Taking HRT purely for bone and heart health without symptoms?

[harderthanIexpected]

I'm 50 and I'm very fortunate not to be experiencing any menopause symptoms at all, other than creeping weight gain which I've managed to get on top of by cutting out carbs. In fact in many ways I've never felt better - sleeping well, mentally sharp and surprisingly chilled despite some really difficult and worrying family problems over recent years.

I have very heavy periods and had the mirena fitted a while back (it's helped a bit but disappointingly I still have regular periods). At the clinic the nurse was absolutely adamant I should be taking HRT for bone and cardiac health and basically wouldn't let me leave without a prescription for Lezzetto (?) and strict instructions to use two sprays a day, building up to three "if I needed to".

I do understand that there is good evidence for this, so I dutifully started using it, but after a week or two I felt generally "off" and so I stopped, and immediately felt better.

I had a half hearted follow up call with the nurse who said to persevere until it "started working" but she didn't seem to grasp the fact that that is impossible for me to judge because I have no symptoms that need fixing, and that actually I felt worse on it.

So my question - is anyone else taking HRT purely for the "invisible" benefits? If so, what regime are you on and how did you judge it was right for you?

(Obviously this could change in the coming years as no doubt I will experience symptoms at some point, in which case I wouldn't hesitate to try HRT again).

Just to add - the nurse was absolutely insistent that the breast cancer risk has been debunked and that I should not let my mother's 3x postmenopausal breast cancer put me off. Is that really true?

Yes but I'm a lot younger (42) and have a very long history of poor bone health in all the women of my family.

Hrt comes in a lot of forms. I would pay for a private assessment and ask about what might suit you better if you're keen to try it.

@harderthanIexpected I did have symptoms but I didn't take HRT because of the breast cancer risk. I got breast cancer anyway at 61. Also diagnosed with osteoporosis at 62.
So in hindsight I absolutely would have taken HRT for the bone protection alone.

I take it primarily for bone health, but have a family history of osteoporosis and none of BC so that affects my personal risk calculation. It's worth really looking into it and understanding the risks and benefits. In particular I don't think the cardio benefits are anything like as well established as the bone health benefits.

The BC claims being debunked is a bit of an overstatement - they're small but not negligible. The WHI study was actually looking at whether it was a good idea for all women to be taking HRT for long term health benefits including heart health. It concluded that combined HRT led to an increased BC risk for older women which, while small, was enough that it wasn't a good idea for all women to be taking it from menopause onwards just for prevention. Unfortunately this got blown totally out of proportion and ended up being misinterpreted as saying nobody should take it, thus cutting off younger women with awful symptoms who would have really benefited.

I'd say if you need it for symptom relief or have some bone health concerns by all means go ahead, but I would be sceptical about it being prescribed for general health.

@harderthanIexpected It's hard to understand why the nurse behaved like this because HRT is not licensed for prevention UNLESS someone has significant bone loss (shown on a DEXA scan) when it can be prescribed.
It is absolutely not prescribed for heart health as such.

(For context I've used HRT for close to 20 years with an excellent consultant who trains other doctors, works with other specialists on bone health etc.)

The risks of breast cancer are not 'debunked' and it's more complicated than you have been told. The old WHI trial has been debunked, as it was flawed.

At the moment, there is evidence (observational as there will never be proper trials) that micronised progesterone has a lower risk than synthetic progestins (which does include the Mirena coil.) The current data shows no increase in risk for 5 years .

There is simply not enough evidence to say 'no risk'.
So it's best to assume there is a small risk, but you're offsetting that against symptoms, affecting quality of life, or risks of not using HRT- for bones.

The guidance on family risk depends. One member (mum or sister) with BC at any early age (not 60+) is not considered added risk because the stats on BC are that 1 in 7 women will get it.

Likewise family history of heart disease.

What you need, ideally, is a DEXA scan to see if you have bone loss. That's an important factor in choosing HRT.

If you have no symptoms, you do not need HRT and it is against NHS guidance.

There are private consultants who will prescribe it, but that's different, not because they are being careless but because you would have more appts, close monitoring etc not available on the NHS.

Thees a lot of this on social media, but currently hrt should only be prescribed to reduce symptoms of peri/meno.

GLP1s are also showing causal links with improvements in cardiovascular health, osteoarthritis, dementia. Bet she's not pushing you to go on them.

I began HRT at 52, when I was still ovulating (albeit from the one remaining ovary and Fallopian tube). I had been symptomatic for a couple of years, but what swing it for me was really painful tendonitis, hip pain and insomnia, on top of the usual sweats and dry vag. I’m 60 now, I plan to take it forever, so happy am I with the results on physical, mental and sexual health. There are oestrogen receptors all over your body, including brain. It’s needed for balance as well as joint health, heart health, muscle function and bone densité. I want to keep lifting weights and walking 6miles a day so that I don’t fall, break a hip and become immobile and dependent - or dead prematurely.

There’s loads of good quality information around - and no, that study on breast cancer risks and HRT has been discredited by studies with better data and bio-identical HRT.

The current theory on risks, from menopause consultants, is that micronised progesterone appears to have a lower risk but not 'no risk.'
There is no data to support that statement (of no risk.)

Using data available it appears to be safe for 5 years and safer than synthetic progesterone, used long term.

@BigSkies2022& your nurse are correct. There is more risk to NOT taking HRT than there is in taking it.

I was massively against it at first, until I had no choice due to debilitating symptoms. Once I started to educate myself I was so glad I started on it early enough & I will never stop it.

It's when we reach 45-50+ that everything starts going wrong for women - our heart disease risk goes from being 50% that of men to at least equal, and evidence now shows that HRT is better than statins at lowering BP & reducing cardiac events. It's preventative for osteoporosis, dementia, breast & other cancers, diabetes and autoimmune diseases.

Take a look at the Balance Menopause website & app - the podcasts (Louise Newson) are amazing (I listen through spotify) The top World experts give you all the current research & evidence. But even the very first one from about 7 years ago tells you so much.

Tough one. With regards to breast cancer your risk is increased much more through drinking than hrt, but if you're doing both probably even more so ( although drinking will more than likely be the cancer trigger). It does help with bone health. My family has both. I opted for her to manage symptoms and made up for it by mostly stopping drinking. Have you had your hormone levels checked? If you have no symptoms your bodyay still be making enough?

Like you OP, I had no serious side effects from menopause, I’m fit and in pretty good shape at 65..

However, I do have low bone density and have regular DEXA scans. My GP has never suggested I take HRT for this. I was prescribed calcium carbonate and advised to do more load bearing exercise. My vitamin D levels are fine.

This doesn’t exactly answer your question as GPs are notoriously shaky on the subject of HRT.

I did listen to a Dr Chatterjee podcast with a female hormone specialist who said on balance it was probably not worth taking unless it made your symptoms better, which was good enough for me, but it’s frustrating that the advice out there is so patchy

My experience: I had brief, negligible symptoms. I decided to address the bone health risk with strength and impact training. And I eat well (including carbs). I also gave up alcohol. I later started vaginal estrogen when I became symptomatic.

I would take HRT if i had symptoms.
But at tbe moment I prefer not to take it prophylactically.

I have family history of osteoporosis. I have the early signs of it. I also have severe joint pain and Sicca. I started hrt for all these reasons. I told GP this and she prescribed. I have had none of the typical symptoms and to be honest I don't feel any different on hrt. No family history of BC.

To be honest I hate the faff and would not take it if I didn't have these conditions.

Taking calcium will not build up bone density. You need enough calcium but taking more won't build bone.

How low is it? Do you know your results, out of interest?

This advice from your GP on calcium is outdated.
There is new research showing that calcium supplements may cause heart disease- the calcium gets laid down in the arteries. (This doesn't happen with calcium in food.) You need 700-1000mgs a day.

Weight bearing exercise can help but it won't make a huge difference unless you're using weights and targeting the vulnerable parts- hips, wrists, spine.

How often are your DEXA scans? The NHS tends to do them 5 years but I have mine privately and every 2 years.

I take it and have never had a hot flush or traditional symptoms.

A friend of mine was told by consultant HRT was best treatment for her osteoporosis along with weight bearing exercises.

I can't really do weight bearing because of joint pain. I swim a lot but that doesn't really help with bone density.

Formal complaint. That's shocking from the nurse and against all current guidelines.

I’m confused as to why you’d take to Mumsnet to ask, rather than seeking a second opinion from a specialist in this area. Seems like a no brainer to me, it has been proven to have good effects, but there can be side effects so you find the best form of treatment for you.

I started it mostly for bone density/joint stiffness but I did also have hot flushes/insomnia/ low energy and it has helped.
my understanding from reading up on it that the breast cancer risk is relatively low but you can’t take it if you have had breast cancer.
But actually my gp was reluctant to prescribe because my mum had breast cancer despite the fact that she was in her late sixties and not on hrt when she got breast cancer and she smoked/drank heavily and subsequently got lung cancer. And when we asked at the time the consultant said it was not hormone related.

I have read this about calcium supplements and yet it's prescribed by the NHS to women with osteopaenia and those with osteoporosis.
I have osteoporosis and I'm on bisphosphonates but my rheumatologist still insists on calcium supplements. I try to get as much calcium as possible by diet but it's actually quite difficult to achieve the amounts recommended for osteoporosis sufferers.

There are different types of breast cancer, and one that is increasing is linked to HRT use, among other things - though that link is still small. I’ve had this rarer type of breast cancer three times now. When I was genetically tested, the questions the consultant asked included questions about HRT use, as well as hormonal contraception use. Other questions were number of pregnancies, how long you breastfed for, age of starting and finishing periods - Everything that affected how long hormones were circulating in your body. Personally, I would not take HRT.

Sadly our surgery has gone from being one of the leading surgeries in the SW to being totally useless. I have to wait over two weeks for an appointment to see someone (about something else) who isn't even a trained doctor. There is no one else to go to or ask,unfortunately.

The Royal Osteoporosis Society recommends dietary calcium, only supplementing if you can't get enough through diet, so I think GPs are out of date. That said there are some medications where I believe supplemental calcium is needed to get the full benefits. Though if you are taking it, spreading the dose through the day seems to have better absorption and less risk to the arteries. I'd ask your rheumatologist what they think.

The NHS is often 10 years out of date with lots of things.

I stopped taking them a few years ago.

I eat a LOT of plain yogurt- up to 300mgs a day, green veg, cottage cheese, other cheese, milk in tea, chickpeas,tinned sardines, salmon (canned too with the bones.)

If you can stomach them, dried prunes are shown to improve bone density - lots of research on that - but you need 5 a day and ideally 10.

The ROS website has lots of very good info.