Massive dilemma about whether to take HRT (fibroids, health anxiety)

[Jobs4kids]

At the risk of echoing another recent poster that I know a few of you got a bit frustrated with, I'm having a massive dilemma about starting HRT. What doesn't help is that several GPs and a gynecologist seem unable to advise me!

A bit of background, I'm nearly 58 and still haven't reached menopause which gynecologist told me is rare. Having said that, I haven't had a period since mid January (never missed one before in my life), although I did have a tiny bit of spotting in early Feb, but since then nothing. Therefore, I'm hopeful the end is nigh! Prior to that I was having regular but erratic periods with lots of in-between spotting. I ended up having an ultrasound in December due to a month long period in November which needed progesterone to stop. The scan showed nothing but multiple small fibroids which I have a 10 year history of and have had 3 operations to have resected, last op was 3 years ago. Every time they grow back. As a result I've been reluctant to take HRT as I know the oestrogen can make them grow.

However, I feel I need to do SOMETHING due to the following which I presume are menopause systems:
Anxiety, particularly crippling health anxiety
Irritability, mood swings, poor concentration
Brain fog/forgetfulness, some days I literally don't know if I'm coming or going, I'm forever losing things & forgetting to do things
Joint aches & pains
Restless legs
Poor sleep
Dry mouth
A bit hot & sweaty during the night
I was told a year ago I had mild vaginal atrophy for which I was prescribed estriol. The only symptom I had was occasional slight bleeding when wiping, no dryness or soreness. Therefore, I didn't use it until a couple of weeks ago as I was scared of the oestrogen risk to fibroids but have since realised it doesn't apply to topical HRT! Not noticed any benefits so far.

I can't go on like this and want to go back to my GP to discuss the possibility of HRT. However, based on my previous experience I think I need to know what to ask for as it seems they won't tell me what I need!

As I said, I've avoided HRT to date because I don't want my fibroids to get worse. I exercise regularly, try to eat healthily l,'m fit and am not overweight. I take Menopace which possibly helps a bit (the night sweats have stopped) but clearly not enough. I cannot take antidepressants due to a bad experience with Sertraline a few years back. This has made me scared of taking any drugs apart from Menopace tbh. I did CBT for the health anxiety a while back but it didn't help much although I'm trying to work through the exercises on my own with limited success.

I do feel my issues are hormonal, as my problems, particularly my health anxiety, ramped up massively when I stopped the combined pill just over 4 years ago. The mini pill was suggested but progesterone brings me out in terrible acne (bad experience with Merina coil which caused acne and constant spotting!)

Thank you for reading if you've made it this far. My health anxiety together with my fibroids make me very worried about HRT but I feel I may be out of options.

Would be most grateful for advice 🙂

I hear you :)

I honestly think it's better to do anything than be paralysed with anxiety.

First, has anyone suggested a hysterectomy for your fibroids? Are they 'that' bad? is it something you'd consider? Or have the drs said they will reduce once you're post-meno? (Which is what they tend to say.)

Although you aren't technically post meno, you could possibly use the type of HRT that is for post-meno and is a no-bleed type. You're pretty old now for periods and it's likely they will stop soon.

Fibroids grow when stimulated by estrogen. But no bleed HRT balances the estrogen with daily progesterone so the womb lining (and fibroids) won't grow.

If you don't want another Mirena, you could use any type of estrogen (it's personal choice) - gel, patch or a tablet.

For the progesterone side you could take micronised progesterone as a daily pill (which is body identical), or Norethisterone (which is stronger and may control your fibroids more) and it comes as part of patches or as a pill taken daily.

Many women find gel better than patches as you can change the dose yourself rather than having to see the dr for a different dose of patch.

@JinglingSpringbells thank you so much for replying. In answer to your questions:

First, has anyone suggested a hysterectomy for your fibroids? Are they 'that' bad? is it something you'd consider? Or have the drs said they will reduce once you're post-meno? (Which is what they tend to say.)
Yes, this was mentioned when the fibroids were first diagnosed 10 years ago but, even then, I was told they would shrink post meno and I must be close. If only we knew I'd still have periods 10 years later! It's been revisited a few times since but we always concluded meno must be close so probably not worth it! I'm apparently not suitable for keyhole, so major surgery. While the fibroids have caused horrendous bleeding in their time, it's been pretty light since the last op 3 years ago, just persistent, erratic and longlasting. For the last year my periods have been mostly more like spotting.

Although you aren't technically post meno, you could possibly use the type of HRT that is for post-meno and is a no-bleed type. You're pretty old now for periods and it's likely they will stop soon.
One of my fears about taking HRT is that it would kick off the bleeding again when I'm so close to stopping, so a no-bleed type would be good, assuming the GP will agree to it.

The gynecologist I saw just recently said he was sure my periods will stop very soon as he has met very few women as old as me who still have periods! I'm to go back if I have another long bleed like I had in November. As to HRT, he didn't seem to have an opinion and told me to discuss with GP.

One last question, presumably whatever HRT I have (bleed or no bleed) I won't know if I've actually gone through meno, will I?

Thank you for making the options clearer.

One last question, presumably whatever HRT I have (bleed or no bleed) I won't know if I've actually gone through meno, will I?

No one does if they start HRT before their periods have well and truly stopped.
The stats are that by age 54, 80% of women are post meno.

Quite strange that the gynae you saw didn't have any advice on HRT.

Is going for a private consultation an option? The problem with specialists is they all have their own specialism and not all gynaes are up to speed on menopause or HRT. It sounds ridiculous but it's true.

Its also not out of the question that if you needed a hysterectomy in order to use HRT for your quality of life, you could ask for one - or again, there is the private option if that's affordable. Not to be done lightly, but something to consider and again, just because one dr has said it couldn't be done by keyhole or vaginally, that doesn't mean it can't be- all depends on the expertise of the surgeon and there is a massive difference.

Thank you. Slightly confused though why I'd consider having a hysterectomy for fibroids that aren't causing issues atm as you suggested "no bleed HRT balances the estrogen with daily progesterone so the womb lining (and fibroids) won't grow."

Because you won't know for sure until you try it. And some women are progesterone-intolerant and find it hard to find a sort that is acceptable.
One way round that is long-cycle (using it every few weeks not monthly) but for a woman with fibroids that may not work.

My fibroid ( I wasn’t aware I had one) grew rapidly when I started HRT. You are lucky to be aware and not start.
mine grew to nearly 10 cm (6 months pregnancy size) and I went for a uterine embolisation (rather than removal/hysterectomy). Thereafter I have continued HRT and planning to have my 1 year scan soon. I don’t have any choice on HRT as I suffer from debilitating drenching night sweats every night, insomnia and acne if I stop. It’s unliveable. But I am worried about fibroids and so I have stuck to the minimum dose. Recently found a Fibroadenoma in my breast and it has worried me even more about HRT. there are no easy answers - we simply have to choose the LEAST of evils.

in your position I would find alternative remedies and ride out another year/two until period stop. And then start HRT minimum dose.

in your position I would find alternative remedies and ride out another year/two until period stop. And then start HRT minimum dose.

@DoItLikeAWoman Why do you suggest that? HRT can stimulate fibroids so waiting till OP is post menopausal won't make any difference.

I have small fibroid and I wasn't told that for these small ones hrt would make them grow.
If it's a risk then why not try it and get a regular scan?

Ah, still not sure what to do as it would be a shame if HRT caused them to grow now I'm so close to menopause when they will presumably shrink or disappear. Having said that, I was on the combined pill for years and whether they caused the fibroids I will never know but they have always been small (but problematic due to their location in the womb lining). I came off the pill over 4 years ago but they still grew back after my last surgery 3 years ago, so the pill definitely wasn't responsible that time!

It's not a one-way street. You can try HRT for 3 to 6 months and see how you feel. IF HRT makes your fibroids grow, stopping it should make them shrink to how they were, especially as your own estrogen will continue to fall.
Why don't you just try it?

I have been told by multiple doctors that post meno fibroids are unlikely to develop or grow bigger. The HRT minimum dose is unlikely to fuel the fibroid growth by itself if the body’s estrogen is very low. Hence I think if at all OP wants to try HRT this might be the ideal time. But it would be safer to keep scanning to check growth and make an informed decision.