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?

@DeftGoldHedgehog You could just ask your GP to write a consent letter? You're saving the NHS money! OR a private GP referral.

TBH the cost is worth it. How much was the scan? I pay around £250 but that's south east and they only need doing every 3 years if they don't show any issue. That's around £70 a year, so less than £2 a week. I think that puts it in perspective.

If you are near London there are loads of places where they do them. I'm pretty sure you can self-refer to most. Happy to PM you if you want more info.

I read this, this morning. I feel we need more studies done on women who do well while not having HRT tbh.

But that's 90% of women (not using HRT) and the stats already exist on those.

https://theros.org.uk/latest-news/a-response-from-the-royal-osteoporosis-society-to-the-new-ons-sickness-absence-data/

Facts about osteoporosis

• Osteoporosis causes bones to lose strength and break more easily (also known as fractures).
• Broken bones caused by osteoporosis can be painful, impact on daily life, reduce independence, and sometimes lead to life-changing disability.
• Osteoporosis causes 500,000 broken bones every year in the UK, costing over £4.5billion. (7)
• Half of women and 20% of men over 50 will break a bone because of osteoporosis. (8)

• Broken Bones are the fourth worst cause of disability and premature death. In the 2020 league table of disability, fragility fractures were placed as the fourth most burdensome condition - outranked only by ischemic heart disease, dementia and lung cancer. (13)

Not saying that this is a reason to use HRT but those stats do exist.

HRT is not prescribed for prevention.

(It is available for severe osteopenia to treat osteoporosis and many specialists would use it instead of other drugs for younger women.)

If you have symptoms, then consider HRT. If you don't have symptoms, don't use it. But if you're having some meno symptoms and have low bone density then it's worth thinking about.

I think it would cost me £250 all in all, £50 for private doc appointment and £200 for scan. It's not too bad compared with what I've paid for my teeth at times. Or the cats!

^^
Many women are prescribed medications for their various symptoms and they would never need to take these if the root cause - hormone decline - was addressed.

This is interesting because it's the exact opposite of what Annice Mukherjee says, namely that we should treat the symptoms which may well be exacerbated by menopause.

Newsom does have her critics, most notably the British Menopause Society who believe she prescribes too high a dose and after many disagreements have removed her from their list of recommended specialists. Article below.

It seems the more you read the more confusing it becomes!

https://www.thetimes.com/uk/healthcare/article/dr-louise-newson-tells-of-menopause-witch-hunt-9fzmmr38r?gaa_at=eafs&gaa_n=AWEtsqfO2qMwQXynGt9xE1AqGCGZ_Uu4691roAqfCUn83M54Rz5-SBWW82WBr70pqGk%3D&gaa_ts=697b9a6b&gaa_sig=AueVkbNLdllCcG5P9Ia6qzAhe262t3CNE5HbIJQGEKt6En2OsG5EjZhdj5lbmOn9ogwD55rduRaBlrxR04Vpvg%3D%3D

If there is family history your GP may well be happy to refer you.

I had a DEXA scan about 10 years ago. My mother had just been diagnosed with osteoporosis (she had dementia and very little mobility it was discovered in hospital after she had been taken ill) and a nurse friend told me I should ask for a scan for myself. My GP arranged it immediately.

I have hereditary stroke risk and from what I have read there is mixed opinion about the risks of HRT when it comes to strokes. I won’t be taking it unless I absolutely have too.

You might like to read more about that online, on reputable medical sites. eg the British Menopause Society website/ guides/ reports.

The stroke risk with HRT is not raised using transdermal HRT (through the skin.)

There is no mixed opinions now because most HRT now is transdermal and you'd be offered that.

The risk is slightly higher using tablet form estrogen but it's still much lower than for example the contraceptive pill.