Is *everyone* on HRT now?

[Kangaroobrain]

I'm 56, last period 3 years ago. TBH I think my menopause symptoms haven't been too awful compared to some people (although with my terrible brain fog I might have forgotten them already 😂) but I'm still getting some. I still have night sweats and occasional flushes, I've noticed my skin is starting to feel very thin and itchy, and I have completely lost the ability to multi task - I'm getting really forgetful.

When my sister asked her GP about HRT she was advised not to as we have a strong family history of breast cancer, so I didn't really even consider it myself. But speaking to friends and coming on here makes me wonder if it's now the norm to be on it?

Discredited where how?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780820/

I'm on HRT, and so are a lot of my friends . Cured my anxiety and insomnia , strengthened my bones , improves my sex life . Keeps me looking younger . Improves my moods.
My mum had a terrible menopause , really grumpy with everyone for 10 years , changed her personality.
And she is in constant pain now from
Osteoporosis fractures in her spine .

My friends thy definitely aren't on hrt (but in my opinion have lives that are being seriously impacted by the symtoms of perimenopause)are those who would have loved to have children but it hasn't happened for. The idea they are now at the next phase of thier biological lives is not something they can consider.

going by this, it seems that HRT uptake is very much linked to friendship groups, so I wonder if there is an element of social contagion in some of these menopause symptoms?

You think women are making up their menopause symptoms to be like their friends?! That’s bonkers. Surely it's the choice to use HRT that's 'contagious', not the (genuine and common) symptoms women take it for? If you're having a bad time with your symptoms and a friend tells you how brilliant HRT has been for hers, of course that's likely to encourage you to try it.

I’m 60 next year, final period 13 months ago (yep really). None of my female friends of the same (ish) age are on HRT.

OP, What a stupid question is everyone on HRT - I am on it due to having a troublesome menopause. HRT is not something one just decides on taking.

There are various combo's of HRT, the correct dosage & combo has to be worked out. It is not one size fits all

If you had a trouble free menopause. Good for you !!!

I last had my period three years ago...I am sorry but are you sure your night sweats are due to menopause? I am concerned for you because I would have thought you would have finished these now and it can be a sign of other things.
I am thinking of going on it for brain fog reasons.

I'm in my late 50's and had my last period at around age 45. I've never taken HRT and tbh my menopause has been far easier than what I had to deal with every month before.

No!

I dont think one person can judge another person's symptoms.

I quite often here "my mother/aunt/wife claims to be having a good menopause, but I have to live with her "mood swings" and "brain fog", even though she refuses to admit it herself"

You then speak to the mother/aunt/wife and hear their side of the story, and more often than not they are saying they have changed, feel stronger, feel more independent, feel more positive, and are no longer subservient, and have come out from under and stopped being a doormat

This is often interpreted by their nearest and dearest as they are having a "bad" menopause, they are no longer the person to be relied on to remember everyone else's birthdays because they have "brain fog" and they are insisting someone else does the washing up because they are undergoing "mood swings" etc etc etc!

It’s given me back my sanity. The insomnia was terrible. Never want to stop taking it. I’m not sure if I would have been able to continue working in a challenging role without it.

Not me and not planning too either.
I am 18 months post menopause and symptoms are minimal, mainly disturbed sleep.
Hot flushes weren't frequent, so they didn't bother me too much.
I have had a bone density scan as part of a research study and that is well above what it should be at my age.
🤞🏻 I can stay away from it, taking hormones for the rest if my life doesn't appeal.

So much conflicting, confusing information out there. Now here's a report talking about risks.

Hormone replacement therapy (HRT): further information on the known increased risk of breast cancer with HRT and its persistence after stopping - GOV.UK (www.gov.uk)

• Key findings:
• All forms of systemic HRT are associated with a significant excess incidence of breast cancer, irrespective of the type of estrogen or progestogen or route of delivery (oral or transdermal)
• There is little or no increase in risk with current or previous use of HRT for less than 1 year; however, there is an increased risk with HRT use for longer than 1 year
• Risk of breast cancer increases further with longer duration of HRT use
• Risk of breast cancer is lower after stopping HRT than it is during current use, but remains increased in ex-HRT users for more than 10 years compared with women who have never used HRT
• Risk of breast cancer is higher for combined estrogen-progestogen HRT than estrogen-only HRT
• For women who use HRT for similar durations, the total number of HRT-related breast cancers by age 69 years is similar whether HRT is started in her 40s or in her 50s
• The study found no evidence of an effect on breast cancer risk with use of low doses of estrogen applied directly via the vagina to treat local symptoms

• Advice for healthcare professionals:
• a new meta-analysis of more than 100,000 women with breast cancer has shown that some excess risk of breast cancer with systemic HRT persists for more than 10 years after stopping; the total increased risk of breast cancer associated with HRT is therefore higher than previous estimates (see key findings)
• prescribers of HRT should inform women who use or are considering starting HRT of the new information about breast cancer risk at their next routine appointment (see resources provided)
• only prescribe HRT to relieve post-menopausal symptoms that are adversely affecting quality of life and regularly review patients using HRT to ensure it is used for the shortest time and at the lowest dose
• remind current and past HRT users to be vigilant for signs of breast cancer and encourage them to attend for breast screening when invited

I do worry about things like bone health and so on, especially as I've had a lengthy spell on steroids in the past. Mum's bone health is fine but that doesn't mean mine will be I suppose. DEXAs have shown I'm okay although the last one was pre-menopause and I am due another, so who knows.

I haven't had a period for four years and so far I'm ok. I get hot but no actual hot flushes. I don't cope very well in the heat and try to avoid that. I make sure I wear natural fibres and layer so I can strip off if hot. So far I've been lucky. I have periods of waking up in the night and not being able to go back to sleep but I manage.
Davina McCall and Mariella Frostropp seem to be constantly popping up and telling me I must have HRT.

Royal Osteoporosis Society - Osteoporosis Charity UK (theros.org.uk)

I just used the risk checker here. My only risk seems to be my low dose steroid which my Consultant has recently suggested I wean off.

It was interesting to see the risk factors for osteoporosis, menopause being one of course. But then men and children get it too. I didn't have any other risk factors as I am not underweight, don't smoke or drink, etc, my diet is fine and so on.

Inflammatory conditions aren't good for bone apparently, so I must keep an eye on that. My condition is inflammatory, hence the steroids to dampen that down.

I’m 52. No periods for 18 months. No HRT. Have felt mostly ok with only really night flushes so not looked into it and DM died from BC so it’s not really on my radar if I’m doing ok without.
I am doing a month alcohol free and interestingly have not had one flush since.

PS DM was on HRT for 10 years and her cancer was a hormone sensitive one.

No! Menopause at 51, no symptoms other than hot flushes, am 67 now. Had things been very different no doubt I'd have considered HRT, but glad I didn't need to.

@koalaknickers I think what a lot of people don't realise is that the link you posted to the meta analysis actually includes ALL the trials over the past 20-odd years.

It includes the flawed WHI, the flawed Million Women study AND several trials that are not even peer reviewed.

The most recent analysis did not include many women using Utrogestan (it was a tiny, tiny number like 30 out of hundreds of thousands of women).

There is a separate analysis of Utrogestan and a statement by the BMS which says that in all probability it is safe for 5 years with no added BC risk.

The WHI trial is not regarded as obsolete. I've never read of or heard any menopause consultant refer to it that way.

It did include many errors in the design (previous health issues, age of subjects, - starting in their mid 60s - previous HRT use, weight, smoking to name some.) It wasn't just about using conjugated equine estrogen.

That trial did show that women on estrogen-only (no progestogens) have less BC than the non-HRT population, and this is confirmed by other trials since.

My advice to anyone wanting to use HRT and who has concerns about the BC risk should see a specialist consultant to discuss them.

The information online does not show the whole picture because it's often a summary.

In addition, the trials are always retrospective / observational. There is no single double-blind, placebo trial that's been done on HRT. Menopause experts are pushing for these. All the good specialists admit that the evidence available is unclear and nobody really knows the risks, which may or may not exist. The best they can say is that the risks appear small, and for most women the benefits outweigh the risks.

I found exercise switched off my hot flushes. Had to walk for an hour every day. Hard to fit in but if I missed days the sweats came back so I made myself do it.

Thank you for your helpful detailed reply.

I must confess I am guilty of just looking at the "takeaways" from these type of reports. I am no good at figures or statistics and my eyes sort of glaze over as I cannot interpret the data. I am also guilty of not looking deeper at the (flawed) reports being used.

I naively thought, "Oh, here's a UK Government report from 2019, that must be accurate", but no. It just shows you why women can be confused about all this. Like with food, so much conflicting advice, people despair and might give up trying.

There is no single double-blind, placebo trial that's been done on HRT. Menopause experts are pushing for these.

This is what's needed. Women should have this trial. Couldn't one of the HRT companies fund this, perhaps? Women need this information.

I feel bad for any woman who is debilitated by her symptoms and struggling and having to try and make decisions in this climate of confusion.

It needs to be independent of drug company funding.

I’m the same age as you and wasn’t on it, despite the fact that virtually everyone in my friendship group is. Then a gynaecologist strongly recommended that I reconsider due to its protective effects re osteoporosis etc.

I’ve since been on patches and didn’t think they made any difference - until one fell off without me realising and it was quite startling how much more tired I’d felt for those couple of days. I’d got used feeling utterly exhausted for years but the improvement on HRT was so subtle I hadn’t really clocked it until then, when I was suddenly back in that fog of tiredness.

I wouldn’t say it’s rocked my world the way it does some people’s, but it’s definitely made a positive impact on my energy levels and I’d be loathe to stop it now.

I'm 51 and periods started going irregular 2 years ago. Other than that, I've not really had any noticeable symptoms (a couple of bouts of insomnia, but given that's been my go-to stress symptom since I was at school, there's no certainty it's down to meno, and I any case, I'm much better at managing it these days.) GP would happily prescribe it - and asked me about symptoms when I was there about something completely different. If I get symptoms then yes, I will go back for a prescription. Plenty of friends are on HRT - some have had quite debilitating symptoms. But as yet, mine are not.