Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Bebbo on June 06, 2022, 03:06:44 PM
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I am the poster girl for HRT. I was prescribed it after early onset menopause at about age 42 and have done spectacularly well on it. I am healthy, fit, sexually active and feel much younger than my chronological age. I just turned 70.
The problem is this: my gynecologist of 30+ years, who supported my position that if HRT was working so well for me there was no reason to change the program, retired about a year ago, and I was shifted to another, younger doctor in the same practice. On my first visit with her, without asking any questions about my health and well-being, she announced it was time to wean me off HRT, citing the various general problems that have come up in various studies. I protested, but she insisted, and dialed back my prescriptions accordingly. I have been on a lesser dose since, with a few negative side effects which may or may not be related to the lesser dose — hard to tell whether it’s that or “aging.” But when I saw her a few weeks ago and again protested the “weaning,” she basically ignored what I was saying and dialed the prescription back even more.
Does anyone have experience with continuing HRT past 70? I know I should probably try to find a more responsive gynecologist, but wonder if I’m going to encounter this weaning approach with any other doctor.
Thanks for any advice and experience you can share.
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Oh my goodness, no you should not be getting taken off HRT!! The NICE guidelines say that you should remain on it for as long as the benefits outweigh the risks - and considering your risk of osteoporosis is going to be the same as someone who has never taken HRT about a year or two after stopping it - the risks of stopping are far greater!!
Please please find yourself another menopause-friendly doctor who is prepared to continue prescribing. You might need to go private and there are now many online clinics you can have video consults with and then be posted your prescription. I do video consults with the Newson Clinic, although they have a waiting list - but there are many others. Look at the BMS website for lists of members of the BMS and choose someone private from there... You can also get them to write to your GP and tell your GP to continue prescribing it for you. Your GP might still refuse but often they then agree....
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That’s great you’re doing so well on hrt at 70 it’s promising for the rest of us behind you. However, as Joziel says you’re doctor is not up to date. You have a few options: You could print off the NICE guidelines and try her again. You could change GP’s. Or you could email Doctor Currie and ask for her advice which you could then use to continue your prescription.
Good luck with it, don’t give in and let us know how you get on x
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Stand your ground.. I am 71 and been on HRT for over 18 years. Had some battles over the years with GP's. 2 female GP's said they don't believe in HRT and one accused me of "wanting to make myself younger!" Unbelievable! Find a practice with a GP(s) who are menopause friendly.. Also google Louise Newson she is a menopause expert and there is plenty of info on her website.. she also advocates you can stay on HRT for life. All the very best.
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Just what I suspected! Thank you all for your advice and the resources.
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Oh my goodness why on earth would the Dr want to deny you something that is clearly working so well! I am 69 and have been on HRT since my surgical menopause aged 42. I have absolutely no intention of ever coming off it unless something forces me too but that would be a medical something not a medical someone! Is it worth you going to see a Menopause Consultant - they can prescribe for you if your GP won't. In fact I think if a Consultant writes to your GP saying they want you on HRT I would think the GP would be hard put to refuse to prescribe it for you. I have regular check ups and blood tests now with a Menopause Consultant and she wrote to my GP who is totally happy to prescribe me my patches on the NHS. It does seem that there are still so many GP's who are still not up to date with the latest research on HRT. Hope so much you get to continue with your HRT on the dose you want and feel well and happy on. x
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Get a referral to a dedicate menopause clinic, not a gynaecologist. What GPs fail to remember is that across the spectrum of conditions, not simply menopause, if the correct regime works, then stick with it. Regardless of age. Because that in the long run, saves repeated Surgery visits when a patient feels unwell due to lack of support, both physical and psychogogially. (sp). This is common with thyroid function tests: GPs will read a 'normal' result and due to costs, are reluctant to do further testing or referallas to an endocronoligst. ?? they forget to listen to the patient :-\ ??
I would be reporting this GP to the British Menopause Society ;-).
Let us know how you get on and welcome !
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That's brilliant that at 70 you are doing so well . I would love to be doing as well . Do you mind if I ask what hrt you are on . I would see another doctor too as obviously it is still working for you so no need to stop
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Hi just wanted some reassurance lm 63 post menopausal 4 years last july had smear one week later all symptoms returned especially horrible thoughts of not being here dr put me on antidepressants which eventually started to work till 5 weeks ago bad news in family anxiety and thoughts back worst ever today .Seeing dr tomorrow first face to face do you think hrt would help ir am l too old and anyone else had this symptom :'(thanks Dee xxx
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Yes Dee, most of us have had these thoughts!
You need Hrt. I’m 65 and many women in their seventies are taking it and never intend to stop.
Find a sympathetic Gp if the one you have doesn’t think beyond AD’s.
This will get better, but you need to inform yourself so that you can talk to your GP in a proactive way.
Your on your way now.
Let us know how you get on xx
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Bebbo, uou shouldn't have yo go privately for these. Going privately is a yip off and these clinics might think they know more than they really do. You should, as others have suggested, see another gynaecologist on the NHS. As for osteopotosis, I think it"s usually hereditary snd you would probably have to be underweight to be at risk. I do hope that another NHS gynaecologist who is more clued up can sort something out for you. I'm wondering if your current one is deliberarely refusing to prescribe you HRT because they are ageist and are trying to save it for somebody younger than you. If that's the case then it's pure age discrimination.
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Hi Marchlove been gp this morning changing ads blood tests just to check he isnt missing anything see him 2 weeks if no improvement will consider hrt but not overly keen as mum had breast cancer .Thinking about it mum must have been suffering in menopause depression etc nobody noticed all too busy so got no help .Feel guilty about that .will keep updated thanks so much for replying Dee xxxx
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Dee, HRT doesn't cause breast cancer.
Estrogen-only HRT actually decreases the risk of breast cancer. (But you can only have that if you don't have a uterus.)
Progesterone and estrogen HRT only increases it by LESS than drinking ANY alcohol or being overweight. It is a tiny tiny increase, it is doubtful if it is even statistically significant and the research was carried out using the old progesterones and not body identical progesterone or new progesterones.
(My mum had breast cancer too by the way, and was not on HRT. She is obese and an alcoholic.)
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Thanks Joziel will make note of that for next visit to drs more ammunition for hrt just need these thoughts to go sure l can manage with other symptoms will post on outcome thanks so much Dee x
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Yes Dee, joziel is right.
My mum had breast cancer in her thirties but none of her sisters or daughters have got it.
My mum also had full hysterectomy soon after and like you I feel guilty for what she must have suffered.
Hrt is quite different now and certainly with me I would rather have relief from symptoms now than worry about the minuscule cancer risk.
X
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It's also more than just relief from symptoms. HRT:
Reduces the risk of osteoporosis hugely.
Reduces the risk of dementia hugely (by 73% according to a recent study).
Reduces the risk of bowel cancer.
Reduces the risk of heart disease (which is the leading cause of death for women).
Whilst breast cancer is a very common cancer for women, it is highly treatable and detectable and 95% of women with it survive it. Not so all those diseases above...
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Good post joziel! Thank you for reminding us of all these benefits xx
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This is all strengthening my resolve to get hrt l intend to hold out for it .will have lots of information to discuss with him thanks for help will let you know what happens
Dee xxx
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I apologize for my lack of attention; I did not realize when I made my initial post that this is a UK-based forum. I am in the US, so some of your kind advice regarding your system does not apply. Still, much of the information and suggestions applies, and as often medical approaches on your side of the Atlantic seem more progressive and common-sense than on ours, having your perspective and experience is invaluable. I thank you all again for your responses.
To the lady who asked specifically what HRT I have been on: until about a year ago I was prescribed .45 mg Premarin and 500 mg prometrium daily. Did wonderfully well, no side effects. Concurrent with insurance company halting coverage of Premarin, which would have resulted in cost going to nearly $500 per 90 pills (3 month supply) was the new gynecologist’s insistence on lowering dose, whereupon she switched me to .5 mg estradiol, alternating one pill with 1/2 pill every day, which was effectively only a slight reduction in dosage. Most recently she is insisting I further reduce to 1/2 estradiol pill per day (no change in prometrium), which is nearly half of long-time successful dosage. Beginning to feel slight effects — more stiffness, mild night sweats, difficulty sleeping, etc.
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Bebbo, my husband is from the US and all his family is over there and a lot of our friends. Plus my brother and his wife and kids ;D
Which is all to say, the main difference is that the UK is currently ahead of the US on the HRT subject. I think this is because the UK is used to having a standardised approach to things (as in the NICE guidelines) so once something has been approved, it spreads rapidly amongst doctors and (on the whole!) they all get roughly on board with the same approach. Whereas the US is like the wild west in that there is no standard approach and a bazillion doctors doing their own very individual things. So there are going to be doctors who can help you out there but you might need to do more research to find one than in the UK. And maybe travel further.
I don't know where you are based, but there is a Newson Health podcast interview here where they interview a US based menopause gynae and she mentions many different centres for menopause and doctors and of course herself as well and it might be you can find something there - or even email her and ask for a recommendation or a way to find someone, near where you live. They also talk about the different products available a bit too: https://podcasts.apple.com/gb/podcast/newson-health-menopause-society-podcast/id1608917458?i=1000559072824
Hope that helps - keep looking! Ditch your current gynae!!
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Feeling the need to clarify a few points!
For most women, HRT does provide more benefits than risks, and there is no arbitrary limit to the duration--it can be taken for as long or as little as each woman feels the benefits outweigh the risks.
There is a small increased risk of being diagnosed with breast cancer if combined HRT (estrogen and progestogen) is taken for more than 5 years after the age of 50, which is duration dependant. That known risk is small but needs to be balanced against the benefits to the individual. HRT is mainly taken for symptom control and at some point it can be stopped as a trial to see if symptoms are still present and, if so, what impact they may be having.
Estrogen only HRT should not be viewed as reducing the risk of breast cancer-- the Women's health Initiative trial showed this, in women who had had a significant gap between becoming menopausal, and then started HRT as part of the trial. It is believed that when introducing estrogen after a significant gap (several years), the breast cells react differently than if estrogen is taken from menopause onwards. However, estrogen only HRT does seem to be associated with a lower risk of breast cancer than combined HRT.
HRT is helpful for bone health, and the benefits do last beyond the time of stopping HRT, and, if started within 10 years of the menopause, or under the age of 60, is believed to be helpful for heart health. However there is not yet enough evidence to confirm that it reduces the risk of dementia.
This is all summarised in a joint statement published today, by the British Menopause Society, Royal College of Obstetricians and Gynaecologists, and the Endocrine Society.
I hope that this is helpful.
Best wishes
Heather
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This is the statement from the BMS: https://thebms.org.uk/wp-content/uploads/2022/06/Optimising-the-menopause-transition-Joint-position-statement.pdf
I feel that statement is just so conservative, it's hard to believe. Things like stating that testosterone should only be prescribed for low libido when bazillions of us know (first hand) that it improves cognitive function, mental clarity and muscle/bone strength, for example.
And the statement about dementia... when this paper out last month, looking at 400,000 women in the US, found that transdermal estrogen is associated with a 73% reduction in risk of dementia: https://pubmed.ncbi.nlm.nih.gov/34027024/
What on earth does it take....?
And the obvious criticism of Dr Newson (not by name) for comparing it to thyroid hormone deficiency and stating that menopause shouldn't be seen as a deficiency or compared to that.... Clearly there are loads of politics at play here and a huge resentment of the stage that Louise Newson has - and a fear of the messages and reach that she has, as an individual. There is some sort of counter-effort now to be super-conservative in response. As if doctors aren't already extremely confused, now they have to deal with a personality war too.... Can we not just put personalities and feeling-threatened aside and look at the science? Because there is more of it than is included or referred to in that BMS statement and even when it is patchy or incomplete, it is possible to look at the bigger picture of multiple studies and what they altogether suggest. I am just a (well-read) casual bystander in all this and that much is clear even to me.
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This is the statement from the BMS: https://thebms.org.uk/wp-content/uploads/2022/06/Optimising-the-menopause-transition-Joint-position-statement.pdf
I feel that statement is just so conservative, it's hard to believe. Things like stating that testosterone should only be prescribed for low libido when bazillions of us know (first hand) that it improves cognitive function, mental clarity and muscle/bone strength, for example.
And the statement about dementia... when this paper out last month, looking at 400,000 women in the US, found that transdermal estrogen is associated with a 73% reduction in risk of dementia: https://pubmed.ncbi.nlm.nih.gov/34027024/
What on earth does it take....?
And the obvious criticism of Dr Newson (not by name) for comparing it to thyroid hormone deficiency and stating that menopause shouldn't be seen as a deficiency or compared to that.... Clearly there are loads of politics at play here and a huge resentment of the stage that Louise Newson has - and a fear of the messages and reach that she has, as an individual. There is some sort of counter-effort now to be super-conservative in response. As if doctors aren't already extremely confused, now they have to deal with a personality war too.... Can we not just put personalities and feeling-threatened aside and look at the science? Because there is more of it than is included or referred to in that BMS statement and even when it is patchy or incomplete, it is possible to look at the bigger picture of multiple studies and what they altogether suggest. I am just a (well-read) casual bystander in all this and that much is clear even to me.
Well said,
there is more risk with smoking and drinking and being over weight than combined HRT and it is the older progesterone's . Utro or dygessterone , which are more breast friendly.
PMXX
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And a "well said" from me, too!
JP x
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Again, so appreciative of all the information and support. I promise, I will not just roll over and do what the doctor says, when there is so much evidence that goes against the standard age-related advice. I feel I know my body better than anyone, and while I respect a doctor’s years of training and experience, I feel every patient is an individual and should be treated as such and that my healthcare should be a partnership between myself and the doctor. And I will, if I must, keep looking until I find a doctor who feels the same way, and at least listens to me before making a recommendation rather than simply parroting the standard approach.
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My view is that HRT is good for some and those who want to take for as long as they live is their right.
But let's face it. Menopause is a natural part of ageing for women and it should be accepted as that. I understand that we have symptoms and they can be horrible at times, I, myself, am not symptom-free, but we shouldn't try to medicalise the menopause because it's not a disease. Thyroid dysfunction is and it can cause serious problems, same as an adrenal disorder, which is potentially fatal if not treated.
As for all the health risks associated with a lack of oestrogen such as osteoporosis, heart disease and dementia, I know a lot of ladies who don't have these and they are well past the menopause. I believe that, as men and women age, there are inevitable physiological changes in the body as we age, allowing for potential disease to develop, there are also a hereditary factor and an element of luck of whether we will develop any of these diseases or not. I refuse to beleive that a lack of oestrogen contributes to diseases and I get the impression that the menopause takes the blame for everything.
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If you refuse to believe that a lack of estrogen contributes to diseases, then there's not much more to be said really. There is now endless research that it does contribute to all kinds of health conditions and no one is even debating that.
What does it matter if menopause is a 'natural' part of ageing? Death is also 'natural'. So is cancer. So is suffering. 'Natural' doesn't mean 'good' and we need to stop equating these two words. Women didn't even live past the age of 60 until about the turn of the century, on average - that was 'natural', too.
As for whether or not it's a disease, I can't see that that really matters. It's a physical process which speeds up ageing and other diseases. So whilst not being a disease in itself, it's something it's desirable to address medically. There are many other changes the body goes through as it ages which are not 'diseases' but can be treated and reduced. And, in fact, many researchers do consider ageing itself to be a disease which one day we will understand better and be able to largely prevent.
Of course there are women past the menopause who don't have heart disease and dementia. Just like there were many people who smoked 60 a day and didn't get lung cancer. It's not evidence that something is okay just because you can come up with some unaffected people... That's why we have science and research.
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I apologize for my lack of attention; I did not realize when I made my initial post that this is a UK-based forum. I am in the US, so some of your kind advice regarding your system does not apply. Still, much of the information and suggestions applies, and as often medical approaches on your side of the Atlantic seem more progressive and common-sense than on ours, having your perspective and experience is invaluable. I thank you all again for your responses.
To the lady who asked specifically what HRT I have been on: until about a year ago I was prescribed .45 mg Premarin and 500 mg prometrium daily. Did wonderfully well, no side effects. Concurrent with insurance company halting coverage of Premarin, which would have resulted in cost going to nearly $500 per 90 pills (3 month supply) was the new gynecologist’s insistence on lowering dose, whereupon she switched me to .5 mg estradiol, alternating one pill with 1/2 pill every day, which was effectively only a slight reduction in dosage. Most recently she is insisting I further reduce to 1/2 estradiol pill per day (no change in prometrium), which is nearly half of long-time successful dosage. Beginning to feel slight effects — more stiffness, mild night sweats, difficulty sleeping, etc.
I think what strikes me as slightly odd, Bebbo, is that from what you say she is reducing your estrogen but not your progesterone (Prometrium/Utrogestan in UK). It does sound like it is being led by age and money rather than a sound assessment of your needs. Is she suggesting that you stay on the Prometrium, or will she just want you to ditch that once the estrogen is at zero?
Your estrogen dose is very low, as you have explained, and you were not on a particularly high dose to begin with. The Prometrium is high in comparison. A second opinion would be useful.
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If you refuse to believe that a lack of estrogen contributes to diseases, then there's not much more to be said really. There is now endless research that it does contribute to all kinds of health conditions and no one is even debating that.
What does it matter if menopause is a 'natural' part of ageing? Death is also 'natural'. So is cancer. So is suffering. 'Natural' doesn't mean 'good' and we need to stop equating these two words. Women didn't even live past the age of 60 until about the turn of the century, on average - that was 'natural', too.
As for whether or not it's a disease, I can't see that that really matters. It's a physical process which speeds up ageing and other diseases. So whilst not being a disease in itself, it's something it's desirable to address medically. There are many other changes the body goes through as it ages which are not 'diseases' but can be treated and reduced. And, in fact, many researchers do consider ageing itself to be a disease which one day we will understand better and be able to largely prevent.
Of course there are women past the menopause who don't have heart disease and dementia. Just like there were many people who smoked 60 a day and didn't get lung cancer. It's not evidence that something is okay just because you can come up with some unaffected people... That's why we have science and research.
Great post joziel!
Hurdity x
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I apologize for my lack of attention; I did not realize when I made my initial post that this is a UK-based forum. I am in the US, so some of your kind advice regarding your system does not apply. Still, much of the information and suggestions applies, and as often medical approaches on your side of the Atlantic seem more progressive and common-sense than on ours, having your perspective and experience is invaluable. I thank you all again for your responses.
To the lady who asked specifically what HRT I have been on: until about a year ago I was prescribed .45 mg Premarin and 500 mg prometrium daily. Did wonderfully well, no side effects. Concurrent with insurance company halting coverage of Premarin, which would have resulted in cost going to nearly $500 per 90 pills (3 month supply) was the new gynecologist’s insistence on lowering dose, whereupon she switched me to .5 mg estradiol, alternating one pill with 1/2 pill every day, which was effectively only a slight reduction in dosage. Most recently she is insisting I further reduce to 1/2 estradiol pill per day (no change in prometrium), which is nearly half of long-time successful dosage. Beginning to feel slight effects — more stiffness, mild night sweats, difficulty sleeping, etc.
Hi bebbo
To add to the other posts.
First Premarin is one of the old-fashioned types of HRT ( made from pregnant horse urine for those how don't know) and is the oestrogen that was used in the controversial Women's Health Initiative trials whose results (in terms of increase in various health risks) led to drastic reduction in HRT being prescribed until relatively recently. Judging by posts on this forum it is rarely prescribed now in UK, rather, the bio-identical estradiol is recommneded and available in several methods of delivery and dose.
Second - there is no exact comparison between estradiol and premarin as the latter is a mix of horse oestrogens (including estradiol). However looking at the dose chart here: https://www.menopausematters.co.uk/treatafter.php, 0.45 mg premarin is somewhere between low and medium dose whereas what you are now taking - in effect 0.37 mg per day, is ultra low dose - look at Femoston here: https://www.menopausematters.co.uk/postmeno.php (0.5 mg estradiol per day). Given the same absorption, then the equivalent tablet estradiol would be approx 1.5 mg so yes it is understandable that you are noticing an increase in symptoms.
Thirdly - 500 mg prometrium is a HUGE dose. No gynae or menopause specialist would prescribe this amount (except for fertility indications). I'm amazed you've been able to function at all! I would be more worried about this in terms of potential increased breast cancer risk then the tiny amount of estradiol you are now taking. The standard daily dose of Prometrium (which is the same as our Utrogestan I understand) for continuous combined HRT is 100 mg - yes you see it - 100 mg! This can be increased (to 200 mg) if it does not control bleeding though with low doses of oestrogen it is less likely to happen (ie poor control of bleeding).
Fourth - here in UK, the recommendation for women post 60 taking HRT is to use transdermal HRT ie patch gel or spray - because of increased stroke risk and cardio-vascular problems in older women, especially if you have other risk factors such as High BP, excess weight etc.
So in terms of the standard approach - you're not getting it - neither before nor recently!
Take a look at the options available in uk that I linked to - HRT preparations for post-menopause, and the separate oestrogens (transdermal) and progestogens, There will be the equivalent in US - many patches are available....
As for the age thing - I have nothing to add to that - I am approaching that age myself and don't intend to come off HRT provided there are no heath reasons that mean it would be advisable (to stop).
Incidentally it is heartening to read of other women approaching and post 70 still on HRT - including especially those who still have a uterus as this is more challenging, due to the need to take progestogens.
All the best bebbo - do let us know how you get on
Dr Currie - thanks for alerting us to the new statement by BMS - and joziel for the link must have a read....
Hurdity x
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If you refuse to believe that a lack of estrogen contributes to diseases, then there's not much more to be said really. There is now endless research that it does contribute to all kinds of health conditions and no one is even debating that.
What does it matter if menopause is a 'natural' part of ageing? Death is also 'natural'. So is cancer. So is suffering. 'Natural' doesn't mean 'good' and we need to stop equating these two words. Women didn't even live past the age of 60 until about the turn of the century, on average - that was 'natural', too.
As for whether or not it's a disease, I can't see that that really matters. It's a physical process which speeds up ageing and other diseases. So whilst not being a disease in itself, it's something it's desirable to address medically. There are many other changes the body goes through as it ages which are not 'diseases' but can be treated and reduced. And, in fact, many researchers do consider ageing itself to be a disease which one day we will understand better and be able to largely prevent.
Of course there are women past the menopause who don't have heart disease and dementia. Just like there were many people who smoked 60 a day and didn't get lung cancer. It's not evidence that something is okay just because you can come up with some unaffected people... That's why we have science and research.
I have never said that 'natural' means pleasant. I see the menopause as a phase like puberty. The only difference is that the menopause symptoms last longer. Can a lack of oestrogen be compared to, say, a lack of cortisol? I don't think so. Although hormones are important, a lack of cortisol is life-threatening but I'm not so sure about a lack of oestrogen. If oestrogen is so important, what about a lack of testosterone in men? Does research say that it contributes to diseases in men? I've never come across an article that it doees. Why should it be different for women? Is oestrogen more powerful than testosterone?
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It's not really comparable to puberty, seeing that puberty enables us to be fertile and have a functioning body and mind and develop secondary sexual characteristics. Whereas menopause... doesn't do anything positive at all, except perhaps relieve people of periods. And does a lot of negative stuff, removing and reducing physical and mental functioning in so many ways - the opposite of puberty.
I don't understand the constant need to attempt to compare the lack of estrogen to other things. The lack of estrogen is a lack of estrogen. If someone had a broken leg, we wouldn't spend time comparing a broken leg to a broken arm. If someone had thyroid deficiency we wouldn't say 'well it compares like this to this other deficiency'. A lack of estrogen is a lack of estrogen - although menopause isn't just about estrogen but also about losing testosterone, let's not forget, and who knows there is even some thinking that progesterone plays a useful role in health as well.
Losing all our hormones isn't comparable to anything else. It doesn't matter if you think it's a 'deficiency' or a 'disease' state or a natural process, those are just labels. What matters is simply the effects that it has and whether these are desirable and whether they can be prevented.
Men do lose testosterone by the way and there is such a thing as TRT - testosterone replacement therapy. Where do you think Testogel, Testim and Tostran all come from? They are all made for men, to replace low testosterone from ageing. The only difference is theirs reduces slowly as they age, so they notice the effects less. And yes, low testosterone does contribute to many diseases in men. You can read about them here, a quick google will bring them up: https://www.healthline.com/health/side-effects-of-low-testosterone
Finally you still seem to be caught up in a binary thinking that estrogen is about women and testosterone is about men, which is really inaccurate. For the record, the NORMAL male ESTROGEN level is from 20-242nmol. Which, at the higher end, is the same as many women trying to replace their estrogen with HRT.
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If you refuse to believe that a lack of estrogen contributes to diseases, then there's not much more to be said really. There is now endless research that it does contribute to all kinds of health conditions and no one is even debating that.
What does it matter if menopause is a 'natural' part of ageing? Death is also 'natural'. So is cancer. So is suffering. 'Natural' doesn't mean 'good' and we need to stop equating these two words. Women didn't even live past the age of 60 until about the turn of the century, on average - that was 'natural', too.
As for whether or not it's a disease, I can't see that that really matters. It's a physical process which speeds up ageing and other diseases. So whilst not being a disease in itself, it's something it's desirable to address medically. There are many other changes the body goes through as it ages which are not 'diseases' but can be treated and reduced. And, in fact, many researchers do consider ageing itself to be a disease which one day we will understand better and be able to largely prevent.
Of course there are women past the menopause who don't have heart disease and dementia. Just like there were many people who smoked 60 a day and didn't get lung cancer. It's not evidence that something is okay just because you can come up with some unaffected people... That's why we have science and research.
100% and there are even moves towards the WHO classifying ageing itself as a disease rather than a 'natural', inevitable process.
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My view is that HRT is good for some and those who want to take for as long as they live is their right.
But let's face it. Menopause is a natural part of ageing for women and it should be accepted as that. I understand that we have symptoms and they can be horrible at times, I, myself, am not symptom-free, but we shouldn't try to medicalise the menopause because it's not a disease. Thyroid dysfunction is and it can cause serious problems, same as an adrenal disorder, which is potentially fatal if not treated.
As for all the health risks associated with a lack of oestrogen such as osteoporosis, heart disease and dementia, I know a lot of ladies who don't have these and they are well past the menopause. I believe that, as men and women age, there are inevitable physiological changes in the body as we age, allowing for potential disease to develop, there are also a hereditary factor and an element of luck of whether we will develop any of these diseases or not. I refuse to beleive that a lack of oestrogen contributes to diseases and I get the impression that the menopause takes the blame for everything.
Shelton, E. K. (1954). The use of estrogen after the menopause. Journal of the American Geriatrics Society, 2(10), 627-633.
"The final argument that the menopause is a natural phenomenon and should not be tampered with, is to me the most vapid of all. (...) The very person who argues that the menopause is a natural phenomenon fights nature very day. He pasteurizes his milk, boils his instruments, vaccinates his stock and his children, sprays and buds his fruit trees, flies against gravity, makes new elements and splits the atom. Is the menopause any different?"
Wilson, R. A. (1966). Feminine forever. New York: Evans.
"It has been argued that the extension of a woman's femininity by means of estrogen is ''interfering with nature". One might counter such objections by asking whether curing the measles----or any other disease---is also interfering with nature. If so, the art of medicine as a whole would have to be abandoned. I have never been able to elicit from these glib critics whether they consider "interfering with nature" merely inadvisable or outright immoral, and, if so, for what reasons. If such arguments were carried through, mankind would have to give up all efforts at healing, along with, for example, all types of farming-another form of interfering with nature. It is noteworthy, by the way, that the very origin of human civilization lies in the kind of interference with nature that led to the development of agriculture."
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Thirdly - 500 mg prometrium is a HUGE dose. No gynae or menopause specialist would prescribe this amount (except for fertility indications). I'm amazed you've been able to function at all! I would be more worried about this in terms of potential increased breast cancer risk then the tiny amount of estradiol you are now taking.
I've not come across any studies showing an increased risk with bio-identical progesterone, only with progestins.
Climacteric. 2020 Jun;23(3):226-228. doi: 10.1080/13697137.2020.1735797.
"In the Lancet paper, they state that, in general, the relative risks did not vary by progestogen type, including oral micronized progesterone, although the risk appeared to be somewhat lower for dydrogesterone. But users of estrogen plus dydrogesterone comprised just 2.1% of HRT users, and users of estrogen plus oral micronized progesterone comprised only 0.4%. It is therefore impossible to draw any firm conclusions from these figures. The vast majority of combined HRT preparations contained medroxyprogesterone acetate, norethisterone acetate or levonorgestrel. "
Fourth - here in UK, the recommendation for women post 60 taking HRT is to use transdermal HRT ie patch gel or spray - because of increased stroke risk and cardio-vascular problems in older women, especially if you have other risk factors such as High BP, excess weight etc.
I've not come across any studies showing conclusively that oral bio-identical estradiol results in increased cardiovascular risk and increased blood pressure. Actually, the opposite of that.
Hypertension. 2005;45:399-405
“We studied 13 normotensive postmenopausal women (54±2 [mean±SE] years) before and after 1 month of oral estradiol 2 mg daily”
“In summary, in normotensive postmenopausal women, estradiol increases angiotensin II, but not aldosterone, at rest and during orthostatic stress, yet lowers, rather than raises, BP under both conditions. Downregulation of vascular and adrenal responsiveness to angiotensin II may protect healthy women against this activation.”
Circulation 76, No. 4, 753-758 1987.
“In the present study we found no change in systolic blood pressure and a tendency toward a lowering of diastolic blood pressure during both percutaneous and oral estradiol therapy. Exactly the same response has been reported during oral estrogen replacement therapy with higher estradiol doses*.27”
*4 mg oral estradiol vs. 2 mg in this study
Acta Obstet Gynecol Scand Suppl. 1975;43:1-11.
“Two different dosages of the oestrogen hormones were used: 4 mg 17-B-oestradiol with 2 mg oestriol, and 2 mg 17-B-oestradiol with 1 mg oestriol”
“The tablets containing oestrogen alone (E 42 and E21) were given with an intermission of 3-7 days between each treatment period, or in some cases with an intermission of 2 days each week.”
“The material comprised 352 patients, each of whom underwent 3 to 18 four-week treatment periods on one and the same preparation. The investigation covered a total of 2 101 four-week periods (Tables I1 and HI).”
“Neither thrombosis nor any rise in blood pressure occurred in any of the patients.”
“In menopausal women the blood pressure is often raised. During the treatment, if there was any tendency it was towards normalisation. In no case was an increase in blood pressure noted during the oestrogen therapy.”
Ann Clin Res. 1983;15 Suppl 38:1-121.
“Blood pressure, central hemodynamics and peripheral blood flow were measured at rest in 20 normotensive and 20 hypertensive postmenopausal women during cyclic placebo/estradiol-17 beta treatment. Micronized estradiol-17 beta was given in daily doses of 2 mg and 4 mg."
"Estradiol-17 beta substitution decreased the systolic and diastolic blood pressure in normotensive, hypertensive and borderline hypertensive postmenopausal women."
"Irrespective of the pretreatment blood pressure levels, heart rate decreased during estradiol-17 beta substitution”
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If oestrogen is so important, what about a lack of testosterone in men? Does research say that it contributes to diseases in men? I've never come across an article that it doees. Why should it be different for women? Is oestrogen more powerful than testosterone?
Yassin, A., Haider, A., Haider, K. S., Caliber, M., Doros, G., Saad, F., & Garvey, W. T. (2019). Testosterone therapy in men with hypogonadism prevents progression from prediabetes to type 2 diabetes: eight-year data from a registry study. Diabetes Care, 42(6), 1104-1111.
"Long-term TTh completely prevents prediabetes progression to T2D in men with hypogonadism and improves glycemia, lipids, and AMS score. TTh holds tremendous potential for the large and growing population of men with prediabetes and hypogonadism."
Lv, W., Du, N., Liu, Y. et al. Low Testosterone Level and Risk of Alzheimer’s Disease in the Elderly Men: a Systematic Review and Meta-Analysis. Mol Neurobiol 53, 2679–2684 (2016). https://doi.org/10.1007/s12035-015-9315-y
"Meta-analysis using random effect model showed that low plasma testosterone level was significantly associated with an increased risk of Alzheimer’s disease in elderly men (random RR = 1.48, 95 % CI 1.12–1.96, P = 0.006). Sensitivity analysis by omitting one study by turns showed that there was no obvious change in the pooled risk estimates, and all pooled RRs were statistically significant. This meta-analysis supports that low plasma testosterone level is significantly associated with increased risk of Alzheimer’s disease in the elderly men. Low testosterone level is a risk factor of worse cognitive function in the elderly men."
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Thanks everyone for your input but to me the menopause is not a disease. That"s a phase that marks the end of a woman's reproductive life because the ovaries stop functioning after a while. That's my view. I was making a point when comparing oestrogen to cortisol because a lack of one can cause death while a lack of the other can't. I don't think of the menopause in a negative way. To me, the menopause diesn't mean the beginning of end.
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Thanks Erika28 for that research, very interesting.
Karine, that's your opinion. Your opinion isn't based on the science or supported by it. There are still people out there who believe the world is flat. Their opinion is also not based on science or reality. Everyone is entitled to their opinion. Opinions aren't facts.
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Now if the menopause is not a natural phenomenon, what is it? Why do we all go through it?
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Well, Joziel I just have to hope that I won't get all the horrible diseases that exit because I haven't supplemented my body with HRT.
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Thanks Erika28 for that research, very interesting.
Karine, that's your opinion. Your opinion isn't based on the science or supported by it. There are still people out there who believe the world is flat. Their opinion is also not based on science or reality. Everyone is entitled to their opinion. Opinions aren't facts.
This is just rude. I thought this forum was to help and encourage each other. Clearly not, so I am afraid I am out ladies. The science is still developing and is encouraging, but not conclusive in all areas.
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It's not rude :o Several people have given a lot of evidence supporting their views here and even responding directly to what Karine has said. In turn, Karine doesn't accept the evidence or even engage or discuss it - and continues to hold the opinion she had before. In my opinion, that is more rude - because people have taken the time to find research papers and quotes, only to be completely disregarded.
She's perfectly entitled to believe whatever she wants to believe, of course, we don't live in a dictatorship. But what she believes isn't in keeping with the science and the research. That's not being rude, it is pretty clear from the perspectives in the thread.
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It's not rude at all - on the other hand the blanket refusal to entertain the various evidence based research that is being cited here is bewildering
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It's not rude at all - on the other hand the blanket refusal to entertain the various evidence based research that is being cited here is bewildering
Well, you know the old saying, "You can lead a horse to water but you can't make it drink".
JP x
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There's no need to carry on having a dig at someone who wants to voice their opinion, even if what they say it's not back by science. If a woman doesn't want to supplement her body with artificial hormones it doesn't make her more at risk of getting a disease than someone who does.
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If a woman doesn't want to supplement her body with artificial hormones it doesn't make her more at risk of getting a disease than someone who does.
That's just it though: there is good evidence that not supplementing does indeed put women at increased risk of life threatening conditions such as heart disease (the number one killer of women), osteoporosis and cognitive malfunction.
And given that the majority of women in the UK now take body identical estrogen, it's not clear what you mean by "artificial" hormones...
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What I mean by 'artificial' is that it's not produced by the body. 'Body identical' means it's similar to what the body used to produce. Because it not made by the body, it can only be artificial. I'm sorry to say this but I know a good bunch of post meno women and they don't suffer from heart disease, osteoporosis or dementia. I think it's the luck of the draw, HRT or not.
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What I mean by 'artificial' is that it's not produced by the body. 'Body identical' means it's similar to what the body used to produce. Because it not made by the body, it can only be artificial. I'm sorry to say this but I know a good bunch of post meno women and they don't suffer from heart disease, osteoporosis or dementia. I think it's the luck of the draw, HRT or not.
We are all entitled to our opinions , but could i venture to say that 99% of women do have osteoporosis later in life, who do not take hormones - my NHS nurse who did my dexa scan said as soon as I stop my HRT I will be like the rest of them - meaning not on HRT, with osteoporosis.
Also as soon as we loose our estrogen we are at the same risk as men of having a heart attack. Believe me that you can't see the risk , I know loads of women and men and have not been able to predict a bone break until a fall or a heart attack until it happens. And dementia rose when HRT declined . There is the luck of the draw, but I would rather stack my cards up high, with all the " artificial " support I can get.
It is personal choice, being informed and weighing the risk and benefit.
Best wishes PMXX
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I agree Pepperminty, lack of oestrogen is for life x
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Oh Pepperminty, I’m so with you on this! All the evidence is there.
Testosterone very much comes into the equation.
Who said, “ it’s our hormone too and we have to reclaim it”?
xx
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Hi Perinowpost and Marchlove,
Lets face it most medical professionals don't know all about the research and facts, so there is not much hope for the average person being clued up! Most of us here have spent hours trawling the internet and researching.
We used to pop our clogs around 50 to 60 not that long ago. We are living longer due to " artificial" medical intervention. Men died earlier ( as they do not have the protective estrogen).
Apparently testosterone has anti inflammatory properties too! So that declines also as men get older. As we are living longer due to medical advances it makes sense to me to try to top up what we have lost. We are unfortunately not designed to last after menopause.
Sometimes looking at the elderly - and I have extensive experience with this in both men and women- once the GP takes them off HRT usually around 70 years ( that is if you are lucky to get it that long) the health declines - but the women just keep silent and every one has said to me " my body started to go wrong once I stopped HRT, - but I just put up with it.
If you were to look at me , you would not think I had any symptoms . Women and men do not usually talk about pain, exhaustion, anxiety, vaginal atrophy , wetting themselves, stiffness, to others. We do not know what goes on behind closed doors. We just put up with it and blame it on getting older.
There are lots of side effects with most medications.
But the interestingly, there are no recorded contraindications with taking trans-dermal estrogen in women without a womb . It is the progesterone component that slightly raises any risk and that is less than drinking , smoking and being over weight.
A positive attitude and good gut health also goes a long way to a happy longer healthier life.
Incidentally the thyriod can cause all the same symptoms of perimenopause too - so ladies look into your T3 as the medical profession can be a little behind on this generally too - only treating when we are completely out of range and not on symptoms etc
PMxx