What's it like on the other side?

[crackofdoom]

I've never seen this question asked, yet surely it's the most important one of all. What's it like once you've been through the menopause? Does it get better- ever?

I'm on HRT, but still get symptoms- the one which bothers me most is the tiredness, but also aching joints and weight gain. Is this the new normal, or can I look forward to a future in which I get my energy back?

Your fall sounds scary and it's great you got away with just one fracture.
And you are very lucky to have strong bones.

This info I'm posting is for anyone reading who might find it helpful.

I think it is more widely recommended now than it was. The Royal Osteoporosis Society recommends that we should all be taking vitamin D supplements from September till April but hey what do they know.

Medical advice from the NHS is that everyone takes Vit D during the winter months. men and women. It helps the immune system.

I've had bone scans, every 3 years, for over 15 years.
Vit D is necessary for bone health but that's not the same as saying taking it on its own will prevent fractures.

www.nejm.org/doi/full/10.1056/NEJMoa2202106#:~:text=Vitamin%20D3%20supplementation%20did,low%20bone%20mass%2C%20or%20osteoporosis.

In this large randomized, controlled trial, supplemental vitamin D3 (2000 IU per day) without coadministered calcium did not result in a lower risk of fractures than placebo (with adjustment for age, sex, race or ethnic group, and n−3 fatty acid randomization group) among U.S. adults who were not selected on the basis of vitamin D deficiency, low bone mass, or osteoporosis.

Lol it did cross my mind to keep an eye on it! Got them at Christmas, have eaten three in total, so I don't think they're to blame.

It's never been my drug of choice but I was curious about edibles. I have a bulging disc in my back, had hoped I'd get some pain relief and maybe lighten my mood but really they only seem to help with sleep.

Im 58 and have not had a period since 2014 when I had an endometrial ablation. I have no needed HRT and have only had the occasional hot flush. I have never looked back.

I've had bone scans, every 3 years, for over 15 years.
Vit D is necessary for bone health but that's not the same as saying taking it on its own will prevent fractures.

I didn't say it would prevent fractures.

From the US: "Osteoporosis affects about one in five women over age 50, but only one in 20 men. Other risk factors for osteoporosis include:
A family history of broken bones or osteoporosis
History of a broken bone after age 50
Previous surgery to remove the ovaries before menstruation periods stopped naturally
Poor dietary habits, including insufficient amounts of calcium and/or vitamin D or protein
Physical inactivity or prolonged periods of bedrest
Smoking cigarettes
Heavy use of alcohol
Long-term use of certain medications, such as corticosteroids, proton pump inhibitors, and antiepileptic medications
Altered levels of hormones, such as too much thyroid hormone, too little estrogen in women, or too little testosterone in men.
Low body mass index or underweight."

www.nia.nih.gov/health/osteoporosis

That's quite a few modifiable factors. It's not just estrogen at lower levels.

@buffydavis The US stats aren't relevant to the UK (for many reasons.)
This was the press release from the ROS last year.

Women’s Health Strategy needs to go big on osteoporosis emergency affecting one in two women over 50
Media releases
20 Jul 2022

Women’s Health Strategy needs to go big on osteoporosis emergency affecting one in two women over 50

^Today (20 July 2022) the Department for Health and Social Care will publish the first-ever government-led Women’s Health Strategy for England.
The 10-year strategy sets to tackle the gender health gap, prioritising care on the basis of clinical need and not gender, improving the health and wellbeing of women, and resetting how the health and care system listens to women.
The Royal Osteoporosis Society (ROS) has been influencing Ministers and officials to include a strong focus on osteoporosis in the strategy.
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.^

Going to buy a skipping role as these osteoporosis statistics are worrying!

I'm on the other side and I feel brilliant. Strong, fit, clear minded....thank god! I honestly think this is the best I've ever felt, as I also feel powerful in my age and wisdom - I know what I like, what I don't like, and I don't take any nonsense. Don't worry! The best is yet to come 😀

Yes. Too many women and drs are not aware. From the same press release.

Why osteoporosis matters within women’s health

Osteoporosis affects women much more than men: 3.5 million people in the UK are living with the condition and one in two women over 50 will break a bone because of it.

Pre-existing inequalities in osteoporosis care: There is already a postcode lottery for Fracture Liaison Services (FLS) in England and Wales impacting women’s health outcomes, with only half (51%) of NHS Trusts providing the treatment and care needed. Addressing this postcode lottery would lead to improved diagnosis rates in line with the NHS Long Term Plan
.
Menopause is a key time for bone health: women’s bone health is crucial at the time of menopause because oestrogen levels (the female sex hormone that helps keep bones strong) decrease. Placing osteoporosis at the forefront of menopause care is paramount to ensure women maintain good bone health throughout the menopause and beyond. With our ageing population, osteoporosis will put an increasing burden on the NHS – currently £4.5bn a year and projected to rise steeply
.
Impact on the economy: Acknowledging osteoporosis as a significant part of women’s health and tackling inequalities in access to timely treatment and care, will improve their ability to contribute to the labour market – a quarter of working age people with osteoporosis have to give up work, change their job or reduce their hours.

Awareness and information: Osteoporosis and fractures are preventable, yet there’s an ill-informed perception that osteoporosis is an unavoidable consequence of women getting older, significantly contributing to the gender health gap. If all women had access to high-quality information and education on bone health, they would feel empowered to advocate for their own health, reducing disparities in outcomes.

I have osteoporosis and I take HRT, vitamin D and C, cal-mag and osteoporosis-P from Nutri Advanced as well as walking, yoga, some weight bearing exercises at home and on a mini trampoline. My problem is I have chronic fatigue and everything I do however small has repercussions of fatigue and more bed rest. If @JinglingSpringbells can add any other tips to improving my bone density I would be glad to hear it.
Also not overweight and have a veg and protein dominant diet.

Sorry to hear that @Flowersintheattic57 It looks as if you are doing alot of good things anyway.

I might have some tips :) but the most important thing is....

Are you seeing a rheumatologist?
Are you on medication for your bones through a dr?
How bad is your osteo- T-score?
Is it mainly your spine or hips?
Are you having DEXA scans every 2/3 years?
Have your bones improved on HRT?
Is your HRT dose optimised to help your bones?

The consultant who looks at my Dexa scans suggests calcium top ups only if a diet isn't getting up to 700mgs calcium a day.

The ROS helpline is really good where you can talk to them and get advice. They also have videos on their website of weight bearing exercises. These are with dumb bells (for spine and upper body) or ankle weights for hips. There are also some types of pilates that help.

It depends where your bones are thin so the exercise targets those areas.

Walking sadly doesn't do wonders. Research shows it needs to be at 4mph at least (pretty fast) and doing weights gives better results. Your trampoline won't help as the trampoline absorbs the impact - soft landing.

Thank you so much Jingling, this is where I’m at:

I’m not with a rheumatologist as the diagnosis of RA in the nineties has been erased/not available on my notes according to my gp , (in the process of appealing at a pip tribunal and RA was thrown out.)/When I did see him all those years ago, he offered anti depressants as I was pretty upset at the time.
I do have a bone scan regularly but every five years and I have to be persistent to get them.
I can’t remember the score but it’s going down with every scan. I did manage to pause it for five years and even increase a bit when I had a really amazing strong vibration plate to stand on every day, but sadly that died and hasn’t been replaced.
Gp does her best but the impression I get is that she has no idea why I want to take HRT or its effects on my general health and my bones specifically. She recently asked me to come in for an HRT check up, and the nurse took my blood pressure and that was the extent of the check up.
The walking and the trampoline are mostly to make my blood move around and not clot in my legs.
I will look at the ROS helpline , thank you for that.

That sounds pretty poor treatment from your GP.

I can't understand you not being on any other treatment for your osteo. if it's bad. Do you have RA as well?

Many women with osteo are on bisphosphonates (which do have some side effects) but there are newer treatments out now including infusions every few months, or injections, if it's very severe.

You really do need to push your GP for a referral to a bone specialist ( a rheumatologist) and if they won't, and you can afford the first appt privately, it would be helpful just to get advice and they would write to your GP with a treatment plan.

You need DEXA scans ever 2 years ( 3 at the most.) This is what people I know have (on the NHS) and close monitoring.

Please get some advice as you don't want spinal fractures which are really painful and disabling. All the best.

Thanks jingles , you’ve inspired and motivated me to tackle it again.

Well, I have just had a GP call and she is upping my oestrogen patches to 100 for 3 months so we can see if that stops the usually daily small amount of blood loss.

Maybe it’ll give me more energy too!

Great! Hope you get the help you deserve!

I feel for you on the fatigue. I'm just coming towards the end of long covid and it is wonderful to be getting some energy back. Natural fatigue when we have been very active is really different isn't it, for about 4 months I could barely drag myself out of bed and I'm my husband s carer so it was a total nightmare with no housework being done, living on takeaways being delivered and just feeling like it would never end.

Most of my symptoms have gone or reduced drastically but it really has been the longest 12 months of my life, well 11 months and 10 days since diagnosis.

@ancientgran, that’s great that you feel your long covid is finishing - it sounds like a very difficult time.

I am 59 and definitely feel less energetic than say even ten years ago. Eat healthily drink plenty of water no vices. Probably usual.

That's why HRT needs to be used within 10 years of the menopause starting so that the arteries are not already furrd up.

My understanding is it is more that by or before then, the veins and arteries have lost up to 50% or more of their oestrogen receptor sites. One does not automatically get artherosclerosis simply by increasing age; diet is important.

I am 58 and had a full hysterectomy at 42 with no HRT. It was hell for the first 6 months , then so much better. No acne, no mood swings , no greasy hair. I would hate to have those hormones in me again. There certainly is life on the other side and it is so much better. Diet, exercise, skin care and good vitamins will go a long way to helping any negative effect, as will keeping your mind active. I do not work, but volunteer, go to a reading group, a walking group, 2 WIs and the U3A and have an active social life as well as a fun life with my husband. It is the best of times!

@milkyaqua If it was simply down to diet, then why would women's risk of CVD rise post menopause to be the same as men's?

The reason that it's advised within 10 years is because cardiologists say that some artereosclerosis will have occurred by then (regardless of lifestyle and diet- it IS an age thing too.)

Women who use HRT after this 10 year 'window of opportunity' as they call it, can start on a very low dose of transdermal estrogen which is safer re. clots.
It also reduces the risk of deposits breaking off the arteries and entering the blood stream, because estrogen relaxes and dilates the blood vessels.

For anyone on HRT long term, the advice now is to come off it very slowly, because new research from Finland showed that when estrogen is withdrawn too fast, the arteries can go into a kind of rebound effect and fur up faster - risking strokes.

This is all online if anyone wants to read more. There's a great explanation of CVD /HRT on the BMS website thebms.org.uk/publications/bms-tv/

Coronary heart disease (CHD)
Prof John Stevenson, Consultant Metabolic Physician, Royal Brompton Hospital, Trustee – British Menopause Society, answers these FAQs: What is CHD? How can I reduce my risk for CHD? Does HRT affect CHD? I am at high risk for CHD, is it safe for me to take HRT? What type of HRT should I take? I have a history of high blood pressure, is it safe for me to take HRT?

Thanks for that link @JinglingSpringbells
Could anyone point me in the direction of any medical research articles about the benefits of coming off/staying on HRT after 5 years?
My GP is of the opinion that at 57 I am now 'over' menopause (ie hot flushes) so should stop HRT. When I mentioned possible benefits of staying on longer (osteoporosis) she gave me the lifestyle lecture without asking me a single question about my current lifestyle. (It was a phone appointment and I've never met her so no visual assessment of me as unhealthy/ unfit looking.)
I asked her for 1 more year to research the pros and cons but I can't find any proper evidence to go back to her with (just fluffy pink internet sites, Davina documentaries and MN!)

thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/

@Haffdonga Same link but different section- this is the Consensus statements.

In particular, see the points about no arbitrary limits to be placed on length on HRT and treatment to be individualised according to women's risk/benefits profile.

There is no 5- year limit. It was something that used to exist decades back, then it was changed, then a little while back they started muttering about 5 years again when some research came out a few years ago, but there is no real reason for this other than the small risks of breast cancer may increase after 5 years with some types of HRT (but maybe not others.)

Worth watching ALL the videos on the link I left which cover a lot of this. John Stevenson covers osteo, Michael Baum talks about BC risks.

If your GP is making an argument for stopping, then ask her to arrange a bone density scan. That way you can see for yourself how your bones are now and if it's worth carrying on with HRT. The thing is, your bones are probably fine at the moment after 5 years on HRT straight after menopause, but they will lose up to 5% a year for maybe 5 years then more slowly. If you want to find research on this, search engines throw up a lot of medical papers.

Thank you so so so much @JinglingSpringbells
(I'd give you a Friday as well as flowers but, you know, BC risks and cutting down and all that).

These links are exactly what I needed and the Michael Baum video has answered exactly the quandary I've been angsting over all year, ( should I stop longer term HRT due to BC risks? ) and I nearly kissed the screen.

I had done my googling but as a non medic it's hard to filter and understand the bona fide peer-reviewed medical research from the quackery.

Thank you