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

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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.

@LoremIpsumCici

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'd like to know more about this please. I haven't come across it before.

It doesn't.

HRT doesn't shut down estrogen and neither does it rise again when stopping it.

HRT supplements our own estrogen, which, after menopause is very low. It doesn't increase after using/stopping hrt. It's dependent on our ovarian cycle and when the eggs are gone, they're gone.

Happy to see science showing otherwise but never heard any doctors saying this.

Suprised you haven’t seen the science on this as you are so well informed. It’s not really new.

Bite size course in human biology for endocrine hormones:

Endocrine hormones like estrogen are messenger molecules that are secreted by endocrine glands into the bloodstream. They travel throughout the body in the circulation. Although they reach virtually every cell in the body in this way, each hormone affects only certain cells, called target cells. A target cell is the type of cell on which a hormone has an effect. A target cell is affected by a particular hormone because it has receptor proteins — either on the cell surface or within the cell — that are specific to that hormone. An endocrine hormone travels through the bloodstream until it finds a target cell with a matching receptor to which it can bind. When the hormone binds to the receptor, it causes changes within the cell. The manner in which it changes the cell depends on whether the hormone is a steroid hormone or a non-steroid hormone.

Regulation of Endocrine Hormones
Endocrine hormones regulate many body processes, but what regulates the secretion of endocrine hormones? Most endocrine hormones are controlled by feedback mechanisms. A feedback mechanism is a loop in which a product feeds back to control its own production. Feedback loops may be either negative or positive.

• Most endocrine hormones are regulated by negative feedback loops. Negative feedback keeps the concentration of a hormone within a relatively narrow range and maintains homeostasis.
• Very few endocrine hormones are regulated by positive feedback loops. Positive feedback causes the concentration of a hormone to become increasingly higher.

A bit more advanced:
Cellular physiological response to estrogen begins in the cell cytoplasm with estrogen binding to either alpha-estrogen receptor or beta-estrogen receptor. The activated estrogen-estrogen receptor complex then crosses into the nucleus of cells to induce DNA transcription by binding to nucleotide sequences known as estrogen response elements (ERE) to enact a physiological response. Estrogen hormone levels in the body are regulated by the negative feedback effect of estrogen on the hypothalamus and pituitary gland. An example of negative feedback can be observed during the menstrual cycle. Estrogen metabolic activity primarily occurs within the liver hepatocytes CYP3A4, and it is excreted from the body in the urine.[6][7][8]
https://www.ncbi.nlm.nih.gov/books/NBK538260/

They are still pinning down the exact locations and impacts of the negative & positive feedback loops for estrogen in perimenopausal and postmenopausal women. It is very well understood in menstruating women.

But the sum effect is that HRT surges your estrogen and progesterone levels, this then kicks off the negative feedback loop signalling the body to reduce its own production. Stopping HRT takes you below the presurge, preHRT level until your body gets the message and restarts producing what it still can.

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 think it is contradictory when you look at who is in each group.

The two groups have vastly different risk profiles for developing a new case of cancer though. Women on HRT are 100% low risk for cancer and have never had cancer before. Women not on HRT include some low risk for cancer and some who have never had cancer before but also 100% of the women who are high risk for cancer and have had cancer before.

The second group is much more likely to get cancer than the first group. The second group are the only group with a risk of recurring cancer or missed cancer (declared cancer free but they weren’t really). The deck is stacked There is no control group for each.

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.

This is a good rule of thumb tbh, there is a risk free 5yr window for HRT for breast, ovarian and endometrial cancer unless you are a cancer survivor of any kind of cancer. So every woman who has never had cancer should feel safe to at least try HRT if their symptoms are difficult to cope with.

I still take HRT in my 60s and actually increased my dose a few years ago. It's for so much more than hot flushes.

@LoremIpsumCici HRT is not contraindicated for any sort of previous cancer. (If you are sure it is, a link would be helpful.)
It's also even possible for some women (depending on certain factors) if they have had Stage 1 endometrial cancer.

That doesn't actually say what you wanted it to.

You've not linked to the sources. (Just one link at the end.) This is not about HRT.

Women post menopause are not 'menstruating women'.

Their ovaries are empty.

I'm not sure what the point of this is.

No older , post meno woman is going to get her estrogen back once she stops HRT. And for younger women, it's topping up their falling levels- hence the tern 'replacement'.

The reason for a better outcome sometimes for women who develop BC when on or having used HRT is that they are usually having more mammograms, often out of choice, so it's picked up early.

The other reason is that (for some mechanism not fully understood) the type of cancer in women who have used HRT and develop BC tends to be less invasive.

Never heard doctors say erectile dysfunction is 'over medicalised'

I wonder if there is a cost consideration? When I mentioned it in passing to the ‘Associate GP’ (or whatever the non-gps they fob you off with these days) she pulled a cat’s bum face which meant no way are we prescribing you that unless we have to!

Where is your original post about accessing HRT? Are you having issues?

I think HRT is actually pretty cheap I think?

This is true, it males had the menopause it would be a totally different situation I imagine, its like they even talk about how a man losing his sexual ability as having an impact on his mental health but when women have similar issues its dismissed as a natural part of aging and just to suck it up.

I totally agree when I started it a few years ago I ached every morning when I woke up, I was so tired nearly all the time, my mental health was poor and I felt like I was done as a viable person in many ways and this is all without the hot flushes and night sweats. I felt like a new person within weeks of starting it.

HRT is cheap.
I pay for mine (privately) and it works out at around £22 a month or so. Less than £1 a day. And that's the retail price with the pharmacy dispensing fee added, so the cost to the NHS will be less.

No women are being refused HRT because of cost.

@JinglingSpringbells Can I ask how that works for you? Did you go to a private doctor to get the prescription and it can just be repeat filled via pharmacy? I am just seeing if that could be an option for me if my GP ever says I need to come off when there isn't any medical need to.

If your GP says that, you would be best to challenge them and show them NHS guidance or this https://thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/

Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.

If you want to use private medical care, you need to decide who to use and each doctor has a different way of working.

Some will inform your GP of the meds required and that's transferred to your GP/NHS for repeats. And that usually means your GP takes over your care and reviews.

If you stay with a private dr, to have your HRT reviewed or for meno advice, they will issue the prescription to you- often posted- and you take it to the pharmacy.

One of the GPs at our practice said “the lowest dose possible for the shortest time possible” to me.
I’ve not been back to her either.
Luckily we have another one who has an interest in it.

My GP told me she has a patient in her 80s on HRT and expects me to do the same…yours is 40 years out of date!

HRT is not routinely prescribed in the US because it increases the risk of heart attack, stroke and cancer while you are on it. I got through menopause fine without it as did all of my female friends. Take evening primrose oil and use natural progesterone cream. They are sold OTC here and work wonders without increasing health risks.

OP's GP is spouting rubbish. However, when I first began HRT (way back when!) my menopause consultant did warn me that if I ever stopped taking it symptoms like hot flushes would occur.

At one point a few years ago my GP was worried about breast cancer scares (since refuted) and I came off for a few months without any symptoms. BUT I had bone density scans that illustrated osteopenia in my spine and full blown osteoporosis in my hip (I think). I insisted on going back onto HRT and my bone density improved as a direct result.

At the age of 76 I plan to continue HRT until my dying day. It works for me even if other women find it doesn't work for them.

Are you living in the US?

The WHI study from the States it now 22 years old and has been discredited many times, internationally. If this is the basis for your opinion it would appear that the new research (not a flawed study 22 years ago) hasn't been shared with US women.

One of the main points is that HRT protects against heart disease and stroke (but needs to be started within 10 years of the last period.)

Natural progesterone doesn't work as a cream. It can't be absorbed and metabolised.

In the UK the RCOG has looked at all the science behind alternative therapies. EPO is no good for menopause.

Its weird she is a woman not that much older than me, its odd how outdated her knowledge is!

Evidently, in med school, students get half a day on menopause.

There's no excuse for not learning more once they leave med school.

There is LOADS info online that even a child could access with some google searches including the NHS site where it says clearly that there is no time limit.