Should I start HRT?

[Autumnrabbits]

I am 49, still have regular periods and my only symptoms are anxiety (which I've had all my life and not materially worse), irritability (getting very annoyed about stuff but again, nothing new!), low energy and low libido. I have a full time professional job (am main breadwinner), 3 kids (one of whom does a lot of competitive sports so I have to drive to training 2 evenings per week, 2 hours each way, 2 hours training so 6 hours), a 17 year old with ADHD, v poor attendance/PDA issues and their dad/my ex does nothing so I am basically a single mum to the older 2) so it's understandable that I am tired and stressed. My main worry is that my DH is annoying me massively with everything he does and my libido has dropped. Lots of my friends are on HRT and tell me to start taking it asap but not keen due to cancer risk, even if not significant, and because I am not sure I feel bad enough to justify taking it.

You say you don't feel "bad enough" but it sounds like the symptoms are having a serious negative effect on your marriage, so on that basis alone I'd try it, yes. And that's before all the other symptoms you list. It's not a lifelong commitment so if you find it makes no difference you can stop it.

I did and am really pleased I did. Mirena +
oestrogel has been great for me.

I also ‘just’ had the heightened anxiety and irritability.

Ditto.
I was overwhelmed and low libido. 3 months in i feel so much better

I think you need a conversation with your GP. None of us on here - even those of us on HRT - are in your shoes. Book an appointment and take it from there. You won't know how low your hormone levels are until you have a blood test anyway. Good luck - it's a rocky journey - or has been for me - but so much better than when I was wondering what all of these horrible symptoms meant.

Also cancer risk is not a given and it's beneficial in other ways protecting against heat disease and osteoporosis if you start taking it early enough. Lots of things to balance and all personal to the individual so better to talk it though.

I would ask if there is a menopause specialist prescriber at your practice and speak with them or a GP. Unfortunately a lot of the advice you get online is very pro or anti and you really need a consultation where you can discuss your individual circumstances, concerns and expectations to make the best decision

Thank you. Have booked an appointment with the GP. Will they test my hormone levels and are the results reliable?

Test results are reliable, but they may just listen to your symptoms and suggest a low dose HRT regime to start with. My GP chose to do that as it was clear I was suffering and they wanted to get me started sooner rather than later. They tested my blood six months later and then upped the dose which was what we both thought needed doing but was then proved by the tests. I wish you all the luck in the world. Advocate hard for yourself, don't hold back on telling them how you feel - I made a list of my symptoms before I went so I didn't forget anything.

I didn't have bloods either, just prescribed based on my symptoms

@Autumnrabbits Blood tests are not done on women over 45- (nice guidance.)

They are only done to diagnose early menopause (under 45) OR for an overall health check to rule out other things.

'Have booked an appointment with the GP. Will they test my hormone levels and are the results reliable?'

They should be diagnosing perimenopause based on your symptoms.

My advice - yes you should be on HRT. You have some symptoms that are affecting your life - only you can decide how significantly. HRT reduces your long term risk of developing osteoporosis and heart disease. They prescribe bioidentical hormones these days - exactly the same as what your body has been producing by itself.

But you're doing the right thing by discussing your body and your medical history with your doctor. They should also discuss your nutrition, exercise, sleep too, because they are all really important when managing perimenopause

Research the cancer risk. HRT is the same risk level as a couple if glasses of wine. Other things like ham and bacon and other processed foods are a cancer risk. Lots of things carry a risk but it’s about balancing that risk v benefits. Only you can decide what risk it worth it for you.

There is a really good podcast called What’s up doc which discusses menopause with a consultant. It’s worth listening to.

@Autumnrabbits one off blood tests aren’t reliable as female hormones fluctate anyway.

I wondered if you could change the amount of driving and childcare- it sounds horrendous. 4 hours a night after work, 2 nights a week?
That's not good for anyone.
It seems that it's all of the family commitments that are exhausting you. Is there any way around that?

I'm not saying you don't need HRT but it can't change the reasons for feeling tired if it's all based on your family situation. What you describe seems to be a reaction to circumstances, rather than hormones.

The latest research shows no increase in breast cancer with using micronised progesterone for 5 years, as the progestogen part of HRT.
This is on the British Menopause Society website/ statements.

The figures that show a BC risk are all based on the synthetic types of progesterone and don't include women using micronised progesterone.

The highest risk for BC is being obese - it's 7 times more risky than HRT.

My diet is terrible (I'm vege, and basically survive on coffee, diet coke, wine and toast) so am definitely a candidate for osteoporsis (sp?) I hate milk and dairy products apart from cheese so my only protein is that and occasional pulses. Am screwed basically.

Thank you for commenting. DS2 was actually on trial at at football club and found out today he isn't getting in. Gutting for him but think we're both glad that the 3 x 6 hour drives each week are no longer! Hopefully some of the other lifestyle factors will get easier. Eldest 2 DSs have A-levels and GCSEs this year, and after they're done surely life will get easier.

They dont do a blood test for it as far as I know. well mine hasnt.

Mine did - six months down the line as I mentioned in my earlier post.

Do you do much weight bearing exercise? If not I'd definitely be looking at HRT for bone health. Menopause is bad for bone density and increases the risks of developing osteoporosis which HRT can help protect against. Although you'd also want to do the exercises as you get older.

'My diet is terrible (I'm vege, and basically survive on coffee, diet coke, wine and toast)'

Honestly, you'll need to rethink your diet, not just from a bone health POV, but health in general

My diet is terrible (I'm vege, and basically survive on coffee, diet coke, wine and toast) so am definitely a candidate for osteoporsis (sp?) I hate milk and dairy products apart from cheese so my only protein is that and occasional pulses. Am screwed basically.

@Autumnrabbits To be honest I'd ask your GP for a bone density scan now (a DEXA scan.) On the basis of no dairy, other than some cheese.

If they refuse you can get them privately if that's an option - around £200.

You could quite easily already have osteoporosis or loss of bone density on that downward curve.

HRT should be considered in the context of bone health, as it's a prescribed medication for osteoporosis, or bone loss before 60 especially.

Diet Coke is a disaster for bones as the phosphoric acid in them leaches calcium from bones. Wine doesn't help either.

https://theros.org.uk/information-and-support/bone-health/nutrition-for-bones/calcium/

If you decide to use HRT cut out the wine (more than 1 small glass a day is a bigger risk for breast cancer than HRT.)

Hope you make some progress.

I know. Weird though as I am never ill, touch wood.

But you feel exhausted, are irritable and anxious.
All of those are known to be linked to diet and overall health.
There is a very close link between gut health and mental health.

There is and its part of the wider picture and OP obviously needs to try to focus on that, but its not a sole factor, Im exhuasted, irritible, depressed, confused, all the things I said above, I think it was this thread anyway, cant scroll up, and need HRT. My diet is excellent, my sleep is excellent, I dont smoke and dont drink, I exercise (walking) regularly so although I am a believer in lifestyle advice and changes, It does get a bit wearing when its proposed as the solution to everything.

Then you need GP to run the standard time all the time tests as you’re like to be deficient or at least suboptimal it lots of things.

Do you take any vitamins?