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[Missy141]

I am 52 and had my ovaries and tubes removed 5 years ago. I was on the Mirena coil and oestrogen patch. Had coil removed this year and went on combined patches which have not worked. They are suggesting putting coil back in. I don't know if I want that though. If I was to stop HRT altogether will this have an adverse effect on my health, memory, bones etc. I am really at a loss and have reached pout to my
Doctor who hasn't been any use. Any advice or help would really be appreciated as don't know where to turn.

[Dotty]

Hi which patch were you on when you had the Mirena and which patch are you on now ?

[Missy141]

I was on Evorel 50 when I had the coil and without now on Evorel Conti.

[bombsh3ll]

You have so many options.

Another mirena and patches.

Micronised progesterone and patches

Another oral progestin and patches.

Oral estrogen with any of the above

Estrogen gel with any of the above

An oral combination product

Tibolone

Whilst not everyone chooses to take hormone therapy, it does confer valuable health benefits as well as quality of life.

I would think about what your goals are from both treatment and if you discontinued treatment.

When you say the combi patch "hasn't worked", what do you feel it hasn't achieved? It is unlikely you will have had two DEXAs or two coronary artery calcium scores in the same year showing significant deterioration between your previous regimen and now.

Is it not giving the same symptom relief or is it causing side effects?

If you figure out what you are looking for in a treatment and what you don't want, you can then identify the best option.

[Missy141]

Basically I am frightened on what will happen to me if I come off HRT and also what will happen to me if I stay on in regards risks of cancer etc. Am I better minimising risks and staying off HRT and suffering menopause symptoms or taking a risk and not suffering menopause symptoms or at least reducing them. My mother died from Ovarian cancer in her 50s and i looked after her till the end. So I have witnessed first hand that horrible disease.

[CLKD]

Morning.  Quality of Life should be our first concern B4 getting as much advice as is possible.    

Depending on why you underwent surgery 5 years ago should determine which route you take.  How have U felt since the operation?  As the mirena can be removed if it doesn't suit next time, this may B 1 method to consider.

Or you could stop HRT for a few months 2 see how you actually feel reading up the options.  U will get varied advice on here, the idea being to filter out what suits you now and what to shelf for later consideration.

In your situation I would be asking for a referral from my GP to a dedicated menopause clinic because there are waiting lists, both in the private and NHS sectors.  Should U now need the appt when it arrives, it can be cancelled.

Browse round.  Make notes.  Do read the 'bladder issues' and vaginal atrophy threads: 4warned is 4armed ;-)

[bombsh3ll]

I am so sorry your mother passed from ovarian cancer, it is horrible - is that why you had BSO? Are you a BRCA carrier?

I am a non carrier within a BRCA2 family so it is something I have had close contact with too, and lived in terror of it myself until I got risk reducing mastectomies at 29 and then genetic testing at 34 showing I was negative.

Perhaps irrationally, I was always much more frightened of breast than ovarian as most of my rels with breast were young, whereas the one aunt with ovarian was old, and also I could see my breasts, and was always scared of feeling a lump - I used to use a sponge to wash so I didn't have to touch them! But ovarian is far less treatable and often diagnosed too late.

I am surprised they left your uterus when you were having this surgery anyway, committing you to potentially long term progestogen use should you choose to take estrogen. It was known well over 5 years ago that it is the progestogen that confers the breast risk.

Regarding the cancer risk, you no longer have ovaries and combined continuous MHT confers a LOWER risk of endometrial and colorectal cancers than untreated women have.

Breast cancer - worst case scenario there is a SMALL increased risk with combined MHT in general. This cannot be extrapolated to BRCA carriers who have a high risk anyway and there is not currently any evidence that hormone therapy further increases breast cancer risk in this population.

It does add an extra layer to the decision making process, but to put it in perspective far more women suffer and die from cardiovascular disease and osteoporosis than any type of cancer, and you are already in an advantageous position not still having your ovaries at least.

I think in your shoes if breast cancer is still a concern I would probably go for Tibolone. I may also choose this myself when the time comes to switch from the COCP which I have been on since right after my risk reducing surgery, primarily to halve my risk of ovarian but for other quality of life benefits too.