How do you know when you need to start HRT?

[vetprob]

Just that really. I had bloods done a couple of years ago to test my hormones and they predicted my menopause will come at age 52 (in about 5 years time). Obviously peri is probably in full swing - or is it? I'm assuming here.

I'm pretty tired these days, can't seem to stay up very late. And brain fog is definitely a thing (but it has been since DS arrived 13 years ago tbf 😄).

Other than that no real symptoms as such.

Any advice?

It was a private nurse and no 100% guarantees were given so don't worry I've not placed any bets or anything 😅 it's just a prediction based on my hormonal state at the time of the test. Better than no info at all.

@vetprob was this a test you buy online and arrange for a nurse to come to your house and take blood?

All these tests are a waste of money. They are unreliable and NICE says they are not to be used, only to rule out other illnesses which may have some similar symptoms for menopause.

It's not giving you any info at all.

The average age of menopause is between 51- 52, so it's hardly surprising that's the age they gave you.

I was 44 when I had it done.

I have received the message loud and clear - it was just a prediction, never a guarantee but something to work with rather than having simply nothing.

I guess my symptoms (if that's what they are) are relatively mild at the moment. Cycle is almost normal still.

@falalalaa I was thinking along the prevention better than cure lines really, it's all new to me so no idea if I can prevent potential issues before it's too late.

It feels a bit like pregnancy in the sense that changes are happening to our bodies but everyone is different and we have to find what works best for our individual needs.

It's good to talk about it!

@vetprob

Best thing you can do is to be aware and monitor what is happening.
And don’t worry - it’s not a case of ‘missing’ it,
or being too late. Not a case of prevention better than being too late. it’s not binary, and nothing is irreversible.

What happens often is some have very clear traditional symptoms and get on HRT. Some have symptoms that are more generic - connective tissues, MH - and try get treatments that don’t quite work until HRT is added to restore hormonal balance.

The prediction would be done by using the average age of menopause in the UK. Out of interest how much did you pay for the test?

I understand where you're coming from on this but it's not a reliable test from what you have described.

HRT is there IF you have very bad symptoms that affect your day to day life.
It's not a case of taking it to prevent those symptoms.
You may not need it at all.
Wait and see.

Also, no doctor would prescribe HRT for you now, without symptoms.

Thanks @jsku that's reassuring!

@JinglingSpringbells it was part of a wider set of tests so I couldn't tell you how much exactly, sorry. But I found it all very interesting all the same.

Oh hi, are you me? What specialist did you see please? Was it expensive and what tests did they do? I just don't have it in me to fight a gatekeeping GP.

Statistics show that around 14% of women in the UK use HRT to get through menopause. I'm 55, have a Mirena (have done so for over 25 years due to C section scarring) and still have periods although irregular. I'm desperate for them to stop but other than that, I wouldn't say I've noticed anything to warrant needing medical attention over. Fingers crossed.

Only 14% - that surprises me!

I thought it was the rule rather than the exception. Shows how much I know!

Normally when your periods stop is the main indicator. I was 51. I’m 55 now and not on HRT because I didn’t feel bad. I had some night sweats for a few months but otherwise ok. I started vaginal estriol 2 years ago after I kept getting PH balance issues and thats all good as avoids atrophy. I look after myself better, food wise and exercise and drink much less. I have lots of energy for life and no aches or pains or other medication. So it’s not that you will definitely need it.

Considering hrt at the moment (and antidepressants!) I’ve constantly itchy skin, I’m weirdly shaky, get heart palpitations, brain fog where I can’t remember very normal words regularly , and I regularly suddenly feel really sad and cry out of nowhere, the other morning I just stood in the shower and cried with no thoughts and no trigger, or infuriated over things that aren’t that big a deal. I wake up at four o clock nearly every night though so wonder if a lot is lack of sleep and stress so am torn. Gp diplomatically advised me to think about it and hurry back!

oh edited to add horrendously dry down there and wake up every morning sweating and stinking!

This nails it.

It used to be higher. It dropped off early 2000s after some misinterpreted data got published and the media got hold of it. It is increasing again now.

I find the discourse around HRT quite confusing.
IF, as current research seems to suggest, the benefits of taking HRT outweigh the risks for MOST women (eg lowering risk of osteoporosis, dementia, heart disease), not to mention alleviating nasty perimenopausal symptoms, then why are all women not encouraged to think about taking it in mid/later life? (Obvs with women for whom it is contraindicated taken out of that equation.)
is it a cost thing? An ignorance around women’s health thing? Medical misogyny?
Or maybe I have the wrong end of the stick about the benefits?!
Sorry to hijack with another question OP!

I wonder if my hormones have always been all over the place and perimenopause is actually helping me! I'm calmer, less anxious and generally more settled. The only peri thing I do have is brain fog sometimes and vaginal atrophy so on estrogen cream for that. I'm also tired but put that down to just life.

All of those.

A lot of women think HRT is 'risky' and prefer to manage without if they can. That's fine- their choice. There are small risks but there are also risks (some doctors would say higher) of not using hrt.

And most GPs are not trained in menopause. Many still hold onto the old data of risks and are reluctant to promote it. Or if they do prescribe it they often aren't aware of all the different types, doses, what can be tweaked etc so women give up if their first type isn't working.

The cost is irrelevant. I pay for my HRT and it's very cheap. Less than a few coffees a month. Costs the NHS peanuts compared to the cost of fractures and other health issues women may suffer.

Many women won't need hrt but there are a lot who will 'struggle on' when it could help.

I started when I couldn’t manage the sleeplessness and anxiety any more.

That's ok @wherethewaterisdarker I think it's a really relevant question!

I too thought there were protective/preventative benefits but pp said it's more about alleviating symptoms when they get to the point of affecting day to day life 🤷🏻‍♀️

I have osteoporosis in the family so want to do all I can to prevent it!

Oh this is timely. I’ve been finding that generally I’m just not feeling quite myself - a bit of a loss of spark and increased irritability. But not to the point of some on here - I’ve not thrown anything or burst into tears for no reason yet.

I do have a loss of libido and dryness - that is the most notable symptom. And whilst I wouldn’t describe it as brain fog yet, I definitely find myself unable to remember words. Periods still regular but shorter in length (3 days), with about 24 hours of really heavy flow and the rest very light flow.

I read Davina’s book (useful, but I found the tone, ironically, quite irritating!) and got myself off the GP yesterday. I deliberately requested a female GP. Amusingly, whilst chatting with her, I found for the life of me I couldn’t remember Davina’s name, so she saw some of the symptoms in action.

Was expecting a bit of fight as it doesn’t feel “that bad” but having explained the above, she thought it was very much peri-menopause, and explained that research suggests there are benefits to starting early. Spoke through the options, prescribed HRT patches and as the pharmacy had them in stock I had them half an hour later. Now waiting for period before I whack one on…

@vetprob You can't be prescribed HRT for prevention. It's not licensed for that other than for women at risk of osteoporosis ( usually diagnosed from a bone density scan) where it's an alternative to other drugs for bone loss.

So if you ask any dr for it as 'prevention' they can't prescribe it unless you also have symptoms like flushes, sweats, insomnia etc.

No need to go through GP, book at a private hospital will be £150-200

and explained that research suggests there are benefits to starting early.

The benefits to the heart are if HRT is started within 10 years of a last period. Beyond that, the arteries can already be showing signs of arteriosclerosis and HRT won't help.

'Early' means that, not at 45 rather than 55- it depends if your periods have stopped and for how long.

That's on the cheap side. A consultant will be charging £300+ - maybe you're talking about a private GP?

Sorry I wasn’t clear - she meant early as in early on in symptoms, as opposed to waiting for them to become worse.

I tell my early 40 something friends that they will know if/when they need to explore HRT. Knowing your periods will stop in your early 50s isnt a reason to take HRT. The range of quite identifiable symptoms, as well described in this thread, are a sign to explore HRT once they are persistent. I doubt I'd seek to take it without any symptoms, but for me it was pretty clear when I was experiencing negative peri symptoms, so that was my trigger to access HRT. Which has been a help albeit not a perfect 'cure'.

You will know.

when the symptoms become unbearable.

with me it was mood swings & arguments & aching bones in the morning.

now been on hrt for 10 years