How long do you plan to stay on HRT for?

[NetZeroZealot]

I've been on it since I was 52 and am 60 now.

It's been a genuine life changer. I can't imagine ever stopping! But think I must at some point, probably when I retire - I still have quite a demanding job.

Interested in others experiences, especially people older than me who are still taking it.

How do you know when you should quit?

But you said your bone density was normal in 2015?
How would you know without a scan?

And that you took meds for it (or did you mean the HRT to age 56?)

@CulturalNomad That's interesting and also puzzling.
I've had DEXA scans for many years - probably about 7 scans in total.
The BMD is given as grams per square 'whatever' so the density is certainly measurable as is the density of the lumbar region. My scans show the density of individual vertebra as well as several regions of the hip so when I'm doing exercises I'm trying to 'load' those weaker areas.

It's well known that some of the regular drugs for osteoporosis - the bisphosphonates - stop bone turn over so the bone is dense, but dead and liable to fracture in some areas. The worst areas can be the femur where micro-fractures can occur, according to some research.

The idea of HRT is that the bones are building new bone.
You're right that there are some issues because the T-scores are measured against what a 30 year old female would have, regardless of build. And smaller people won't have a much bone mass anyway as someone with a bigger frame. And yes, the same machine should be used and a consultant should interpret the scans.

But even allowing for that, it's better to have some knowledge than none at all.

Yes to all of the above!

Sometimes the "improvement" in DEXA is nothing more than that build up of dead bone cells and there's no evidence that that build up = increased bone strength.

And shorter than average women almost always have high scores as they simply have less bone. There's nothing to say the bone they have isn't perfectly healthy, but statistically there will be less mass when compared to the database that was used to determine what is "average". And the reverse is true of taller than average women - overestimating bone mass.

There's some interesting research using ultrasound to measure bone density, but afaik no clinical trial results as yet.

@JinglingSpringbells I think the sticking point might be that "density" or mass doesn't necessarily translate to bone strength.

The idea of HRT is that the bones are building new bone.

But is there clinical evidence that new bone is actually being built? I believe slowing bone loss has been proven but not sure about actually growing new bone.

At any rate, my SIL's tale isn't all that unique. We shouldn't let a "good" DEXA score or hrt use lull us into a sense of complacency.

I think the clinical research shows that estrogen does in fact help make new bone by continuing the renewal cycle of osteoblasts and osteoclasts (unlike other meds that simply stop bone loss ) but also the quality of bone.

Your sister is one example and we don't know what type or dose of HRT she was on , or anything about her diet and lifestyle (all of these are factors.)

My own experience shows it didn't just stop the rot as my DEXA showed a big increase in a short amount of time.

I said I had a bone scan in 2015 and it was normal. Not had one since!

See post at 14.25 today. Yes HRT to age 56

Wondering too will rtft

@JinglingSpringbells I'm not implying that hrt is not beneficial to bones. It is, and has been proven to slow bone loss. But there are a percentage of women who, despite hrt, will develop osteoporosis.

My own personal approach to osteoporosis prevention is to throw everything at it: Nutrition, lifestyle, intensive weight training, etc. So far, so good, but I'd certainly welcome something more reliable than DEXA should that ever come along!

Afaik the REM scans that have been developed are far more reliable but I have no experience of them

@MILLYmo0se Thanks for the REM scan reference! I remember reading about it last year but availability was really limited. I'll do more research.

I'm 70 and been on it for about 15 years, and see no reason to stop it.
I have to get it privately though, as GP was reluctant to prescribe it for more than 5 and I couldn't stand the constant justification.

They can prise it from my cold dead hands, I'm not going back to feeling angry, sore and miserable.

I felt like a stranger in my own body until I started and the relief of being the old me again was immense.

@CulturalNomad The evidence is that HRT improves density and can also create new bone. It's out there in medical research. Out of personal interest I read some papers after you posted about your sister (I won't link to them as it's a bit off-topic maybe but could if you wanted) and unequivocally the improvement in bone is not simply density - unlike bisphosphonates.)

Is it ok just to keep using it?

Do you have yo change anything as you age, ie dose?

I had two HCP at the time and one said fine to keep going the other not

I had a TH and BSO at 42, had an implant lasting 3 months, followed by oral, then patches up to the age of 56. This was in the nineties. I think at that time HRT was given for the duration of the menopause, then discontinued, whereas now, it is continued long afterwards and for the rest of life, whether it’s necessary or not.

@Bignanna I'm really confused by your experience.
You came in for a lot of comments by saying HRT was being used for vanity reasons and maybe when it was unnecessary.

@SebastianFlytesTrousers Asked you if you'd had any meds after your ovary removal at 42 because the risks and side effects without estrogen are significant. I was interested too.

You had HRT for 14 years and stopped at 56. BUT you also had some other drug for 5 years (for your bones as you had a bone density scan?) although this has never been followed up as the last scan was almost 10 years ago.

If you had drugs for your bones, there must have been a problem surely? Which kind of proves the point that women sometimes need HRT longer term as prevention or treatment.

You need an annual review (at least) to discuss pros and cons for your individual circumstances and your own choice.

The point about HRT is

• why are you using it anyway?
• is it for symptoms like flushes, mood, night sweats?
• is it for other longer term reasons like bone and heart health (taking family history into account and ideally with a DEXA scan of your bones)
• are you at a higher risk of breast cancer?

You've got to look at the whole picture and then make your own choice, along with a doctor who knows about hrt.

I wonder if that review is supposed to happen automatically, I don’t mind booking though

Reasons - Mostly mood, no flushes or heart issues or DEXA scans

Feel really good, positive about various things

It is hard to say how much is HRT but happy to stay on it if there’s fewer downsides

Breast cancer risk - is that determined by family history or other factors / methods?

I have done a couple of mammograms and nothing flagged but maybe needs more in depth

Legally, all drugs have to be reviewed annually - for any condition. This should happen automatically with the GP requesting you have a review. I don't know if or how the NHS does it for HRT because I have a private consultant.

The breast cancer risk- it's not entirely clear what the risk is but there are figures out there is you want to look. The reason they are not clear is that most of the research was done using old progestogens not Utrogestan. There's nothing more in depth than a mammogram. Women who have dense breasts are more at risk of BC anyway but in the UK density is not reported on NHS screening.

Ok thanks

I lived abroad and had the bone density scan ( which was within normal limits) before returning to the U.K.Yes I did have drugs for a while to prevent osteoporosis ( which my mother suffered from) they were discontinued after reading of the side effects. Blood tests since have been normal. I might ask the GP if I can have a bone density scan, though .
I do think that some women don’t want to come off HRT because of its supposed anti ageing properties, even though it’s not the elixir of youth as some purport it to be.
In my case, my skin is pretty good and not very wrinkled even though in my late seventies, so must have done something right since I stopped take HRT!

Couldn’t your private consultant write to your GP and recommend that you have HRT via the NHS?

Bignana I've been going private for such a long time and I can afford it, so am happy not to add the cost to the NHS. It's about £90-£100 per month.
There is an on-line consultation every six months, and they will phone me if they have any questions, and vice versa. Once I submit a request it is delivered within 2 or 3 days, so it's also very convenient. More so than NHS tbh.

It's hard to know what to say....

Another poster asked if you'd had no adverse effects after your surgery and had never used HRT ( partly as you seemed dismissive of women who do, long term.)

But you've explained you've used HRT for some time, it was stopped at 56, you then had a bone density scan (because of family history) and 5 years' treatment. Bisphosphonate treatment at least in the UK isn't given as prevention in younger women (I can link to that if you want) as HRT is preferred at least to 65 (because of the possible long term unknown effects of bisphosphonates.) The maximum time on it is 5 years which is what you had.

So , many women would still be on HRT at 65 for prevention or treatment.

It IS the elixir of youth, (in the medical sense- not the wrinkles!) because medical research shows that women on HRT live longer than women not on HRT.

Do you know women in real life who want to stay on it because they don't want wrinkles?

A note on breast cancer risk - I’ve seen growing awareness in the uk about the BRCA gene. It’s more talked about in the US. Seems to be most prevalent in women with Jewish ancestory. If this is you worth reading up on?

Not anyone who will admit to it, of course not!
Its up to the individual to weigh up the pros and cons of staying on it, but although the advantages are clear, the thought of the possible increase in breast size leading to another reduction would be off putting.