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[Maryjane]

Where are the two pieces in the guidelines re NICE one about some ladies need local and systemic HRT for VA.

Also where it says it's the women's choice how long she stays on HRT for, no 5 year rule anymore.

Please 😊 Just can't find them , doing the search thingy , brings up everything with the words you put in.

[CLKD]

Bounced a few - might they be what you are looking for?

[Maryjane]

Thank you for helping 😊 driving me mad as I am on another group where ladies are , being told you have to come off HRT after 5 years , and another lady has VA and only allowed systemic HRT she needs both, so I no somewhere the guidelines say some ladies need both for VA , and also there is no time scale when HRT should cease , so long as the lady is aware of the risks/ benefits ratio. I will keep searching and slowly go mad doing so . 🤗

[MicheleMaBelle]

hello- went to see consultant last weekend. his view was that both systemic and HRT oestrogen required. on HRT his view was that if started below age 55, benefits outweighed risks, between 55-60 it was neutral and above 60, could still be beneficial at a maintenance dose but the risks would increase especially if you smoked and were overweight.
He did say that a lot of GP's were afraid to prescribe for longer than the minimum but it was an individual decision and you've got to remember that HRT can protect against certain diseases. X

[CLKD]

   Michelemabelle

GPs should KNOW what the Guidelines suggest but we keep getting told that they don't have to act, as they are 'guide'lines 

Send a PM to Emma?

[Jenna]

Hi Maryjane,

Here are the Guidelines:

https://www.nice.org.uk/guidance/ng23/chapter/recommendations

The info on using local and systemic oestrogen is here:

"Urogenital atrophy

1.4.9 Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms."

I haven't found the guidance on timescale yet - at least the above is a start!

[Maryjane]

Thank you 😊 Ladies I just found the VA one at the same time . One down.


The other is along the lines that it's down to us basically. 😊

[Jenna]

This is from the NHS Choices website - http://www.nhs.uk/conditions/Hormone-replacement-therapy/Pages/Introduction.aspx

"Stopping HRT

There's no limit on how long you can take HRT, but talk to your GP about the duration of treatment they recommend.
Most women stop taking it once their menopausal symptoms pass, which is usually after a few years.
When you decide to stop, you can choose to do so suddenly or gradually.
Gradually decreasing your HRT dose is usually recommended because it's less likely to cause your symptoms to come back in the short term.
Contact your GP if you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms. You may need to start HRT again."

I'm not sure whether that helps or not, Maryjane!

[Maryjane]

Thank you , yes that is it it's a bit ambiguous I guess , as it says the duration of treatment they recommend?

Thakyou . 😊 What's lol is one of the peeps who was on the guidelines , see that person privately and happy for you to stay on it for life , and has many older ladies on it.

[Jenna]

Yes, it does suggest it depends on the opinion of the medical professional you see.

However, I have also found this information here on MM, which states that women have a choice as to how long they stay on HRT:

https://menopausematters.co.uk/newsitem.php?recordID=159/In-response-to-the-paper-RE-Duration-of-Menopause

[Maryjane]

Fab  , that's it .😊

Thank you very much.

[Jenna]

You're very welcome! 

[Hurdity]

Hi there Maryjane

It seems rude not to answer when my name is in the title but as you see there are lots of knowledgeable women on here - anyway I'm not a lady  - and Jenna has given you the answers you are seeking.

Just to give you some idea of the provenance of that statement - that the guidance on no limit to HRT that Jenna refers to below - it was from a paper back in 2013 that reviewed HRT - under the banner of the BMS  and Women's Health Concern and Panay was one of the authors. It was reported on here - the BMS statement:

https://menopausematters.co.uk/newsitem.php?recordID=145/BMS-Council-Consensus-Statement-on-HRT.

Here is the original paper:
www.csp.org.uk/sites/files/csp/secure/menopause_int-2013-panay-59-68.pdf

I think it has been updated since - I saw another paper dated 2016 but it is not freely available.

As you saw from the NICE Guidelines there is no mention of age whatsoever but that an annual review should take place. Also that any long term risks are discussed with the woman.

The approach is also enshrined in the advice given here on this website about balancing risks and benefits:
https://menopausematters.co.uk/balance.php

Hurdity x

[Maryjane]

Thank you Hurdity. 😊👌💐

[Jenna]

Here is the original paper:
www.csp.org.uk/sites/files/csp/secure/menopause_int-2013-panay-59-68.pdf

I think it has been updated since - I saw another paper dated 2016 but it is not freely available.

Hurdity x

Hurdity - I found the link to the update in the MM News section - https://menopausematters.co.uk/newsitem.php?recordID=184/Langer-Paper-RCOG-BMS-Statement

http://journals.sagepub.com/doi/pdf/10.1177/2053369116680501