What happens if you don't take HRT?

[Loverofoxbowlakes]

So it appears I am very deep in the throes of peri, with symptoms that I have been mostly putting down to a sudden and awful bereavement last year, work stress, a chronic illness, but should now be easing off, but they're not (plus periods now all over the place).

Hesitant to get GP advice just yet (as they've been not great up to now, but not rejecting it at all) but what happens if you don't take HRT? Does the fog, the sweats, the forgetfulness, the insomnia (ye gods the insomnia) stay forever? Do you just get used to it? My mum and grandmothers never had any drugs to cope but we never spoke of dealing with such things - are my symptoms here to stay indefinitely otherwise?

@Sidslaw you are clearly very anti-HRT and that's fine, it's not compulsory and if you feel it is of no benefit to you, then nobody's going to force you to take it. But you also said that women who do not have HRT are "shouted down and cancelled" which is exactly what you are trying to do on this thread.

no I am not, I am giving an alternative view. I looked into it in detail in case I was missing something, and was particularly interested in this "protects bones" point of view - it does protect bones, but it is only worth doing if you have an early menopause - 20s or 30s. Then the impact on your bones by the time you are 60 makes it worth taking HRT. However, if your menopause is in your 50s, HRT doesn't really have any impact on your bones until you are 80s, and then very little.

Protecting my bones was the only reason I thought I might have needed it, but then realised I didn't

Perimenopause killed my sex drive. Testosterone has revived it!

I probably cant because it was a while ago now, and some of it was talking through the situation with a medical researcher in the family, but your articles are interesting too.

As it happens I am having a bone scan for an unrelated medical issue in about 10 days, so will be interested to see what it shows, 10 years after menopause, no HRT, age 60, will report back

I had horrendous symptoms - all the usual, plus excessive prolonged bleeding. I take HRT and have no intention of stopping. My old school friend, on the other hand, had few if any symptoms and took nothing.
It depends on the individual.

I'm sure some people might maintain the majority of women are not fine, but in any case the vast majority in England are not on HRT, so many of us will not have a lot of friends on it and it does seem like users are overrepresented on these threads.

According to this:
Around 15% of women aged 45 to 64 in England are currently prescribed HRT, which has increased rapidly in the last 2 years from around 11% and continues to increase.

https://www.gov.uk/government/news/hundreds-of-thousands-of-women-experiencing-menopause-symptoms-to-get-cheaper-hormone-replacement-therapy

I didn't have HRT and neither did my sister. We had minimal symptoms. But if I had had depression or brain fog I would have taken it. Have the conversation with your doctor, have the blood test and then decide.

HRT is a licensed treatment for osteopenia and osteoporosis. So it is proven.

HRT has also been found to help women with deprescribing from lots of different tablets to manage symptoms that are actually affected by lowered levels of oestrogen.

Oestrogen is found all over the body and is probably misnomered as a sex hormone.

I completely agree with free choice in taking it but do not agree with people posting conjecture or out of date 'facts', as I believe this is harmful to women who are really suffering and worried.
The latest NICE guidelines are here: www.nice.org.uk/guidance/ng23

Ditto!

I’ve not had HRT and am 9 years post menopause.

I haven’t ever seen a gp about the menopause, I’ve had symptoms, night sweats, insomnia, hot flushes, anxiety but mist have passed by 2 to three years in.

I do cardio and weight bearing for osteoporosis and cardiovascular risk, try hard with diet for Alzheimer’s risk

@Loverofoxbowlakes Have the replies here helped?

No one can tell you how long your symptoms will last.
For some women it's a couple of years, others it's for life (into their 80s.)
You won't know which you are!

The best thing to do is consider hrt if your symptoms are impacting on your life enough to make you very miserable, maybe unable to function at work or home.

There are unfortunately is outdated stuff on this thread .

Often it's around 'no symptoms= good health in later life. Having no symptoms doesn't mean you are 'safe' from bone loss or heart disease.

1:2 women over 50 have osteoporosis.
100K women die a year from complications of fractures.

You won't know if that is you without a bone density scan either after a fracture or to assess your risk.

HRT is proven to prevent and treat osteoporosis.
It needs to be taken longer-term as it takes 2 years at lease for bones to change.

Heart health- it's now medically proven that using hrt within 10 years of the menopause protects against CVD.

Whether this means you use it is a personal choice, as there are small risks too so it's balancing your own benefits and risks.

I think it's a medical fallacy that no hrt signals disasters for future health. I weight lift, I eat a high protein diet. I use complementary medicine to balance hormones. I try to incorporate relaxation. I don't want to be pumped full of biddable hormones like oestrogen all my life to fit in to what society expects. I don't want a massive sex drive! I find me a little Boring.🤣🤣 Fine if it helps someone but we shouldn't be bullied into taking it if we want to take another path.

*men

I really appreciate the range of voices and perspectives on this thread. It highlights how very individual every woman's peri/menopause experience is, and while it's useful (invaluable, in fact) to share stories, ultimately we all need to take an active role in choosing the path that's right for us.

I got caught in the 2020 Davina-Newson PR and was prescribed HRT after about 5 minutes talking to a Newson consultant. I had wanted an in depth conversation with an expert (and definitely didn't feel I could take up GP time with that while the pandemic was at its height!) but I quickly realised she was there to give me a friction-free route to HRT and not much else. My symptoms were entirely mental - anxiety, insomnia and the inability to focus on work. By the time my prescription arrived I had already realised that the global situation (and the domestic shitshow it created in my life) was a far more likely cause of my symptoms than hormones. But it was such a seductive thing to think that I could join this empowering club of midlife women, taking HRT and reclaiming their confidence, sex drive, shiny hair, glowing skin and energy for life, whilst also future proofing themselves against some of the miseries of older age.

Three and a bit years on I'm in the depths of an anxiety surge again and went to the GP this time, to ask if it was time to start on HRT. In the continued absence of any physical symptoms at all, and with my periods still regular, she thought it was pretty unlikely that the anxiety would be relieved by HRT, though was willing to be guided by my wishes in prescribing it (her preferred option was propranolol, for acute anxiety episodes.) I came away with a prescription for HRT, but after some more reading here I've decided once again not to take it. My body is comfortable and pain-free, and my anxiety is again a fairly obvious response to external circumstances, and a look through the threads on this board is a reminder that HRT can cause a whole lot of symptoms of its own. (The 'weaning of HRT thread' is particularly sobering.)

I'm 54 and realise that I'm almost expecting any problems I have to be menopause related, because of the more prominent narrative around it now. It's obviously an incredibly positive thing that women are speaking up and having their experiences (a lot of them horrendously challenging) recognised and validated, but as individuals I think it's important for us to remain aware of the wider picture - that this lifestage is not a condition that inevitably requires medication.

I also would like to see an alternative narrative about the basic things women should be aware of when they reach midlife and the steps they can take to manage their health if HRT isn't appropriate (or until such time as it is.) I'm still very much at the stage of researching these, but so far have got on my list - requesting a bone density scan, taking Vitamin D, Magnesium for sleep issues, Omega 3 (for cardiovascular health?) and B12 (for bones, brain and mood?) Any other suggestions anyone can add would be very much appreciated.

I haven't ruled out taking HRT by any means, but I've found it useful to be reminded to focus on my own body and do extensive research on what's best for me at the stage I'm at, rather than see HRT as a conveyor belt we all get on. It's really useful to have the variety of perspectives shared here as a reminder that it's not a one-size-fits-all situation and that all women should be able to feel confident in making a decision that's right for them.

(Sorry for long post! I'd also just like to emphasise that I know that, for many women, medication is an obvious and lifesaving option - not making light of that AT ALL.)

That's interesting about your mother-in-law and her sisters artis1. Do you know if they all carried on with their sports into and after the menopause?

I can't talk for other people but if I hadn't have taken HRT I would have remained an angry hot, sweaty, fat mess. I take HRT to pass for normal.
My colleague who doesn't is avoided by the entire dept.

It is licenced to treat osteoporosis and osteopenia but I haven’t seen evidence that it will prevent it. Probably because we don’t know who is going to develop it. Bisphosphates are now the go to drug to treat bone density. They are well researched and for post menopausal women who are most likely to be diagnosed probably more effective than reintroducing estrogen.
Osteoporosis is probably far more complex than just estrogen deficiency.
For women who lose their ovaries pre menopause it makes complete sense to restore estrogen levels since they are effectively going through an early menopause. It remains to be seen whether taking estrogen during perimenopause will have the same desired effect. It will be a number of years before any useful research/data emerges since until recently estrogen was only supplemented when you had had your ovaries removed or had been determined post menopausal. Treating perimenopause is relatively new.
My concern is that HRT during peri menopause may be exposing our bodies to high levels of estrogen and we don’t really know what that does yet.

Thank you artis1, goodness what a fit family! I find it particularly interesting that the swimming sister was fine (with HRT) but your mil wasn't (no HRT) despite high impact tennis, natural sunlight vitamin D and calcium. I should declare an interest in that I'm 62, don't take HRT but I do run, cycle up hills and eat lots of cheese, which I was hoping might be enough!

Thank you artis1, yes, I really ought to see if I can get a bone density scan as I am also slim and small-boned despite eating well (and my cheese habit). A routine scan for women over 50 would be a great idea.

And I know what you mean about competitive sport; my cycling and running is all done at 6ish in the morning in an attempt to avoid competition!

I started taking HRT 6 months ago and it hasn't had the life-changing impact I hoped it would - I'm now on my second lot of tablets to try and on reflection I probably feel better on these after around a month. Insomnia was my main symptom - the others I could live with ok but not sleeping was literally driving me insane. It's still bad but mixed in with the awful nights are some good nights so I need to take that as a win. The hot flushes have stopped too. So overall probably worth taking.

This is not true at all.
Lots of people benefit from HRT who have not had hot flushes.
It's fairly widely proven that there are many symptoms of the menopause, including those listed above.
Whether or not people want to take HRT, it is important to realise that the menopause is more than just hot flushes, and if they start experience symptoms, they can look at getting a variety of different kind of help.

Have you been given tablet form oestrogen? Most are synthetic. I think one is body identical. For main body identical forms, transdermal (patches, gels, sprays) are used. They have no risk of clot as they don't need to be processed by the liver.

It is the index symptom though. It is the one that tells you if your other symptoms are menopause related. Hence the GP saying to the poster I was responding to, that they only prescribe HRT for hot flushes, nothing else,

Obgyn said not everyone gets hot flashes. So 🤷🏽‍♀️ as I said my other symptoms are much, much worse while my other conditions are stable

I don't think anyone would accuse me of being amenable and meek.

If anything I'm more kick ass and terrifying as I have so much more energy.