing still.

I slipped on the drive the other day and hurt my ankle. The weekend before I stubbed my toe that I think I fractured last year and set that off again and I've got what turned out to be tennis elbow in both elbows. But I got that from boxing. Years ago I fell on my hand and my fingers swelled up and I couldn't move them for a few months so I probably had a fracture there and I injured my rib once but didn't go to hospital for that either cos there's nothing they can do.

But what I meant was I could have had more xrays and been exposed to more than I would be from one mammogram and bone scan.

But tbh I never thought about that exposure.