HRT being denied to women over 60. What do you think?

[meyesmyeyes]

I wondered what people make of the fact that a woman who is benefiting greatly from HRT, ie:

Protection from heart disease
Better distribution of healthy fats
Stronger bones
Increased libido
Better mental health
Better sleep patterns
Improved memory
.....to name a few of the many benefits,

has to give up HRT once she reaches the age of 60. She gets to have the 'talk' from her GP, apparently and they do their best to frighten you off taking them.

But a man of the same age, who is transgendering, is not only offered female hormones, but is apparently, allowed to stay on them indefinitely.

Is this fair to Women?

This is not another transgender 'bashing' thread.
I am genuinely interested, from a fairness (and equality) point of view really.

Surely if a woman is not allowed this treatment after a certain age, and has to accept that she will lose a lot of her womanly ways (lack of oestrogen causes a woman's body to start acting more like a man's especially when it comes to where fat is distributed),
then surely it's only fair that a man who is transgendering and is aged over 60' should also have to put up with less female hormones..

(I know about the slight increase of breast cancer, which by the way could do with updating - and is often quoted, which causes unnecessary scaremongering)

Are women getting a raw deal from the medical profession?

I completely agree about the points being made about women's access to hormone treatments and how female health generally is viewed.

However, I don't think the comparison to trans women's hormone treatments is a good one. Better to compare the access to such treatments between trans men and trans women. Because I see this as an important issue, the visibility of trans women is relatively high now but not of trans men. But it's separate to the discussion around cis women's access to health care.

I'm really agreeing with most of the posts here. But my inner pedant demands this: all hormones are neurotransmitters. Alter the levels of one, all the others adjust in a sort of domino effect. It's wrong to separate antidepressants from hormone therapies in this precise context.

One could argue that menopause is an evolutionary adaptation due to the extended care that human children require. Once you reach the age where you are unlikely to be around to rear children to maturity then switching to helping to care for your grandchildren will be more beneficial to the survival of your genes. Conversely, you could argue that anything that affects women after they've already had plenty of children cannot be selected against (or at least not to any great degree) so it's just a quirk of nature that never had a benefit.

Either way, you cannot say that just because it is natural, that it is also good for the woman in question as there is either no positive selection or positive selection via descendents.

Menopause is natural?

So's Death!
And I don't want to go through that anytime soon either!

Although, I'm sure that horrendous menopausal symptoms that go on for years and years must feel like a living death to some I'm sure.

Believe me - in some women the hot flushes, extreme insomnia, feelings of confusion, forgetfulness, anxiety, dry skin, lack of libido, basically an overall general feeling of crapness, basically all the things that often happen at menopauce can last years and years! Some poor souls experience all of the above for the rest of their lives. It's not only months, as the medical profession will have us believe.

Yes, the lucky few sail through it in months, but most women suffer for a lot longer than that.

That's no way to live.

It's surviving/existing.

And with all due respect, no amount of aloe vera, healthy eating, menopace or meno this and that and the other, or soya products etc or any of the other natural remedies is going to sort that lot out.
They may help a little bit, but the only thing that will come anywhere near fulfilling the role that your hormones used to - is to replace those lost hormones.
In other words - HRT.

I think a lot of younger women think that menopause means cessation of periods and hot flushes - and that's it

If only that were true.

Yeah. It's like childbirth, miscarriage, period problems, endometriosis and the rest of it. Nobody tells you much.

From a feminist perspective I'm a bit hum-ho about HRT in the same way I'm a bit hum-ho about hormonal contraception. Women's mental health and biology having to be medicated, most probably with side effects (I am woefully uninformed about this!).

Which is fine scallops but equally these things are an utter liberation for many of us. I'm probably a couple of decades away from menopause yet, but at 30 I've been menstruating for a couple of decades also and the Pill has been wonderful for me. It has saved me from dealing with the unpleasant, sometimes life limiting side effects of periods, things I'd have been medicating to sort out anyway. And it's extremely convenient to know when I'm menstruating. To say nothing of being able to have PIV sex when I want to without risking unplanned pregnancy, something I'd also have to deal with medically. I understand that there have been some negative effects for women as a class too, but there are also many, many positives.

On the subject of legal issues, is there actually any case law on this? I'm a solicitor, not in the medical negligence field though, and I'd be interested to know. I can understand why GPs would worry, but equally I do also wonder if it's true that a good solicitor would make mincemeat of a doctor who continued to prescribe HRT to a patient who was aware of the risks and documented accordingly. Has this happened?

While I agree that original studies probably overestimated the risks of HRT, I don't agree that the long term benefits outweigh the risks. When we look at natural ageing there is a decline in lots of hormones- growth hormone, thyroid hormone and sex hormones, and levels of these towards the bottom of the reference range in older people are associated with better health, and longer lives.

Secondly, HRT certainly replaces sex hormones but does not do so in a physiological manner. The females reproductive hormone axis is incredibly complex, and despite massive efforts, it has proved thus far impossible to reproduce. This is probably the reason that women with pituitary disease have much higher mortality rates then men with similar conditions.

It's also important to address the specific issue- vasomotor symptoms can be well controlled with beta blockers or antidepressants, vaginal dryness with topical oestrogens. There certainly isn't a one size fits all solution. As an aside symptoms are not exclusively caused by a drop in hormones- breastfeeding women for example have a similar decline in oestrogen, but do not have the same symptoms- this is due to the fact that the levels of pituitary stimulating hormones (FSH and LH) are low in these women, but high in menopause.

There is definitely no evidence to support stopping HRT on every woman at the age of 60, but certainly consideration should be given to a slow taper at that age. As a female medic, with an interest in the area I personally would prefer long term treatment with beta blockers or antidepressants than HRT in its current form.

Milkyway, you make some good points. The HRT that is currently being offered to women at the moment isn't perfect.
Perfect HRT would (should) also contain small amounts of testosterone, which the HRT that is usually offered is lacking.
But that's another battle for another time.

May I ask if you are at the menopausal age yet? If not, you might change your mind completely when you reach that age and are experiencing those symptoms.

I think that feminists (younger ones especially) should really think about HRT and other medications that have been specifically designed with females in mind, with a view to protecting them and fighting for them to be made more readily available to the women that need them.

If we don't protect what we have now, then a couple of years down the road there might not even be any HRT any more.
The next generation of women won't even get to decide, because there will be very little to decide about.

The way I look at it, a drug has been designed, to help women.
It has been extensively tested and approved.
If it wasn't deemed safe, it wouldn't have got through all the testings and checklists.
But it has.
It's safe and yet it is being either:

Withheld, Rationed and Withdrawn.

No, I'm not at that age, and I have nothing but sympathy for those who are very symptomatic. However rather than pushing for HRT to be more freely I think we need to push for better HRT/menopausal therapies and also particularly better HRT for women who have an early menopause or pituitary failure. These women are generally consigned to either OCP or menopausal hormone therapy and while it is reasonably effective symptom wise, it does not offer same benefits physiological hormones do. Absolutely agree re testosterone therapy, which is becoming a more accepted add on for women with libido loss etc.

I will be 60 next year and I intend to carry on with HRT for life. I do find it strange that the slightly increased risk of breast cancer is banged on about so much when alcohol consumption and being overweight increase the risk far more. You can easily buy it on the internet if your GP won't prescribe.

Agreed about testosterone :) I don't want any (more) androgens at this point in my crappy health, but I will do if I recover and keep getting older!

Also agreeing with above points querying health risk. As well as HRT I'm on levothyroxine and 2 antidepressants, plus I get diazepam when needed. The risks associated with the other meds are actually higher. I'm a self-monitoring patient, but the vast majority of women requiring HRT are otherwise healthy and should not be offered antidepressants before hormone therapy in my (strong) opinion. Why treat a symptom when you can treat the cause?

I'm highly doubtful that beta blockers are less risky than HRT in the long term.

I agree with women taking HRT if they need it, but wanted to mention that the idea that "no one got old enough to be a grandmother in olden times" and such is completely false! Many biologists and anthropologists believe we evolved menopause BECAUSE grandmothers are good caretakers of children who have no competing children of their own to care for.

Lifespans were short in ancient and prehistoric times because of childhood disease and infant mortality. If you lived to 20, your average lifespan was 65, and there are good records of 80 and 90-something people for as far back as we have census records. By 65, given a first age of childbirth of 21-24 (the median for non-nobility in ancient times), you'd be a grandmother or even a great grandmother.

YY, Womb. I've seen similar arguments for the continued existence of sub-fertility, too. If there were no evolutionary advantage to child-free pack/tribe/family members, the trait would have selected itself out within a couple of centuries! At the very worst, having a proportion of child-free females is no disadvantage to the group.

Sorry, that was a thread diversion - obviously of interest to sub-fertile me, so I forgive myself

Gay uncles are also quite useful to have around. Or rather, women with gay brothers tend to have more children. It's not clear if there is a genetic component to this or if it's a resource thing. DP and I won't be having children so when we die it will be his brother's children that inherit (presuming he does have children). We'll also be in a better financial position to help out with expensive things like prams and possibly even university.

Hi Chicken please don't think I was saying "Stop taking the pill!" just like I am absolutely not saying "Stop taking HRT!". I absolutely agree that women should be able to take these things if it suits and works for them. And in your position I would absolutely be doing what you are doing (in fact I have thought about going on the Depo to help with some stuff). and I agree with the OP that stopping women taking HRT at 60 if it is helping them and they aren't showing side effects, are aware of them etc seems quite arbitrary and

I was thinking more overall at how "women's issues" are dealt with by dismissively giving them a pill e.g. PND, contraceptive (and the lack of alternatives to hormonal contraception) rather than actually dealing with some of the societal issues around why women are getting PND, how the menopause is viewed, how contraception is viewed etc. There is a lot of misogyny out there that goes for the quick solution to pack the little ladies off without any of the wider issue stuff being addressed. For example PND is very situational based i.e. lack of support, isolation, world turned upside down that are not always accepted and PND is often dismissed as hormonal. There are also expectations that women will take hormonal medication/contraception which plays into the trope that women need their hormones managed. There is no such expectation of men. And I think the OP is tapping in to some of this with comparing the way women are treated as opposed to men within the medical profession.

So please don't think I am against women having access to this medication/contraceptive, I am absolutely not. I am all for women making informed decisions about what is right for them, with options as well!

And I am clearly missing something here but being put on ADs instead of HRT - how does that even begin to address menopausal symptoms?? Even with Owen's explanation on Saturday, I'm just not getting it. Also why is taking ADs or beta blockers long term any more beneficial? Surely they have long term risks too? Especially as we "don't think we fully understand how they work."

And thank you everyone for some really erudite and articulate posts on here. It's been incredibly interesting and thought-provoking - especially as I am fast approaching the menopause!

That was supposed to say "arbitrary and almost cruel".

I understand the point you're making scallops, I'm just always quite wary of the whole medicating women's natural functions argument. Too often it's a short step from that to things like problematising a woman's desire for pain relief in labour or her decision not to breastfeed: plenty of us find the physical side effects of being female a painful nuisance to be minimised if possible, and the things that allow us to do this as highly liberating. I'm not saying you're making this argument, but some people do, and biological essentialism is terrible for us as a class.

That's not to say women aren't fobbed off with the pill, yes. I have a relative who had various menstrual difficulties as a teenager and, when she went to the GP, was simply put on the Pill without investigation. Which stopped the irregular bleeds she was experiencing, but did nothing towards the underlying cause. So there's that.