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?

That's interesting, thnx

This is really concerning. I wonder if there are other studies looking into this. I can't imagine any other medication thought to increase the risk of dementia being prescribed.
I understand it isn't conclusive but worrying nonetheless.

It is nuanced. I think the research tends to say that HRT around the time of menopause (within about 10 years of menopause onset) is associated with a neutral or slightly reduced risk of dementia in most studies.

Transdermal oestradiol is considered to support cerebral blood flow, synaptic plasticity, and glucose metabolism in the brain — all protective mechanisms — when begun within about 10 years of menopause.

HRT started later in life (after age 60–65) may increase dementia risk, especially vascular or mixed types.

Also the increased dementia risk seen with some combined HRTs was mainly with oral oestrogen + oral synthetic progestins, not with transdermal or local preparations.

From the limited research that's been done (there's definitely need for more),
there are many benefits associated with HRT. Deciding NOT to take it without a dexa scan is foolhardy IMO. As estrogen levels drop, so does bone density. This is the reason so many more women than men have osteoporosis. All the calcium supplements and weight lifting won't have nearly as much of an effect as HRT.
Its also beneficial for heart health.
And possibly for reducing the risk of dementia but the research is not as definitive on that.
I take it for those reasons. I think the benefits will become more evident as we age not just in terms of outer appearance

Deciding NOT to take it without a dexa scan is foolhardy IMO.

You can only get a DEXA scan on the NHS if you meet certain criteria.
Taking HRT as a preventative medicine is quite a big decision to take.

You can get them privately. Cost is around £200-£300 depending on whether a consultant reads the results or you simply have them sent to your GP.

They need doing around every 3 years. NHS says 5 years usually but that's considered too long if there is bone loss.

Women with a family history of osteoporosis can often get them on the NHS via their GP but you'd have to ask.

You should read the 'Limitations of the Study' in that report. They were all women in Taiwan, mostly of Chinese origin it says.

The 'only' advice worth taking (IMO) is that of the best UK menopause consultants who read all of this stuff and come to a conclusion.

What they say is at the moment, there is no proof it causes or doesn't cause dementia because all the studies are observational (not placebo controlled trials) and there are numerous factors that limit the validity of them.

One factor mentioned somewhere was that some women who use HRT may have asked for HRT because of brain fog/ memory issues and were in fact in the early stages of undiagnosed dementia.

It’s not the aging I worry about - it’s the body count 🫣

There was another UK study done recently, particularly about the risk of dementia in women who had a genetic predisposition to it, and it was found to increase the risk in those women. The study had women who were on a whole variety of types of HRT though, including both oral medication and transdermal, so it's still not clear cut. I expect there are other limitations to the study as well, and I've not looked at it more recently (this was a few months ago), but I was quite concerned, as I do have a strong family history of it and suspect I do have the gene in question that they were investigating (because of other studies I have been in via biobank, though I don't know for sure that I have the gene, just that it's likely). But I'm conflicted, because other studies seemed to show it could help protect against dementia, and because of all the other benefits of it for bones/heart etc. And of course the actual hot flushes/incontinence/dry hair and skin etc issues, though mine are not so bad I wouldln't just put up with them if the dementia risk was actually increased. I really don't know what I'll do. At the moment, my doctor won't discuss it anyway, as I'm waiting for some other appointment that will be at least a year away.

I’m happy to trust my GP will refer me for a DEXA if it would be beneficial.
I’m 55, 2 years post menopausal and no HRT.
I have a history of stress fractures, which are not fragility fractures. I’m do have a low BMI.
I do a lot of weight-bearing exercise.

Tbh GPs don't have the time to risk assess everyone. If I were you as you've a history of fractures, are post meno and have a low bmi I'd request a dexa scan. Often patients need to push for things.

I have already discussed with my GP. She did a risk assessment and I am low risk.
No family history of osteoporosis.
No fragility breaks.
No falls.
She said my age, low BMI and stress fracture history didn’t meet the criteria, and I am very heathy and exercise a lot.

I'm not in the UK.
I'm very fit. Exercise way more than most people, always have. I also eat healthily. 2 years into menopause, I was osteopenic (precursor to osteoporosis). I actually only had the scan on the recommendation of a friend who's medically trained and very up on research. She's a few years older than me and was actually Osteoporotic. The only reason she went on HRT was due to that. 2 years later she got rescanned and her bone density has improved significantly. Im due to getvacrescan in a couple of months. Hoping my number hadn't disimproved🤞
Bone density probably won't have a huge impact on quality of life in your 50's but very well might in your 70's and 80's, if you live until then

A low bmi is a risk factor for osteoporosis. I'm actually surprised that, with a low bmi and a history of stress fractures you haven't been sent for one.

I'm 60, had one and only DC mid 40s. Deffo a menopause baby and very much longed for. GP put me on mini pill after birth so that very unreal state of no way to tell what fertility is doing. After 18 months I took myself off it as I basically didn't feel like me. About 18 months of erratic periods took me to 50 and an absolute stop of menstruation. I was flatly refused HRT.

i'd say that as first time oldest parent on the block locally I was approx 6-8 years older than the average. I didn't feel different and had more energy than many of the other mums. I was just up for it. The menopause to me was hot flushes and having to work at bring slim for the first time ever. Spool forwards to secondary school years for DC and I met several mums I'd not seen since baby groups. Well, honestly I felt no older than them and had less grey hair than several.

Re HRT, aren't there side effects and surely my GP was right when he said that I'd had a rapid menopause and it wasn't appr to have HRT. So if one hasn't had a period for a year, it's probs all done

I've never taken it. My worst symptoms by far were in perimenopause which I had never even heard of until about five years ago, after I was out the other side. Like loads of women, I was put on anti depressants which I didn't need. When my periods ended, I felt better, more energetic, lost a stone.
I am pretty ambivalent about HRT as it caused serious illness in two close friends.
I definitely aged rapidly this year. My skin is saggy. No one ever queries if I am a pensioner. :(

But... I can walk ten to twelve miles a day and not ache at all, I have a demanding job that I love, I have WAY more energy than in perimenopause, (though that could have been the antidepressants exhausting me) and go out several nights a week, when i used to be too tired to move after work.

It's an old fashioned view, but I think menopause is natural and I am not sure HRT is right for me. I don't mind growing old. I'd rather change society's perception of aging looks than try to preserve youth.

My understanding is that stress fractures are over-use injuries (they certainly were in my case), and that it's fragility fractures that increase your risk for osteoporosis. They are quite different. Google says "stress fractures involve normal bone with high stress, whereas fragility fractures involve abnormal (fragile) bone with normal stress".

My BMI is healthy and I have always been very slim but am muscular. I think my GP thinks I am not at a higher risk of osteoporosis.

I just took this risk checker and it says I do not have an increased risk.

I'm in the perimenopausal window, and despite having some annoying symptoms, I look and feel better than I have done in 15 years. I considered HRT but my GP cautioned against it on grounds of family medical history. All my friends are on it and love it, so periodically I feel as if I'm missing out, but then give my head a wobble and thank my lucky stars.

I don't drink or smoke, and eat a protein rich, low carbon diet while enjoying an active lifestyle with plenty of exercise. I do have quite a low BMI (interesting to read about link to osteoporosis), but am deliberately holding on to a few curves as have heard that oestrogen is stored in body fat so don't want to be completely ripped.

I take estriol cream topically twice per week and supplement with a few choice herbs prescribed by a herbalist. I don't use any skincare products other than a very basic bar soap and natural moisurising ointment made by a friend and my skin is good. My new students asked my age at the start of term and were amazed, saying I looked no older than their mums, all of whom were at least 10 years younger than me. I was delighted!

that it's fragility fractures that increase your risk for osteoporosis.

I think you have this backwards. Fractures don't increase your risk of osteoporosis, osteoporosis increases your risk of fractures of all kinds. Yes, stress fractures are overuse injuries, but they're more likely to occur in people with bone loss.

Everyone should obviously make their own health decisions, but a DEXA scan is easy and non-invasive and gives you a baseline, and I'd want one in your position.

@limescale Those online checks aren't 100% accurate. They don't 'catch' everyone. Your GP can only work within the guidelines.

The NHS is focused on saving money. In the absence of risk factors, they won't send you for a DEXA scan until you break a bone - and even then it may not be offered.

The ROS has been campaigning strongly for years to have DEXA scans offered to all women over 50 but NICE has turned it down.

It's completely up to you what you do but don't rely on the 'risk factor' chart- it's not 100% accurate.

Yes, of course, it was late and my brain was on a go slow!
My first stress fracture was in 2012 (when I was 41) and I've had 3 since - though not in the last few years. I'm confident they were overuse injuries and not due to bone loss.

My GP would not refer me for a DEXA and I am not in a position to pay privately.
I exercise a lot and take vit C and D supplements.

Yes, I understand that an online check only asks a number of questions and doesn't look at the actual person.
I actually don't think I know anyone around my age (55) who's had a DEXA scan, but from this thread it sounds like it's really common to push for one.

It depends how much it bothers you. You won't get one on the NHS but I know friends - no risk factors-diagnosed only after a fracture. Once every 3 years the cost works out at £70-ish a year, for info.

I understand.

It's just so irritating when the NHS falls down on preventative care which could ultimately save them so much money in the long run.