Am I missing out not taking HRT?

[pingpongding]

I'm nearly post menopausal. Not taking anything. Have some mild flushes and my sleep isn't great anymore plus few joint aches. I'm wondering though if I'm missing out by not taking HRT?

Friends swear by it and how improved their lives are plus the other health benefits.

I'm also concerned the worst is yet to come (waves to atrophy).

So, am I missing out?

I don’t take anything apart from vagifem pessaries when I remember. Every single one of my friends swears by hrt. I want to ride it out. I am 54. Thought I had reached the menopause but started bleeding. After tests consultant recommended progesterone only hrt which GP won’t give due to my mental state. So not taking any. Never had a hot flush either.

I managed to get HRT to suit me after 3 attempts and it's been good, not this amazing life changing thing I hear about, it's helping manage symptoms.

I'd say if you can afford private, why not try and see? It won't do any harm.

Sport mention add my plan is to stay on it past menopause for the long term benefits.

If you don't need it you're not missing out.

I went six years without it and finally caved because the poor memory and brain fog started to affect my job.

I'm back on track now having been on it for 18 months, but like a PP I don't see it as a miracle cure.

Despite being a fan of chemical assistance, I don't believe in taking drugs you don't need. If you feel okay, you don't need them.

Couldn't function without it😁. I take magnesium daily also (helps me sleep)

i'm too old to consider it (67 and post meno for over a decade). i wish i had taken something for no other reason than to prevent osteo and cardiac disease.
i had very few peri-or meno symptoms so did not see the point at the time.

I think it's better than sleep aids and pain killers, but I also had memory loss, brain fog, trouble with word retrieval, loss of libido, the dreaded atrophy, anxiety, lack of motivation, low mood, and the most awful one, fatigue. I feel 20 years younger when my hormones are balanced.

There is a lot to be said for the host of other benefits such as:

&bull;	<a class="break-all" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178928/" rel="nofollow" target="_blank">reduced risk</a> of cardiovascular disease
&bull;	<a class="break-all" href="https://alzres.biomedcentral.com/articles/10.1186/s13195-022-01121-5" rel="nofollow" target="_blank">improved</a> cognitive function
&bull;	<a class="break-all" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227948/" rel="nofollow" target="_blank">improved</a> sexual function
&bull;	<a class="break-all" href="https://pubmed.ncbi.nlm.nih.gov/10912438/#:~:text=Recent%20use%20of%20HRT%20was,of%20use%20was%20not%20significant." rel="nofollow" target="_blank">reduced ris</a>k of colorectal cancer

Depending on the dose and duration, HRT may reduce a person’s risk of developing certain chronic conditions.
These include:
• bowel (colon) cancer
• cataracts
• heart disease
• osteoporosis and bone fractures
• type 2 diabetes
• endometrial cancer

On the flip side HRT may increase the risk of stroke and breast cancer although these risks appear only to be associated with tablets, not patches or gels.

From my perspective, we are living far longer than we were perhaps designed to and that means a very long time without the benefits of or reduced levels of oestrogen, progesterone and testosterone.

The problem with things like osteoporosis and certain cancers is you can't just start taking HRT once they develop. It's too late.

On balance it seems there are greater risks associated with not taking it than taking it.

Yes, @HucklefinBerry, I've just restarted after 7 years because of:
worsening symptoms;
the availability of combined transdermal patches, which show massively reduced risk profiles.

It's still a fact, though, that many women have always weathered menopause and old age in sturdy good health.

It's never a bad a idea to look at your mother and her mother: mine suffered increasing cardiovascular issues with age, and my mum has shrunk. Neither really started 'ageing' until their seventies, which is why I've decided to get patches now (69). I look older than they did, but that's the after-effect of a hedonistic lifestyle 😁

If we were still looking at oral delivery, I wouldn't have done it.

That's great you can access HRT at 69. Lots of doctors won't when women are past 60.

I do wonder though if the benefits are still there when starting later.

Bone density for example won't improve. It will help prevent further damage but it won't redensify. Sadly some things once gone can't be replenished.

Hopefully the heart benefits can still be there

I don’t take it. Am 53. I have some symptoms (sleep, but have done a lot help that with an eye mask and going to bed earlier). My joints used to ache but increasing exercise has helped that.

am exercising more, lifting weights, and eating healthily. I know it’s heavily marketed these days but I don’t want it and there are increased risks of various cancers on the downside. The evidence for & against is confusing, there needs to be more research and it isn’t as clear cut as either camp will insist.

I would look into it if I developed raging anxiety or my symptoms impacted on my daily life but they haven’t yet. I am also aware of vaginal atrophy and thinking about localised protection.

There was a recent thread where there were a lot of people not taking it -might be worth reading that as well.

If you feel you’re coping without it, then don’t take it. I never took it although t did take epo for the flushes for a while.

I think taking or not taking HRT is a personal choice really. It does sometimes feel as if not taking it is seen as a badge of honour a bit like giving birth without painkillers (my mother certainly boasted about not taking HRT, ended up with osteoporosis, dementia, cardiac disease and at the end Breast Cancer) and certain did not sail through the menopause and frankly was a nightmare to live with which was something I was very aware of when I hit the same age).

You need to do your research. I found the balance app by Dr Louise Newsome very informative. I’ve ended up taking Oestrogen gel, micronised progesterone and testosterone gel - all of which was prescribed to me by my NHS GP having attended the local menopause clinic and seeing a consultant there. The information from the app gave me the confidence to ask for what I wanted rather than have something foisted upon me according to availability or cost. I know it can be a bit hit and miss at surgeries but unless it is completely avoidable I would try and get what you need from the GP. Be aware that guidance as to how or when to take HRT is pretty rubbish so do your research there too. I have found that for me taking hormones before bed works - progesterone promotes sleep so that does help. And avoiding eating for a couple of hours before taking them reduces any nausea.Testosterone for me was the game-changer in terms of libido and return of brain function but I did take the other two hormones for 6 months to see if I felt better before adding it into the regime. It definitely works for me.

Joint aches, low mood, itchy skin, dryness, energy levels, low libido, insomnia and flushes have all gone now. The only thing I thought HRT would help with is weight loss but the reverse has been the case really. Still, I’d take the extra stone and feel more like 20 year old me any day. Obviously diet and exercise play a part in all of this. However the big push for me was being told I was absolutely horrible to live with. My Dad never broached the subject with my mum but I know what I lived with growing up so I appreciated him telling me how miserable I was making the family. Obviously I didn’t want my kids putting up with what I had to put up with so off to the doctors I went and I never looked back. Rod Stewart’s wife Penny described a similar conversation.

I feel brilliant, my friends of a similar age would have feelings which range between fantastic, game-changer, meh, great, no discernible difference and I couldn’t get on with it. Everyone is different so you need to listen to your body and proceed accordingly.

I’m 51 and I’ve opted not to take hrt for a couple of reasons . One being that I’m concerned about the cancer risk . The second is more prosaic , I can’t be bothered with sorting out a regime that suits me . I genuinely believe that it’s a matter of personal choice.

It's a very personal decision and I'd recommend the Balance app or reading Perimenopause power book.
You really need to do some research because there's a lot of urban myths. For example, PP described it as drugs but it's not really drugs in the conventional sense of the word. It's replacing hormones not introducing a new compound into your body. The risk of breast cancer is poorly understood as based on an old study which used different types of HRT to that used today and, for example, women who had had a hysterectomy actually reduced their risk on HRT.
I have personally weighed.up the risks outlined by @HucklefinBerry and decided on balance the cardio vascular and osteoporosis risks were higher for me than anything else and I take it with good results, symptoms reduced etc.
But basically do the research !

I'm just finishing my second month of HRT aged 54 and a half. I had been trying to avoid it as I had DCIS aged 46 and my mum died of breast cancer aged 46.

I'd been struggling through with peri symptoms since 2016 and was still having regular periods then from January my anxiety went through the roof as my periods became more irregular and I could see the it was a physical cause. I took myself to a spa for three days and even in the spa pool with nothing to worry about at all my heart rate was racing and I could feel the adrenaline coursing through me despite all the meditation and relaxation I could try 😢. I couldn't sleep and just wanted someone to take it all away. I was also pretty horrid to live with.

It settled a bit with regular periods in Feb/ March but then all came back with a bang in April/ May to the extent that I thought I was going to have to give up work as I just couldn't cope.

I went to a private clinic in May, started HRT at the end of May and it has literally been life changing. My anxiety and fatigue disappeared overnight, I discovered a joy and interest in life that I didn't realise that I had lost. My hip pain that worried me (dad had osteoarthritis) has also vanished. My heart rate is down and I've just coped with an exhausting and challenging 7 weeks at work that would previously have seen me on my knees.

I've been lucky that the oestrogen patches clearly work for me, I'm struggling with getting the progesterone level right but I'll get there and I know that there are multiple options to try.

As PP have said, we are all different and should follow our own path. I'd never said never about HRT but had tried to avoid it because of the potential BC risks. It's a balance though and I definitely reached a point where I had to give it a go. Do I wish I'd started earlier? Sometimes yes as I hadn't realised just how much I was struggling and how bad I felt.

Good luck OP, I took the view that I'd try HRT for 3-6 months and if I couldn't make it work for me then I hadn't lost very much.

I involuntarily went through it without hrt in my 30s and i wouldn't recommend any woman go through it without hrt if their menopause is even close to how I experienced it.

Yes, but the health benefits are clear. Decreased oestrogen is responsible for higher rates of osteoporosis, cognitive decline, heart problems. Hrt is very beneficial.

Agreed, but you can start or restart it if you develop a need - as I'm doing. Let's not forget that a fair proportion of women stay strong & healthy well into old age. I'm not advising anyone, mark you! Just observing that HRT doesn't seem universally needed.

@CurlsnSunshinetime4tea I'm wondering if you've been told you are too old by a GP or you just imagine that's the case?

It's not too late. Women over 60 are definitely allowed to take HRT as long as they start on a low dose and use transdermal products.

Not clear if you already have osteoporosis or heart disease? If it's heart issues then you might not be able to.

Otherwise, you could investigate it if you still have symptoms or need it for bone density.

My consultant has started women aged 80+ on HRT.

But also let's not forget that 1 in 2 women over 50 have a fracture due to osteoporosis.

And that 100,000 women die each year from complications of falls/ fractures.

It's national scandal no one talks about.

@HucklefinBerry I wonder where you're getting your info from that bone density won't improve for older women using HRT?

HRT is actually licensed for the prevention and treatment of loss of bone density and is regarded as being equal at least to other drugs for that condition.

If GPs are refusing HRT for women over 60, they are either ignoring the guidance or not aware of it.

The BMS has very clear guidance on use of HRT over 60 and it's absolutely 'allowed'.

Your other point about heart benefits.

No, the benefits aren't there. This is because the damage and deterioration to the arteries has already happened. The risk of too high a dose of estrogen (initially) for older women is that estrogen opens up the blood vessels and could cause plaque to slough off and cause clots. Transdermal estrogen has fewer risks but older women start on a low dose.

It's actually sad that this info is not getting across.

Transdermal estrogen has fewer risks but older women start on a low dose.

Thanks for this, @JinglingSpringbells. My patches have just arrived, so I looked it up and am cutting them into quarters for at least the first couple of months.

Knowing my history with patches & plasters, they'll probably keep coming off and I'll be glad I'm only wasting small ones!

I had an earlyish menopause, finished at 45. No symptoms except vicious night-time hot flushes. GP put me on citalopram, a very low dose, and that was sorted. My bone density is excellent and all other measurements are too. Sisters are similar. We all walk a lot and I am sure outdoor exercise helped us all.