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.

You need a DEXA scan ideally more than every 5 years.

I have one every two years (and have for almost 20 years.)

The NHS is woefully behind on this. The ROS has been pushing for more screening and getting nowhere. It seems crazy that women are being pushed to have screening for cervical cancer when the deaths are very few each year, yet 100,000 women die each year from complications of osteoporosis (usually falls, hospitalisation, pneumonia, etc) or have 10 years of disability before they die.

I'll get off my soap box.

@JinglingSpringbells I have ovarian cancer which is not screened for and a deadly diagnosis because Drs don’t seem to think about it

I do appreciate screening for ovarian cancer is not simple - before someone tells me that

But there would be no harm in offering a Ca125 blood test to women on HRT. My cancer could have been picked up 7 months earlier if the specialist nurse I saw had just done that blood test.

If as a woman you get unexplained new gastrointestinal symptoms or abdominal bloating, that you think is menopausal weight gain - I would ask for that blood test, and preferably an ultrasound too

I'm really sorry.

OC is easily screened for (if you pay for it or have a referral because of family history).

The C125 test is very inaccurate. It can be high for all kinds of reasons including benign conditions. I had an ovarian cyst some years ago (sorry this is all about me) and was screened every few months for a long time on the 'watch and wait' policy. I had a C125 test but was told that whatever it showed, it could be inaccurate either way. I now have an ultrasound regularly, but not provided by the NHS.

I agree that women need to be better informed by looking for signs, but also appreciate that a lot of screening is available beyond the NHS if they are able to fund it.

The NHS tends to work on the basis of being reactive, not preventative.

I'm sorry you are going through all of this.

Sadly, women's health and screening doesn't feature often until symptoms are there.

@JinglingSpringbells I have a genetic syndrome which puts me at higher risk of several cancers, including bowel, endometrial and ovarian. The risk for bowel cancer is by far the highest and regular colonoscopies are performed to screen. However having a hysterectomy and oophorectomy after age 40 (and family is complete) is part of the recommended protocol because ovarian cancer actually isn’t easy to screen for. Ultrasound is unreliable and not every tumour produces ca125.

This info isn’t meant to derail the thread, by the way. When I started HRT I was told a small risk of ovarian cancer - didn’t think it would be me! No family history of relevant cancers

I just don’t think Drs think about it, either - because early symptoms are so vague.

I absolutely see the point in HRT, but I think we need to be aware of the risks.

I don't care if HRT reduces my life, it has already given me 10 years of a life I wouldn't have had otherwise. The GP should be sacked, how dare they act like they are God, they are not even particularly well trained as doctors let alone complex issues. Sometimes, living in the ME I do find religion comes into it. 10 years ago HRT was generally seen as against God's plan but luckily that has fizzled out but I do find that a lot of friends who are British Muslims are much more devout about this and other interventions, for example anti depressants. But not IVF, that's ubiquitous.

I have been on HRT now for 26 years following a hysterectomy in my very early 40’s. I feel good and never intend to come off it.
My GP gives me the yearly talk about the risks and how I probably should consider coming off it but then agrees I’m fine and gives in for another year.
When I was last at the dentist for an implant he remarked how strong my jaw bone was, I put this down to the HRT.

Like most things in life there are pros and cons to everything but for me it’s worth it.

It is maybe a small risk and being honest, the jury is still out on it.

There is a big debate about it with research showing there may be an association but no real proof. Some of the stats show one extra case per 1000 women over 5 years (for women using it for 5 years.) Which is the same as saying 1 extra case per 5000 women in a year but even that is not proven and other research says there is no absolute evidence.

I know this isn't helpful to you, but it might be worth bearing in mind that your use of HRT didn't cause it, as no one can be sure.

I'd have to disagree with the ultrasound. It depends on who does the screening and their level of training.

It all boils down to risk and reward and how we view it.
Personally I’d prefer a shorter life of better quality. So if my HRT allows me to work and remain a functioning member of society I’d much rather do that than have the miserable existence I had before.
The breast screening is interesting, I’ve seen a friend have irreversible lung and heart changes because of treatment for something for which someone else might have adopted a watch and wait approach.

One piece of information that women need is their breast density.

My understanding is that this is not reported/info given to women after an NHS routine mammogram, yet it's visible on mammograms.

There are 4 types of density from 'fatty tissue and not dense' to 'very dense'.

If you have a mammogram not through the NHS, that information is usually on the report.

The reason it's relevant is that statistically women with dense breasts have a higher risk of BC (this is not about using HRT.)

Sometimes HRT can cause breasts to become more dense and also make it harder to identify changes on screening.

Knowing this can help you decide if you want to have more screening (outside the NHS) and help your decision over HRT.

That’s really interesting. Thank you

It's beyond my comprehension why the UK is the only place where you can't just go for a mammogram when you want one. It's about £50 where I am and during breast cancer month in O tober, the government reimburse even that if you are over 40 and haven't had one for a year. Why is access to basic medicine so guarded in the UK? It's my bloody body, I can't imagine some dopey middle aged GP because they weren't clever enough to be a consultant deciding whether I live or die. I have been to 3 funerals of under 50s recently, all killed by GPs refusing to refer serious symptoms of women's cancers.

You can.

Many private hospitals offer them and if you're in London or can get there, it's very easy.

They aren't £50- more like £200-ish which includes the feedback from a consultant looking at it.

I agree, the CA125 isn’t perfect, but it is so cheap to do! There is no excuse imho for how women’s health is so neglected

I can get one at any polyclinic, see a specialist immediately and then receive the detailed report the next day. Not beg some half arsed GP for a referral and then pay through the nose. I did my last one in a shopping mall clinic while I was waiting for my takeaway to be ready.

Are you in France?

Here, it's not always necessary to have a GP referral. It's possible to make an appt and self-refer.

I am glad you mentioned the fact that X-rays cause cancer and so the mammogram spacing is for good reason. It’s the same reason the dentist cannot do X-rays all the time too.

However, for breast cancer you can screen using ultrasound. Ultrasound is ideal for dense or lumpy breasts.

BUT it is more expensive and labour intensive so not often used.

We also know more about cancer signs in our blood, there are approved screening tests that can pick up literally a dozen different cancers. The NHS is trialling the Galleri one that can detect 50 cancers!!

https://news.cancerresearchuk.org/2021/09/13/the-galleri-multi-cancer-blood-test-what-you-need-to-know/

I hope that the NHS can be properly funded such that every person can be tested regularly with a test like this in the very near future,

There is a difference between mammos and ultrasound.
They aren't the same or as accurate.

In the UK (are you in the UK?) they always prefer mammos and then if anything is found they do an ultrasound.

Ultrasound is used to examine lumps or other abnormalities picked up on a mammo, but they don't always pick up lumps across the entire breast.

They use them in younger women under 40 who usually have denser breasts.

I realise that they are different and one is better than the other for different aspects- ie mammograms spot calcification while ultrasounds can see difference between a tumour and a fluid filled cyst,

Both are a form of cancer screening and if you can’t have a mammogram frequently because it has its own risks, then adding ultrasounds between mammograms is better than going 1-3yrs with no screening.

So I’m saying we can add screening, it’s not mammogram or ultrasound, but do both.

There are also breast MRIs…but again that’s expensive.

Yes, that's right.

It's even more important to have HRT if you have early menopause.

I'd make an official complaint and see a different GP.

Thank you everyone who has shared their knowledge on this thread - both the benefits and the risks. I can't help but think this should be required reading for GPs.
I'm with those who've decided to keep going at least until retirement.

My gp said that opposite, that I should stay on hrt as its better for bone strength as I age.