Do you really age dreadfully without HRT?

[Lia73]

I'm just about postmenopausal at 52, no period in a year. I've had a few hot flushes and a bit of trouble sleeping but other than that (and some dryness) feel OK. I take vitamins and am fairly active. We have menopause meetings at work and along with my Instagram feed, everyone seems to be on HRT. I keep hearing and reading that women on HRT look younger and age better than those not on it. I'm an older mum so want to look and feel as young as I can for as long as I can...now I obviously wouldn't go on HRT just for appearance sake. I do appreciate it's absolutely essential for some women too but I'd like to hear from those NOT taking it...are you doing just fine without it?

The evidence on HRT and dementia is mixed and pretty poor quality - a lot of the data comes from population studies, like this one, which can only show correlation not causation. It's quite possible that the women who took HRT in this study share other factors which lead to higher dementia risk. I'd say it's a similar picture on heart health. On the flip side there are some promising studies suggesting HRT can improve markers that are generally linked to heart and brain health, but it's not clear whether this would translate into long term benefits. Long term prevention of illness is always the hardest to get good data about because studies that are randomised and long enough to show whether there is an effect are expensive and rare.

Osteoporosis prevention and relief of immediate symptoms are the clearest reasons to take HRT. If you don't have menopause symptoms, it's still a good idea to check your family history and if there is any evidence of osteoporosis or worryingly easy fractures, get a DEXA scan to assess your bone health. I don't know about HRT and osteoarthritis as I think that is a different sort of bone. But it's pretty clear that HRT slows the rate of trabecular bone loss which tends to accelerate after menopause. Women on HRT have been shown to have a significantly lower risk of hip fractures, which can be devastating. I started HRT when I had mild peri symptoms mostly because I was worried about osteoporosis due to my family history, and shortly afterwards was confirmed as having osteopenia. Weight bearing exercise can help with bone health, and I do it regularly, but my mum has been active all her life and still got osteoporosis so I wanted all the help I can get.

@Lia73 Going right back to your original post I'm not sure what you want to know.

This thread has developed into the (usual!) 'argument' around HRT.

For you personally, if you have symptoms that are causing your quality of life to suffer (ie you can't sleep, you can't work so well, you have low mood that's overwhelming etc) then you could try HRT.

We're all different. Some women get 1 flush a day, which they cope with, some get one flush or more an hour, as well as night sweats, and they can last for decades.

If, at the same time, you have a higher risk of osteoporosis, or there is heart disease in the family, you will gain some benefit from HRT too.

You can't be prescribed HRT as prevention for anything (especially wrinkles!) but if you are at risk of osteoporosis, or have got severe osteopenia already, HRT is a prescribed treatment for women under 60 rather than other drugs.

Have you taken testosterone?
I wonder if that’s the miracle drug mine never arrived in the post and I’ve not chased it up but I would if I thought it was gonna help

If anyone wants to become more aware of all of the facts it's a good idea to look at the BMS website where there are videos on all these topics, by UK menopause experts. https://thebms.org.uk/publications/bms-tv/

There is a good one there on osteoporosis which covers pretty much everything raised here in this thread (ie does HRT help, does exercise help, etc etc.)

@HRchatter yes I do take T and have been doing since August 2023.

I suppose define energy. I workout every single morning - either fast dog walking/power walking without dogs, or weights/HIIT.

But I am done in by 3pm and at 7pm I'm in jammies and by 8pm in bed, sleep by 9.

At the weekend I nap in the day, sometimes twice. I occasionally sleep in my car at work lunchtime too!

I am on 100mcg oestrogen, mirena coil and testosterone. Plus I take masses of magnesium and vitamin d/k2 everyday.

I've literally just started today in peri. I know your OP said those not taking it, but the HRT expert suggested to me that it has preventative qualities too. For example bone density to avoid osteoporosis - hip fractures are a big worry for elderly and cause a huge upheaval as often it signifies the start of not being able to live independently. Another protective factor is for the heart with prevention of heart disease and high blood pressure and another on lowering cholesterol. The osteoperosis was a worry for me as I was on the depo injection for over 20 years.

Thought I should explain another angle on why it might be a good idea - it isn't all about mood swings and hot flushes; not having hormones alters a lot in your body that you can't see or necessarily feel.

That's all 100% true but HRT is not licensed for prevention and any good dr will tell you that.

No dr can prescribe HRT to prevent heart disease. If you have diagnosed severe osteopenia or osteoporosis then yes, it's an option.

The bonus to the heart and bones is that- a bonus.

So if you're taking it for meno symptoms you will get extra benefits.

I'm 57 and not on or even considering hrt. Someone was surprised the other day that I am 57 as they thought I was much younger so I'm obviously not ageing dreadfully. Over the last year I lost just over 2 stone and I also don't decline cake.

Oh yes, I had forgotten but I also had pruritis and the only thing that stopped that was HRT.

Yes, I began getting hormonal migraines that knock me for six for whole weeks. I am only in peri but the migraines tipped me into HRT even though they can also be controlled with Proprananol for example, it feels like if I had to pick I would rather use HRT to control them (currently using both until established but want to drop Proprananol if I can). The preventative side effects are my reasoning there.

My doctor was absolutely clear that you can gain many anti-ageing benefits through exercise and healthy diet. It's a perfectly valid choice not to take HRT, I just slightly object to the implicit suggestion that I sometimes perceive (not accusing anyone on this thread) that it's a bit shallow to take it. Everyone wants to grow older in the best health possible and no one wants to be incapacitated by the menopause.

Wtf? My GP proactively suggested it to me! And the other GP prescribed testosterone. No fight. No begging. Just prescribed on basis of symptoms and following blood tests to rule anything else out (I was 44 at the time).

I have heard that some GPs are very reluctant to prescribe it. A friend of mine was told by her GP that she's too young to be menopausal - she's 49! My peri symptoms started at 45.

Thank you I might just give the vitamins ago. I’m done in by 3 pm unfortunately though I don’t finish work until at least 8 🤣

On HRT, I sleep better, I have more energy and my little aches and pains have gone, tiredness and pain show up in the face and posture so I guess perhaps I look a little younger.

It certainly won't get rid of wrinkles but energy is youthful I guess and I had none before HRT.

It's worth thinking about having a DEXA scan within 2 years of being post menopausal.

NHS won't do them unless you get a high risk score which is usually family history or fractures before age 50.

They cost around £200 and need doing every 3- 5years.
Then you can make an informed choice.

100,000 women die each year from complications of fractures- usually hip fractures which can result in being bed bound, often getting pneumonia.

You don't have to use HRT but you can make lifestyle changes and take other drugs if appropriate.

@JinglingSpringbells osteoarthritis - wear and tear. Just wondering if HRT prevents it. I've never taken HRT but have recently developed some bony lumps on my fingers which is related to osteoarthritis.

No, I don't think it does.
HRT does reduce inflammation throughout the body so it may have some relationship but you can't take HRT to prevent it. It's not licensed for that.

You might find the UK website on arthritis helpful as that has some good info on diet that can play a role.

I haven’t and neither have any female members of my family.

There are oestrogen receptors in all our joints, which is one of the reasons osteoarthritis tends to affect people after menopause. I believe the research is inconclusive on how effective HRT is at staving that off/relieving it.

Anecdotally, I can tell you that my first real menopause symptom was joint pain in my hands and fingers, starting about two months after my periods stopped, which was fairly sudden at 56. And then the crazy hot flushes followed, no real peri-symptoms leading up to it. Because I have one autoimmune condition, I was referred to a rheumatologist who conducted all the various tests, which were fine, and suggested HRT, which completely knocked the joint pain for me. I'm now 6 years on with no return.

I don't know whether or not I look young, but I do have an excellent trainer, hairdresser and dermatologist (no fillers). I exercise, both weight bearing and cardio, eat well, have a good skincare routine (do a little facial pilates when I remember), seem to manage to juggle a busy life without feeling excessively tired. My bone density scan was good and I haven't struggled with weight gain.

I have no plans to go off HRT

Yes, there is no conclusive evidence. It may help but the point was it can't be prescribed just for joint pain if a woman asks for that.

So the risk remains the same for osteoarthritis whether you are on HRT or not?

How do you mean? There are lots of things that can cause joint pain, including menopause. The NHS says that joint pain is one of the menopause symptoms that can be relieved by HRT:

https://www.nhs.uk/conditions/menopause/treatment/#:~:text=The%20main%20benefit%20of%20HRT,mood%20swings%20and%20vaginal%20dryness.

The question asked by a poster was does HRT prevent osteoarthritis.

Osteoarthritis may include joint pain, but not all joint pain is osteoarthritis.

If you have severe joint pain it needs an assessment by a consultant.
If you have menopause symptoms including joint pain, HRT may help.

That's how I understand it.

Osteoarthritis has a lot of causes including genes.

HRT is not prescribed to prevent it which is what the question was.

If you want a more in-depth analysis there will be plenty online-using the search words.