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?

I'm 65 and sailed through menopause but now suspect I'm developing arthritis so I really wish I'd known about this benefit of HRT but it's only recently been made more widely known.

May I ask what persuaded your GP to give you HRT later in life and is it oestrogen only? I want to make an appointment and ask as I'm probably needing a diagnosis now, and I'd like to have some facts and figures to give.

And has late HRT helped?

It's an indication that the GP needs to read up on the menopause.
It could of course be something else but menopause should be explored.
Do you not know anyone who did not have hot flushes but has gone through the menopause?

@Angrymum22 I'm not coming here to argue over taking or not taking hrt as it's personal choice. But I do feel it's important to correct misinformation.

Your post on estrogen and osteoporosis is incorrect. if yo would like to listen to a consultant, he explains this very well on the British Menopause Society website. It's under EDUCATION and TV. There is a series of videos with a lot of consultants. It's Prof John Stevenson.

Basically, estrogen does protect bones and bone health is directly linked to estrogen levels.

Bisphosphonates are not the 'go to ' as they are for women with established osteoporosis. This is covered in another statement on the BMS website. (It's wealth of info but not many women seem to know it's out there.)

Bisphosphonates have long term risks including jaw necrosis and micro fractures of the femur. They stay in the body for decades and a lot is unknown about all their long term risks.

HRT is actually the first choice of treatment and prevention for osteoporosis in women under 65, or who have not yet had fractures. It isn't only for women with POI. In reality many women starting hrt in peri do so because they also have flushes and other menopause symptoms and their bones also benefit.

@Angrymum22 the link to Prof Stevenson is under PUBLICATIONS on the BMS site - under BMS TV.

Short, 5 mins Q&A interview.

Not everyone is the same - I am 76 and have no crumbling bones, Altzheimers - and I never took HRT.
I think the word 'may' should be included for all those claims about HRT.

I know people the same age as me who were on HRT for years and have arthritus, osteoporosis, diabetes and heart problems.
There are lots of other variables such as family history, lifestyle choices that affect your later life - Davina is not the fount of all knowledge.

No we do not wither and die of awful diseases if we do not take HRT during menopause.

If someone suffers DURING menopause - it will absolutely help them to feel normal.

I’ll turn 50 next year and even though my peri symptoms are manageable so far, I’m planning to ask my GP to arrange a DEXA scan to measure my bone density. My Mum suffered from osteoporosis and rheumatoid arthritis, so I want to find out whether I’m heading the same way.

She developed a chronic disease in her 40’s though (which eventually killed her) and that contributed to those conditions soI may not be as susceptible. 🤞I’m willing to take HRT if I am and it’ll help.

I am probably on the side of thinking that HRT will protect your bones if you are prone to osteoporosis.

But given that so many of us are having to make repeated visits to the GP with severe symptoms and are fobbed off, or have to practically beg them for a prescription in tears, the idea that GPs might proactively prescribe HRT as a preventative in a woman who is not complaining of any symptoms is just laughable. It's an academic debate.

Not true about the hot flushes being some sort of gold standard. My advice is to find a doctor who specialises in menopause because the level of ignorance generally across the profession is shocking. Many gps openly admit that but some aren’t even aware of the gap in their knowledge.

There isn’t a one size fits all even though we talk about it like that. I’ve had to tweak oestrogen doses, the strength and duration of progesterone as well as delivery systems. Vaginal oestrogen transformed my sex life.

A key thing to understand is that the problems of peri/menopause are not caused directly by lack of oestrogen/progesterone but by the hormones the brain releases in response to the variations. Those effects taper off after a few years once the levels of oestrogen and progesterone stabilise.

But there are long term effects from low oestrogen on every part of the female body, so hrt is protective over the long haul.

It’s a very blunt tool for now and hopefully will be improved for our dds and gds. Oestrogen, without the counterbalance of progesterone, causes the womb lining to thicken, and can make problems worse. Some women don’t tolerate progesterone or need to try different delivery systems; some have symptoms that worsen during the progesterone break. And it takes time to work.

Even if it’s not suitable, working with a menopause specialist can help find other solutions

If we do take HRT, does that mean we continue to have periods?

Whilst I don't wsnt to suffer and battle in, i can probably cope for a few years knowing there's a period free life afterwards

well yes, but not everyone going through the menopause has any symptoms, many woman have no symptom at all

@Stroopwaffels I should’ve mentioned that I’m in the US and I doubt my health insurance will cover it so it’ll be part of my deductible. That’s why I’m waiting to see whether my bone density warrants it!

It is important to remember that we evolved to not die at menopause - we’re quite distinct as a species in that way.

The more voices and experiences that we encourage the better an understanding we all get.

No one I read on here has been Davina evangelical, i feel this is dismissive. It's absolutely a choice and no one who takes HRT on here has said otherwise.

Although we have not evolved to die, if you think about it, not so long ago, life expectancy on average meant the majority of women didn't make it past the menopause. Moreover, most women didn't have the long child rearing gaps we have and they started having babies much much earlier than we do now. So less periods, more chance of death (30% in childbirth in medieval times), less chance of living into peri and menopause. Modern medicine has led to far more elderly women than ever before with in the UK a huge rise in dementia, CV disease and osteoporosis.

@ruby1957 It's great that you are healthy at 76. You're one of the 50% of women who have good bones.

However, personal experiences don't change the facts that 1:2 women over 50 do get osteoporosis.
They may not be diagnosed till 70 or 80. Some are diagnosed in their 50s and 60s.

There is no other disease that affects 50% of women.

Sadly, NICE has decided that routine DEXA scans (unlike smear tests and mammograms) are not going to be offered to women over 50, despite many medical professionals asking for this. This is a real shame because how else can anyone make an informed choice without knowing the state of their bones?

I have some menopause symptoms (some hair loss, creaky knees) but manageable. I was thinking I should go on HRT anyway, just because of the bone protection. I know I could do weight bearing exercises, but I have known this for a long time. I just don't do them. I don't want to get to 70, have osteoporosis and think 'If only Id gone to the gym'. I have a Mirena coil, but no oestrogen treatment.

I was wondering the same as Angrycat above. 53, menopause symptoms perfectly manageable, eat well, do weight bearing exercise as part of life generally. Might visit thr GP to find out if I should be taking HRT anyway.

I found this very useful:

I was on HRT and then taken off by an overcautious GP. My symptoms were classic but not huge. About to start patches again so we'll see. In between being on and not on patches I have had terrible stomach problems (t the extent I cancelled a holiday) which may or may not have been anxiety which may or may not be linked to HRT. I feel I have to accept the fact that I suffer from anxiety now and would rather it was perimenopause and treatable iyswim.

I do think some of the 'anti' HRT ambassadors are similar to some of the people on threads about food, exercise, and people in met IRL about pain relief in labour. A little self satisfied, a little superior. The assumption that 'normal' and 'active' go in the same sentence suggest many people don't know much about average people. Yes, we should all be fit, the correct weight , active and stress free - but the reality is many people aren't.

I certainly didn't find any miracles when I was on HRT but it did zap night sweats. I am hoping going back on will also sort out flooding and painful periods.

My big gripe is I have never been able to have a proper sit down chat with a medical professional. Everything is rushed, everything is a bit bewildering : I have never been on the pill so hormones are not something I really have experience in. We do at least now have a nurse at our surgery but she only does phone consultations once a month. To discuss testosterone , or anything complex,you need a menopause clinic appointment at the hospital and this can take six to eight months after a GP referral.

'Not everyone is the same - I am 76 and have no crumbling bones, Altzheimers - and I never took HRT. I think the word 'may'should be included for all those claims about HRT.'

It is hard though it's like saying your gran smoked 40 fags a day and lived to 100. Statistics are statistics and as jingling says osteoporosis is common in older women, the problem is hrt only protects for as long as it is taken and most women don't carry on into old age.

@Janiie I agree with 95% of your last post ! but one point isn't correct.
There is newer evidence that the 'dramatic' loss of bone once HRT is stopped is not as great as it's been supposed previously. I agree that a few years ago it was thought that, once it was stopped, bone density fell again, but now they think there may be longer lasting effects.

As a PP said, it's important to bear in mind the bonus of more bone ('bone in the bank') women will have if they use HRT for a shortish time (like 5 years) compared to women who don't.

There's a loss of up to 5% of bone a year immediately after the menopause (for the next 3-5 years) which mean by the age of 55 many women will have lost 25% or more of their bone density.

Personally, I think it's a scandal that the NHS ignores this (and doesn't offer scans) yet spends billions a year on repairing fractures, or paying for care for women disabled from fractures. There are almost 4 million people in the UK (mainly women) with osteoporosis.

The scan is quick, non invasive and cheap. But the NHS doesn't want to know.

@JinglingSpringbells can you share your source on the drop not being so severe? This is something I've been wondering about as I try to keep my bone bank balance healthy.

I had to stop listening to Davinas' book. I found it so depressing. Maybe because I didn't have symptoms as bad as she did or the people she wrote about, it did nothing but tertify me that I had this horrific life to look forward to. I am older than many of the people in the book too. It is clearly useful to many, but not for me.

I’m sorry I was referring to treatment of osteoporosis and osteopenia post menopause. I see a lot of patients who are put on bisphosphates because of the risk of osteonecrosis post ortho surgery. I would say that we are at least one patient a week in practice for assessment.
I have not seen anyone prescribed HRT post meno as a treatment for osteoporosis or osteopenia.
It takes a long time for new ideas to filter down to primary clinical level.
I was only going on what I am presented with on a day to day clinical level.
Also bisphosphates do not cause osteonecrosis they just increase the risk of it developing post tooth extraction. It also very much depends on the method of admin. We are far more cautious with patients who have infusions 3 or 12 monthly rather than those who take a weekly tablet. However GPS are risk averse and like all of us litigation looms large so are super cautious about prescribing them. What is interesting is that most patients have no idea why they have to see a dentist prior to staring the meds.
I apologise if I seemed misinformed.

@Angrymum22 It's not clear from your post if you are a GP or 'admin' in a surgery.

Prescribing HRT and not just bisphosphonates for bone loss in peri or post menopause is not 'new' - it's been around for almost 20 years. Sadly many GPs are not informed and reach for BP far too quickly.

The info is on the BMS website.

Bisphosphonates have a limited prescribing regime. A break is suggested every 2 to 5 years as the long term side effects are not fully understood but those that are, are serious. And even the stronger infusions are only used for 2 years after which another has to be tried.

I don't want to give my personal experience here but I'd be happy to share off forum it was relevant to you.