Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Therese83]

It is illogical to worry about being on hormone therapy "too long". If your ovaries were still working would you be concerned about them producing exactly the same hormones, probably in far higher amounts than you are taking?

This isn't even a concern after the usual age of menopause because hormone therapy has an overall net benefit for most women's health and quality of life.

The fear mongering that has led to such worries is rooted in misogyny because there is no condition that affects men, or both genders equally, for which beneficial treatment is rationed to an arbitrary length of time and then withdrawn.

Can you imagine a doctor saying "I'm sorry sir, you've had that replacement knee for long enough, we'd better dig it back out now and let you hobble round in pain for the rest of your life"?!

I would also urge anyone with osteopenia to make sure you get a follow up DEXA in a couple of years to make sure you aren't continuing to lose bone on your current treatment, as younger women in particular are at high risk of undertreatment.

Yes I've very much got this on my mind (repeat Dexa). I was a bit worried when my Dr checked my estradiol level after several months of HRT and it still wasn't that high. But chatgpt tells me this is a bit meaningless in perimenopause anyway!?

I was actually annoyed last time I went because after the Dr upped my estradiol to 125, I had to see the nurse for a quick blood test who apparently saw it as her place to tell me:
- this is an extremely high dose and they only have about 10 patients of 11,000 on such a high dose
- if I'm on this now at 42, what will I be on at 55?
- sometimes you just have a crap day and it doesn't mean you need to up your dose.

All of this briefly freaked me out but it's totally illogical. In fact evidence shows younger women need higher doses as bombsh3ll alludes to. There's just a lot of nonsense and misunderstanding even in those who should know better!

[bombsh3ll]

I would ignore the nurse's comments, she may not even be a prescribing clinician and it is inappropriate when your dose has been determined following a full evaluation of your needs and based on shared decision making which she has had no part in, and probably has ill-informed personal views on hormone therapy.

Many clinicians are ignorant around the particular needs of younger women which is why I personally am a big proponent of the combined oral contraceptive pill because in an ideal world everyone (who wanted to) would get adequate replacement with transdermal and body identical etc but in the real world this doesn't happen and younger women often go undertreated and develop problems like osteoporosis.

Blood tests are of limited value in perimenopause however they can help if they pick up a low estradiol level as in your case, because it doesn't matter whether that estradiol was coming from your ovaries or your patch, it simply shows that you are spending at least some of the time with too low a level for optimal health.

[Therese83]

I would ignore the nurse's comments, she may not even be a prescribing clinician and it is inappropriate when your dose has been determined following a full evaluation of your needs and based on shared decision making which she has had no part in, and probably has ill-informed personal views on hormone therapy.

Many clinicians are ignorant around the particular needs of younger women which is why I personally am a big proponent of the combined oral contraceptive pill because in an ideal world everyone (who wanted to) would get adequate replacement with transdermal and body identical etc but in the real world this doesn't happen and younger women often go undertreated and develop problems like osteoporosis.

Blood tests are of limited value in perimenopause however they can help if they pick up a low estradiol level as in your case, because it doesn't matter whether that estradiol was coming from your ovaries or your patch, it simply shows that you are spending at least some of the time with too low a level for optimal health.

Ok thank you, that's really useful to know! I was a bit concerned because after 3 months of HRT my estradiol had gone from 103 (before treatment) to only 226. I was on 75 dose at that point. Three months later having been on 100 all that time it was still only 235. Even though I know it will be fluctuating, I must admit it struck me as low. Dose is now up to 125 so I guess I will see how it's looking next time and if still looks low maybe I should instigate some review of whether it's increasing my levels enough, do you think? I want to reverse my osteopenia and clearly lifestyle/exercise factors are not enough as I did weight bearing and strength training exercise already for years before this.

Totally agree about the nurse, it was so inappropriate and ill-informed. I could really have done without it but once I was feeling better (was starting to get ill that day and very busy day too) I was able to see the interaction for what it was.