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[Patchsmama]

Hello everyone.

Today I was told that I have osteoporosis by the GP following the results of a dexa scan 7 weeks ago. I had the scan after being pulled out as I’d had two previous fractures, 5 and 10 years ago.

I am now extremely worried. I struggle with health anxiety anyway. I’m being started on weekly Allendronic Acid and calcium and vitamin D tablets.  I was already taking vitamin D.  I worried about the side effects of the AA too.

I had a TAH & BSO when I was 50 and I’m now 60. I’m blaming myself for not having HRT. I had a borderline ovarian cyst and I was worried about whether HRT might cause anything.

I wonder if anyone can offer any reassurance?  Is it all downhill from here with the rest of my life being filled with fractures?  Is there any chance that things might improve?  I need to have another scan in 2 years. Feeling very upset and anxious right now.

[marge]

Hi, sorry to hear about your diagnosis. I was diagnosed 7 years ago after breaking a bone in my foot. l’ve been on Alendronic Acid and Vit D/Calcium ever since. No problems at all. Currently awaiting another dexa scan.  I walk a lot, do yoga twice a week and eat very healthily.

[bombsh3ll]

It's not your fault at all.

Particularly a few years ago, it would probably not have been standard practice for hormone therapy to be offered after oophorectomy beyond the average age of natural menopause, which is 51.

I don't agree with that, however that practice was common. Even now much younger women are having their ovaries removed and going untreated for the loss of hormones.

So you would have to have had a level of both clinical knowledge and advocacy skills that frankly most people do not, to get hormone therapy at that time.

That said, you are still within the somewhat arbitrary but often cited 10 years from menopause which is considered the window of opportunity to start hormone therapy, so whilst the best time to act would have been 8 years ago, the next best time is now.

Having had a hysterectomy, you are also in the fortunate position of being able to take estrogen without a progestogen.

Hormone therapy is more effective than bisphosphonates, treats the intravertebral discs as well, and has a positive effect on quality of life as well as multiple health outcomes.

It doesn't even have to be either or, you can take estrogen in addition to bisphosphonates.

[Patchsmama]

Hi, sorry to hear about your diagnosis. I was diagnosed 7 years ago after breaking a bone in my foot. l’ve been on Alendronic Acid and Vit D/Calcium ever since. No problems at all. Currently awaiting another dexa scan.  I walk a lot, do yoga twice a week and eat very healthily.

Thank you so much. It’s good to hear something positive xx

[Patchsmama]

It's not your fault at all.

Particularly a few years ago, it would probably not have been standard practice for hormone therapy to be offered after oophorectomy beyond the average age of natural menopause, which is 51.

I don't agree with that, however that practice was common. Even now much younger women are having their ovaries removed and going untreated for the loss of hormones.

So you would have to have had a level of both clinical knowledge and advocacy skills that frankly most people do not, to get hormone therapy at that time.

That said, you are still within the somewhat arbitrary but often cited 10 years from menopause which is considered the window of opportunity to start hormone therapy, so whilst the best time to act would have been 8 years ago, the next best time is now.

Having had a hysterectomy, you are also in the fortunate position of being able to take estrogen without a progestogen.

Hormone therapy is more effective than bisphosphonates, treats the intravertebral discs as well, and has a positive effect on quality of life as well as multiple health outcomes.

It doesn't even have to be either or, you can take estrogen in addition to bisphosphonates.

I really appreciate your response Bombsh3ll. I am a retired nurse but hadn’t looked after adults since I finished my training in the early 90s, I don’t think HRT was a thing then! 

I think if I had plucked up courage and taken it after the surgery, life would have been better. I’ve struggled with anxiety, VA, feeling tired etc. I do take Vagifem and oestrogen cream but that’s obviously irrelevant to the osteoporosis.  After the surgery I asked the surgeon whether I would be okay to take HRT. His response was, “see your GP”. I did this and my GP at the time said it was up to me though I’d “have to go through the menopause at some point!”  I never feel I can get an informed answer but I know that I would still worry about the risks for me.  I often wish someone would take me in hand and say, “do this” and that is what I have to do xx

[Mary G]

I'm sorry to hear that but I don't think it's too late to reverse some or even all of the damage.

You had the operation 8 years ago so you are still within the 10 year window for HRT.  If it was me, I would start HRT immediately and I would definitely recommend Oestrogel and testosterone.  You could still take the other medication but the hormones will probably be the most effective treatment.  If you don't have a womb, you don't need progesterone although many women find natural progesterone to be very therapeutic and it helps with sleep.

I would now find a way to start HRT immediately although I know it's difficult to get a GP appointment.

I hope that gives you some reassurance.

[Patchsmama]

Now I’ve thought about things, it is actually 10 years since I had the surgery, so I’m guessing that HRT wouldn’t be worthwhile now.

[laszla]

If it were me I would not hesitate to go on oestrogen. Although my HRT hasn't yet resolved all my issues, it has had a dramatic effect on my bone density.

 I don't have the numbers to hand but my dexa of 2022 showed that one of my T scores had declined into full blown osteoporosis (the previous year all three T scores were 'only' osteopenia). Cut to this year following a moderate to high dose of hrt (including implants and testosterone) and that worst T score has increased by about 25%, it's better than it was even in 2021, the two other scores also improved
Bone density is one symptom of meno where you can get a very concrete, measurable sense of the benefits of HRT. Note that I do not take and would not ever want to take biphosphonates.
Even low dose estrogen therapy can help bone density

[Bungo]

If it were me I would not hesitate to go on oestrogen. Although my HRT hasn't yet resolved all my issues, it has had a dramatic effect on my bone density.

 I don't have the numbers to hand but my dexa of 2022 showed that one of my T scores had declined into full blown osteoporosis (the previous year all three T scores were 'only' osteopenia). Cut to this year following a moderate to high dose of hrt (including implants and testosterone) and that worst T score has increased by about 25%, it's better than it was even in 2021, the two other scores also improved
Bone density is one symptom of meno where you can get a very concrete, measurable sense of the benefits of HRT. Note that I do not take and would not ever want to take biphosphonates.
Even low dose estrogen therapy can help bone density

Have you ever had your oestrodial blood levels taken ? I started hrt in 2022 but my density decreased slightly, I don't think I was absorbing the oestrogel though as blood levels were less than 120. On patch now but blood levels between 120 and 200 so still not sure if had adequate for bone density or if should increase the patch..interested to see what your blood levels were that caused increase in density

[Patchsmama]

If it were me I would not hesitate to go on oestrogen. Although my HRT hasn't yet resolved all my issues, it has had a dramatic effect on my bone density.

 I don't have the numbers to hand but my dexa of 2022 showed that one of my T scores had declined into full blown osteoporosis (the previous year all three T scores were 'only' osteopenia). Cut to this year following a moderate to high dose of hrt (including implants and testosterone) and that worst T score has increased by about 25%, it's better than it was even in 2021, the two other scores also improved
Bone density is one symptom of meno where you can get a very concrete, measurable sense of the benefits of HRT. Note that I do not take and would not ever want to take biphosphonates.
Even low dose estrogen therapy can help bone density

Thank you Iaszia

Did you start HRT within 10 years of menopause?  The thing that bothers me is that it’s now too late to make a difference since I had a surgical menopause 10 years last August.

[bombsh3ll]

It's never too late to make a difference with regard to bone health or quality of life.

The "10 years" dogma came about following the Women's Health Initiative study, which was flawed in multiple ways but did generate some useful information.

It was shown that women starting hormone therapy within 10 years had LOWER all cause mortality than those on placebo, particularly regards cardiovascular deaths.

Those starting later did not get this particular benefit, however they didn't do any worse vs the placebo group,

Also, and this is particularly relevant to you, is the main "risks" people think about with hormone therapy ie breast cancer and thrombosis, which do exist but are minuscule in terms of additional attributable risk, are caused by the progestogen, not the estrogen.

You are in the very fortunate position of being able to take estrogen without a progestogen having had a hysterectomy.

[pepperminty]

I am not a medical professional , but I would join the  "Osteoporosis UK ~ Friendly Support & Natural Options." group on FB . They have lots of good researched advice.
There are risks and benefits with all medication and without thoroughly researching I would not jump into anything.  It is never too late to build natural healthy bouncy bones.
- vitamin D K2 and magnesium, prunes.

GP's have no knowledge regarding how to keep healthy bones through diet . HRT etc  - it's never too late unless you have a medical reason not too.  Dr Nick Birch has a good pod cast . Join the FB group and hopefully you will get all the info you need.

PM xx

[Patchsmama]

I am not a medical professional , but I would join the  "Osteoporosis UK ~ Friendly Support & Natural Options." group on FB . They have lots of good researched advice.
There are risks and benefits with all medication and without thoroughly researching I would not jump into anything.  It is never too late to build natural healthy bouncy bones.
- vitamin D K2 and magnesium, prunes.

GP's have no knowledge regarding how to keep healthy bones through diet . HRT etc  - it's never too late unless you have a medical reason not too.  Dr Nick Birch has a good pod cast . Join the FB group and hopefully you will get all the info you need.

PM xx

Thank you so much for this Pepperminty. I will look at the fb page. I read about prunes last night so shall definitely be going out to buy a tub tomorrow.

Unfortunately the experienced GPs at our surgery have all left and we are left with people who don’t seem to have a clue and don’t care. I felt yesterday that he was blaming me … did I smoke, drink, have an eating disorder …. No, no, no. When I asked if it was because I had a surgical menopause, he said it was nothing to do with menopause!!!  Unbelievable really.

We deserve so much better, it’s depressing.

[laszla]

If it were me I would not hesitate to go on oestrogen. Although my HRT hasn't yet resolved all my issues, it has had a dramatic effect on my bone density.

 I don't have the numbers to hand but my dexa of 2022 showed that one of my T scores had declined into full blown osteoporosis (the previous year all three T scores were 'only' osteopenia). Cut to this year following a moderate to high dose of hrt (including implants and testosterone) and that worst T score has increased by about 25%, it's better than it was even in 2021, the two other scores also improved
Bone density is one symptom of meno where you can get a very concrete, measurable sense of the benefits of HRT. Note that I do not take and would not ever want to take biphosphonates.
Even low dose estrogen therapy can help bone density

Have you ever had your oestrodial blood levels taken ? I started hrt in 2022 but my density decreased slightly, I don't think I was absorbing the oestrogel though as blood levels were less than 120. On patch now but blood levels between 120 and 200 so still not sure if had adequate for bone density or if should increase the patch..interested to see what your blood levels were that caused increase in density

I regularly test as I'm a poor absorber - hence having implants after a few years of gel/patches. My serum E2 levels have reached about 400-500 now and my osteoporosis has incontrovertibly reversed/improved. Some people might improve on lower levels, exercise is also very important. But I don't believe your levels are high enough for bone protection for which a minimum of 300 is advocated.

[CLKD]

Get the HRT prescribed.  Age is a number ;-).  What research is this idea based upon for example?  We all age at different levels ..........

let us know how you get on.  If U don't ask, you won't get.  If U meet with resistance get a referral to a dedicated menopause clinic.