When IS the best time to take HRT? Pre or post menopause?

[CaraVann]

I am asking this question as I have had no joy with the GPs I have seen, over the last few years, in my quest to get help for perimenopausal symptoms.

In fact, my current GP was really angry with me because I didn’t want to continue with the Citalopram she prescribed me for my anxiety/depression/brain fog/low libido/gut issues etc etc.

When I asked about HRT she kept on and on about the BC risk and reluctantly printed off a few sheets of info from the Patient website (Tbh, I have gleaned more info from Davina and Dr Newson etc).

I am 50 in March and have been experiencing awful symptoms since 45 which are gradually getting worse and I am basically as miserable as sin.

I must be in peri by now with all these symptoms but my GP will not commit to agreeing as I’m having a regular cycle although this has changed to very light periods as I had a uterine ablation last year after years of recurring polyps, heavy flooding and severe anaemia. I also only have hot flushes and night sweats before my period which she says shows I’m not there yet!?

I obviously don’t have the support of my GP but she said if I REALLY want to try it she could prescribe it to me! I cannot afford to go private so this will have to be my only option.

I am doing as much online research as possible and feel that as my poor mum suffers greatly with osteoporosis, heart disease and Alzheimer’s, I should seriously consider taking HRT. She always wished she had gone on it.

I am petrified of the risk of BC, I won’t lie. I don’t drink or smoke, have a low BMI and exercise but also fully aware that just being female puts me at risk regardless.

But what I can’t find out much about is should HRT be taken at perimenopausal stages or once periods have ended for over a year and you are in full menopause? I have one friend who has been on it since the age of 45 and says peri but another who (same age as me) is going to wait until in menopause as she believes you should only take it once your body is fully depleted of hormones and you are basically replacing those lost (even though peri it’s obviously very up and down with the hormones).

Can anyone offer up some advice on this please. I’m truly feeling like shit every single day and don’t think I can wait till fully menopausal (which could be several years away).

Your GP is an idiot, and like most, totally ignorant regarding peri-menopause. I very highly suggest you go to a private clinic. You should have started HRT years ago.

Change your GP and get on it now. I'm 50, perimenopausal and have taken it for 18 months.
I had sertraline for about 6 months before all my HRT was sorted, and then came off that.
I have: mirena coil for progesterone, evri patches for oestrogen and am awaiting a trial of testosterone. It took about 6 months for it to make a difference and I feel SO much better than I did three years ago.
Look on the NHS website as well for your rights as a patient - called something like 'patient knows best'. Doctors should be listening to your views and knowledge.

How frustrating for you. Hang in there and insist on HRT. ❤️

Your GP is ignorant.

Saying you can't have HRT because you still have periods is nonsense.
Most cycles in peri are anovular anyway (no ovulation.)

You can start hrt as soon as you have symptoms.

The risk for breast cancer doesn't start till the average age of menopause anyway (51) so you could have started it at 45.

Drinking, being overweight and not exercising have bigger risks.

Funny how GPs don't mention these and rarely suggest women lose weight.

I am doing as much online research as possible and feel that as my poor mum suffers greatly with osteoporosis, heart disease and Alzheimer’s, I should seriously consider taking HRT.

Yes, you should.

You also need to insist on a referral for a bone density scan now. Osteo is hereditary and you need your bones assessing now.

HRT protects against heart disease if it's used within 10 years of your last period .

Aquamarine1029 sadly, I have no funds to see anyone privately and can’t change gp due to a huge influx of new builds in our area, the services in our area are overwhelmed.
Aquamarine1029 I can’t change GPs right now but will go and see her and say I want to trial it, hopefully she will oblige.
Thank you JinglingSpringbells I will definitely go back and ask for a trial of hrt. My lovely family GP who I’d seen since a child sadly retired a few years back she always said as soon as I got to late 40’s I should get a DEXA scan due to our family history but unfortunately with the new GP it’s like banging my head against the wall (that’s when I can actually get an appointment with her!).

This makes me so cross to read! Unless there's a high risk of BC in your immediate family – that your mum or sister has had it – your GP is being pig ignorant about the risks. And also is wilfully ignoring the NICE guidelines that women over 45 who present with menopausal symptoms should NOT to be offered antidepressants and instead should automatically be prescribed HRT. I've just seen there isn't another GP at the practice you can see instead – in that case, you need to go back again quoting the NICE guidelines and take someone with you who can advocate for you. Your GP should not be refusing to give you HRT.

New research suggests HRT can be protective against Alzheimer's

www.thetimes.co.uk/article/hrt-could-protect-at-risk-women-from-alzheimers-disease-59x8wk038

My GP told me the risk of breast cancer increases if you START taking HRT after 60, most women having started 50+. The study that showed an increased risk before 60 was flawed. She told me to look at Louise Newsom site, Menopause Matters etc and if I still wanted HRT she would prescribe it. I decided against it because of my age and only having very mild symptoms.
BUT if I could turn back the clock 10 years I would definitely take it for the protection against osteoporosis. (I didn't because I was in a bad place at the time. )
Look up Menopause Matters etc, write down the salient points and tell her you want HRT. Good luck OP.

You can start taking it whenever you have symptoms, be that at 40 or 55.

My GP told me the risk of breast cancer increases if you START taking HRT after 60, most women having started 50+.

Your GP has misread the information.

Yes, the WHI study was flawed, but what she's told you isn't right either.

The risks increase after the age of 50 (this is on Menopause Matters website, which your GP referred to.)

At worst, the stats show less than 1 extra case per 1000 women, per year.
The stats are based on the older types of progesterone rather than Utrogestan which may be safer.

Obviously, for some women, that risk or the possibility of risk outweighs the benefits they might get.

You need to decide if the possible small risk outweighs other more likely risk.
For the OP, that's a high chance of osteo, heart disease and dementia.

The risk of blood clots rises after 60 but not so much if women use transdermal (rather than tablets.)

Paywall.

Any chance you can copy and paste the feature @applecatchers36

Run it through this.

12ft.io/

Doesn't work.

It shows a couple of paragraphs that are visible anyway through the paywall.

Sometimes Dr Louise Newson posts stuff like this on Twitter, or her own website, so it might be possible to see it there.

Link to the Alzheimer's/HRT study report
www.bbc.co.uk/news/health-64276452

AFAIK the only slight risk of breast cancer is with HRT taken in tablet form. And there are far far bigger risk factors for breast cancer, such as being overweight or smoking or drinking too much. My GP told me that patches or gel, where you absorb the estrogen through the skin, are very low risk indeed.

If you can't change Gp then you are going to have to get arsey. She should be treating you based on your symptoms if you are 45+. please please go back and ask her to prescribe patches or gel and see how you get on. Living miserably isn't living, it's existing.

@HufflepuffRavenclaw The type of HRT (tablets or transdermal) make no difference to BC risk.

The only things that do affect risk ( current research)

The type of progestin (synthetic higher risk than micronised progesterone)
The type of regime - continuous has a higher risk than sequential.

It seems that some GPs are giving out misinformation.
The different risks between tablets and gel/patches apply to stroke/ clots not BC.

I stand corrected! To be honest I have listened to so much nonsense from GPs over the years when I have been in floods of tears in their surgeries begging for HRT and being fobbed off with antidepressants that I have lost track of who said what.

OP it sounds like you would benefit so much from HRT, and it's most definitely worth a try. Please don't let yourself by scared into misery by your GP. Osteoporosis in the family is in itself a reason to be starting HRT I'd have thought.

Thank you all for the advice.
I will ask at my next appointment for a trial of body identical hrt and keep my fingers crossed it will help me. I just hope she doesn’t go on about any risks, my anxiety can’t take that right now!