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.

My dads partner is on HRT at 77 and says you can prise it out of her dead hands, she never wants to come off it

Yes and no

yes, they are advisors you are free to ignore
no, they don’t have to write the prescription

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.

For me, I feel it shows her GP as saying she'd 'go through the menopause anyway' once she'd stopped HRT (which is a myth.)

https://www.balance-menopause.com/menopause-library/hormone-replacement-therapy-hrt-the-basics-factsheet/#:~:text=HRT%20does%20not%20'delay'%20your,had%20never%20taken%20it%20before.

There is no maximum length of time for which you can take HRT – you can take it for ever. HRT does not ‘delay’ your menopause ­ if you have menopausal symptoms after stopping HRT, this means you would still be having symptoms even if you had never taken it before.

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.

Does it? Our bodies continue to produce small amounts of estrogen for life and brown fat is a source (fatter women produce more which is why they have a higher risk of endometrial and breast cancer.)

I am not aware of any science behind duration of use and a return of severity of symptoms.

The OP has got a lot from her post and let's hope she finds a good way forward!

I started HRT at 41 and I have no intention of ever coming off it. Your GP sounds very out of touch but for HRT review you may be able to see the nurse rather than the GP

@yeesh You can see a nurse for a review but I wanted to increase my dose and that meant I had to see a doctor.

Can we swap GP's? Mine wants me to start HRT despite having no symptoms.

I did briefly have eostrogel 8 years ago but it gave me hot flushes so was pointless.

Isn't it weird how people that need meds can't have them and people that don't need them get them pushed on them.

Thanks so much for this thread! My Dr told me I’d have to come off HRT at 55, and I didn’t even think to question it, so I have everything planned to that deadline including semi-retirement, paying off the mortgage etc because I don’t think there is any way I could do my very demanding job without HRT.

https://thebms.org.uk/wp-content/uploads/2022/12/09-BMS-TfC-NICE-Menopause-Diagnosis-and-Management-from-Guideline-to-Practice-Guideline-Summary-NOV2022-A.pdf

@spaceagemat If you want more evidence for your GP, point 8 on this sheet is very helpful- about stopping hrt gradually or suddenly.

https://thebms.org.uk/wp-content/uploads/2022/12/09-BMS-TfC-NICE-Menopause-Diagnosis-and-Management-from-Guideline-to-Practice-Guideline-Summary-NOV2022-A.pdf

This @JustPleachy discredits the old 'advice' of coming off at 60. Not 55!

Your GP sounds completely out of touch.

Many women don't even start till 55.

Anecdote offered without comment. I'd say my GP is the same age as me.

10 years ago I believed I was peri-menopausal. I'd let my coil run out by mistake, started seeing symptoms. Went to my Gp who completely poo-poo'd me, laughed at any suggestion of HRT, questioned its efficacy in the first place and told me to be careful what I read. Happily replaced the coil tbf, but that was for contraception, not in anyway to replace hormones.

Six months ago I saw the same GP for my HRT check. She waxed lyrical about HRT for ten minutes, had a really interesting, in-depth discussion about whether I should replace the coil or not, adjusted my patch dose, got me referred for coil change and said she could quite confidently say this was the 'gold standard' of HRT, because she was on it and she was a GP.

What a difference the menopause makes, eh?

Did you say anything to your GP @HelloMyNameIsElderSmurf ? If it were me I would be sorely tempted!

I think I will request HRT eventually, more for my bone density than for peri-menopausal symptoms which so far thankfully I seem to be avoiding, hope I'm not speaking too soon!

But, when I was considering HRT my very lovely female GP (whom I respect enormously - our GP practice fantastic with all the generations of our family) said I should weigh it up very carefully due to cancer risk. Coincidentally, the day after a friend confided she would be ungoing cancer treatment for cancer and that her consultant told her she was very lucky she wasn't on HRT or it would have progressed so much more quickly.

These 2 conversations have made me more hesitant. There is so much hype around HRT and it must be big bucks for the pharmaceutical companies. On the other hand it seems all my other peers rave about it ... I'll probably take the leap eventually, but there is something about the very strong HRT push which makes me uncomfortable.

I'll put my hard hat on now, because people are evangelical about HRT and according to some all risks are no more.

@NamechangeRugby , I totally agree with you .

Are you referring to increasing the dose of your gel? If so then you can take this decision yourself, up to 4 pumps. I have adjusted mine over the years depending on my symptoms. The GP doesn't need to give you permission to do this.

@Floofydawg I use patches so I needed my GP to do a prescription for a higher dose patch.

TBH your GP if giving you a 'warning' should tell you the actual numbers and then allow you to make up your own mind.

I wonder if she is aware that (this is BMS statements) that the risk of using HRT which includes Utrogestan does not raise BC risk for the first 5 years. This is all online so you can find it yourself.
I don't think anyone is evangelical, it's about knowing the facts and then making a choice.

When I went onto it the GP (younger female) said yes you'll be on it 5 years maximum.

@NamechangeRugby HRT is certainly not a choice to take lightly but as fas as I am aware with hormone sensitive cancers it will not cause it but can "feed" it if you do get it. The other contradictory information is that women who develop a hormone sensitive cancer who were on HRT actually have better outcomes than women with the same cancer who were not on HRT.

I don't know what to make of it myself to be honest and I don't think any woman should feel pressured to use HRT is she doesn't want to. I am probably influenced by how sharply my own mother lost her health after stopping HRT in her 50's post menopause. In my view even if there were some risks her health and quality of life would have been so much better on HRT than off it but her Doctors forced her off it due to the panic around the WHI study which is now heavily criticised and seen as flawed.

I can confirm that my female GP did actually tell me about this when I first started HRT earlier this year. In my initial consultation I admitted I wasn't sure because of the risks, which is when she informed me how things have moved on now and mentioned all of these believed benefits.

I was sorely tempted but what would have been the point? It is actually quite cheering how much things have moved on, I got my first HRT prescription from a GP registrar (that's a GP in their final year of training) who looked about 12 and literally did not hesitate. I do think things are changing.

@NamechangeRugby This is me. Developed ovarian cancer on HRT. It fueled the spread of the cancer - I know this because my Ca125 (cancer marker for this disease) was over 1000 on diagnosis
The first thing I did was stop HRT, and the next Ca125 was 600

Currently I’m on an anti oestrogen to block the cancer from growing. So hot flushes aplenty. There is irony for you

HRT is all very well, but it’s not without risk, and women are not monitored properly on it

@RedRosesPinkLilies I am so sorry to hear of your cancer and wish you all the very, very best with your treatment.

Thank you for posting. I've no wish to scare monger and accept all the benefits may make it worth it for most, but the consequences are so high where the risk materialises.

I agree there definitely should be greater awareness and better monitoring.

At the minute, to me, it does feel like a bit of a frenzy to access, combined with a self medicated approach to ever up the dose. I imagine some GP's / clinics are better than others with monitoring.

@NamechangeRugby I completely agree with you. I think there’s a little too much emphasis on women taking it, and that is from the media rather than Drs
I took it for bone health as much as anything - and was going to come off it at 55, but that all stopped suddenly at 54.5

Thanks to modern medicine I seem to be stable just now, the hormone blocker is seeing to that. But historically my prognosis is only 1-1.5 years, with this new medication that might be a bit longer.

@NamechangeRugby , I completely agree with you , I do feel the risks need mentioning more , and also the fact that not all women can take hrt .

Statement The Australasian Menopause Society issued a statement this week, prompted by concerns about overstated benefits and understated risks of HRT (now called MHT).

One of the points raised is that much more research is needed into the breast cancer risk. Also that there is not sufficient evidence to support HRT/MHT for primary prevention of cardiovascular issues or dementia.

I’m in my mid 50s and have had very few menopause symptoms. Perimenopause was basically a non event for me. As someone who has had a (non hormone related) cancer I won’t consider HRT unless I had debilitating symptoms and I would consult a menopause specialist. But I have had friends who are on HRT really urging me to take it ‘to prevent heart disease and dementia’. So I have seen firsthand there is an evangelical element at play.