Not having HRT

[DeftGoldHedgehog]

So my periods have stopped now for the last 12 months and I'm 50. I'm still taking a low dose of GLP-1 at the moment and trying to lose a few more pounds to get down to BMI 23, but will gradually phase that out this year. This could be masking things (as it is a hormone) but I feel better than I have since I was about 32 and I have zero symptoms of menopause - even the slight brain fog seems to have got better recently.

I've done weights since I was 18 and have good muscle tone, even though I'm slim now I'm not a waif, nor am I planning to be. I eat a very good diet, exercise (yoga, free weights, circuits, cardio, swimming), and take a few supplements.

For years I took the combined pill and felt great on that, but came off it to have DD2 aged 33, then had the copper coil after which was a big mistake. In my 30s and 40s I had laser excision of pre-cancerous cervical cells, endometriosis and PCOS - had surgery (removal of cyst and as much endometriosis tissue as he could get hold of without damaging my bowel or bladder) for that and was on desogestrel for years (which managed it very well though I was overweight for 15-20 years - not helped by all that hormonal shite certainly) then went back on the combined pill for a couple of years with low oestrogen symptoms - which helped to a degree. I wanted to just take nothing in terms of pill/HRT for a bit while I found out if my periods had stopped naturally and fully expected to feel crap (thinking about the experience with my own hormones in my 30s) and to be considering what HRT to go on by now.

I now feel like I did all the menopause stuff in my 30s and 40s in peri-menopause and post-partum- I had hot flushes, vaginal symptoms, pelvic floor issues, IBS, anxiety and depression, low energy, rage, you name it.

My DM died at 85 and never had HRT and did not seem to have any issues. However physically I take after my DF (low resting heart rate, low BP, hypermobility) who had osteoarthritis (in spite of being fit and doing lots of exercise). I'm always looking out for signs of that anyway and do plan to have a private Dexa scan at some point.

I just feel at the moment like if it ain't broke don't fix it. But am I setting myself up for problems down the line?

Essentially, yes. (Which it’s your right to do, of course)

Good call on the dexa scan - by the time bones start to break it’s difficult to build more. But oestrogen involves SO MANY more systems and is incredibly safe for most women. They will be prising mine out of my cold dead hands.

The biggest killers of women are dementia and heart disease. HRT protects against heart disease - not just deaths but also disability from it. We know it’s cognitively protective, and while its role in dementia hasn’t been well studied (because who cares about mad old women?!) its logical to assume it helps (given that women largely find it helps with cognitive capacity generally) either by protecting capacity in mid-life and raising baselines or possibly by preserving it. We know women are more prone to dementia perhaps because men are much more likely to die from other things and more of them don’t live long enough to get dementia, but more likely oestrogen has a role. It also has huge roles in musculoskeletal and joint heath which are beginning to come to light.

If you’re interested, I’d highly recommend ‘unbreakable’ by Dr Vanda Wright for the science. It can be a bit heavy going, but is evidence based and includes lots of practical options for the few women who can’t take HRT, those who don’t want to and those who are and want their best possible health span, not just lifespan

'while its role in dementia hasn’t been well studied (because who cares about mad old women?!) its logical to assume it helps (given that women largely find it helps with cognitive capacity generally) either by protecting capacity in mid-life and raising baselines or possibly by preserving it'

Tbf that isn't the case. Some studies have shown hrt actually increases the risk whilst others have been inconclusive. One released today vaguely says menopause itself may ne associated with dementia but found hrt inconsequential and we should all just eat well and exercise which is always good advice!

I know it's not hereditary apart from some kinds and it can be random but there is literally no dementia in the family whatsoever and plenty of longevity. Also something will get us all in the end by dint of age being the biggest risk factor - cancer, heart etc. I'm not looking to achieve immortality, just, like most people, to live as along a healthy life as possible.

My DM died at 85 and never had HRT and did not seem to have any issues. However physically I take after my DF (low resting heart rate, low BP, hypermobility) who had osteoarthritis (in spite of being fit and doing lots of exercise). I'm always looking out for signs of that anyway and do plan to have a private Dexa scan at some point.

Are you confusing osteoarthritis and osteoporosis?

Arthritis is wear and tear and normal, resulting in joints becoming stiffer and bone rubbing against bone= pain.

Osteoporosis is loss of bone density and has no symptoms until you have a fracture.

Which did your Dad have?

It's not compulsory, OP. Lots of us never take HRT, and we're absolutely fine. Why would you actively seek to medicate yourself if you feel OK? Let's not medicalise the normal ageing process.

I found this podcast helpful.

I'm in a very similar place - no awful symptoms (I sleep well, no brain fog, no aches and pains), but I am osteopenic, I exercise regularly and have a good diet. There's quite a long run in but the last section addresses this point. Basically she says that HRT is to treat symptoms, so if you don't have any then you don't really need to take it, but you can if you want. Basically menopause can have many negative symptoms, but so can HRT so it's a balance in the end as to what works for you.

Personally I decided that I'm okay continuing without it, I take other meds for bone density and some supplements, and follow various other recommendations for this stage of life.

https://drchatterjee.com/everything-you-need-to-know-about-menopause-with-professor-annice-mukherjee/

Pertinent to note that Annice went through breast cancer diagnosis and treatment which blocked oestrogen and can’t / doesn’t take hrt.

her cancer specific podcasts are very revealing for all the ways that the main concerns about menopause can be dealt with without hrt.

Hrt helped me at the time but wasn’t the fix I’d hoped for. Was still trying to adjust when I had to come off it for Bc. It’s taken two years and periods have stopped (might be the tamoxifen) but I’m genuinely better than when I was on it due to diet, cbt and exercise; specifically resistance training imho.

i am getting a bone density check next month though, so I know what im dealing with. Plyo and lifting are both important for bones

I’m now of the opinion that young women should start resistance training and continue their whole lives. For bone and brain health.

Annice and Liz o Riordan saved my sanity as stopping hrt was at the time more scary than a breast cancer diagnosis due to the online messianic chatter about hrt

Yes I know. I quite deliberately haven't confused the two.

That's fine then!
It was only how you mentioned osteoarthritis then a DEXA scan as if they were related that made me ask. A scan won't pick up osteoathritis but I guess you know that.

(I've had DEXAs for 20 years, every 2 years.)

No, I just thought having a Dexa was just worth doing anyway, and osteoarthitis is an additional worry!

I can’t take it, I did for a while and it was a godsend. No even though symptoms have subsided, I’d rather be on it for the other benefits….possible heart protection etc

It is definitely worth it.
My bone density was very low (and no risk factors.)
They've all been done privately and worth it.

Messianic, that's a good word.

HRT has helped thousands of women but there is so much confusion surrounding it. I thought Annice offered the best and clearest explanation I have heard so far.

I personally will be using hormone therapy as part of my longevity protocol without waiting for symptoms.

Both my parents have osteoporosis and this is one condition that preferentially affects people who have always been health conscious, as they tend to be slimmer and live longer.

However this is a personal decision and each to their own.

I would however highly recommend anyone who can afford it (or can access it through the NHS with specific risk factors) get a DEXA at 50, whether or not you choose to use hormone therapy.

Osteoporosis is far more common than breast, cervical and colorectal cancer as well as heart disease, all of which the NHS screens for, yet there is no routine screening for osteoporosis and most women only find out they have it when they fracture, despite the availability of multiple effective treatments that can prevent this if deployed early enough.

I don’t understand why anyone wouldn’t take it? Unless breast cancer risk in family

I’m 50. I took it for 2 years.

Reasons I stopped:
It made me put on weight when I had 3 stone to loose already.
Stoped and started and it was def the HRT.
It made my boobs huge and painful
It gave me heart palpitations
I couldn’t tolerate the progesterone phase - just made me feel like crap.

Things it helped with:
Aches and pains
Mood
Shorter less painful periods

I’m now on GLP1s and have lost 2 stone so one more to go.
Still regular bleeds
I weight train and eat low carb. Am feeling much better.
Also take collagen, magnesium (glycinate), Vitamin D and multi Bs
Sodium Butyrate for digestion

Will see how I go.

I’m hesitant to quote it, because I can’t remember where I read it and can’t reference it or check it. But I read somewhere that if all women routinely took HRT, women’s life expectancy (in general) would increase by three years. (I don’t read the popular press and I do usually check sources, so I’m reasonable confident it’s good science and will have been by someone qualified and reputable. But I can’t be certain) In which case this ‘as little as possible for a short a time as possible’ is deeply harmful to women and a disgrace to the medical profession.

It’s not helpful to think of HRT as medicalising a natural process anyway, or even unnecessary unless you’re having problems. Because so many problems aren’t themselves understood by women as menopause. We are beginning to see multiple things that have always been known to happen to peri and post menopausal women, which have themselves been medicalised, and hypothesise that they are a part of menopause. Frozen shoulder, for example, is virtually unheard of in other cohorts of healthy people. Fibromyalgia is largely perimenopausal women. Osteoporosis, is a good example. It is something that happens naturally as we age. But menopause accelerates and accentuates it and HRT is already licensed to prevent it in the USA. It’s not routinely monitored, but once you start breaking bones and know about it, it’s much more difficult to build bone again. And it can massively impact women’s lives.

There are few downsides. Modern HRT doesn’t significantly increase breast cancer risk. But even if it did, breast cancer is very survivable. And it, and it’s treatment are finite and give excellent quality of life to survivors. The same cannot be said of heart disease. Eostogen is protective. (I think the patriarchy just loves boobs more than women.)

it’s an emerging field and I’d encourage women to form their own opinion at this point. However, women deserve better information to make that choice. And I’m betting (and I’ll be honest, hoping, my own peri-menopause is shit, especially musculoskeletal wise!) that our daughters will not think of HRT like that. Mine wall to wall symptoms that I had NO IDEA were peri, put up with for years and that just VANISHED on HRT and I had a whole different quality of life. I’ve never even had a hot flush, still. And that’s not an unusual experience.

I‘m genuinely sorry you had this experience and I don’t want in any way invalidate it. I do want to highlight that I was consistently given poor information by my GP (and they weren’t terrible. Just normal. But they were out of their depth and should have referred on). Although I’m responding to your issues, my aim is to give information generally about what may be available for any women in a similar position, not to dispute or refute to your choice as right for you.

I had terrible problems with progestone. Even various contraceptions. The bloody mirena fucked my life up, yet I was consistently told it was the most local, lowest possible dose (spoiler. It’s not. And even if it was, it was still a stupid choice). The best possible option. But now I NEED the oestrogen. So I (finally) got a great gynae who prescribed body identical progesterone patches (mirena is not body identical and it makes a massive difference. Trust me!). And I have them for two weeks every three months on long protocol HRT. And while those two weeks aren’t great (makes my ADHD SO MUCH worse) I can plan for a quiet two weeks. And they are better than my best days on the mirena.

It changed my life. It was affecting my life so much either having to have progesterone or not being able to have oestrogen that I had got a second job (on top of being a widowed parent) to save for a private hysterectomy. It really was that bad, and I’m not being dramatic. I only just avoided bankruptcy (through mistakes in my business and inability to work efficiently. As it is I have had to suck up more than a hundred thousand pounds worth of losses, not including lost opportunities and earnings. Just straight out errors which were not normal for me, and assets I had to sell to get by)

So there are options. And I shouldn’t have been the one to have to research, suggest and push (and push) for the referral. (And I’m still having issues getting the GP to work with the gynaecologists protocol. It’s hard not to feel that GPs are gatekeeping a bit, although I can’t see for the life of me why they would. They’re fucking awesome with my ADHD meds, which are much more problematic usually and were privately prescribed)

Look at your frax score and discuss with your gp - list any factors that you think may mean you have increased risk.

This is what I did and gp agreed it was worth checking

if no BC risks but an issue with bone density id definitely consider it but iirc it must be be alongside lifting heavy and other lifestyle factors. Creatine is also helpful I believe (I’m taking it.)

https://www.fraxplus.org/calculation-tool

Look at your frax score and discuss with your gp - list any factors that you think may mean you have increased risk.

Yes BUT- it's a very blunt tool and won't always be accurate.

I had no risk factors at all. FRAX would show zero.

I went for a private DEXA scan and had severe osteopenia. If I'd not had that scan I'd have developed osteoporosis (without knowing.)

I agree 100% with @Charliede1182 who said this

I would however highly recommend anyone who can afford it (or can access it through the NHS with specific risk factors) get a DEXA at 50, whether or not you choose to use hormone therapy.
Osteoporosis is far more common than breast, cervical and colorectal cancer as well as heart disease, all of which the NHS screens for, yet there is no routine screening for osteoporosis and most women only find out they have it when they fracture, despite the availability of multiple effective treatments that can prevent this if deployed early enough.

NICE won't introduce DEXA scans for all women over 50.
Around 2-3 years ago the Royal Osteoporosis Society provided a very compelling document, based on cost/ benefits of screening. The cost of treating fractures, managing disability at home as a result of fractures often for decades, outweighed the cost of scans but NICE still refused.

At the moment, unless you break a bone (and even then it's not a given you will get a DEXA scan) you need to tick enough boxes for one on the NHS.

There has only just been a directive from NICE to X ray the spine as well as the hips if a woman has a fracture (on the basis that fractures of the vertebra are sometimes painless at least initially.)

More women die, or are disabled from osteoporosis than all female cancers - but because bones 'aren't cancer' and don't hit the headlines or tick enough boxes, it's ignored.

I find the statement from NICE stating that HRT is unlikely to prolong or shorten life expectancy really helpful. I personally would only take it over the age of 50 if I felt my quality of life was affected by menopausal symptoms. I did try it for a short while but with swollen sore breasts I felt worse. Apart from definitely improving bone density the jury is still out on cardiovascular and dementia benefit but the evidence may become more robust with time. HRT is really helpful for a lot of women but it is not the elixir of life.

Should we be having dexa scans every 2 years if there's no immediate reason to have one?

Why would you take it if you have no real symptoms that are troubling you?

I phoned up one private place about a DeXA scan and you can't just go and have one but need a GP referral or a private doc consultation first. I'm not going with that provider anyway as their nearest scanner is about 40 miles away.

I read this, this morning. I feel we need more studies done on women who do well while not having HRT tbh. Particularly when endometriosis and having too much oestrogen in peri menopause has been a factor.

https://www.drlouisenewson.co.uk/knowledge/what-are-the-risks-of-not-using-hormone-therapy?mc_cid=ca5eecb8c4&mc_eid=8048d4bd63

I'm having good sleep (and have had insomnia off and on all my life so this is not a given) and have plenty of energy, sex drive and no vaginal symptoms which I very much did have a few years ago while taking progesterone (along with much worse sleep) so I am loathe to mess about with hormones just now.

I'm having a over 40s (50s!) health check next week anyway as I've not had my cholesterol done for five years when I last had a full blood count done. My only issue was being overweight when I had the actual over 40s check at 42. They gave me zero risk of heart problems in the next ten years as my resting and heart rate and BP were low and my cholesterol was very good.

Also aware that my DM had a MI at 53, but she smoked 20 a day then and was very stressed running her own business in a recession. Then she lived to 85. I don't smoke, never have apart from a bit socially in my 20s, and am not stressed. And now, I'm a healthy BMI and my waist to height ratio is in the low risk for diabetes. My DM did get diabetes as she was apple shaped.