Doing it without HRT

[whyschoolwhy]

Late last year, at the age of 45, after months of feeling much more emotional/low moods/night sweats/general hot feeling/aches and pains, I spoke to the doctor about HRT. He had to do a bit of investigation because I have a liver condition, but eventually was able to prescribe patches. I started on them and found an improvement with my mood and the sweats, and just generally felt lighter.

Unfortunately my regular blood tests showed spikes in my liver enzymes, and so my liver consultant said I should come off them. Normally HRT is well tolerated with my condition, but I do have a history of liver enzyme spikes when taking new medicines, and he says I just need to “pick my battles” and avoid “elective medicine”. For the same reason he strongly advises against weight loss jabs as well. I do of course understand and appreciate his advice.

So I’ve now been off the patches for a couple of months, and the sweats are back! Fortunately my mood hasn’t gone quite as low as before but I worry it will. I already take 200mg for sertraline for OCD so can’t take any further antidepressants.

I feel in a real catch-22, medically. My BMI is over 40, which has recently meant that I was refused surgery for one of my knees, which is in very poor state due to another rare condition. I can’t take weight loss jabs because of my liver, and I’m peri so finding natural weight loss very hard - apart from anything else it’s the motivation!

I sound like such a moaner and in all honesty I’m not writhing around in despair. I just want to find a way that I can get through this - find the motivation to lose weight so I can get my knee sorted and just generally feel healthier, which will probably help with other issues such as emotional wellbeing and lack of energy. But with my knee as it is I’m limited with exercise and I have no motivation! And I also don’t want to spend my life feeling boiling hot and sweaty, nor having angry outbursts over minor inconveniences.

Anyone have any suggestions on any of the above?

And thanks, if you’ve read this far, for sticking with it 😁

Hi op. That sounds rubbish.

Regarding the weight, I would ask if they have a target weight to achieve for the knee op. And then go hell for leather to lose enough for the op. 1200cals a day for a few months and see if having the knee replaced helps your agility and motivation further.

Everyone suggests good diet and exercise for menopause. But that's impossible with a bad knee.

With regards to the hot flushes and night sweats, mine crippled me. I can’t take HRT (breast cancer) but I was prescribed Fezolinetant. My liver was monitored closely for the first six months. It has been a game changer for me in terms of better sleep and quality of life.

Op you don’t sound like a moaner at all x I’m just warning that anything people recommend check its ok with your liver issues because I know someone refused hrt because of something similar and then went on herbal supplements recommended in a health food shop and had the issues they’d warned her against

I think the weight loss is your priority for obvious reasons but it also impacts on menopause symptoms.

There will be exercise you can do that avoids making your knee worse- swimming for example, or weights at the gym that don't impact on your knee.

But weight loss is 80% food so that's your priority.

why is your GP against using weight loss injections of pills? what liver condition do you have?

WLIs directly affect the liver. I’d imagine that is why.

@whyschoolwhy. I would seriously get a second opinion on weight loss injections. There is a HUGE amount of unconscious bias against WLI filed under the catch-all phrase of ‘we don’t have the data yet’. I am afraid doctors and Hospital consultants are not immune to this behaviour. I had severe fatty liver disease. I was refused WLI on the basis of ‘not enough data’ . Luckily I have a fabulous GP. She agreed to prescribe MJ and monitored me with blood tests twice a month. I had absolutely no side effects bar a couple of uncomfortable days with constipation. That was it. My GP prescribed under the BMI 40 + 4 other Co morbidities. In my case weight related arthritis in both knees. Fatty liver disease, Sleep Apnoea and High Blood Pressure.

I was 18.10 with a bmi of 41.7 . I am now 9st 9 . BMI 22.9 . I have no pain in my knees, no fatty liver, no high BP, No sleep apnoea. It has changed my life. I have maintained on a low dose for a year.

please get a second opinion. Not sure if it is the natural cynic in me - but the liver consultant was a man and I felt he dismissed my request for MJ without and discussion and on (research later showed me) absolutely no medical evidence of contraindications . Wheras my GP was a menopausal overweight female who was far more empathetic and truly understood the real threats to my health of the continuing obesity.

I had to stop taking HRT for reasons to do with breast tissue density - it was a choice - they said I could go back on if the symptoms came back too badly.

I was probably lucky and also a fair way through the menopause but despite my worries it's been fine. I also managed to lose weight - about a stone and a half. I still have a stone (and a bit) to go.

It was primarily food - I've upped my exercise as I lost weight - but it was food.

I don't calorie count - but I started eating a lot more veg, fibre and protein. A lot more veg and fibre.

I make salads with lentils and beans in the summer to take to work and lots of veg and bean soups in the winter.

The fibre and protein keeps me full and away from the cakes and biscuits at work.

I try and have protein at breakfast - so yogurt in porridge and nuts. Or eggs on wholemeal toast.

I walk a fair amount as have a dog - but am trying to up that. Slight issue with my hip at the moment is making that difficult.

But it is possible to eat nice tasty food and still loose weight and not feel hungry.

I was already on a ‘weight loss journey’ when I had a twisted ovarian cyst which sent me to A&E. I met with a consultant yesterday and he said he was inclined to leave the cyst if the mri indicated it’s benign and stable. And my weight was one of the reasons as I’ve had two caesareans so the resulting scar tissue already makes the operation more complicated. I am post menopausal and have type 1 diabetes so no WLI. But this has just given me extra incentive to keep on track to get to below 35 BMI where it’s much less of a factor (obviously I want to get into the healthy range ultimately but for the op below 35 reduces the impact of extra weight). I don’t want a grapefruit sized cyst in my body but to optimise a successful operation I need to lose. I track with My Fitness Pal and keep to sub 1500/day and lose on average 4-5kg/month. Walking is my only exercise currently but will add more resistance training eventually. I also figure that time will pass anyway so do I want to be at my current size six months from now? No I do not. Do you?

I’m also trying to get through it without HRT. My symptoms are pretty awful. I just had a six week heavy bleed so I feel pretty spent. My mood is very low. I have migraines and hot flushes. And various others.

My mother has had three different kinds of hormone-sensitive breast cancer, and 2/3 of my female relatives have had some form of breast cancer. 20+ years ago my mum’s consultant warned me against taking hormonal contraception and I have stuck to that.

I want to avoid increasing my breast cancer risk but bloody hell the symptoms are brutal.

Losing weight may well help with your menopause symptoms as well as every thing else

Thanks for the replies.

To respond to a couple of questions/points, my liver condition is primary biliary cholangitis. And in respect of getting a second opinion on the WLI, this was my first instinct. I discussed it with my GP and he and I both thought the consultant was being over cautious. However, having seen what has happened with the HRT, which was supposed to be the safer option for my liver, I’m more inclined to agree. I do have a history of my liver reacting like this to new medications. I was on orlistat several years ago and the enzymes spiked, and after some strong antibiotics when my son was born I had an even bigger spike. So I do think my liver is particularly sensitive to medications.

Of course we do have to do a risk/benefit analysis, and if my menopausal symptoms got really bad, HRT might be the lesser of two evils. And I do think that the potential benefits of weight loss, including the ability to have my knee operation, need to be factored in. But since it is actually possible to lose weight without WLI, I know I should do it that way rather than risk upsetting my liver.