Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Dandelion on January 29, 2014, 01:24:24 PM
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Hi
I would like to ask a question about stopping HRT at 47 and risk to bones.
See my signature line for details.
I am on day 9 of Femoston 2/10, which I went on cos 1/10 didnt work.
I don't want to go on the other synthetic HRT's because of bad experiences that I have read regarding norethisterone and levongesterol (SP) and bad moods, while the dydrgogesterone is not causeing me any bad moods.
I woke up this morning in a lather of sweat. I had to put the fan on, then I was cold, so I turned it off, thinking maybe it was just my imagination, and got hot again, and so on.
I have asked my doctor about utrogestan, and she hasn't got a clue what it is.
We do not have a menopause clinic or a well woman clinic, or even a nurse who deals with menopause, so, synthetic progestins are my only choice.
I do not want to ask the doctor about utrogestan again, in case she gets funny with me.
I dont want to go to another doctor to ask about hrt, as she may get a bit funny with me.
The 2/10 works about 30% but it's not enough for me, so I want to give HRT up.
Will this make my bones all brittle>?
I am 47 years old and dont even know if I am menopausal.
I also have got a white discharge this last couple of days but my headache has lessened.
Im in despair to be honest, cos it looks like i will have to feel overheated and moody and not have a life while some other women get their life back.
It's the sweating that pisses me off the most, and needing a wash all the time.
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Very few doctors know about utrogestan. You have to ask for micronised progesterone. I don't see why your GP would get funny with you.
If you explain to your GP the problems you are having then perhaps they would prescribe something new to try.
Honeyb
x
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Very few doctors know about utrogestan. You have to ask for micronised progesterone. I don't see why your GP would get funny with you.
If you explain to your GP the problems you are having then perhaps they would prescribe something new to try.
Honeyb
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Hi honeyb
My doctor said that there was the patch with levongestrel in, but I am scared to take that.
There's also the congugated estrogens but again, I am scared of the side effects.
Do you think that I have not given this 2/10 dose long enough?
I have only been on it nine days.
Sorry to be a nuiscance, im just really scared to go back to my doc.
Also i am wondering what risk no hrt wil have to my bones.
Thanks
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You could you an oestrogen only patch and utrogestan. There is no need to go anywhere near conjugated HRT.
It is a bit soon to say that your stronger HRT is not working so try to stay with it for a while yet if you can.
You are right you really need to take some form of HRT if you can at your age. Unfortunately it can take a while to settle on one that improves your quality of life.
If this HRT does not suit then you will have to go back to your GP. Try writing down or printing out the information you need and go and discuss your needs.
Honeyb
x
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Hi Dandelion
I agree with the others.
It is your right to have the medication you need and only the other day the chief of NICE was urging people to be more assertive with their doctors regarding drugs, treatments and medication.
As has been said print off the info from here.
Here is the info about oestrogens:
http://www.menopausematters.co.uk/treatafter.php
Here is the info about progestogens:
http://www.menopausematters.co.uk/to_progestogens.php
Your doc should not make you feel like this. Are you able to take someone with you to help you insist on what you want?
Having said that, I do agree also you should give it more time to settle before deciding it's not for you. Sudden increase in oestrogen can cause headaches temporarily but you would usually feel this straight away I would have thought?
I would continue with HRT to help protect your bones until at least 51-2 - the average age of natural menopause.
Hurdity x
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You could you an oestrogen only patch and utrogestan. There is no need to go anywhere near conjugated HRT.
It is a bit soon to say that your stronger HRT is not working so try to stay with it for a while yet if you can.
You are right you really need to take some form of HRT if you can at your age. Unfortunately it can take a while to settle on one that improves your quality of life.
If this HRT does not suit then you will have to go back to your GP. Try writing down or printing out the information you need and go and discuss your needs.
Honeyb
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Hi Honeybun and thanks.
I am perplexed why my GP looked at me blankly and asked ME what bio-identical/utrogestan was. She had never heard of either.
I think I was feeling really fed up earlier.
I willl give this 2/10 longer to work.
I do have hopes that it will start working, and I accept that, perhaps, I am being impatient.
I'm glad I am not feeling like this after three months on, glad it's early days, the hope is still there.
I have two more months supply of 2/10 left, besides the blister-pack that I am currently on. She gave me three months supply.
Should I give this 2/10 the whole three months to test it?
I agree, re: writing stuff down for the GP. i do that all the time, I put bullet points on a slip of paper, it keeps us focused and saves her time, so I think she likes it.
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Why not print off some info from this site to take with you to your GP. As has been said, its under micronised progesterone in their drugs book. You can use it with a patch, gel or separate pill such as Elleste.
9 days isn't really very long - I would give it at least a couple of weeks to see if it works. The fact you're having a white discharge would indicate the oestrogen is being absorbed though.
If you come off HRT try to take a supplement such as Osteocare which contains calcium and Vitamin D.
Hi Stellajane
Thank you for informing me that the white discharge means the oestrogen is being absorbed.
That gives me some hope.
The idea of printing off info is a great idea, but me and my GP have been there before, and she didn't like it, saying "I dont have the time to read that...."
The printed info in question was relating to involuntary tranquiliser addiction, she put me on valium and told me I would not get addicted if I only took it a couple of times a week. WRONG! I did get addicted, I stopped taking them thinking I would be ok, as I had stuck to docs instructions and I got terrible withdrawals.
I tried to get her to read Dr Heather Ashton's taper protocol, and she was having none.
I am going to include on my next note to her, that I take to consultations, that, as there seems no support for menopause in our local area, I have read up online.
Here is more suport than my GP, but I cannot expect a GP to specialise in meno.
What would be nice is some kind of meno specialist in our area.
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Hi Dandelion
I agree with the others.
It is your right to have the medication you need and only the other day the chief of NICE was urging people to be more assertive with their doctors regarding drugs, treatments and medication.
As has been said print off the info from here.
Here is the info about oestrogens:
http://www.menopausematters.co.uk/treatafter.php
Here is the info about progestogens:
http://www.menopausematters.co.uk/to_progestogens.php
Your doc should not make you feel like this. Are you able to take someone with you to help you insist on what you want?
Having said that, I do agree also you should give it more time to settle before deciding it's not for you. Sudden increase in oestrogen can cause headaches temporarily but you would usually feel this straight away I would have thought?
I would continue with HRT to help protect your bones until at least 51-2 - the average age of natural menopause.
Hurdity x
Hi Hurdity and thanks for the links.
I do have a support worker, but he is a man. hahah
The consensus of opinion on here, is to stay on the Femoston a bit longer, so, that is exactly what I am going to do.
My hope is for it to work, and for me to just take the daily HRT pill, forget about meno and get on with my life, waking up sweat-free and optimum temperature.
Thanks for the advice about the oestrogen increase and headaches. That also makes me feel better, as my body is now accepting the oestrogen, it seems, so I feel positive about this.
I am glad that I made this thread, because you lovely ladies have really helped and reassured me.
A big thank you for that. :)
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Hi Dandelion
It sounds like your own hormones are fluctuating quite a lot, which is why some days you feel better than others. I think you should keep a diary of all your symptoms and then go back to your doctor after you have given the higher dosage another couple of months.
One tip that may help is to take your tablet in the evening. It could be that you are waking up in a sweat as your body is running low on estrogen overnight.
I think you should really give this a go for 3 months before changing again, as sometimes the changing can cause more symptoms and your body needs to settle down.
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HI Dandeloin
I would be inclined to give the 2/10 a bit longer to work for you rather than give up on it.
When I was put on HRT my GP said I needed it (early menopause) it was to protect my bones (among other things) and when I said I wanted to come off (this was when I was 52) he said he wanted me to I stay on until I was 55 (which I did). It was explained to me that staying on under until 51/51 was only putting back the oestrogen that my body would naturally have been making (using 51/51 as the average age of menopause), So the logic was that any HRT after 50/51 “starts the clock†for the number of years on HRT rather than the HRT replacing what was not being produced by your body naturally. Anyway that's what I was told.
You say that you “don't even know if I am menopausalâ€. Have you had any blood tests to see where you are in terms of the menopause?
I hope this makes sense and is helpful for your next appt with your GP.
Lubylou
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Hi
The chairman of NICE made the point last week that patients need to be more pushy and ask their doctors for drugs and treatment that are available. If this means educating your dr about Utrogestan, so be it! You just need to be calm and persistent!
I can tell you quite a bit about bones after being diagnosed with osteopenia at your age.
I was nowhere near menopause- not for another 7 years in fact, but my bone density was already low.
I knew this because I'd paid for a private DXA scan.
I spent the next few years building my bones with exercise and diet ( can't eat dairy so this was a challenge.)
I got a personal trainer and lots of info from the NOS about which exercise to do.
If you are post meno at 47 then yes, you need HRT really. If you are still peri then you maybe can go without. I have a bone density scan every 2-3 years. Up till now my bones have got much better and are now classed as 'normal'. Some of this may be due to HRT but I managed to increase my bone density for 2 scans in a row ( 4 years in total) before using HRT.
You only need a tiny bit of oestrogen to build bone. They used to think it was a minimum of 1.5mgs a day but there is new evidence that even a quarter of that amount can help. I think this is on some paper possibly written/ summarised by Nick Panay.
Not sure if this helps and not sure if your question is about bones or about finding a suitable HRT?
Your next step could be to ask for a bone density scan then you know where you are and can make a decision on that. If your dr won't fund it then you can do it privately if that is an option for you.
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Hi Dandelion
It sounds like your own hormones are fluctuating quite a lot, which is why some days you feel better than others. I think you should keep a diary of all your symptoms and then go back to your doctor after you have given the higher dosage another couple of months.
One tip that may help is to take your tablet in the evening. It could be that you are waking up in a sweat as your body is running low on estrogen overnight.
I think you should really give this a go for 3 months before changing again, as sometimes the changing can cause more symptoms and your body needs to settle down.
Hi Katie and thanks for your reply.
I have been keeping a daily record of my symptoms, noting when each thing happens.
After reading this thread, i feel quite optimistic, as the white discharge and headaches have just started coming this week and it has made me feel that the oestrogen is being accepted by my body.
I will give this higher dose till the end of my supply which runs out in about 10.5 weeks.
By then, I will have tapered off the valium completely, only about half a mg to go.
The valium taper has gone really well, so I hope the hrt follows suit.
:)
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Hi
The chairman of NICE only made the point last week that patients need to be more pushy and ask their doctors for drugs and treatment that are available. If this means educating your dr about Utrogestan, so be it!
I can tell you quite a bit about bones after being diagnosed with osteopenia at your age.
I was nowhere near menopause- not for another 7 years in fact, but my bone density was already low.
I knew this because I'd paid for a private DXA scan.
I spent the next few years building my bones with exercise and diet ( can't eat dairy so this was a challenge.)
I got a personal trainer and lots of info from the NOS about which exercise to do.
If you are post meno at 47 then yes, you need HRT really. If you are still peri then you maybe can go without. I have a bone density scan every 2-3 years. Up till now my bones have got much better and are now classed as 'normal'. Some of this may be due to HRT but I managed to increase my bone density for 2 scans in a row ( 4 years in total) before using HRT.
You only need a tiny bit of oestrogen to build bone. They used to think it was a minimum of 1.5mgs a day but there is new evidence that even a quarter of that amount can help. I think this is on some paper possibly written/ summarised by Nick Panay.
Not sure if this helps and not sure if your question is about bones or about finding a suitable HRT?
Your next step could be to ask for a bone density scan then you know where you are and can make a decision on that.
Hi Sarah
Sorry to hear you were diagnosed with ostapenia.
I am peri menopausal. I have been flushing for over two years now, but I didn't know what it was, and blamed the valium I was tapering from.
I had a blood test and the doctor said the result was to run another test. Im assuiming the result was ambiguous.
My doctor said that as I am flushing, she was happy to prescribe the HRT.
I cannot think of any other explaination for my flushing, but earlier today, I was really fed up and assumed that as femoston worked for other women but not for me, I jumped to the conclusion that I must have some other problem.
Thanks for the idea of bone density scan. That's something else I can request.
I got myself quite worried about bones, but then I remembered my mother.
As far as I can tell, my mum swapped her HRT (I think it was called premarin) post hysterectomy, for natural ways of getting rid of flushes.
She has never broken any bones (*touches wood)
I don't speak to my mum so I cannot ask her, or my two sisters how their meno is going, and even if they are meno.
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HI Dandeloin
I would be inclined to give the 2/10 a bit longer to work for you rather than give up on it.
When I was put on HRT my GP said I needed it (early menopause) it was to protect my bones (among other things) and when I said I wanted to come off (this was when I was 52) he said he wanted me to I stay on until I was 55 (which I did). It was explained to me that staying on under until 51/51 was only putting back the oestrogen that my body would naturally have been making (using 51/51 as the average age of menopause), So the logic was that any HRT after 50/51 “starts the clock†for the number of years on HRT rather than the HRT replacing what was not being produced by your body naturally. Anyway that's what I was told.
You say that you “don't even know if I am menopausalâ€. Have you had any blood tests to see where you are in terms of the menopause?
I hope this makes sense and is helpful for your next appt with your GP.
Lubylou
Hi Loubylou
Thanks for your reply also.
I put my reply about saying I may not be meno on another post, sorry for the confusion.
I said it as other women seemed to get on with Femoston, so when I thought it wasnt working, I jumped to the conclusion my problems lay elsewhere.
I am glad you have a nice doctor. I like my doctor, I am just dissappointed at the lack of choices of hrt at my surgery.
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Hi,
The section that Sarah2 refers to in the Nick Paney (and others) done on behalf of The British Menopause Society and Women's Health Concerns says:
Osteoporosis
HRT is effective in preserving bone density and preventing
osteoporosis in both spine and hip, as well as
reducing the risk of osteoporosis-related fractures.
HRT is the first-line therapeutic intervention for the
prevention and treatment of osteoporosis in women
with POI and menopausal women below 60 years, particularly
those with menopausal symptoms.
Initiating HRT after the age of 60 years for the sole
purpose of the prevention of osteoporotic fractures is
not recommended.
The bone-protective effect of oestrogen is doserelated.
Recent studies have shown a bone-preserving
effect even with relatively low doses.
The bone preserving effect of HRT on bone mineral
density declines after discontinuation of treatment.
Some studies have shown that the use of HRT for a
few years around the menopause may provide a longterm
protective effect many years after stopping HRT.
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Hi,
The section that Sarah2 refers to in the Nick Paney (and others) done on behalf of The British Menopause Society and Women's Health Concerns says:
Osteoporosis
HRT is effective in preserving bone density and preventing
osteoporosis in both spine and hip, as well as
reducing the risk of osteoporosis-related fractures.
HRT is the first-line therapeutic intervention for the
prevention and treatment of osteoporosis in women
with POI and menopausal women below 60 years, particularly
those with menopausal symptoms.
Initiating HRT after the age of 60 years for the sole
purpose of the prevention of osteoporotic fractures is
not recommended.
The bone-protective effect of oestrogen is doserelated.
Recent studies have shown a bone-preserving
effect even with relatively low doses.
The bone preserving effect of HRT on bone mineral
density declines after discontinuation of treatment.
Some studies have shown that the use of HRT for a
few years around the menopause may provide a longterm
protective effect many years after stopping HRT.
Hi
Thank you.
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luby- just to clarify that statement from the BMS- he's saying it is first line therapy for women with low bone density AND meno symptoms. NICE does not recommend HRT as a first line treatment solely for bones but if given for menopause symptoms then the bonus is HRT will help bones. There are clearly some differing views on this, but most GPs will not- because of the guidelines- give HRT just for bone density UNLESS there are other reasons why a patient cannot take other drugs for osteoporosis. [Note osteoporosis- treatment is not always needed or given for the precursor- osteopenia.)
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Estrogen and progesterone and testosterone are needed to maintain bone density. HRT or estrogen alone along with other bone maintaining, diet,exercise and supplements, far better then the drugs prescribed with their awful side effects ( some can not tolerate them and can cause jawbone crumbling) as HRT has been revised now I think that it will be looked at again for a first line treatment. My GP prescribes my patch for bone density, I have just got another six months prescription.
I have mixed views about Nick Panay as he endorsed Femarelle ( which contains Soya and Linseed) which makes an awful lot of claims and is very expensive, you can get it in Holland&Barrett.
http://www.youtube.com/watch?v=kicVSLQdCbg
Menostar is a 0.014 estrogen patch that is marketed for bone health and progestin is not necessary ( not available here though I do keep asking my GP about it) I would advice cutting 25 patch in half or quarter or try to keep it on for a week or more, even one week on one week off, the ultra dose patch is not designed to combat menopause symptoms, using progesterone every now and then ( say every three months) for a "progesterone challenge" if you are post menopause to see if you bleed.
Some info about maintaining bone density.
http://www.drnorthrup.com/womenshealth/healthcenter/topic_details.php'topic_id=60
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This thread now has 2 topics .....
might be helpful to start a new one for the valium...??/
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Edit by Emma
This topic has been split and the valium posts have been moved to
http://www.menopausematters.co.uk/forum/index.php/topic,23712.0.html
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There are very few if any drs who will give you oestrogen for bone health unless you cannot take other drugs.
It's against prescribing rules in the UK.
Likewise you would not be able to take oestrogen only HRT even at a very low dose without a progestogen.
Tibolone is licensed as an HRT for bone health and has the same risks as oestrogen only HRT but is not recommended for anyone over 60 due to risk of stroke and heart disease.
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This topic has been split and the valium posts have been moved to
http://www.menopausematters.co.uk/forum/index.php/topic,23712.0.html
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Sorry don't agree http://www.medicines.org.uk/guides/evorel/hormone%20replacement%20therapy/evorel%2025%20patches
There are ladies here who use estrogen and use progesterone every three months, there are also ladies who use HRT for bone health ( osteoporosis) as well as for menopause.
http://www.health.harvard.edu/newsweek/Ultra-low_dose_estrogen_patch_improves_bone.htm
http://clinicaltrials.gov/show/NCT00310531
I have never had a doctor tell me I could not have my patch.
After my DEXA scan it was proposed that I took HRT along with Calcichew D3 I get both on prescription. I do not have ostesporosis, but am small boned. That was over 10 years aso and after recent tests I have been told my bones are very good so it has done its job..
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If you read the NICE guidelines HRT is only licensed for bone density IF other treatments are not suitable because of for example problems with side effects such as digestion.
This is from the NOS website on HRT and bone health:
There is a range of treatments licensed for the
prevention and treatment of osteoporosis all
with their own benefits and risks. HRT should be
considered for women younger than 60 in which
the benefits outweigh the risks especially for those
who cannot tolerate other osteoporosis treatments,
or who have other reasons for wishing to take
HRT; and recommended as a treatment option for
osteoporosis in women who have undergone an
early menopause
The links you have left here are
- information in a pack of the product, and not meant to be prescribing info for drs- they are an overview of that the product can be used for in context of a patient.
- the other two are from the USA and may not apply to the UK- prescribing rules are not the same.
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Then you are saying my GP is wrong to prescribe me my patch for my bones?
I am sure she knows what she is doing, she regards me as an intelligent woman who is knowledgeable and knows I look after my health and am aware of the pros and cons of HRT and ERT. she is one of the enlightened doctors who lets me make up my own mind how long I want to keep using the patch.
I would never take any of the bone density drugs and the have to take proton pump inhibitors to counteract the damage some of them can do the gastric system, to me it would be estrogen as first choice. I feel very sad that these drugs are the first choice now for ladies who have osteoporosis.
I use my patch to prevent my bone density from thinning along with the maintenance of skin etc. I use supplements, diet and exercise too.
I really am not to worried about NICE guidelines, my doctor prescribing the low dose patch is good enough for me. If Menostar was available in the UK I would use it, even if I still had a womb.
We obviously have very different opinions on things and that's OK but I don't relish having to defend myself for thinking "outside the box" each time I post, it gets tedious.
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That is so sad Stellajane, lets hope there is a review and we go back to how osteosporosis was treated, I remember reading quite a while ago about the Head of the Osteosporosis society resigned over the current thinking about how osteosporosis would be treated.
The details are very hazy, and I might not have got them exactly right but it always stuck in my mind. but I expect someone may know about it.
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I'm not quite sure what the argument is here? Just a wee bit confused.....
There is no question that the relationship between bone loss and oestrogen is dose dependent.
That is to say - yes it has been shown that a small amount of oestrogen will prevent some bone loss, but the greater the dose ( up to a certain point) the greater that effect will be. A while ago I read the stats on it, in a published paper and as always it's down to percentages of women showing percentages of bone loss. Can't lay my hands on it at the moment.
So yes a menostar patch or smaller will likely have some beneficial effect, but not as much as a 50 mcg patch which you will see from the menu is the licensed dose for prevention of oesteoporosis.
Re the NICE guidelines - I haven't looked at these for a while but these do become outdated, and as new information becomes available, specialists, and some GPs use this knowledge to prescribe differently. The NICE menopause guidelines are a good example - they are way out of date and are being updated (due in 2015) right now.
To me the NOS guidelines extract quoted below imply that HRT is beneficial as a prevention for osteoporosis, for women under 60. Taking it for prevention surely does not require a prior investigation to determine bone density?
Hurdity x
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No one is arguing- just discussing.
Have you been diagnosed with osteoporosis or are you at high risk?
I don't know anyone who takes HRT for bone density problems without having been flagged up as high risk, or been diagnosed with low bone density through a scan. The NHS does not offer preventative medicine sadly, nor do they offer scans for bone density unless there is a hereditary link. Any dr who is doing this is going against the grain.
I don't know why this is becoming an argument- I am not saying your dr should or should not do whatever, I'm discussing the guidelines.
A close friend of mine has a mother who is crippled with osteoporosis- started in her 50s. My friend requested a scan when she was in her late 40s and was diagnosed with osteopenia. She used HRT for a short time but it was not prescribed for her bones- she was given calcium supplements on prescription/Vit D. This is through a very snr consultant ( rheumatologist) at a London NHS hospital. Her next bone scan showed an increase, but the one after that showed a decrease. She is taking Tibolone which is a HRT which does not affect the lining of the uterus because she has a large fibroid. The Tibolone is for her bones as she does not have any menopausal symptoms.
This is the full page from the NOS website.
http://www.nos.org.uk/document.doc?id=823
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I had my DEXA scan because I was fine boned, very slim and under five foot, no heredity reasons, this was in the nineties things were different then. it was discovered I had slightly low readings in the osteopenia range of my hip and it was advised that I take HRT, I still have copies in the results and a copy of the letter written to my doctor at the time, advising me to take HRT, that was before my hysterectomy.
DEZA scans were considered gold standard then to help diagnose and treat osteoporosis just like mammograms are. I
My bone density is normal now.
DEXA scans are not prescribed now I expect because of costs.
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Originally I am sure that it was Prof John Studs' speciality, I first read his books back in the nineties before he had a website and went into privately prescribing hormones.
Back in the day I also had bone scan on wrist and heel this was at an osteopath, a lady used his rooms in the evenings, they were normal.
If ladies are not on HRT or ERT I would advice taking and Vitamin C ( to increase collagen) and Boron 3mgs, this will help with bones and joints and have an estrogenic effect ( google it) Foods that are high in this are Apples, prunes and raisons. Don't take Boron if you are on estrogen though.
Some info on Brittle bones, note the date of the article 2001 when HRT or estrogen was the guideline for osteoporosis treatment, before the now debunked WHI results came out, and now have been revised.
http://news.bbc.co.uk/1/hi/health/1268201.stm
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The reason small women are more at risk is that you need to load your bones over a lifetime to build up the bone. They say ( somewhere) that you need a minimum weight of around 9st.
I know quite a few women ( friends) who have had back pain due to degenerating collagen in between the discs. They can treat this by surgery and put 'cement' in to build up the gap.
There is some disagreement over the actual benefits of bisphosphonates - they make bones dense but this can also mean the osteoblasts/osteoclasts do not turn over as they should- there is no breakdown of old cells and replacement with new cells,so the bone is in fact old and 'dead', which for some women means they are more brittle in structure.
There are now newer treatments including an annual injection, which avoids the side effects of oral bisphosphonates, but this is only suitable for people with osteoporosis not osteopenia.
After the WHI and MW studies were published, it became harder to prescribe HRT just for bones. The prescribing rules state there has to be a risk factor or existing evidence of bone density issues, post menopause, or inability to tolerate other treatments.
The bottom line is that more/all women should receive DEXA scans in mid life ( more deaths from complications of osteoporosis/ hip fractures than breast cancer) and either treatment or diet/ education about bones and not wait until they are in their 70s and older and break a hip. But the NHS is not interested in or able to afford mass screening as prevention for this.