Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Chrislm on December 09, 2013, 10:59:01 PM
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Does anyone know why women are discouraged, or even prevented, from taking HRT forever after the menopause?
I have read (of course) that it is not natural for our bodies to have estrogen later in life. Yet if you look at the 'normal' range for post menopausal women, the upper end is pretty high.
So if post menopausal women can have naturally quite high levels, surely it can't be a problem to raise them with HRT?
I feel so so good now. I love my life and I want be able to carry on making the most of it for as long as is possible. I have had two (mercifully quite brief) periods when my hormone levels were low and it was really hard to find joy in the day to day. Now that my joy is back, I feel like I would do almost anything to protect it.
Perhaps I am in denial, but it just doesn't seem right that we are supposed not to feel right??
I should say, I'm not yet 50 so it's not as though I'm facing imminent withdrawal, but the speed that life is flying by, I'm sure it won't be too long before I am!
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Hi Chris - it seems to be the length of time a woman is exposed to oestrogen which affects the cancer risk. If a women begins her periods early and has a late menopause then this is one of the risk factors for certain cancers so it stands to reason that if you prolong the time that high levels of oestrogen are present in the body by using HRT for a long time then the greater the risk. The risk of stroke is also thought to rise as we get older and still use HRT and also the risk of heart disease. It also seems that not much research has yet been carried out on the use of HRT in over sixty year olds!
Taz x
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Hello chrislm
I so agree with you!
I was just commenting on a similar thing in another thread. As Taz says, the HRT risks are said to increase with age but there seems to be little research on women 10+ years post-menopausal on which to base these increased risk factors. I imagine the risks get harder to assess as the subjects in any study are more likely to get age-related illnesses anyway. The risk of most cancers rises considerably with age, as do strokes etc. Also, there are some contradictions in these studies suggesting that more exposure to hormones over a lifetime = more risk. Studies show that more pregnancies and prolonged breast-feeding lower risks of breast cancer considerably - hormone quantities are huge during pregnancy!
The idea that estrogen (and progesterone) in older women is not natural is an interesting one. We are happy (and often encouraged) to take plenty of other substances - statins, hypertension-controllers, anti-inflammatories etc. so I find it a bit odd that the use of naturally-occuring hormones is so frowned upon. My dad took a drug for high blood pressure every day for the last 30 years of his life until his death (from an accident - not related to his health). It carried risks to take that drug but there was no question that he shouldn't take it every day for life and it certainly wasn't natural.
Our medical system does everything in it's power to prolong life with every available drug and surgical intervention (all highly unnatural - previously we'd just have died of old age!) so why the problem with taking a substance which may improve the quality of that prolonged life? Especially when risk factors are not too clear or can at least be assessed on a case by case basis so informed decisions can be made.
I, personally, would like to be able to choose for myself whether I am prepared to take the risks of staying on HRT if I feel great on it. Natural - my a***!
hil x
ps I'm one of the younger ones too (47). I'm not even on HRT yet and already I'm fretting about being made to stop!
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This is a very interesting one. I regret to say that it seems many women are totally perplexed as to how they can get control of menopausal symptoms. My own doctor must be typical of many others who are refusing to prescribe hormone replacement therapy let alone work with a patient to find one that can be tolerated. Then there is the question of whether you want withdrawal bleeds forever if you have a uterus or if you can tolerate any of the progestins or progesterone available. Coming off HRT cold turkey if you had to for health reasons would be a tricky one. The alternatives to HRT seem to be anti-depressants, clonidine and then there are the other meds you might need to sort out problems brought on because of dropping oestrogen. The thing is we need more really good advice from people who are really experienced in treatment of menopause because it is so important for so many women's well-being. Sorry if this all seems a bit negative. 59 and still flushing etc.
Meg
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Thank you all for your replies. As it ever, it is so interesting to hear the views of other women.
I have seen some of the various reports about increased cancer risks, Taz2, but like Hil says, there is a lot of contradiction and it gets harder as people get older to distinguish between age related and other factors. I am very far from convinced that there is clear evidence against HRT over 60.
I am fortunate that my GP practice is exceptionally good. I have seen a few doctors there but one in particular made an interesting point to me when I saw her recently to change my HRT dose. She said that the she believes that women do not need progesterone beyond menopause. She thinks the reason it is still prescribed to prevent the build up of the uterus is merely outdated advice. And this makes sense to me. I can well believe that it isn't good for us to keep on taking synthetic progesterone, but estrogen, at the quantities in HRT, seems to give women what some post menopausal women have anyway.
Meg, I agree we need good advice, but perhaps also some more challenges to the current thinking. I don't know if you wanted to take HRT, but I think it is outrageous if you are being prevented by your GP. Presumably he would happily stick you on anti depressants for the rest of your life, as Hil says!!
I have never had mental problems, the ones I had (only quite briefly so I am not moaning) were all physical. I went from being a very fit, active, happy person to a stiff, tired, sickly old woman. Now, on HRT, I'm at the front of the pack with my womens cycling club again. I simply cannot, and will not ever believe that this is not better for me and everyone who knows me, works with me, lives with me etc. that I should stay feeling like this for as long as possible.
There are many examples of where medical advice is out of date and it can remain out of date for ages. A good example would be the current change in advice relating to osteoarthritis. (This is another area of interest to me because I don't know anyone over 45 who has done serious sport all their lives and still has all their cartilage). The latest advice from NICE, which is still in preparation, tells a very different story and suggests a very different way of treating it to the previous guidance which has been around for years. And I know from my own experience that the new guidance clearly makes much much more sense.
So maybe things will change re guidance for HRT. I just wish there was more that we could do to prompt intelligent debate. Perhaps it is already happening?
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your GP's opinion that progesterone beyond menopause is not necessary is interesting.
Have you read anything written by Dr John Lee? He's a US medic who has written a number of books on hormones and menopause and is absolutely convinced that progesterone (but NOT progestins) is vital and far more important than oestrogen! He reckons that a lot of menopause symptoms are caused by oestrogen dominance as, whilst oestrogen drops at menopause, progesterone almost vanishes completely so the ratio of the two is severely altered.
His argument for the importance of progesterone (through menopause and post-menopause) backs up evidence I mentioned earlier - that pregnancy considerably reduces breast cancer risk. A pregnant women produces around 200 times the progesterone of a healthy non-menopausal woman during a normal menstrual cycle! At birth that huge rise in progesterone completely drops and he believes that dive in hormone levels may well be a big factor in post-natal depression. Maybe there could be a link between low progesterone and low mood in menopause?
As you rightly say, we really need more hormone experts in the UK to give clear advice regarding menopause and hormone balance. Sadly, most of the politicians in charge of funding for more research/debate are men ::)
It is a real tragedy for their patients that there are still GPs out there who have such an extreme bias against HRT. Is there really nothing that can be done for those patients? I know this is a regular topic on this forum, but so many of the women who are refused by one GP are also refused by subsequent GPs at the same practice (due to some sort of colleague solidarity?) and changing surgeries is not always an option, especially for those of us in rural locations or without adequate transport provision.
When I hear brilliant success stories like yours Chris it makes me incredibly angry that your 'health' could be taken away again some time in the future. Especially if that decision is based on guidelines which, as you say regarding arthritis, often alter considerably over time anyway >:(
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Oh ladies, what a great thread. You have all brought up such good questions and thoughts.
I have recently come off HRT for a break to see where I am(I'm 57) and so far flushes etc have not been too bad but my hips are really hurting at the moment. I was a professional dancer so my joints have taken a battering - I'm reasonably slim, walk a lot, love gardening and my job as a tour guide involves climbing stairs etc.
My instincts tell me I should probably just take a very low dose of oestrogen over the longer term but, as has been mentioned, it's the retched progesterone bit that is the problem. I am using Vagifem for the dreadful burning I get around my urethra but it's not really helping and sex is getting progressively more painful, so it's clearly not helping things in the nether regions - 10mg is obviously not enough!
Healthy debate is definitely needed. I think we all want a better round of trials over the longer term. Many GPs desperately need more training.
There are so many different triggers for cancer and heart decease, stress being one of them. When they do these trials on HRT do they take into account the stress in an individual's life? How can they really know it was HRT that truly caused the cancer when there are so many other factors that play a part.
Do we know what a healthy oestrogen level should be post menopause - with or without HRT? Why isn't our oestrogen level routinely checked alongside other things.
I believe we will see a time when oestrogen will be used routinely as a preventative, after all the cost of osteoporosis alone would make it worthwhile.
I feel a lobby group coming on - more research please.
DG x
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Dancinggirl thought you might be interested in this
http://womensvoicesforchange.org/tag/menostar
http://menopause.emedtv.com/menostar/menostar-dosage.html
You don't have to take progesterone with Menostar 14mcg. Its not available in the UK as far as I know, though have asked my GP about it.
You could get round it by halving a lowest dost patch if you are post menopause, the dosage is not enough to build up the lining of the womb, if I had not had a hysterectomy this is what I would do for the sake of my bones. I would use it long term.
I usually keep my 25mch patch on for a week and use tape to keep it from falling off at the moment, if Menostar becomes available in the UK I would switch. Its designed to stay on for a week.
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DG -
that's a really good point about stress being pretty much impossible to assess properly in a controlled trial. I firmly believe that stress is a huge factor in health anyway. High stress = high cortisol levels = hormone imbalance and raised risk of heart problems, stroke, diabetes etc.
One thing which really needs thinking about with any hormone trials post-menopause is the stress caused by returning symptoms without HRT (such as the joint pain you mention) to counter any increased risks of being on HRT (and hence with less symptoms and stress). Very hard to measure though.
I also wonder if the medical world has any idea of 'safe' doses of oestrogen post-menopause. It just seems to be accepted that oestrogen falls and that's just part of ageing - but why? We fight ageing in other areas of medicine so why not hormonally? What is wrong with wanting the hormone levels of younger (and healthier) women? We want (and spend lots of money attempting to achieve) younger skin, younger hair etc., why not younger insides (with the potential benefits of reducing age-related diseases like osteoporosis)?
The whole thing needs very careful analysis.
On a separate note DG you mention "retched progesterone" - have you had a bad experience with it?
hil
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Dancinggirl, Hil, yes, yes, yes! It is so important that we understand more about the impact of hormones on health. The perimenopause has certainly highlighted this to me so clearly. I am very interested in your comments about progesterone and I will look at the stuff by Dr John Lee. (Although I have generally been very healthy in the past, I did have problems with low progesterone levels in my 30s and as I told my GP, many of the symptoms felt the same then as the menopause symptoms I started to get more recently, although not all. Also interestingly, I was given norithesterone then which I couldn't tolerate but I'm fine with the lower dose of it in Elleste Duet).
Your point about stress is so important.
Also interested in your comment about your joint pain Dancinggirl. I have read that osteoarthritis increases in the menopause but I bet it doesn't! I am sure it is just that we get joint pain in menopause and when it is checked out, tests reveal cartilage wear which was there already. It is another medical effect of the menopause which is just accepted.
One of my recent obsessions has been why we see few women over 50 taking part in different sports compared to men over 50 and younger age groups. I am sure that it is the effect of the menopause making it challenging for many women just to get through the day!!
We need to find a sensible female MP to lobby!
It would be great to hear from any women who are from within the medical profession who might have a perspective.
And Dancinggirl, I wish you the very very best of luck coming off HRT. I hope it goes as well as it possibly can for you and that the quality of you life isn't affected too much. You seem pretty savvy about all things menopause so I am sure you are aware of the different forms of progesterone. When I was in my 30s I used I used cyclogest pessaries which worked well.
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It's so good airing our frustration - such good issues coming to light.
devonhil - Like most women I found it was the progesterone that seemed to cause side effects. I've had a Mirena for the last few years on the basis that it has less side effects. When I was peri I used oestrogel with progesterone pills each month and got terrible period pain &/or headaches with the withdrawal bleed - so yes, my experience of progesterone is not good.
I find it very interesting about progesterone, or rather the lack of it, being as important as oestrogen - something else we need clarity about!!!!
I have to say I'm not desperate to go back on HRT but definitely want to be proactive in preventing long term problems like osteoporosis.
silverlady - thank you for the links - very interesting.
Chrislm - thanks for your kind support. I was peri from my mid 30s and one of my symptoms was bad joint pain even then. HRT has definitely helped (not sure quite why). I was thinking of restarting my dance class i used to lead a couple of years ago but if my hips are bad I don't see me doing it.
I will probably do a thread under 'Personal Experiences' about my withdrawal from HRT. Firstly because so many women dread coming off HRT and, so far, it hasn't been as bad as last time (i had a 3 year break from HRT after all the scares in 2002 ) - also what steps I take for the longer term. Incidentally, re: stress - I am enjoying a relatively stress free phase at the moment, unlike when I had the break from HRT before and life was extremely stressful, and I'm thinking that may well be why my meno symptoms are less severe!!!!
DG x
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Dancinggirl, yes please do share your experience of coming off HRT. I am sure many of us will be very interested to hear about your progress. :) :) ;) :) :)
I am very glad that your life is better and less stressful now. I am sure it is easier to deal with menopause symptoms when life is less stressful, even if the symptoms themselves are just the same! (I still remember with horror delivering a presentation to a high profile board up in Scotland with sweat running down the sides of my face! I doubt anyone's stress levels could deal with that easily! :)
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Oh Chrislm
What a ghastly experience. :hot flash:
DG x
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Very interesting thread - and has been covered quite a lot recently.
There is a lot to reply to but I can't concentrate on all of it at once!
First of all those of you who are not yet 50 - well really don't worry at all!!! The most important thing is to make sure you take oestrogen until at least the average age of natural menopause - 51 in UK. By the time you reach 60, recommendations, practice and guidelines will have changed dramatically.
There was mention about out of date guidelines - many of you will have seen on this site that a group has been set up to revise the Nice guidelines on menopause - the Menopause Guidelines Development Group which Heather Currie informed us about. Menopause Matters is one of the stakeholders - consultees on the guidelines. They are due to be published I think in 2015 and when the draft guidelines have been prepared I am sure Dr Currie will post on this site for comments - so this will be your chance to have an input. The scope of the guidelines has already been prepeared so may not cover all the areas you are interested in.
Someone mentioned her doc reporting the addition of progesterone to HRT post-menopausally as outdated
"She said that the she believes that women do not need progesterone beyond menopause. She thinks the reason it is still prescribed to prevent the build up of the uterus is merely outdated advice. And this makes sense to me. I can well believe that it isn't good for us to keep on taking synthetic progesterone",
The GP is surely mistaken? It is incontrovertibly the case that oestrogen works by stimulating the uterus lining with a blood supply which causes it to thicken. Reliable trials have confirmed this mechanistic explanation in practice. There is definitley an increased risk of endometrial hyperplasia from unopposed oestrogen, which can lead to cancer.
Re synthetic progestogens - I quite agree. These are definitely alien to our bodies and I would not want to take these for any length of time.
Re all the trials and long term effects of HRT. As already discussed there is a multiplicity of factors which can increase the risk of cancer as we age and it is difficult to establish causal relationships and correct for one effect in any trial data. However the trials on which the risk date are based were carried out using conjugated equine oestrogens ( the Premique/Premarin type) and synthetic progestogens - and were shown to be flawed. There are additional more recent studies - in Denmark for example - using bio-identical HRT which come to different conclusions. I am sure there will be more of these over the coming years.
Regarding out of date advice - unfortunately GPs are not up to date on all matters and anyone who encounters out-dated thinking would do well to ask to be referred to a menopause clinic - and to ask to see a gynae not a nurse. The view now is that women should be allowed to stay on HRT as long as they wish, provided the risks have been explained, and there is no other medical reason why not.
Here is the most up-to-date statement by the British Menopause Society and Women's Health Concern
http://min.sagepub.com/content/19/2/59
This website too lists the risks as equal to the benefits between the ages of 60 and 70.
http://www.menopausematters.co.uk/balance.php
Regarding hormones and post-natal depression - it is illuminating to read the work of Prof Studd who attributes this to a decline in oestrogen levels
http://www.studd.co.uk/
http://www.studd.co.uk/postnataldepression.php
Regarding John Lee's theories - we have to remember that the health care system in America is very different from ours and has led to a plethora of different therapies, and supplements, many of which are the subject of dubious claims and lack the scientific credibility of the products available in UK. The US themselves through the FDA also have trouble sometimes with regulating some of these products, which of course make a lot of money.
This website reviews some of the available information and studies on the use of progesterone at various points in a woman's life:
http://www.2womenshealth.com/Progesterone-Supplementation-Cream-Suppositories-Gel.htm
Amongst the references quoted, here is a fairly recent assessment of the use of progesterone for post-menopause from a UK university:
J Obstet Gynaecol. 2007 Oct;27(7):655-9.
Transdermal natural progesterone cream for postmenopausal women: inconsistent data and complex pharmacokinetics.
Elshafie MA, Ewies AA.
Faculty of Health Wellbeing and Science University Campus of Suffolk, UK.
Transdermal progesterone cream (PC) is propagated as a possible alternative to hormone replacement therapy (HRT) in the management of menopausal symptoms and treatment of osteoporosis. Nonetheless, considerable concerns were raised regarding the inconsistent results and the credibility of some studies that were not peer-reviewed. Further, the complex nature and diversity of the pharmacokinetics of progesterone led to difficult interpretation of the findings. Given the current best available evidence, using PC for postmenopausal therapy regimens should be considered as an unsubstantiated treatment option, and its clinical applications must be restricted to well-designed interventional trials that assess its efficacy and safety.
There is a lot more I could say but I think that's enough for now - got a bit carried away!
Hurdity x
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I have a box of tissues in the classroom just for me now to deal with the half hourly sweats. My glasses steam up too which is of great interest to the children!
The thing I hate the most is the constantly damp bra - horrible.
I was struck with a terrible thought today - if I am off HRT too long and then restart it will be as if I am starting from scratch and the stroke/blood clot risk is highest in the first year of using HRT!
Taz x :-\
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Taz2
I've been following your comments about how you are coping with coming off HRT. I'm 59 years old and also working full-time as a teacher; I'm mortified at the thought of having to come off it altogether. I'm currently taking Femoston 1/10 which was reduced from the 2/10 three months ago, and can't believe how washed out I feel. I really do worry about how I'll cope with work when I have to come it completely. Are you thinking of going back on HRT?
Jaydee
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I've been trying very hard to cope without it but can't imagine feeling like this for very long. My main problem is that when I stopped it I had some post-sex bleeding followed by a really hard to shift kidney infection (neither of which I have had before). The month of antibiotics upset my stomach and I then picked up a stomach bug from school. I then had a dental infection and to top it all off a flu-type cold all since the beginning of September. I very rarely catch anything and can only assume that the kidney infection has knocked me for six immunity wise and that as this was due (according to my doc) to coming off HRT then maybe going back onto HRT is the only way to begin to feel even remotely like my old self. I'm now not sure whether it is not having HRT which is making me feel so washed out as you rightly call it or whether it is the after effects of the various ailments and antibiotics - stomach is still not right.
My doc has taken HRT off repeat prescription - although she has asked me to continue with vagifem - but she doesn't know that I have three months worth at home. I am waiting to have investigations to check the post sex bleed and will decide after that about going back onto HRT. My original plan was to take it to age 60 and then retire so that if necessary I could just sit in a sweaty huddle until it passed! That is no longer an option as I have to work at least another five years before getting State Pension.
One problem now though is that the lower you get the more difficult it is to actually argue your case or even make a decision. My mum did have a couple of DVT's and her brothers also had them in their seventies. I have been tested some time ago for the most common clotting problems and all the results were fine so I don't see that I am more at risk than anyone else. My weight is ok and blood pressure usually 120/78 which isn't too bad.
What are you going to do Jaydee?
Taz x
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Hurdity, thank you very much for your very thorough reply. It is very good to know that the guidelines are being updated.
Re progesterone, I am not clear what is likely to be the best. All of the ones listed on this site appear to be synthetic, just dome more 'alien' than others. Would cyclogest be an alternative? I notice a few people have mentioned it and I used it for PMT when I was younger.
It is actually quite difficult to get GPs to prescribe anything other than pills. My GP practice is very good and have certainly not made tried to influence my decision other than to give me information. They have pushed against a gel instead of a pill though. I asked about the gel before I started taking anything, and again when I went back a couple of weeks ago. On both occasions I was told that gels were only used if pills really didn't work. I assume it is because gels are more expensive?
I am still thinking about insisting, although I feel so good now that I am loathe to change anything. But it sounds like it is a much better long term solution.
Taz2, you poor thing. Good luck with whatever you decide to do.
Jaydee, do you want to come off or do you have health problems which mean that you have to?
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Gels work out about the same price as patches. I have looked quite closely at this :)
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Taz2 - I really agree with you about an inability to fight when feeling so run down. This is probably why so many women end up on ADs and sleeping pills. You are clearly a really 'sorted' lady and are, I think, being very objective about what you are going through. It sounds to me as though you need some serious R&R which I doubt you are going to get with Christmas looming. I did some learning support work in a school for a few months and now have enormous respect for the job teachers do - soooo tough! It sounds to me that you need the HRT to get you through the next few years but could you try a lower dose (so reduced risks) or gradually reduce dosage over the next 3-5 years?
I've been working in a very busy store for the last 3 years which also exposes you to lots of viruses. This last summer I had a terrible run of tummy bugs etc which left me totally exhausted (i had also developed RSIs) - I never thought I would have energy again and I was still using HRT at the time. Late August I discussed things with HR and have been able to change my job within the company which has been great - I'm very fortunate.
I started to wind down my HRT in September and by early November I had come off completely.
I have been lucky to be able to come off HRT at a relatively low stress time but after two months my hips are starting to really hurt all the time. I had forgotten that aching joints was one of my meno symptoms and now find it difficult to determine whether it's just bad joints or coming off HRT - I suspect both.
Chrislm - I've used Gel through peri and post meno - it's absolutely fab - much better for adjusting dosage. I understand that the current trend is towards transdermal as we get older anyway. You mention that all the progesterones listed on this site are synthetic but Utrogenstan is a bio-identical progesterone - it is listed under 'Progesterones' under 'HRT Preparations' - have a look at some of the threads about Utrogestan and check out Professor Studd's website - some great info there as well.
Good luck everyone. DG x
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Thanks Dancinggirl. I think I was confused by the fact that Utrogestan is listed under progestogen sand I thought this referred only to synthetic types! ::)
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Hi Stellajane
Thank you for posting this. I'm really glad that everything was ok, and delighted to hear that you have been able to stop HRT at without problems. I really hope that one day I will be able to do the same!!
Good luck and please let us know how you get on. I am sure lots of women will want to hear a good news story like this. ;D
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I pity the poor GP who tries to take my HRT away from me before I'm ready to have it taken away from me...lol... Provided I can stay with my current GP as long as possible, it shouldn't be a problem anyway because she's already told me she has a patient in her 70s who is on HRT.
Regardless of what the risks are or aren't with long term HRT, I have every right to decide if I am prepared to take those risks. As I see it, with HRT I get to have a good quality of life, I sleep well and I'm happy. I may get some nasty illness in my 70s and die, but so what? The alternative is to possibly spend the next 20 years totally miserable, with rampant insomnia, and possibly taking ADs and benzos. I know which option I'll be taking.
I figure that seeing as I'm not yet 55, by the time I reach 60+ there will have been a lot more research and information available, and I'm sure things will be become a lot more relaxed.
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I wouldn't hold your breath Dana as far as things changing greatly in the next five years - there is not much research being carried out on the effects of HRT in the over 60s.
My GP will prescribe it if I insist but I agreed to come off it to see what would happen - maybe hoping that six years after starting it something may have changed - wrong!! I do feel less able to cope with the horrible sweats than I did six years ago which is something my then GP asked me to think long and hard about before first prescribing it. She asked whether I thought being 60 and suffering from all the menopausal symptoms would be easier than being 53 and getting it "out of the way". I thought that at 60 I would be retiring and so wouldn't have to deal with going out to work etc. but now I have to work for a further five years as well as coping with the symptoms.
I think that if you start HRT then you really should see it as taking it for life because it does get harder the older you get to cope with all the meno stuff. I can't believe how differently I feel from five years ago in what I am able to cope with - and that was even before I came off HRT!
I do find it funny that we fight (or I did) really hard to get referred to menopause clinics and then when they say something we don't agree with we totally disregard what they tell us. I had my care transferred back to my then GP when the clinic said that I definitely had to come off it at aged 60 because my that GP was all for staying on it for ever. We often only hear what we want to hear.
I can't imagine cooking Christmas dinner feeling like this - I'll spend more time cooling off in the garden than cooking in the kitchen ;D
Taz x
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Hi Everyone, I have not been on for a while , but wondered if someone has the same experience as me , and if so , what to do about it.
I will not write all the horror's I have gone through since last on this site. :-X
So my question is, early menopause symptoms age 32, was put on full works , Estrogen and ostrorgen ( sorry I cannot remember the name )
then say 3 years ago, made to come of them, my life up till then had been brilliant .
after much crying , screaming and I cannot remember what else, I was put on
Premique low dose 0.3mg/1.5mg modified release tablets, conjugated estrogens and medroxyprogesterone acetate,
flipping heck that took some spelling.
this was 14 months ago , and I still feel like I would expect to feel was I aged 90 , not as I am late 50s.
what am I lacking , or rather what is my body lacking that it can feel so wiped out .
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So for the ladies who advocate coming off HRT for a while when one turns 50 to see where you are in the run of things, how would one do that, just go cold turkey and stop? I have no idea how I would reduce my gel to every other day as I usually get breakthrough bleeds if I miss a day of gel, perhaps just cut it down slightly over a period of months? Any ideas? And what then? Does one see how bad the symptoms are and then restart, is that the idea? Excuse my ignorance but this is all new to me :)
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Chrism
Just for info progestogens is the name for any substance which does the job of progesterone - so it includes the synthetic ones as well as progesterone itself. The name given just to the synthetic progestogens - is progestins.
As for Cyclogest - yes that can be used as the progesterone part of HRT. When I first went onto HRT after a brief foray into Evorel sequi for 3 months (got terrible headaches/migraines from the norethisterone), I used Estradot patches and Cyclogest - my female GP had studied years ago with Prof Studd. However Cyclogest is not licensed for HRT so you would need to find a GP who knows about it and willing to prescribe - or a private gynae. The dose is 400 mg for HRT. I used this for about 4 years I think and then I started to get migraines.
This leads me onto Cassie - I just stopped suddenly because I was fed up of getting headaches - but after 3 months all sorts of symptoms had returned - including sweats and flushes, but a lot of aches and bladder problems too - pelvic aching and tiredness. There has been a little research to show that whether you stop suddenly or gradually doesn't make any difference to the severity of the symptoms - but it does affect the speed at which they return - but more studies are needed. Therefore if you stop gradually by tapering off (which intuitively makes sense) and your symptoms barely return - it may well be that this would have happened if you stopped suddenly ie down to your make-up rather than the method. As always there will be a variation in how women responded so I would tend to err on the side of caution and taper off - if I were going to come off again.
Having said that I mentioned elsewhere recently that I reduced from 50 mcg to 37.5 mcg patch and flushes returned after about a month - not great numbers of them but definitely noticeable - so that could have been the start of a taper - but I didn't go any further and now back to 50 mcg.
The thinking is that you should give it a reasonable length of time - but if you feel rubbish - who wants to wait - and also the longer you leave it the less likely they are to let you re-start if you get to 60!
Chrism - was it you who said your practice said they would only prescribe gel if pills didn;t work? They have no right to force you to take pills if you don't want to. If you prefer to use a transdermal method then you should insist and give your reasons!
Eileen - that is a very low dose of HRT and also the oestrogen is the horse one, and the progestogen a synthetic one which you are taking all the time. The side effects of these can cause tiredness and anxiety. If it is making you feel wiped out I would ask to change to a bio-identical type - either gel ( Sandrena or Estrogel), or oestrogen patches, together with micronised progesterone (Utrogestan).
Taz - it's rotten to have to work another 5 years(I managed to come off fairly lightly as my pension age is just over 63) - and I think doctors are much more likely to be sympathetic to women staying on HRT because of work - I do have friends in this position who have insisted that they cannot work without it.
Hurdity x
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Dana
just wanted to say how much I agree with you! Quality of life is soooo important. We have too much life post-menopause to waste it feeling dreadful when there's something which can help.
hil
ps I pity your GP too!! ;D
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Hi Stellajane
I meant to reply to you as well yesterday....I was thinking about you the other day actually and wondering how you were.
Sorry to hear about your cyst but so glad to hear that it was benign, but I can understand that you must be feeling worried. I have had a couple of lumps over the years - one was a fibroadenoma and the other a galactocoele and I got mastitis several times while feeding my children, so I know it can be more of a risk with HRT. I just make sure I have a feel now and again and go for my mammograms - and have been fortunate so far that they have been all clear.
So glad to hear that you are still feeling well 6 weeks after stopping and fingers crossed that you are one of the lucky ones - are you going to continue with vagifem to ensure you don't get VA and develop bladder problems?
Hurdity :)
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Thanks Hurdity. Your informed advice is very very helpful :)
I think I will stick with the Elleste Duet I am on for now because I feel so brilliant and I want to have all this energy and enthusiasm when I start my new job next year.
I will review again next year (unless anything changes before then).
Last Christmas was my 'black period'. I am looking forward to this one, and my 50th birthday next week, very much indeed!
I hope you are able to have a really happy one too, Hurdity, and good luck Steelajane, Taz and Eileen. And Dana, I am with you! Woe betide any GP who tried!,
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Happy 50th birthday Chrislm for whenever it is next week! I probably won't be on here much so saying it now!
I wish I was 50 again!!!
:hbday:
Hurdity x
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Thank you Hurdity!
Hope you are off doing something nice next week ;D