GP keeps telling me I'll have to stop HRT and how its only delaying the inevitable

[spaceagemat]

I am in my mid 40's and have been on HRT for a few years now and it has been a god send. However I have been getting some hot flashes creeping back in and I asked my GP to increase my dose. They agreed but made a big song and dance about how I'll have to stop taking it eventually and that the more HRT I use the worse my symptoms will be when I have to come off HRT and I'll have to go through all the effects of the menopause eventually. She said the same thing when I started HRT.

I just said yes that I did understand that but I have zero intention of ever coming off HRT unless it is a medical necessity i.e. some kind of hormone driven cancer. Its just so frustrating that my GP who is a women in her 40's herself has such a backwards view of HRT. She is a few years older than me and perhaps thinks that because she is fine or powers through that those of us that use it are just looking for an easy option.

One of the nurses is very positive about HRT so I will ask her next time which GP is the best to see about HRT in future but like I said I do not plan to stop using it ever and will change my doctors or go private in future if I need to.

well there we have it
dont see her again
i have never encountered this view from any of the gps i have seen

One of the most worrying things of this @spaceagemat is that your GP appears to understand nothing about HRT.

It doesn't delay the menopause. This was a myth (not amongst the medical profession) that was going around years ago.

I'd not see her again.

@yepandagain I won't see her again about it! She is obviously opposed to it. I am glad you have not encountered this attitude in other GP's it gives me hope that other GP's are more positive about it. The nurse did mention on how some of the gp's at the surgery were not in favour of it but I already had my appointment with this GP booked and stupidly did not ask her which GP was best to see. I will make a note to ask her the next time I see her.

@JinglingSpringbells I think she is a good GP in many ways but its obvious she is still stuck in the past with her HRT and menopause knowledge.

which is off given you literally cannot read the news or go on social media without some celebrity go on about it

@yepandagain ,I agree .

@yepandagain True, but she isn't alone in thinking HRT is being overhyped not too long ago there was a group of doctors which had a letter in the BMJ saying how menopause was natural and in danger of being over medicalised, so she may be of that school of thought. I've heard weirdly that male doctors are often more positive about HRT, I don't know if that is true.

I have heard her say that HRT is for 10 years max at the lowest dose possible and if that were true I'd probably have to come off HRT at 52 which is way too young in my opinion.

I think the GP was referring to HRT withdrawal symptoms which are usually a few months of menopause symptoms and the longer you are on HRT, the worse
these symptoms tend to be.

I sometimes have to argue my case if I see a new GP, but I fully intend to never come off HRT.

Doctors are only our advisors anyway. We are all free to overrule any medical advice we think is inapplicable or overly risk adverse.

@LoremIpsumCici I see, well I suppose that is true but again I don't ever want to come off unless I absolutely have to.

@hildabaker I do hope that by the time I am at 10 years on HRT the research will have moved on and that it won't be an issue for women to stay on long term.

The nurse did mention on how some of the gp's at the surgery were not in favour of it but I already had my appointment with this GP booked and stupidly did not ask her which GP was best to see

It's not a GP's role to be in favour or not of licensed treatments which manage symptoms. Being 'in favour' is subjective and it's not what a GP should be doing.

It also goes completely against the first points made in the NICE menopause guidance. This is that us of HRT (or not) should be made as a equal decision between a dr and the woman. It's not the dr 'telling you what to do'.

You have a right to effective treatment unless the dr can explain your have medical contraindications. It's the simple.

@LoremIpsumCici There is no science behind the longer you're on HRT the worse you will be when you stop.

It's covered in some of the fact sheets on Dr L Newson's website. If women have symptoms when they stop HRT, they'd have had those symptoms anyway, regardless of HRT.

Some women have no return of symptoms when they stop, others have a lot and they decide to go back onto HRT.

There comes a point when HRT may be used not just for short term (ish) symptoms like flushes and sweats, but for longer term issues preventing bone loss.

It HAS moved on.
The statements from the BMS and Nice say there is no time limit to using HRT. These statements are at least 5 years old now.

I know of women in their 80s and 90s still on HRT.

It tends to be GPs who are behind the times because most consultants (who know far more about it) don't set these limits.

Ok thanks everyone, I do feel more empowered about this now from what you all say. I will take a look at the nice guidance for the next time I need to speak to a GP about this so that I have the information to head off any prejudice or gaps in their knowledge on the matter.

There are great benefits to being on HRT over the age of 65 particularly. Please have a read of this paper https://pubmed.ncbi.nlm.nih.gov/38595196/#:~:text=Results%3A%20Compared%20with%20never%20use,%2C%20lung%20cancer%20(13%25)%2C

The results were:
Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%).

@weaselwords Wow that is great information! I hope this trickles down to GP's as the way it stands it looks like many of them could be putting women off using HRT which could be very beneficial for them, even life saving!

I at least know I want to use and stay on it so I did push back but many would could easily be put off by the way she spoke and her obvious views on hrt.

@JinglingSpringbells

Where is the science behind Newson’s contention that HRT withdrawal doesn’t exist? HRT withdrawal is why Drs wean women off HRT over 2-4 months instead of stopping cold turkey when women ask to come off HRT.

This is the BMS consensus statement on HRT.
It is accurate as of last year on all the latest science behind risks & benefits
https://thebms.org.uk/wp-content/uploads/2023/10/02-BMS-ConsensusStatement-BMS-WHC-2020-Recommendations-on-HRT-in-menopausal-women-SEPT2023-A.pdf

It would take me days to find that for you as her website now is so dense with info! You might find it by googling/searching.
Are we conflating two things here?
There's the issue (mentioned by OP) that using HRT 'delay's the menopause and she will go through it when stopping. That's what her GP seems to say. And that is where Dr N refutes that - ie HRT does not 'delay' menopause symptoms.If you have symptoms on stopping, you would have had them all the time you were not on HRT is how she explains it.

The other issue of whether to reduce it slowly or go cold turkey is not clear. There are two schools of thought. One is that it makes no difference how you stop. Either symptoms will come back, or not. Other drs believe that weaning off slowly might be easier. The fact is all women react differently to stopping.

I don't think there is any evidence that the length of time on HRT correlates with a return of symptoms. It's not 'addictive' like some antidepressants or painkillers, for example.

The most important part of the BMS statement is in the very first few lines....women and their dr should discuss individual risks and benefits and come to a joint decision (and this should be done annually.) The dr's role is to make sure women understand both the risks and benefits to make an informed choice.

It's a long way from the OP's dr 'not favouring HRT'.

The other thing @spaceagemat is you are still very young!
Many of us didn't start HRT till our early or mid 50s.

If you needed it so young, you need to be on it at least to your early 50s to avoid the risks of low estrogen.

That's an interesting paper. Just to be clear, the extract posted is about estrogen 'monotherapy' meaning only estrogen for women with o uterus.

The other stats in the paper are about estrogen + progestin/progesterone.

Yes let not confuse two different things. The OP’s GP said:
”They agreed but made a big song and dance about how I'll have to stop taking it eventually and that the more HRT I use the worse my symptoms will be when I have to come off HRT and I'll have to go through all the effects of the menopause eventually.”

But you have inferred that the above from the OP’s GP is saying “that using HRT 'delay's the menopause and she will go through it when stopping. That's what her GP seems to say.”

Thats why I called it to your attention. Your inferrence seemed less plausible and logical than mine. I see no mention of HRT delaying the menopause like you do.

I inferred the GP was talking about HRT withdrawal which is when menopause symptoms return or appear when you stop HRT. There is loads of science behind this and it does say the longer you take it, the bigger the drop in estrogen when you stop HRT so your symptoms might be worse than if you had stopped sooner. I am sure Dr Newson would agree.

Yes, HRT is not addictive but like all hormone replacement medications, the body responds by shutting down what little production it has and then has to reactivate that hormone production once the hormone therapy is stopped.

I think the BMS Consensus Statement has more than a few important lines in it. It is full of references to recent studies that make it a very helpful and evidence based fact sheet on the risks and benefits of HRT for women.

As it is the consensus of the entire British Medical Society, including consultant Drs specialising in menopause, it carries more weight imho than a fact sheet showing the opinion of any one Dr., even one as esteemed as Dr Newson.

It's a long way from the OP's dr 'not favouring HRT'.
OP’s GP is clearly biased against HRT. I agree the BMS Consensus Statement is a long way from that. It gives the facts as of Sept 2023 and doesn’t push or discourage HRT. It is for each of we women to decide what is best for us.

Without wanting to be facile, isn't most modern medicine largely an exercise in delaying the inevitable, i.e. death? So it seems a very weak argument to me.