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[Ayesha]

Look to Australia with help in preventing osteoporosis. After years of telling the population to cover themselves from head to toe to prevent skin cancer, they now find themselves with a huge rise in osteoporosis in the population. Their research will be well up to date on preventative measures.

[Ayesha]

One in two are the stats for osteopenia.

Interestingly, its those with osteopenia that have the most fractures. 

[DottyD68]

I don't think anyone is trying to scare women from using HRT. I think the point being made is that for some women who want to try HRT, they find that it either does not work or it causes intolerable side effects and/or consequences that outweigh many of the benefits. The danger in saying that HRT categorically "works" for everyone is misleading because it doesn't. It is great that it works for many women and I think it should be more easily accessible for those who want to try it.

[CLKD]

My GP told me some treatments in this country are precautionary and all about potential money saving down the line and not necessarily about the patient's health in the present and that in other countries they have a higher threshold for BP for instance. . a retired nurse told me that a lot of NHS money is put into these types of 'age related' tests which could prevent problems as we age further. However, they are taking away appts for those patients that need 2 B seen because they have developed symptoms . 

Until the NHS provides more medical slots throughout the system, there will be a waiting list for everything we may need to access.

Tamoxifen almost killed me. I was prescribed it as an oestrogen suppressant following histology of a 'non sinister breast lump'.  This showed 'changes at the margins' apparently triggered by oestrogen. It was never seen on mammogram, I felt it whilst in the bath on 14.11.1994. Removed the following June.

Do we take pain relief if we don't experience pain    .  I've not had symptoms bad enough to even consider HRT although VA is under control with appropriate treatment.

[Jules]

Just a query then related to hrt. Are there any circumstances,doses, types of hrt which would mean a doctor would tell someone they've to stop their vaginal estrogen because she'll be getting too much estrogen?

[bombsh3ll]

Just a query then related to hrt. Are there any circumstances,doses, types of hrt which would mean a doctor would tell someone they've to stop their vaginal estrogen because she'll be getting too much estrogen?

Yes, ignorance.

Unfortunately this is common.

[Ayesha]

There are women who are using both systemic and topical oestrogen. If I remember correctly the advice is if your systemic regime is working well for you but you still need topical treatment then its best to use both together.

If a GP said otherwise then that would be bad advice.

[bombsh3ll]

However there is a case to be made that if the systemic dose is adequate, this should restore the health of ALL estrogen responsive tissues, as vaginal atrophy usually only occurs in the setting of very low systemic estrogen.

I personally believe that the ongoing presence of vaginal atrophy should prompt a review of the systemic dose, particularly if the treatment is indicated for osteoporosis prevention or health maintenance and especially if that woman is young or has POI.

Replacement in POI that is so low it needs to be propped up with vaginal estrogen should be a never event, as their age matched peers with healthy ovarian function don't have urogenital atrophy.

However there are women who cannot access a therapeutic dose, others who make an informed choice not to increase their dose, and some who are limited by side effects.

Therefore nobody who wishes to use vaginal estrogen in addition to systemic replacement should be denied it on the basis that it is "too much" estrogen. This is incorrect, especially given the absorption of topical vaginal estrogen is so negligible that it is considered safe in active breast cancer.

There may be some situations in which healthcare systems or insurance based plans won't fund both, but this is a cost issue not a clinical safety issue.

[Jules]

Ok thanks. I will tell her. She's been told not to use it and has to wait 10 weeks for a review. A male doctor. There's no parity of understanding across the GP profession

[Ayesha]

I would never stop topical treatment until the systemic treatment started to do its work at keeping GSM symptoms under control and that will be a wait and see scenario.

[Jules]

I would never stop topical treatment until the systemic treatment started to do its work at keeping GSM symptoms under control and that will be a wait and see scenario.

It's not doing its work. Systemic HRT hasn't prevented her VA. She needs specific treatment to that area. But the GP has told her to stop the estriol cream as he says she'll be getting too much estrogen! 

[bombsh3ll]

This is medically incorrect and she needs to see someone else.

Whilst it is unfair having to pay, vaginal estrogen can be bought over the counter in the meantime until she finds a menopause competent prescriber.

I personally would rather (and do) pay for treatment that I can't get on the NHS rather than go without where I can afford it, particularly if I were in your friend's situation given the consequences of untreated VA.

[Jules]

I thought it was incorrect too only because I know from women on this forum that use both forms. It's so difficult when we don't have a choice of GPs.

[CLKD]

Is it true that women cannot 'overdose' on oestrogen treatments? 

[Jules]

Purely just from googling and reading AI and other medical websites, they all say both can be used so where some GPs get their information from I'm not sure. I'm so relieved my GPs now prescribe what I need or I'd be suffering as I've currently had to increase the frequency of my localised estrogen to get on an evening keel.