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[lubylou]

Thanks for posting the links everyone. We all need up to date information, thanks again for posting these.

The Patient UK site has lots of information as well, you have to navigate the various topic options in the tabs on the side bar on the right of the webpage; and also the tabs at the top which have choices of "article" "related" and "support" and  "discuss" http://www.patient.co.uk/doctor/hormone-replacement-therapy-including-risks-and-benefits and the page at http://www.patient.co.uk/doctor/hrt-follow-up-assessments covers stopping HRT. The information is useful to print and take to show doctors.

This is from the Royal College of Obstetricians and Gynaecologists (RCOG)  http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/briefings-and-qas-/rcog-and-hrt-debate   It states "If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of administration" this may be a good one to refer to a GP who insists on an absolute cut off date at 60! This RCOG also has a section about "recent media reports have presented conflicting stories about the safety of HRT, stemming from the varied interpretations of the different studies which have appeared in recent years". It goes on to say "Given the findings from new research, the risks associated with the use of HRT are low and duration of use may, if necessary, be extended, as the use of HRT for many women provides welcome relief from distressing postmenopausal symptoms" 

Also, RCOG recommended that NICE should undertake an unbiased evidence-based guideline review on the management of the menopause. NICE expect to report sometime in 2015. I had the link to this review but now I cannot find it!

I am posting these links because it seems to me that there is a gradual move away from HRT="bad" (and "never" to those over 60 ) to a more considered approach on balancing risks based on a scientific research model covering the broad range of women of different ages and menopausal "circumstances" and which provides statistically significant results. Hopefully this will lead to woman being able to make their own informed decisions rather than, for the most part, taking that decision out of their hands.

I do find it amusing (she said laden with irony) that there was such a brew ha ha about the dangers of the contraception pill causing cancer etc ……But that all seem to have "disappeared"  from the public health debate. Yet the menopause and HRT is still so dependent on an individual medical practitioner's views on prescribing HRT. The menopause, which every woman will go through, and which for some can significantly and adversely impact on her wellbeing for many years, should be under the personal control of the woman. Something which can give relief from symptoms should be a choice which the woman can make having relevant non conflicting and confusing information available to make the potentially life changing decision to taking HRT or not, and for how long to take HRT.

I am now stepping off my soap box…………………………
Lubylou

[lubylou]

Taz, I forgot to say that I hope all goes well with the Dr appointment this afternoon. I managed to give it 12 months before I went back to HRT; but I left it so long because I was convinced that the symptoms would diminish or stop. When I realised that wasn't happening I just couldn't go on living that way so went back to taking HRT, albeit at a lower dose. I have noticed my symptoms lessening (although some nights they seen as bad as ever) so I am hoping that I am coming out the other side so far as the unbearable nights are concerned.

[mamakaren]

I really can't comment on weaning off HRT as I haven't tried that. But I had to go without oestrogen for 6 months after my hysterectomy and the only way I can describe it is that it was pure hell! I was 38 and totally not prepared for all of this! I had to wait 6 months because my surgeon said that the hormones would stimulate regrowth of cysts on my uterine wall!

As a woman that knows what it's like to go without, I have to say if you feel like you need it, use it! We shouldn't have to suffer!

Love this thread!

Karen

[Dancinggirl]

FYI lubylou - I think our Dr. Heather Currie, who founded this site, is part one of those who are advising for the NICE review you were quoting in your post - which is fantastic.
I agree with all you say and I hope we will soon see quite a change in the attitude towards HRT with better guidelines for GPs plus a much more tailored approach.
I personally want to see more help with Vaginal Atrophy - a very nasty long term meno problem.  DG x

[Taz2]

It's not just GP's though. The menopause clinic I attended also want women to stop HRT if possible at age 60.

The docs appointment went ok. I have had a really low mood and anxiety since the summer so I have agreed to try Citalopram (10mgs) for a while to see if that helps me cope with the meno symptoms. The doc said that if I still feel that I need HRT then she will prescribe me a patch HRT again although she is still worried about the risks.

We had a really good consultation - lots of talking and because she asked me to book a double appointment it wasn't rushed. She gave me an internal examination and has referred me to the gynae to get my prolapse sorted. I went down this route two years ago and chickened out but this time am more determined!!

Lubylou - one thing about giving it a year without HRT at my age is that when you start again it's as if you are taking it for the first time and the first year of any HRT carries the highest risk of stroke.. which is the one risk which women over the age of 60 are really warned about if they want to continue. If I'm not careful I'll full into that bracket as well and never get back on it!!!  Sigh - pass the tissues my glasses are steamed up again!

Taz x

[Sarah2]

Taz if you want to chat about the op for your prolapse ask me- had it done 20 years back. You may be able to PM me but I can't do that with you yet.

Is it not worth showing your GP the recommendations from the BMS and the work of Nick Panay and other consultants about continuing with HRT post 60 or longer than 5 years? Sorry if you have already done this or discussed. The recommendation is that if women are aware of the risks ( and age 60-70 it is equal risk/benefit ratio unless there are other medical issues) then HRT should be given, ideally transdermal. I'm sure you know this- so sorry!

x

[Taz2]

That's ok - yes we discussed all of this at meno clinic and then again with the GP and GP and meno clinic specialist corresponded too. I was even given the clotting factor test which came back ok. The risks have been explained to me so it will be my choice but I can see why the doc would like me to at least try to lighten my mood with the anti depressant and then see how I feel about continuing with HRT.

Thank you for the offer of help re the prolapse. It is a womb prolapse and I am having a vaginal hysterectomy.. probably.. maybe ...   I have had quite a bit of information about it from the gynae who is really good at his job apparently.

Taz x 

[lubylou]

Dancing girl, if the thread appears to have focused on the hot flushes and night sweats symptoms, I have assumed all the comments about symptoms which have such an adverse life changing impact apply to all meno symptoms and the thread can be read in that context.

And to make it worse no one can be sure how long we will have to live day to day with these awful meno symptoms :- 1 year 2 years, 5 years, or 10 years....?!  That uncertainty is in itself is enough to make any sane person feel pretty miserable about things. From my perspective these quality of life reducing symptoms includes the extreme anxiety, insomnia and vaginal atrophy and all the others.

Also let's not forget the impact the meno symptoms have on our relationships with partners, family and friends and how they impact on careers and working lives. The latter can result in having to give up a career/job with all the emotional and practical and financial implications that result from that.

I think the comments about having the choice about HRT applies equally to all symptoms. I have read so many posts here of women who have to cope with high levels of anxiety and depression which are as quality of life reducing as any other symptom and can so easily flip into agoraphobia, and that no life to have to endure; or for our loved ones to have to deal with.

Relationships, both close personal ones and those in a wider social setting, are affected by how we feel physically and emotionally. For the majority of illnesses or conditions (clumsy language -  but I hope you get my drift) which can cause us to feel rough physically and emotionally medication is available (and name me a medication which doesn't have a long list of side effects if taken in the long term). But somehow HRT has be stuck in the mire of the conclusions reached by HRT studies done over a decade ago and which conclusions which are now at long last being questioned and new more robust studies will hopefully now be done. 

The more women who have the confidence to stand their ground about taking HRT, the more positive impact this will have on the medical professions' views. But, in my opinion, it is hard to be confident and stand up for yourself if you don't have access to good, up to date and robustly obtained information on the benefits and risks of HRT. Anecdotal information is useful but it is no substitute for properly researched published information. The absence of such information and the conflicting information currently available is a disgrace and it is emcumbent on the medical profession and researchers to undertake studies and provide in the public domain good clear information so women can make informed decisions about HRT.

I know from my own experience (and I have learnt so very much from all the women who have posted here) that for some of us, life is simply intolerable without HRT. And what is there to be had in terms of real enjoyment and rejoicing in our lives, and the lives of those close to us, when meno symptoms can cause such day in day out misery? 

I applaud the resilience and courage of some women here who have had a much much worse experience of all stages of the menopause than I have. You are truly amazing. But I am so sorry that for some of you the suffering continues because you have been unable to access HRT. What torment that must feel like.

So that's all the more reason for places like this forum to provide support and a place to exchange personal experiences and information; and to just be able to vent in a safe environment with others who understand how meno symptoms make us feel and how we have to live and adapt our lives in all sorts of ways to overcome this and make things better for us and our loved ones. This forum is a fantastic way of giving mutual support so it comes as no surprise that Dr Currie is participating in some way in the NICE study. I hope that there will be a place in this study for consultation with women of their personal experiences and also the emotional, social and economic impact of untreated meno symptoms (e.g. unavailability of HRT, especially after the age of 60).

Rant over!

Lubylou

[lubylou]

Hi Taz,
I am glad that things went fairly well with your GP. I know nothing about prolapses but you seem to have this sorted, I wish you well and a speedy recovery when you have the proceedure.

I thought long and hard about posting this to you because it may seem negative and might disquiet you because you came away from your GP with anti depressants not HRT. I hope you will see it in the spirit it is intended, to make a suggestion (hopefully to help) and not cause you more anxiety.

About the stroke risk, you say that if you start again after a year off HRT it's like starting again anew. If this is a real worry for you why don't you tell you GP this so you don't miss your window of opportunity? I know your GP has suggested a trial run of antidepressant, but logically, if you are depressed only because of your hot flushes, night sweats and lack of sleep etc, is an anti depressant going to help that in the long term? Your depression would be a reactive depression (and quite understandable in the circumstances) and not necessary clinical depression.

Or maybe your GP has prescribed the Citalopram at the dosage which will reduce the meno symptoms?

Which ever, I hope you have enough time to give the Citalopram a go and I hope it works for you. If not I hope you will have time to ask to go back on HRT before you are 60 if the Citalopram doesn't help you.

It would be a shame to miss out getting back on HRT before you are 60.

Lubylou

[Dancinggirl]

lubylou - isn't it great to have somewhere to vent ones spleen - rant away - you voiced what many of us I feel.   

Taz - if you have a hysterectomy then you would be able to just take oestrogen - oestrogen alone HRT carries fewer cancer risk factors.  You've been suffering enough - I hope the AD helps.  I wish you well DG x

[Taz2]

Thanks girls!

lubylou - thank you for your post. The citalopram is really to counteract anxiety which I have always had but has now increased and is beginning to impact on what I can and can't do. I feel that coming off HRT hasn't helped with this as the hot sweats make me feel anxious anyway. I am 60 next month. I trust this doc and know that she is trying to do what she, and the meno clinic, see as best so if I give the anti depressants a try and I still feel horrible then I will restart HRT. I haven't started them tonight - last time I had them I passed out after a couple of hours and then was really sick. The doc said then that I only had to persevere for a week or two and this side effect would disappear but I wasn't brave enough to keep taking them. Hopefully the 10mg wont affect me so badly as I can't really take time off work at the moment.

Dancinggirl - yes the thought of oestrogen only HRT is really good!

Taz x 

[Sarah2]

I'm assuming this has been discussed with your drs- but you may know that Prof Studd is very anti ADs which he feels are now being offered to women instead of HRT.  I know he is very pro-HRT but he may well have a point in that so many women in their 50s are offered ADs for anxiety when all they need is oestrogen.

I wonder if you have considered something like CBT via the NHS? Again, there is a move to get people away from drugs for anxiety and depression and use talking therapies to address the underlying problem.  Has your GP offered you this? Is it something you'd consider?

Re your prolapse- again, have all options been discussed? Do you know what Grade prolapse you have? If it's mild then a repair can sometimes be all that is needed and since I had my repair years back there are new techniques around. I apologise in advance if all this has been discussed but some drs are 'whip it all out ' happy rather than using conserving methods. If your dr is an expert on repairs etc or dealing with prolapse that is what you need.

Sorry if this is all something you have thought about already and discussed but just wanted to offer some other options!

x

[Maryjane]

Hi Sarah2, I was wondering about your prolapse surgery, I have a cysteole but I can't pm you and you can't pm me.

[Sarah2]

Hi there!

I had a cystocele and a slight uterine prolapse. These were fixed around 20 years back now.
They were not 'serious'  but I had a constant feeling of it all bulging , and as I had private health cover I was able to have it done that way. I did however take time out to think about it all after the dr said he could do it.

I think methods have improved a bit because now there seems to be the option of using mesh to support the uterus and also pinning it to the pubic bone. I didn't have that- he shortened the ligaments and took out the excess vaginal 'slack' and at the same time pushed the bladder back into position. I was in hospital for about 5 days, then a year later I had some more slightly minor surgery ( still 5 days in hospital) because there was still some slackness in the lower vagina which was causing discomfort.

The only things to be aware of that you need good recovery time- my husband worked from home afterwards and my mum came to stay to look after my children- because you are not allowed to lift anything heavy for 6 weeks at least. I was advised never to lift anything heavy ever, and not run, jog, high impact sport etc as this damages the pelvic floor in women who have had problems.

The one main issue I had after the op was swelling around the bladder which meant I had to have a catheter for a week. This was not nice but it doesn't happen to everyone. 

Anything else just ask away!

[Dancinggirl]

Sarah2
I think the anxiety one gets with the meno is greatly triggered and enhanced by the flushes and general exhaustion. Professor Studd has done some excellent research and I think many of us are hoping his approach will be adopted by NICE.  I know I can cope with my anxiety when I feel well and life isn't throwing too many stresses at me.
I had CBT for depression during a particularly tough time in my life in my late 30s - I came very close to a total breakdown and my GP at the time was very good and recognised I needed help. She did give a prescription for ADs but my, also excellent, pharmacist gave me a sheet highlighting the side effects and I decided to not to take them. My GP practise had, at the time, a part time therapist who I saw at first but I could only have 4 sessions on the practise budget.  I then had to see her privately as when I was referred to see another therapist on the NHS I didn't like the CBT options available and I felt the original therapist was good.  I saw her every week for at least a year and it has definitely helped me move forward in a more positive way. It cost me around £1500 to get this help!!!!
When 4-5 years ago I felt myself slipping into depression again I went to the GP (I had moved so was with a different practise) who referred me for therapy. However, about 6 weeks later all I got was a phone call saying there was a slot to see a therapist on a Friday morning at 11am.  I was working, struggling with financial problems & caring for my lovely mother-in-law with dementia and therefore couldn't make that appointment - I struggled on in an exhausted and tearful state for some time - I couldn't afford to pay for therapy this time round.
CBT is not right for everyone and, sadly, I think you may well need to be able to pay to get the right help at the right time.  DG x