Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Joyce on November 23, 2014, 10:56:46 PM
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Not sure what to do. At beginning of this year I cut my Estradot 25 patches in half, with a view to stopping a few months down the line. Well nearly 12 months down the line & I'm still cutting in half. I get flushes every day, though relatively short lived, maybe last about 30-60 seconds about 3 or 4 times a day. Sometimes more, sometimes less.
Just don't know whether to pluck up courage & stop altogether. I'm scared in case the flushes get really bad again. I suppose I could try & if it doesn't work, restart the half patch again. Any ideas ladies?
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Hi there
Only you can really decide that, seems that you currently have worst of both worlds- still having some hrt and still having flushes. I suppose it depends what is most important? If you want to stop having the flushes then you might need to up your hrt? Im not sure why i would continue cutting if im still getting flushes? Why do you want to wean off hrt?
If you stop completely you can go back onto hrt if you need to though.
Before you stop hrt have you thought about taking starflower alongside hrt? Might reduce the current flushes you are having? I only have starflower as i didnt like hrt ( personally wasnt right for me) and i havent had a single flush since ( i know this can change in future- but its great for now)
Might be a small step that could help?
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Why do you want to stop HRT?
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It's a difficult one!
I decided to stop my HRT after being on it with no problems for 4 years because I really wanted to see if my periods had stopped, and if I could manage without.
Almost immediately I started with terrible headaches, withdrawal from the hormones I suppose, but then the flushes returned far worse than ever, up to 6 a night really soaked each time.
Like Karin suggested I tried starflower which did help but I think it was the wrong time for me as there was a lot going on at work and it's been quite a stressful time anyway. I've not been sleeping well either, although no periods!!
Now I'm back on a conti hrt and actually feel tonnes better than before. Suddenly I feel really happy and positive about things like I did years ago. I hadn't ever felt unhappy I suppose just a bit flat and more 'can't be bothered'
The only thing I'm struggling a bit with is not being able to drink wine or gin atm as it definitely aggravates the flushes and not sleeping and also I've noticed that I'm bloated by the end of the day, but hoping that will improve, especially since it'll soon be Christmas!
Someone also suggested paracetamol before bed which definately helps and also I've discovered Ovaltine is good too......just need a hairnet and curlers and that completes the picture ;D
It's not the end if you stop and things are no better you can always go back on it and like me maybe find something else that works a bit better...so far so good
Hope this helps, good luck!
Lizzy x
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What worries have you got about continuing with HRT? As you know I had to come off mine and managed for a year but life was "managing" and not really living. I am, like you, now on a half strength HRT and the flushes are mainly controlled but other symptoms such as insomnia, muscle pain, vaginal atrophy, horribly dry skin and lack of energy are not getting any better. I suppose it depends on how much you can sort of dumb down your life to cope without HRT? I am finding work really tough - well I can do the work mostly ok but then have no energy for the nice things in life. My doc is lovely but her advice is to try to work out if I can afford to retire (no) and tailor my life to what I can do without being on HRT.
Taz x
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I have a review of meds due soon & each time I go, the GP "encourages" me to consider coming off it completely. I've been weaning myself off it for past 18 months. My energy levels have depleted over this time, but that could be age related rather than lower HRT. My meno clinic appointment was cancelled by hospital this year, so never got chance to discuss my options with consultant. I don't see her again until May/June next year, hopefully. However, she suggested that as I've been on it for well in excess of 10 years I should really be off it by 60 which is in 2016.
I know this stirs up the usual arguments of why can't we continue with HRT beyond 60.
I appreciate your comments ladies. Taz, I've been following your recent journey before & after your hysterectomy. I'm coping at the moment, but don't really want to feel worse than now. When I joined this forum, 5 years or so ago, I was really struggling after coming off HRT completely. However, GP put me back on it again. I'm now worried that GP will finally refuse to prescribe HRT.
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Well you know all the arguments about prescribing HRT after age 60. If you want to carry on you have the option of going privately as I have. How much I spent so far? Just over £300 for appointments. I am fortunate enough to still get my prescriptions on the NHS, but they are not prohibitive. You can look up the prices on this web site. I could I'll afford the cost, yet for me , worth it.
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Hi Cubagirl.
I'm I a bit confused here.
Sounds like the doctor is living your life for you and making decisions that has no effect on them but many on you. Seems a regular theme on the forum.
I'll post this again - please take a look at the "New HRT Guidelines release" and show it to your doctor at next visit.
http://www.medicalnewstoday.com/articles/181726.php
There is no limit or need to stop HRT at 60 :)
Hope you get back onto a more normal dose and get rid of the flushes.
Hope that helps.
:-*
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Hello cubagirl.
I can understand your dilemma and I feel I am in a similar position.
I am 58 and for the last three months I have been cutting using a 37.5 mg patch ( 75 mg cut in half ). This dosage has helped eliminate the awful juddering sensations I had prior to HRT but I still have problems and never feel completely well. Since using Utrogestan vaginally I have been experiencing some spotting so last week I reverted to the oral route, sure enough the spotting has stopped but my mood has worsened. The situation I feel I'm left with is HRT is treating some of the problems but not all and indeed exacerbating others that I might not have if I weren't using HRT! If I were younger I'd simply increase the patch but at my age I know the pressure is on to reduce the dosage.
As you can tell, I haven't come up with a solution yet and I must day I am impressed that you have managed so well on such a low dose. Let us know what you decide to do as everyone on HRT will come to this point eventually and the more information and experience that is recorded here the easier it will be for other forum users figure out what is right for them.
Wishing you well and keep posting.
K.
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I've been told by my gynaecologist that I can stay on my low dose HRT for long as I wish. I am 60 now.
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Great news Ju Ju :clapping:
Sounds like the message is getting through.
And hopefully your much happier with that news for you.
:-*
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I thought I'd be able to continue taking it, however meno consultant told me last year that I should look at 60 as cut off point, which is why I've been trying to cut back. My friend was on mirena coil & had it removed 3 years ago & has never looked back. She's a month older than me. Her SIL came off HRT years ago & still has drenching sweats & she's in her mid 60's. Her GP refused her any more HRT.
Guess it's fear of feeling c£@p again. My father died of heart attack in his mid 40's, my mum died of heart attack at 80. My brother has had a few scares, though nothing conclusive. I know the risks. Hubby agrees with me that life quality outweighs everything else.
Reckon I'll fight my corner, come my review. Glad of everyone's thoughts though. It does help. Thanks ladies.
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Hi Cubagirl
take a look at the link I posted above and take it along next to your next appointment with Doc.
As others have posted the medical profession are catching up slowly to the news that the limit of 60 is not a limit anymore.
Great to hear that your DH is interested and agree's with you too ;D
:-*
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In my doctors surgery you are advised of the risks and asked to sign to that effect if you want to continue with HRT. What's surprised me is that the menopause clinic were the first to raise the fact that I should stop HRT by age 60 - they suggested slowly cutting down my dose from the age of 58 and also my gynae consultant is really against any woman being on HRT after 60. The stroke/heart attack risk is the one most discussed - especially by the gynae consultant. I believe that it is up to the individual but when you have three "professionals" all telling you that you should stop it does make you doubt your own judgement.
I had to laugh at myself in a way because I fought to get referred to a menopause clinic some years ago and the moment they gave me advice that I didn't like i.e. that I should stop HRT by 60 - I referred my care back to my then doctor who had a more relaxed view.
Taz x
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I've just read the link you kindly posted peegee. Not too sure how this part makes me feel
"HRT slightly increases a woman's risk of some cancers and stroke. It is not a long-term therapy and should last no longer than five years for the benefits to outweigh known risks."
Taz x :-\
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No - I love being on HRT! I've used it for seven years and it suited me just fine but I do wonder why so many professionals are against us continuing to use it after the age of 60. It just unsettles me!
Taz x
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I have been on it for well in excess of 10 years, having had hysterectomy in my mid 30s, although ovaries were left. 2/3 weeks after hysterectomy flushes kicked in. I was in middle of supermarket when my first one struck. GP was more than happy to prescribe HRT. My meno consultant is aware of this, but still says 60.
Not having quite reached 60, I haven't been asked to sign anything. Is that what they do? Not sure I'd like to be asked to sign a disclaimer if I'm honest.
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Lots of interesting points here many of which we have discussed before.
Cubagirl - the main point is - what do you want to do? I see you are on a quarter strength from what I see ie cutting 25 mcg patches in half - which is very little indeed. You also say that you agree with your husband that quality of life is important.
The big question is - are you happy to continue as you are - ie is your quality of life good enough or are you making do? Can you manage your job/work as you are now? This is not just a question of coping with flushes but are you able to do the things you want to do? It does sound that you are one of the few women (I suspect there are several of us on here) for whom flushes mught well continue indefinitely, if they have returned when you have reduced the dose, and tried to come off it before.
If you can cope and are happy then of course you should carry on as you are. If you are finding your quality of life and ability to cope has decreased noticeably over the past year then yes I agree why not go back to your previous dose of 25 mcg. You don't have the progestogen component to worry about which is what many of us are concerned about - the results from the only large study carried out ie the WHI study show the addition of progestogen increases the risk of breast cancer slightly.
Even so the absolute risk of cancer is very small - and according to this website other health factors are equally important ie body weight (if you are overweight) alcohol consumption, smoking, diet and exercise. You can reduce the breast cancer risk of HRT by making sure you do everything possible in the other categories to reduce cancer risk. The information on this website gives benefit = risk for age 60 to 70 http://www.menopausematters.co.uk/balance.php This is what I go on at age 61.
I agree with peegeetip - it is and should be your decision made in full appreciation of the facts/evidence as we know them, and the risk. I didn't have to sign anything at my practice but GP practices will differ as will consultants judging by your experience at the meno clinic Taz?
Regarding the article that peegeetip linked to - I prefer to go directly to the article which led to the change in view. The article in Medical News Today is contradictory which you spotted Taz. The recommendations from the British Menopause Society (which the MNT article links to) says that arbitrary limits shold be placed on HRT. The 5 year limit is out of date but is what many doctors are still using. Here is the BMS article:
http://min.sagepub.com/content/19/2/59
Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.
Re stroke risk - the latest paper produced for World Menopause Day by the International Menopause Society states this:
As with men, hypertension in women is the single, most important, treatable risk factor for stroke.
and this:
...in women on average 64 years of age, MHT non-significantly increases ischemic stroke and reduces hemorrhagic stroke (18% for CEE + MPA and 36% for CEE) in relation to placebo. All of these foregoing events are rare, 5-11 events per 10000 women per year of MHT. Importantly, the risk of stroke is statistically non-significant and rare in women who initiate MHT when < 60 years of age.
This is from result of the WHI study which was with equine oestrogens (CEE) and synthetic progestogen (MPA). MHT = Menopausal hormone therapy.
At the end of the paragraphs on stroke it said this:
In conclusion, the risk of stroke from MHT is rare and of the same magnitude as seen with other medications such as statins and aspirin used in the prevention of CHD in women. When initiated in women < 60 years old and/or < 10 years since menopause, the benefits of MHT outweigh the risks, as MHT statistically significantly reduces CHD and all-cause mortality, two important outcomes not demonstrably proven to be reduced with statin and aspirin therapy, but each of which carry similar risks as MHT 62,63, when used for the primary prevention of CHD in women.
http://www.imsociety.org/downloads/world_menopause_day_2014/white_paper/wmd_white_paper_english.pdf
No-one should have to go privately to be able to continue with HRT but I can underastand why some women have gone down this route. However not everyone can afford it.
Retirement age is a crucial issue and it's time GPs woke up to this as Stellajane mentioned. Taz your GP's comment made me cross however lovely she is!!! I mean really! Any GP that suggests this (even if you did give up work) is condemning many women to a life of an invalid - well almost so if symptoms continue to degrade quality of life. Why should we spend maybe 30 years miserable or unable to make the most of life? Just "there there" and put your feet up and flush away quietly for the next 30 years!!
If I am unlucky enough to get breast cancer in the next few years that would be horrible, but I wouldn't know if it was as a result of HRT or not. I will know that I had done all I could to lower the risk of getting cancer through lifestyle means, and nothing could take away from me the 8 years of good quality work and life I've had since starting HRT.
Got carried away again here - hope someone manages to read it and find it helpful.... sure I've missed some typos!
Hurdity :) x
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Hi Taz
the article is a mix of old and new info and goes to show how things can be skewed so easily.
The main progress is the part where the BMS is saying that there should be no limit on how long we can take HRT.
The earlier part of the article is recycled old style info that has been floating about since all the rubbish scare stories in the noughties.
In terms of the risk of stroke/clot, if you read more into it this is based on the failed studies using ladies that we of an average age of 63. These ladies were long past menopause.
The effect of giving estrogen at such a late stage caused most of this part of the problem that's now sighted by so many.
Its since been proven in new studies that taking estrogen thru peri and menopause actually improves our heart and circulation in the longer term.
:-*