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[fultime]

Hi two years ago I was told to cut down on the HRT (kliovance) as I had fibroids and it would make them grow, I have managed to cut down to 3 a week but.... I have started to get night sweats, neck and shoulder pain, joint pain and worse of all bad depression over the past 3 months so I decided to go to see my GP this morning and ask if I could try increasing the dose up to maybe 5 a week and see how the fibroids went and if my depression eased, well she said that as I am approaching 60 and have been on HRT 6 years I should think of coming off it anyway now, this threw me into a panic as I rely on it to keep me sane, she said she would not force me to come off but I should thing about the risk of stroke and breast cancer and whenever I decide to come off it, be it now or when I am 70 I will still have to go through all the nasty menopause side effects as I am just delaying it by keeping on the HRT, she said she thought I should try anti depressants, low dose 10 mg of citalopram, she gave me a prescription for that and told me to go home and think about it. Well I've done nothing but think about it, I am happy on HRT it suits me and it makes me feel better, obviously by taking a lower dose 3 rather than 7 tablets it has started to have an adverse effect, mainly the depression which in turn is having a very bad effect on my relationship with my husband, he is not the most patient or sympathetic person and reacts in aggression or anger to my low moods which doesn't really help but I have been with him over 40 years and there is no changing him now I fear. Do I just up my HRT and think about coming off again in a few years if it helps me again or do I bite the bullet and go on anti's, which on googling look pretty addictive and hard to come off too, can cause a lot of nasty side effects etc and I do tend to react quite badly to medicines I am the 1% that the side effect paper relates to .  Any input, any advice, would be gratefully received and mulled over thank you in advance. xxx

[peri]

Hi there fultime

This is only my opinion but I wouldn't go on anti depressants if I were you. I think gp's are far to quick to prescribe them and they may keep people quiet but we don't know all the long term side effects and they don't address the real issue.  If you are in good health and aware of any risks then it's your choice and I would stand firm on not coming off your hrt yet, good luck xx

[Sarah2]

Sorry you are finding it all so hard.

Maybe dispel some myths from your GP?
First, it's not a given that you will feel worse if and when you come of HRT for good: figures show it's 50-50.

Second, the risks between ages 60-70 equal the benefits. The actual risks of both cancer and stroke are very low still even at those ages.
My consultant likes to put it into perspective by reminding me there are risks in doing anything in life - ( many of which we don't spend any time even thinking about!) and with HRT there are risks taking it and risks in not taking it.

You could try the Mirena coil which would reduce the build up of the lining and this might reduce the growth of the fibroid.
However, I suppose what you need is some real evidence- how big is the fibroid? Is it actually growing? or is this just an assumption?

You need a scan to see what is going on so it can be monitored.

Have you tried anything else to treat your depression? Are you diagnosed as clinically depressed or are you feeling low due to lack of oestrogen and a grumpy husband- and a marriage that is not happy? I don't want to sound too nosey but you need to work out if the depression is reactive to whatever is going on in your personal life. Being really blunt, no one should have to resort to medication to cope with a miserable relationship. You can't change his behaviour but you do have a choice over yours and whether you stay with him. You are still a young-ish woman at 59, and you don't have to put up with people who make you unhappy.

Have you had counselling to try to see if this helps your mood? drs are supposed to offer this first rather than dish out pills. You should be able to access 6 NHS sessions via your dr.

I hope this isn't something that touches too many nerves, but I am really against people being given ADs rather than being helped to sort out their emotions IF that is what is going on ( and apologies if I've got the wrong end of the stick.)

[Limpy]

Fultime - Have you tried speaking to your OH about the menopause and how it makes you feel? There's something on here called advice to husbands.
http://www.menopausematters.co.uk/forum/index.php/topic,2458.0.html

It may be worth printing it off and sitting down and talking together about it.
Just speaking about it may help.

[Taz2]

I haven't found out any information which says the benefits still outweigh the risks after the age of 60 Sarah. Could you point me in the right direction? I need some concrete proof to show my GP as both she and the meno consultant are adamant that after the age of 60 then HRT is not something we should be using due to the stroke risk and also heart problems.

Sorry you are feeling so down at the moment Fultime. I can't offer any extra advice I'm afraid except to say that citalopram at the dose of 10mg is used to counteract hot flushes and not depression. The dose is too low to lift mood. Prozac is also used at 10mg for menopausal hot flushes. Could it be for this reason that the doc has prescribed it?

Taz x

[Sarah2]

Hi Taz2

I said that the risks between ages 60-70  equal the benefits.

shown here- as on this site.

http://www.menopausematters.co.uk/balance.php

Place your cursor over the ages- eg 60- and watch the pink scales!

[lubylou]

Dear Fultime
I can completely understand how you are feeling, the panic and the thought of losing what is keeping you sane; batting the thoughts about what to do back and forth in your mind. Can you tell if your depression generalised or is it because of anything specific? Could be because you are missing the higher HRT dose or maybe because you are worried about the thought of stopping HRT completely?  It's just my personal opinion, but I don't think anti depressants make much, if any, difference unless there is a clinical depression.  I had reactive depression and my GP tried me on AD's (this was a good few years ago) and they did nothing to help me, I managed to “sort my head out” and even though I still get bouts of depression so far I have managed to work my way out of it without AD or other medication. This is just my personal experience I have no problem with ADs I just think that they are most effective for clinical depression not  if there is a reason and something can be done about that, even if that is just finding a way to accept what's causing the depression and deal with it that way. I hope this is making sense and isn't sounding patronising! 

If you have the opportunity to stay on HRT and you have balanced the health risks then I think (again just my personal opinion) that as important as the “health risks” are the quality of life issues. None of us know what the future holds, but a day to day quality of life we can enjoy with our family and friends is just as important as any other consideration about staying on HRT.

I am in a similar dilemma about staying on coming off HRT, although not complicated by fybriods. I am going to try and reduce over the coming year and see what happens. I hope that you are able to come to a decision, limbo land, is an awful place to be! But for various reasons I put quality of my life - and by extension my husband's life  - very very high on my list of priorities in any risk/benefit analysis.

Sarah2 I am interested about the 50:50 figures you mention, where did you come across this information? I am obviously very interested in what my chances are of coming off HRT gradually without a complete “full on” return of symptoms.
 
I guess we all have to make our own decisions but I wish we could be allowed to make them and not have them made for us.

Lubylou

[Sarah2]

Hi Luby

I'm not sure where I came across the info- it might have been on something like Womans' Hour or it may ( think more likely now I think about it) in a research paper by a consultant- possibly Panay. If you google his name and the topic it may throw something up. Or it may even have been my own consultant! Sorry I can't be more help with that one.

My own consultant goes as far as saying it varies a lot between women and not all women by any means have a return to symptoms. He suggests a gradual tailing off over anything up to 6 months to see how women feel, then re-assess.

It's important to put all the risks for cancer and heart disease into perspective- the info on this site gives a comparison between risk according to lifestyle - drinking alcohol and being overweight carry a higher risk for breast cancer than HRT.

Risks

more than 2-3 units of alcohol per day increases risk by 1.5x,
postmenopausal obesity by 1.6x,
late first pregnancy ( more than age 30) by 1.9x
more than 5 years of HRT by 1.35x.

for a downloadable diagram showing the relative risks of breast cancer with HRT, alcohol and obesity -
Interactive version with weblinks: PDF (677kb)
Print only version: PDF (634kb)

[lubylou]

Taz,
I was interested that you say the 10 mg dose to counteract hot flushes, I cannot take citalopram (side effects)

Sarah2  Thanks for your comprehensive reply. I don't drink and I am not obese and having just had an ECG have healthy heart!  I couldn't download the PDF, is there a weblink to it?

To Anyone - The AD I was given few years ago was Sertraline, at that time I was on HRT at a higher dose to the low dose I take now so I didn't know if it would have helped my symptoms.  I have never tried AD's for hot flushes has anyone had any good results from AD for night hot sweats flashes (mine are more slow burners rather than flashers!

Thanks
Lubylou

[Sarah2]

Luby- the piece I quoted is from this - Menopause Matters website. It's under the green menu- on the left.

http://www.menopausematters.co.uk/pdf/breastCancerRisklinks.pdf

It's under HRT Risks.
Bear in mind that this is from the WHI study which has now been discounted as a flawed study by many researchers so the stats could be even more favourable for use of HRT.

Interesting that both weight and alcohol double the risk yet so many people bang on about the risks of HRT.

[lubylou]

Thanks Sarah, I agree about the alcohol and obesity issues, they barely get a mention re HRT risks but they can cause so many differing health problems
Thanks
Luby

[fultime]

 ;)Just to thank you all for the informative messages you are great, I am going to stick with the HRT I think and up it to 5 days a week Mon - Fri and see how I go and just hope that the bleeding fibroids don't recurr. Has anyone any idea if what I am on is a low dose?  it is 1mg oestradiol (as hemihydrate) and 0.5mg norethisterone? Thanks all x

[fultime]

Sorry you are finding it all so hard.

Maybe dispel some myths from your GP?
First, it's not a given that you will feel worse if and when you come of HRT for good: figures show it's 50-50.

Second, the risks between ages 60-70 equal the benefits. The actual risks of both cancer and stroke are very low still even at those ages.
My consultant likes to put it into perspective by reminding me there are risks in doing anything in life - ( many of which we don't spend any time even thinking about!) and with HRT there are risks taking it and risks in not taking it.

You could try the Mirena coil which would reduce the build up of the lining and this might reduce the growth of the fibroid.
However, I suppose what you need is some real evidence- how big is the fibroid? Is it actually growing? or is this just an assumption?

You need a scan to see what is going on so it can be monitored.

Have you tried anything else to treat your depression? Are you diagnosed as clinically depressed or are you feeling low due to lack of oestrogen and a grumpy husband- and a marriage that is not happy? I don't want to sound too nosey but you need to work out if the depression is reactive to whatever is going on in your personal life. Being really blunt, no one should have to resort to medication to cope with a miserable relationship. You can't change his behaviour but you do have a choice over yours and whether you stay with him. You are still a young-ish woman at 59, and you don't have to put up with people who make you unhappy.

Have you had counselling to try to see if this helps your mood? drs are supposed to offer this first rather than dish out pills. You should be able to access 6 NHS sessions via your dr.

I hope this isn't something that touches too many nerves, but I am really against people being given ADs rather than being helped to sort out their emotions IF that is what is going on ( and apologies if I've got the wrong end of the stick.)Thank you for the advice and no I am not offended lol, I am happily married and have been with my husband since I was 15 and he was 17 he does have difficulty due to his up bringing with being sympathetic and he does try to address it I think probably living together for much of our lives brings up some difficulties at times but I would not want to be without him and I love him very much as does he me. The depression I am feeling is much the same as how I felt when the peri menopause began along with the neck and shoulder pains, the night sweats and the feeling that I can't get a full breathe so I know its the reduction in the HRT that is causing me to feel like I do, well I'm as sure as I can be. After discussing with my Husband and daughter and my Sister and reading everyones input on here (thank you all so very much) I have decided to stick with the HRT and increase it to 5 days a week Mon - Fri and see how I feel after a few weeks and just keep my eye on any bleeding from the fibroids. I did have a scan for this 2 years ago and this showed several 'quite large' fibroids but they had not caused me any problems just the slight bleed that I was getting, the scan also showed the lining of my womb was in a very healthy and 'young' condition with no thickening of the lining at all which I was really happy about. I agree totally with quality not quantity, who wants to live to 100 feeling terrible? As my husband said tonight the anti depressants might lift my mood but they won't take my pains away or help me sleep or protect my bones will they. Thanks again to you all for confirming what I already in my heart knew I would do, its so good to know you are all out there. x

[fultime]

Hi all (again). Having increased the hrt as suggested to every other day, ie Mon, Wed, Thurs, Sat I still feel awful, in fact I think I feel worse than before as I now feel really sick every day, on and off, headaches, generally feeling foggy headed and miserable, I am sick of feeling sick its been going on for months now, is it something else wrong with me or do I need to increase the hrt even more or change it entirely or take it every day? I feel like I am grabbing at straws as to what is wrong with me and why I feel ill all the time, I look around me at friends the same age as me and they all look healthy, happy and full of the joys of spring, I look and feel awful, no energy, tired all the time and this constant nausea. Should I go back to Docs and risk her taking me off hrt altogether? Should I ask for some blood tests? Help please anyone with some advise for me or who has felt the same as me maybe? 

[CLKD]

Have you been advised by your GP to take HRT to alternate days?  Are you taking the AD?  Nausea can be a side-effect of many medications, it can also be caused by hormones  and is debilitating  …….. are you eating little and often? 

Don't take any notice of how your friends look, most of us are good actors!  Blood tests for hormone levels can be notoriously unreliable.