Should I ask again for HRT?

[NewNameNewMeNow]

I’m worrying about the longer term impact of not being on HRT even though I don’t feel I really need it now. I have had 3 periods in the last 2 years and am hot a lot of the time (no hot flushes at all though) but apart from that I’ve been really lucky and had no symptoms apart from a bit of tinnitus and some itching. But I have rheumatoid arthritis and osteopenia and am really concerned about osteoporosis in the future. I had a phone appointment about this a year ago and the doctor said no to HRT but I am wondering if I should insist. Do you think it’s okay to use it as a preventative measure rather than as treatment? Thanks for any advice.

I went on HRT originally purely to protect against osteoporosis as I had an early menopause and was doing ok but had a sneaking suspicion i could feel better. 5 years later I’m still on it. A dexa scan confirmed my bones are in good shape and I’ve no intention of stopping any time soon. My GP was more than happy to prescribe on a preventative basis and it turned out I did feel better so was a bonus all round.

I am not sure if it’s up to your doctor unless there are other medical concerns. I went on it with RA and resultant osteoporosis age 60 and should have gone on it at 50 to prevent that happening. You are already heading there if you have osteopenia so I would be more insistent if you have done your research and that is what you want.

My GP who has a special interest in women's health told me it would be better for my health to go on HRT, even thought I had no menopause symptoms or any other issues at the time.

Why did doctor say No to HRT for YOU, OP?

I take it to prevent osteoporosis and heart disease, although I believe in the Nice guidelines it isn't meant to be prescribed as a preventative treatment, but I stand to be corrected on that. It may be worth saying that you want it for symptom control if they won't prescribe as a preventative only? It might also be worth seeing a different gp.

They said it was because I’m not having symptoms. I suppose if it’s correct that it’s not meant to be preventative then that will be why. There’s a lot of heart disease in my family and I have been on NSAIDs for over 30 years which I believe is also a risk. The osteoporosis is what worries me most though. I think I’ll try again with a different GP if possible.

Bear in mind that symptoms can include low mood and anxiety, plus brain fog, so don't hesitate to mention these if they apply!

Pretty much every woman ought to be on HRT for bone health. No one should be gate keeping this, it’s just misogyny in women’s health.

HRT is prescribed for osteoporosis and that's well established. The BMS and some consultant endocrinologists say it's preferable to use HRT for women under 60 with established osteoporosis rather than other drugs which have potential side effects.

It's not in theory prescribed to prevent bone loss other than for women with POI.
But it can of course be prescribed for menopause symptoms and (in effect) help manage bone loss that's at the osteopenic stage.

If you have been diagnosed with osteopenia who did that and why?
You must have had DEXA scans. Are you seeing a rheumatologist?

What direction is your bone loss heading in and how fast? Do you know your T and Z scores?

I have had 3 periods in the last 2 years and am hot a lot of the time (no hot flushes at all though)

So you do have symptoms- you feel hot all the time.
You could say these are vasomotor symptoms (which they are) and that means you can have HRT.

Tell your GP you have these symptoms and ask for HRT.

The reason NICE makes these statements is that on a population level, they decide the risks or COST of HRT may outweigh the benefits for most women. (But we don't know what stats they have looked at to make that choice.) They also refused to offer routine DEXA scans as prevention to women over 50 even though the ROS campaigned hard for them. It's all about money usually.

But you aren't 'most women' - you already have bone loss. It should be managed on an individual level.

Thank you so much for your help. I am going to make an appointment armed with facts.

To answer your questions - I was diagnosed with osteopenia over 15 years ago by my rheumatologist after a DEXA scan. I had yearly scans till 2020 showing no further deterioration but I haven’t had one since they stopped routine appointments during covid. I requested one last year but have not got appointment yet. I have no idea about my T and Z scores. I see my rheumatologist every 6 months as my RA is well controlled with medication at the moment.

Thanks again for giving me the push to try again.

Why did doctor say no if at risk of osteoporosis? I paid for the BUPA menopause service and the GP has been doing the repeats. I had night sweats though…

Op, this is such a relevant thread for me, thanks! How old are you?

I'm 48 and also have RA, also a STRONG family history of heart disease. My only peri symptoms are joint issues , fatigue (Or is that the RA, I have no idea?!) and maybe some anxiety. I'm weighing up whether to go on it for joint pain and fatigue, and for heart and bone health. OK and hairloss.

I half mentioned it to my Gp last time I saw her and got the impression there was no issue.

I’m 49. It’s so hard to tell if the joint issues are peri or a flare, isn’t it? I hope you find the right answer for you.

Going back to a previous point OP, you have a legal right to see all your data, so ask for your dexa scan results.

My gosh, it's so hard! I think either my medication, or my RA, or my anaemia is causing me bad fatigue. But it might be peri. Except last week, they also suggested fibromyalgia too! I literally have no idea why I feel so bad. But maybe HRT will help address one possibility, and also hopefully protect my heart and bones a bit.

I think I'm going to give talking to my GP about it a go...

Me too, thanks everyone.

If you don't need medication (which it sounds like you don't), then I don't know why you would go through the hassle, risk and stress of obtaining and taking it. But then lots of people medicalise perfectly normal life "stuff", so I guess it's up to you.....

@Cynic17 did you read my opening message to the end? I think I was quite clear about why I am considering this. But thanks for your input.

I hope you got your HRT OP. I'm also RA, sailed through the menopause, a bit early and paid for a private DEXA this year at 67 that showed a vertebra at minus 3.9/5.

Please insist until you get it.