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[Mamie]

Hi, 
I'm wondering if you ladies could give me some feedback on a problem which has been going round and round in my head for quite some time now.

I will be 69 years old next month.  I went through menopause at 51/52, tried a couple of HRTs (Evorel Sequi initially and then Evorel Conti and something else with dydrogesterone) for a very short time but  I could not tolerate the progesterone.  I suffered from very bad PMS for years before menopause and also post natal depression.  So a history of hormonal depression/anxiety.  The doctor I had at the time was pretty ignorant about HRT and thought it better that I should try and tough things out as "it only lasted two years at most".   

I was diagnosed with osteoporosis age 60 and am currently on what they term a drug holiday from bisphosphonate treatment.  Couldn't tolerate the oral bisphonates which caused bad stomach issues which I am still suffering from.  So have been on Zoledronic acid by infusion which bypasses the stomach.

So to get to my issue.  I have never felt completely well either mentally or physically since I went through menopause.  I hate to admit that but there it is.  It's as though when estrogen went, my happy hormone and sleep hormone went. 

I am also very concerned about my osteoporosis treatment and really don't want to be on bisphosphonate treatment on and off indefinitely as in itself can cause a deterioration in the bones.  I thankfully have had no fractures.

I would love to try HRT again but know that no GP would advise it.  I am more than willing to go private and just noticed a post on here regarding Prof. Studd's clinic in Wimpole Street.  I am aware that Dr. Studd has retired but two other colleagues are mentioned, Mr. Mike Savvas and Mr. Neale Watson.  I'm wondering if anyone here has seen either of them or if anyone could recommend someone else?

I know there is a risk with introducing Hrt so late in the day.  Sorry if this comes across as an incoherent muddle but I'd be very grateful for some feedback. 

[sheila99]

There's no longer an age limit for hrt so you should be able to get it. I think they recommend a low dose if it's some years since you had any oestrogen. You could ask your gp for a referral to an NHS menopause clinic if you don't want to go privately and your gp is unable to help. You may find your gp is happy to prescribe. No experience of Prof Studd's clinic but reports on here seem to be more good than bad.

[CLKD]

Hi!  good question.   

Quality of Life is important especially as we are living longer.  Dr Louise Newsom has a good website and sees ladies, can't remember if it's private appts though. 

Browse round.  Make notes.  Do read the threads about bladder issues and vaginal atrophy ;-) forewarned and all that.  Some find that keeping a mood/food/symptom diary of use to chart progress and to decide which symptom you need to ease.

A lack of oestrogen can certainly cause mood changes   -   were you better on Evorel at all?  Many cannot tolerate the progesterone part of a regime and often opt for a longer oestrogen cycle.  A regular scan to check the womb is important if you choose that route. 

You could speak to someone at a menopause clinic I believe that you can self refer if there is one near enough to you.  You can send a question via PM to Dr Curry here for a fee .

If Evorel didn't lift mood mayB consider appropriate anti-depressant and/or anti-anxiety medication until the New Year which will help to decide if you need HRT : - if you feel better you can make informed choices as to whether you need HRT instead of or as well as.  Many are stressed during these difficult times and with C.mas as well as New Year approaching one wants to feel as well as possible.  What support do you have close by?

There is a UK-based osteoporosis web site where you can browse and ask the question too.  Gather as much info as you are able, it gives you a sense of control.

[CLKD]

 Royal Osteoporosis Society - good website ;-)

[Hurdity]

Hi Mamie

 

While there is no longer an age/time limit for taking HRT that a woman has been taking, a study in relation to cardi-vascular health recommended that there is a "window of opportunity" when the maximum benefit and least harm is done healthwise, for starting HRT - and this is under 60 or within 10 years ( maximum) of menopause. This is because of changes in the arteries such that there is an increased stroke risk if starting oral HRT long after menopause (in a nutshell and as far as I recall).

Here is a link to the British Menopause Society recommendations:

https://thebms.org.uk/publications/consensus-statements/hormone-replacement-therapy/

... and the key recommendations relating to age:

"Arbitrary limits should not be placed on the duration of use of HRT; if symptoms persist, the benefits usually outweigh the risks.

HRT prescribed before the age of 60 or within 10 years of the menopause has a favourable benefit /risk profile and is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality.

If HRT is used in women over 60 years of age, low doses should be started, preferably with a transdermal estradiol preparation."

 - as Avalon has already said, you would need to start low dose and with transdermal HRT but if you still have a uterus you would need a progeastogen and as you found earliet this was problematic. I am mid 60's and still take hRT cyclically so have to endure a very unwelcome bleed because I take it long cycle to minimise the progesterone.

Although a 25 mcg patch is lower than the minimum dose for osteoporosis protection it still reduces bone turnover as I recall so will help to some extent.

You should be able to get a referral to an NHS menopause clinic depending where you are in UK, without having to pay - and because of all the lockdowns most clinics are online anyway so you would be able to find someone cheaper than the Studd clinic if you feel you want and can afford to go privately because the wait is too long for NHS, and due to your age, time is of the essence!

You can find the specialists listed here (also linked from this website):

https://thebms.org.uk/find-a-menopause-specialist/

Hope this helps and good luck!

Hurdity x

[Mamie]

Thank you all so much for the very helpful and thought provoking feedback.  I shall respond more fully tomorrow when time permits.
Once again, thank you 

[Mamie]

Hurdity, I have read up a reasonable amount on it all and am aware of the "window of opportunity" margin which is why I need to find a specialist or doctor who thinks outside the box so to speak.  I realize that tablets are a bit risky at my age and would only be happy taking low dose estrogen patches or gel and as you say that would still confer some bone benefit. 

But of course the progesterone is the pesky fly in the ointment.  I have not tried Utrogesterone (I don't think it was about when I first tried Hrt all those years ago) and feel that may be the only way to go.  I have also thought about FemSeven which has a different progesterone to ones I tried, but believe that is difficult to get hold of at the moment. 

I think private is the way to go due to time being of the essence as you say. 

Many thanks for all that very helpful information   

[Mamie]

Avalon,  it is very encouraging to know of women in their 60s who started Hrt - it gives me some hope      Thank you.

[Mamie]

CLKD, the Royal Osteoporosis Society is extremely helpful and I have spoken to their specialist nurses on their helpline on several occasions.  They are a bit non-committal regarding someone in their 60s starting Hrt for bone health as one would expect, but are a mine of information regarding everything else bone wise.

Yes, I had thought about taking an antidepressant, but my thinking at present is that if it is at all possible for me to take Hrt and if it suits and lifts mood/anxiety, then perhaps an antidepressant may not be necessary and neither might a bone medication. There are risks and benefits either way.  I just thought that Hrt is the more "natural" way to go.  But perhaps my thinking is off on this.  I have taken an AD in the past for under a year and found it helpful, so am certainly not averse to doing this again should I feel it necessary.
Thank you.

Sheila, also many thanks for your helpful reply.



 

[Mary G]

Mamie, it's unlikely that the NHS will agree to HRT because of where you are in the menopause and the length of time since you last used HRT.

I think Professor Studd's practice would prescribe HRT and probably the Newson Clinic too.   I used to be a patient of Professor Studd and his treatment was a real life safer for me at that time.  As you know, he has now retired but his two colleagues use the same prescribing guidelines so I definitely think it's worth a try. 

Before parting with any money, I would recommend you ring the clinic first to sound them out and make sure they would HRT for someone in your situation.

I know someone else who reacted badly to bisphosphonate treatment and I don't think it's unusual.  I would say HRT is the way to go if possible.

Good luck and please let us know how you get on.

[Mamie]

Hi Mary,  I also think it unlikely that the NHS would agree to Hrt for someone in my situation.

That's very helpful to know Prof. Studd was of such help to you, and that his colleagues would be likely to use the same prescribing guidelines. As you say it's definitely worth a try.  I have heard good things about the Newson Clinic, but as I live in London Professor's Studd's clinic in Wimpole Street would be handier.

That's good advice about ringing first to sound them out.

Very many thanks.

[warwick01]

Mamie

In my opinion its about quality of life. I too have never been the same person since my Estragon dropped I have gone from the life and soul of the party to someone who has no energy or motivation to do anything. Continue to get my hormones up.... I am 61 and I think the last 4 years have been the worst.

Look for a good Consultant and get your life back

Wx

[CLKD]

Hi warwick01 - great to see you >wave<

[Mamie]

Mamie

In my opinion its about quality of life. I too have never been the same person since my Estragon dropped I have gone from the life and soul of the party to someone who has no energy or motivation to do anything. Continue to get my hormones up.... I am 61 and I think the last 4 years have been the worst.

Look for a good Consultant and get your life back

Wx

Many thanks for those encouraging words and I am sorry to read that you have also been suffering for the last four years.  Take care.

[warwick01]

CLKD -  Still fighting the fight...

Wx