The Menopause conundrum - who do we believe?

[Stridingthroughtheglade]

There seems to be a thicket of information out there, at the same time a dearth of actual rl advice and help! Need some advice negotiating my way through the problem please.

I am in my late fifties. Had a full hysterectomy with ovary removal nearly five years ago.

Went on HRT immediately for six to eight months but I wasn’t given any info about it and it didn’t seem to do anything in particular so I stopped taking it.

Only now, when it’s a few years later, I find myself not sad but just flat, no energy, no motivation, physically sluggish, don’t care about anything. My hair is receding and falling out. I have loads of bristles appearing on my chin and dark hairs on my upper lip. My limbs ache. My back hurts. I’ve gained weight. Any minor task that previously I would sail through, seems to be an enormous burden and I need to psyche myself up to do it, for hours and days in advance. Afterwards, I am exhausted. I’m existing, not living.

I have been offered anti-depressants but I am not sad and I don’t have anything to be depressed about. Good long marriage, lovely adult dc, ok job, ok home, supportive family, great friends, interesting hobbies. My life is a breeze compared to most people’s.

So where do I go now?

I see Dr Claire Newsome (is that her name?) all over sm. She talks about HRT as if it is a necessary, preventative treatment for most women. I understand the risks of HRT have largely been disproved but who do we believe? She seems very sincere and obviously I don’t begrudge her a living, but how much do we trust in what she says?

I’m a keen gardener and trust that nature knows best in most things and we get in to trouble when we meddle with it.

So the options are:

** ADs

** HRT

** diet and exercise

Sorry for long op, but what exactly should my next step be please?

How does everyone negotiate this issue?

Dr Louise Newson is the person you're thinking of, OP. Her app is the Balance app mentioned here.

I don't know where I'd be without HRT. Most of my symptoms disappeared within a few weeks. I had had very severe symptoms which had led to me losing my job. I didn't consider HRT because I had internalised all the negative stories.

All the things you describe are symptoms of depleted oestrogen. HRT replaces some of that- nowhere near what your body had naturally.

NICE guidelines say anti depressants should not be prescribed as a first line treatment. My friend was prescribed them by our GP who doesn't approve of HRT. She was like a Zombie on them. Now she's on HRT after going to a different doctor. She's like a new woman.

I couldn’t survive without my HRT! I still have my uterus so I have to suffer progesterone to avoid the possibility of uterine cancer, it makes me very moody, but don’t take it every day. I have the estrogen patch, dose is 75 at the moment, the 50 strength wasn’t doing it, I started to feel anxious, everything back to normal again with the increase.

My life saver has been testosterone, I like you had NO energy whatsoever, even pulling a weed out exhausted me, I also had no libido. My husband is still sexy who I love but sexually it just wasn’t there, now I’m occasionally relegated to the guest room as I’m tiring him out 😂 So my regime is estrogen 75 strength, testosterone and the dreaded progesterone 🥴

My sister in law decided to go “au natural”. She now has osteoporosis and is breaking bones very easily, she’s only 58 🤦‍♀️

I no longer have aching joints, my hair is lush, my nails are no longer brittle, anti depressants aren’t going to stop the aches and pains.

If the G.Ps are a bit clueless like mine invest in seeing a menopause specialist, it’s money well spent. If you want anymore info you can P.M me, it took me 3 years to get the regime that suited me, but that was due to the progesterone problem. You won’t have this issue as you’ll only need estrogen with the testosterone, 🤓

I’m post menopausal. I used HRT for 3yrs but then was diagnosed with breast cancer so had to stop very suddenly and started taking anastrozole, a hormone blocker. I thought I would plummet into the depths of despair but was pleasantly surprised how little it affected my mental health.

Having looked into hormone levels I now have the same levels as an 8YR old, albeit without the energy levels. The Anastrazole side effects are awful but mainly physical. I do find that the more active I am the better I feel, but I listen to my body and take a break if I’ve done a lot although radiotherapy is probably the cause of my chronic fatigue.

The guidelines around HRT are based on lots of research, it does increase the risk of breast cancer but the research only covers trials done up to the age of 60 so taking HRT indefinitely beyond 60 the risk is unknown. Osteoporosis accelerates during menopause but significantly slows down post menopause. The evidence is scant and is based on correlation with regard to dementia since there are multiple factors known to be involved.

I think you need to look at your own symptoms and risk factors. Taking HRT through menopause is beneficial but there is very little evidence that it continues to be beneficial post menopause, mainly because there are few longterm studies. HRT has changed and practitioners use a much more fluid approach to dose so the affect of the high doses some advise is unknown.

I don’t regret taking HRT, despite it being the cause of my breast cancer. It helped me through the worst of menopause and helped to keep my bone density healthy, but having done a deep dive into the currently available research I’m glad that I have stopped using it.

I have another 3 years of Anastrazole after which I should see big improvements to the unpleasant side effects. However, it significantly reduces the risk of breast cancer returning so I am happy to carry on.

Children don’t need them, no. Adult women do. And your body didn’t ‘decide’ you don’t need them. It just doesn’t make them any more in the past, you wouldn’t have lived long enough to care. Now we do. But we’ll be healthier - our bones, hearts and brains as well as our mental well being - if we replace them.
My thyroxine deficiency isn’t caused by illness either. My thyroid just ‘decided’ not to make thyroxine anymore. Do you feel I shouldn’t treat that too?

Same problem here, OP. Watching with interest

Everyone is different - it's not one size fits all.
I am 58. Haven't seen a GP for 20 years. I take no medication of any kind, nor over the counter supplements, special diet etc. I just carry on as normal, and will do so until such time as I am actually unwell in some way.
That works for me. Everyone else is free to make their own choices.

there is very little evidence that it continues to be beneficial post menopause, mainly because there are few longterm studies.
Absence of evidence isn’t evidence of absence, @Angrymum22
Experts think it’s likely the benefits do continue.

Well, yes. Most of us on HRT went to ask for it because we were unwell - exhausted, anxious, unable to cope.
Thing is, we may be the lucky ones as we have been tipped off to take the missing hormones. The evidence it helps bone, heart and brain health is increasing - and it seems it’s better as a preventative than a response to problems in those areas.

There is no best answer. The evidence of risk was with old style HRT - and there is limited evidence for the newer stuff. It is neither a cure all nor nonsense.

I love HRT, but really suffer menopause. I also need to watch my diet/exercise but good HRT makes caring for myself easier. I try hard with diet and exercise to mitigate any increased risk of HRT.

I get my care thought the Newson clinic and can’t say enough good things. It’s expensive- but essential.

Excellent post!

MN can get very vehement about HRT but as others have said it’s not one size fits all. Louise Newson is at one end of the spectrum but there are other views and lots of evidence for non-hormone approaches. Anecdata are not helpful - HRT is not a treatment for osteoporosis whereas regular weight-bearing exercise is far more protective and has multiple other benefits.

"Only now, when it’s a few years later, I find myself not sad but just flat, no energy, no motivation, physically sluggish, don’t care about anything. My hair is receding and falling out. I have loads of bristles appearing on my chin and dark hairs on my upper lip. My limbs ache. My back hurts. I’ve gained weight. Any minor task that previously I would sail through, seems to be an enormous burden and I need to psyche myself up to do it, for hours and days in advance. Afterwards, I am exhausted. I’m existing, not living. "

This sounds exactly like menopause. I would try HRT first for two reasons:

1. If it is menopause causing the symptoms, which seems likely, it deals with the problem (ie lack of oestrogen) rather than the symptoms

1. It works really quickly. The brain fog, and "meh" feeling passed within a week of starting HRT.

While starting HRT I would simultaneously work on diet and exercise. That will always make you feel better but takes a while to get into the swing of start working, and the improvements in symptoms from HRT will help you get motivated and make exercising easier.

Once you've tried all that (and bear in mind you might need to fiddle with the HRT dose or try a couple of different types to get it right) if you still have low mood symptoms then you could try ADs. I have been in ADs for years for long-standing MH difficulties. For me they are a last resort treatment. They take a while to work (at least 6 weeks) and you likely have to titrate up on them. They can also have many side effects, some of them serious. And the effect over the longer term isn't well understood. They can be life saving but I would rule out other things first. As your symptoms strongly indicate menopause it makes sense to treat that first.

If you can afford it, go to a private menopause specialist clinic. I go to the London Hormone clinic and it’s great.
they would order a proper blood test with a complete hormone panel and find out what’s best for you. For example, I needed prosgesterone and testosterone but not estrogen.
yes, with so many conflicted advice, you need an expert!
also lifestyle changes will always be good for you

That, unfortunately, is the problem. We have no longterm data with regard to using HRT earlier in a healthy “intact” population.
It was only used in women premenopausal if they had a surgical menopause or primary ovarian failure.
One thing that shocked me was the complete lack of reporting by medics when you are diagnosed with hormone positive breast cancer after taking HRT. No data is available for this group of women. The only data we have is that which is collected from studies and trials where selection of participants is likely to be unintentionally biased if women with family history of cancer are excluded.
I was further surprised just how high the lifetime risk of breast cancer is, regardless of possible cause. One in seven is pretty high odds. This means you are likely to know quite a few women who will have or have had breast cancer. Regardless of whether they take HRT.
My biggest risk factor was having a late menopause, as a result I had been exposed to oestrogen for an extended period of time. It may be that the oestrogen we produce is more of a risk to us than that in HRT. Who knows? I am a little more cautious about the data currently being used.
The good news is that breast cancer treatment is much more successful with an overall survival rate of 99%. This means that even if the exponential rise in HRT use does cause an increase in breast cancer it’s easily treatable.

There's a difference though. Your thyroid isn't working as it should be, hence the thyroxine. Menopause is a normal and natural progression in the female body. So there's no deficiency, because you have run out of egg cells in your ovaries and there's no need for the hormones any more. That's not to say that the menopause isn't bloody horrible - it is. I've been struggling with it since 2001.

Thank you so much for all these further replies. I really appreciate everyone taking the time to post about their individual experiences, even though quite a mixed bag of views is represented, which again is part of the problem! 😀

Sadik thank you I have ordered a copy of the book you recommended.

I will also look in to the Menopause Reset podcast recommended by Softwintersun Thank you.

Octavia64 I have just been reading about depression, well when I woke up for the first time at 4 am, which incidentally is another symptom. And that’s an interesting point about it not necessarily manifesting as sadness. It appears that you don’t need to have anything seriously wrong to be depressed either which surprised me as wasn’t it recently disproved that depression is caused by a chemical imbalance or that ADs stabilise one?

Nonplusultra another interesting point about it smoothing the transition. My mother had an unusually late menopause and I wouldn’t mind so much if my menopause symptoms remained at a certain level, but despite being nearly sixty, they seem to be increasing month on month!

I will start cutting down on sugar and start taking a magnesium supplement (which requires more research I gather to find the right one) so thank you to the posters who suggested that.

Smilesup I can relate as I have had awful hormonal issues since puberty. Strangely, the only time I felt totally fit and well and totally “stable” mood wise, was during pregnancy, so my body must have liked the progesterone! This is odd when I have so many symptoms related to oestrogen withdrawal now!

Movinghouseatlast that’s an interesting anecdote about your friend!

I am also very interested in the posts that mention long term benefits or risks. Or about the lack of research relating to those issues! Still reading!

Argh! I wish there was some sort of “guided pathway” where you could have detailed blood analysis done, and have some sort of algorithm applied to the results which would automatically triage you in to treatment for depression, or hormone treatment.

Thank you again everyone. I am constantly re-reading all of the posts which are much appreciated but the trouble is I find myself agreeing with each and every one despite which whichever path they advocate! 😀😃

I think a menopause specialist is a good place to start. But my worry is that they are not completely unbiased either. Is there such a thing as a private menopause specialist who will say “looking at your bloods and symptoms, you don’t need hormones, and you need to look at other pathways”? There are unlikely to do that aren’t they?

HRT was life changing for me. I'd go see the gp. There is a lot of positive evidence to support its use x

It's your choice and you will only find out what suits you by trying various options.

NICE said in 2015 that women were not supposed to be treated with ADs when they need HRT. Many GPs are years behind the times and won't adhere to guidance.

I can't agree with your 'nature knows best' comment. If that was so, we'd all be ill or dead from other things, (no vaccines, no surgery, no antibiotics.)

If your quality of life is suffering, it's worth trying HRT again.
You need it optimised for you.

Your symptoms of aching joints, weight gain and feeling lethargic are classic low-estrogen symptoms.

See another GP or if you can afford it, go and see a gynaecologist who is an expert in menopause. For £250-ish you will get 45 mins to discuss all of this.

You could start with your local private hospital- look at the bios of their gynaes - or you can ask here who women recommend in your home area.

The British Menopause Society also has a list of specialists on their website. https://thebms.org.uk/find-a-menopause-specialist/

They also have some very informative videos where leading menopause experts discuss HRT. https://thebms.org.uk/publications/bms-tv/

Thank you very much JinglingSpringbells that’s very helpful advice.

I think a menopause specialist is a good place to start. But my worry is that they are not completely unbiased either. Is there such a thing as a private menopause specialist who will say “looking at your bloods and symptoms, you don’t need hormones, and you need to look at other pathways”? There are unlikely to do that aren’t they?

They won't do blood tests as they are meaningless.

My consultant offers an integrated approach to menopause where they are as likely to suggest lifestyle measures as well as or instead of HRT.

The important thing is it's YOUR choice. No dr is going to push HRT onto you. They've nothing to gain by that. They ought to set out the pros and cons and allow you to decide. That's my personal experience, anyway!

They should say 'if you choose X, this is what may happen. If you choose Y, that is what may happen.'

They should look at your complete medical history and help you with the choice.
For example, there is a strong history of CVD on my mother's side (going back 2 generations.) That was part of my choice to use HRT, as it's protective. Likewise, I had DEXA scan at 50-ish and was heading towards osteoporosis, so HRT has stalled that and improved my bones.

These things should be part of your discussion.

Hope you find the solution for you.

This is 100% me. Periods seem to have stopped but keep feeling like they anre coming. And you have just made me realise that the nights I slept this week were when I had a valerian tea.

I have no idea whether to go on HRT or not. And OP I have noticed the same. Davina & Claire Newsome in one corner, Germaine Greer in another (I think, am about to read her book). Friends split evenily between the two camps.

I have decided if menopause starts to really affect my mood then I will ask for HRT. I have spoken to the GP but they don’t seem that keen to give it.

But I don’t know whether by not taking it now I am putting myself at future risk of heart disease, dementia etc.

Thank you everyone for all your advice

@JinglingSpringbells your consultant sounds brilliant. Do they work with people from anywhere or are they local to you.

They did Zoom during lockdown but I'm not sure if they offer that now.