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[Taz2]

Since being off HRT for the last seven months I have gradually found that brain fog is descending especially in the way I am unable to remember things or recall events. This prompted me to have a google around and I found this article which is really informative. It's worth reading to understand how lack of oestrogen can impact so much on our ability to function. Sadly the study mentioned was carried out on women up to the age of 59.. again.. so that doesn't help us come-off-HRT-as-you-are-60 brigade! http://www.medscape.com/viewarticle/406718_2

Taz x

[Taz2]

This part is thought provoking

"When discussing the risks and benefits of ERT with patients, pharmacists should inquire about family history, probing such factors as coronary artery disease and osteoporosis in close relatives. Because Alzheimer's disease also has a significant genetic component, patients with a family history of the disorder should be encouraged to ask their physician about using estrogen to prevent or delay onset of this disease. These benefits may in fact apply to a substantial number of women, with or without a family history of the disease. By current estimates, a 65-year-old woman has a lifetime risk of one in three for developing Alzheimer's disease. [1] In addition, the possible relationship between hot flushes and Alzheimer's disease should be considered. Patients who experience frequent and/or severe hot flushes can be advised that ERT will not only ameliorate their symptoms but may also affect their cognitive abilities in the future"

Taz x

[honeybun]

It really poses the question why then are women being taken off HRT when they are 60.

No one seems to be joining up the dots and the different branches of medicine do not work together to make sure all aspects are considered.

It just gets more and more confusing.


Honeyb
x

[Joyce]

But will GPs pay any heed to this? Let me think.............

[Sarah2]

Taz- the link doesn't work unless you register.  Did you need to register to find it?

Also- is it from the US because pharmacists in the UK do not prescribe.

Are women  being taken off HRT at 60? Anyone whose dr is doing this needs to show them the info from the British Menopause Society.

• The decision whether to use HRT should be made by each woman having been given sufficient information by her health professional to make a fully informed choice.
  The HRT dosage, regimen and duration should be individualised, with annual evaluation of pros and cons.
  Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.
  HRT prescribed before the age of 60 has a favourable benefit / risk profile.
  It is imperative that women with premature ovarian insufficiency are encouraged to use HRT at least until the average age of the menopause.
  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.
  It is imperative that in our ageing population research and development of increasingly sophisticated hormonal preparations should continue to maximise benefits and minimise side effects and risks.
  This will optimise quality of life and facilitate the primary prevention of long term conditions which create a personal, social and economic burden.

If drs are stopping HRT at 60 they are not working within current guidelines and need patients to tell them this!

[Taz2]

I'm not registered. It sometimes works and sometimes doesn't. Give it another try.

Taz x

[Taz2]

I googled Oestrogen Brain Function and it brought it up under Effects of Estrogen: Estrogen and the Brain - Medscape

It took me straight into the page without registering.  http://www.medscape.com/viewarticle/406718_2 Wonder if it will work this time.

Taz x

[Taz2]

I think that most doctors are following the guidelines. I have been warned of the risks if I continue and at my docs there is even an "in house" form to sign that my doctor has explained that it is not always advisable to continue with HRT after the age of 60 and that  I understand the risks should I continue. The doc has been sympathetic and will continue to prescribe if that's what I want. The menopause clinic consultant was the first person to advise me that I should come off it at 60 and they began a programme of withdrawal eighteen months ago. When symptoms returned quickly I went back to my GP to continue on full HRT until 60.

I have been on HRT for six years and am finding it more difficult to cope with the symptoms at 60 then I did at 54. This makes me think that if I continue taking it for a further five years and then have to stop then it will be even more difficult to cope although this would coincide with retirement for me.

The stroke risk is the one I worry most about. More research does need to be done on the effects of HRT on older women!

On a slightly different note I have got three months supply of HRT patches in my cupboard. They are my get-out clause but having looked at them today they became out of date yesterday! Damn! 

Taz x

[Sarah2]

I couldn't find that one but I did find this:
http://www.rsc.org/chemistryworld/Issues/2003/March/oestrogen.asp

My own view is you pay your money and make your choice. Nothing in life is without risk and as long as the risks are small then quality of life remains important. Every drug has side effects. There are risks in taking HRT but risks in not taking it.

[Taz2]

Yes I did see that one Sarah but wasn't sure if it was still relevant due to it being over ten years old. It has really sparked my interest in the way oestrogen affects the brain.

Taz x

[Hurdity]

I'm still thinking about oestrogen and brain function - but my brain's not working properly!!

Taz - I've looked up some info about stroke risk (until my brain gave up  ) and will post it on another thread as it's not about the brain.... but I expect you will have read it though!

Hurdity x

[Hurdity]

If drs are stopping HRT at 60 they are not working within current guidelines and need patients to tell them this!

I am always arguing for this Sarah -  and quoting the BMS and Women's Health Concern Paper re HRT and women over 60 - especially being over 60 myself.

However just to take up a small but perhaps important point. Much as we would all love them to be, these are not guidelines, they are the latest recommendations by the most respected academic menopause organisation in the country ( am assuming the BMS is this!) Therefore we would hope that all specialist gynaes would follow them since they review the latest literature.

However the NICE Guidlines are being written as we speak by the Menopause Guidelines Development group and are due to be published in 2015, and will be addressing these issues.

Here is the scope of the guielines:
http://www.nice.org.uk/nicemedia/live/13891/64883/64883.pdf

Here are the comments on the scope of the guidelines (which went out to consultation)
http://guidance.nice.org.uk/CG/Wave0/639/Scoping/SHComments/pdf/English

What I am saying is we can argue with our gynaes and present these recommendations, but as far as I understand, they are not disregarding guidelines if they don't follow them?

I do agree we need to educate our docs though if they are not familiar with these recommendations!

Taz - I wouldn't worry about the date! I'm sure the patches will be fine should you want to re-start them!

Hurdity x

[Sarah2]

I used the word 'guidelines' loosely, not literally. Maybe it would have been better to say reviews of the previous studies.....or more recent research.

Whichever way you look at it, the WHI and the MW studies have been shown to be flawed, and drs need to keep up with the latest thinking.

The BMS provides plenty of training sessions for medics - see their website- to update them on HRT. Unfortunately these are not mandatory.

[Taz2]

I can't understand why some Menopause Clinics are still advising that 60 is the age where HRT should stop.

Taz x 

[Sarah2]

It depends I suppose on who is employed at these clinics. Are they NHS drs who happen to do a shift at a Meno Clinic or are they consultants?