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[Tingly]

Well
I used to think i was reasonably intelligent, but it seems i am not anymore so any help gratefully received.

An eminent professor chap days the hrt protects bones , so stay on it /go on it if you have early menopause.

I have just been fora bone density scan, and i am borderline normal.
But the bone woman says if i go back on hrt and then come off it again in 5 years my bones will deteriorate more rapidly than if i hadnt had the hrt at all.

She is not a doctor and i asked her to explain more, but i still dont understand.

I daid surely 5 more years of strong bone is good but she sid when you come off it they will deteriorate massively.


I feel i have become hard of thinking!

[Rowan]

I found this Tingly  http://www.2womenshealth.com/27-HRT-Risks-and-Benefits/27-08-0201-HRT-osteoporosis.htm

http://www.patient.co.uk/health/osteoporosis-leaflet

HRT use to be the gold standard for osteoporosis at the moment it does not seem to be, though I would rather use estroge, diet, supplements and exercise then drugs suggested for it.

We all lose bone as we age men and women, but I don't think its inevitable that we all get osteoporosis.

I have read that if you come of HRT you could lose bone more rapidly for a while, I have also read that bone loss starts before menopause and for the first 10 years and then it slows down. 

It does sound confusing.

[Suzi Q]

HOW come no periods since 1996 am nigh on 60 now
Never took HRT took mini pill and Ovestin for 10 years or more since 2010 only Vagifem
I fell over badly directly on to both knees so hard on rocks that my KEVALR MOTOR BIKE Jeans
Ripped couldnt walk properly yet the next morning nothing
Fell flat om the roadside face down I bunced ripped my arms and legs NOTHING
I had a bone density test in February bone denisty of a 40 year old
GP was to say the least stunned he reconed it was because between 1978 to 1997
I did up to 5 ex clasess a week rode a bike 5 miles a day god did I feel smug hehehe
Considering I have N O DAIRY except for skim milk no cream no cheese no yoghurt no dips
Veyr rarley I will have scrambled egg dont eat red meat not even beef sausages
Plenty of veg and salads not much fruit so why? GP saiod it was a m ix of ex and Genetics
dads 84 just got a stick ikn the last 3 years after a heart attack his 5th lucky? Maybe or not

[CLKD]

Brisk, weight bearing exercise 20 mins per day will stave off osteoporosis.  We are hunter gatherers historically so walking and short bursts of running were essential to the Life-style. 

The person doing the bone scan was probably a technician rather than someone with medical knowledge?

[Hurdity]

That is not correct CLKD - exercise is only one of many factors influencing the development of osteoporosis. There is plenty of basuc information on this site:
http://www.menopausematters.co.uk/osteoporosisrisks.php

Since oestrogen slows down the rate of bone loss, it is logical that when it is reduced then bone loss will increase. It is just the same as for topical oestrogens and VA - you need to keep taking it to keep VA at bay.

Surely it is better to have stronger bones for longer?

Here is one study involving admittedly only 50 women:
http://www.ncbi.nlm.nih.gov/pubmed/11444087

The findings bear out what I said above:

On average, 3 years after cessation of HRT mean vertebral BMD when expressed as a Z-score was significantly higher (-0.13 vs -0.89, p < 0.01) than at baseline, before HRT was started, which suggested a lasting beneficial effect on bone mass.

So bone is lost rapidly after cessation of oestrogen, just as it does with post-menopausal women who do not take HRT (ie especially in the first 2-3 years post-meno).

The conclusion of the study says this:

In conclusion, the pattern of bone loss observed after cessation of estrogen therapy was found to be comparable to that which occurs in younger women within the first years after the menopause. Such a pattern needs to be kept in mind when the decision to stop HRT is taken, especially in women who were given HRT to prevent osteoporosis. The issue of assessing their risk of fracture several years after cessation of treatment thus needs to be addressed.

So the arguments for taking HRT to prevent osteoporosis are similar to the arguments for taking HRT generally - as long as you are taking it you are enjoying the benefits of oestrogen - but of course - the benefits are not permanent. This is not an argument never to take HRT though!!

In the recent paper by the British Menopause Society by Panay et al  (2013) they say:

HRT is the first line therapeutic intervention for the prevention and treatment of osteoporosis in women with POI and menopausal women below 60 years, particuarly those with menopausal symptoms.

and later:

The bone protective effect of HRT on bone mineral density is dose dependent

Also this:

The bone preserving effect of HRT on bone mineral density declines after discontinuation of treatment. Some studies have shown that the use of HRT for a few years around menopause may provide a long term protective effect many years after stopping HRT

http://min.sagepub.com/content/19/2/59

So yes Tingly - you are intelligent and 5 more years of stong bones is of course preferable to 5 more years of weaker bones!

Suzi you are very lucky - but women should not conclude that it's fine not to protect their bones with oestrogen following early menpopause, just because you are fortunate enough to still have strong bones after premature menopause.

Ooops got carried away again

Hurdity x

[Tingly]

Thank goodness i am not losing the plot

I must say i exercise 40 mins x4 days a week, eat a calcium rich diet, dont drink or smoke...just one of those things i guess


Hurdity, thanks or all the useful info...if he va doesnt improve i may restart hrt with the oetrogel...providing i only have to have 7 days of prog....i really really cant stand it.


Thanks again

Tingly
Xxx

[Dancinggirl]

Hurdity - keep getting carried away girl - I find it most helpful.
In my 30s, when I was diagnosed peri meno, they sent me for a bone scan and i was already borderline!  I'm relieved to know all my years on HRT will have been beneficial and though I am about to take a break from HRT I'm quietly hoping I have to go back on to keep getting the benefits.
My mother has lost at least 3 inches in height - she has always been very active and has fortunately not broken anything yet.  I fear if she had a fall her bones would just crumble.
By the way, does everyone take Vitamin D - so important for bones and everything - particularly in winter.
Keep the info coming. DG x

[Meeka]

Prof Studd is very pro oestrogen for preserving bone density, he writes about it in detail on his website

http://www.studd.co.uk/osteoporosis.php

[Tingly]

So come on then ladies
Shall we have an x factor/strictly/ dancing on ice/ get me out of here vote as to whether i should or should not go back on hrt!!!!

Am 491/2
Been on it since 43
Hate progesterone
Have got vaginal atrophy but am on week 4 of vagifem
Have beem off hrt 4 weeks cold turkey
Get night sweats


Should i go and beg for oestrogel and 7 days prog or shall i continue without

The voting lines are open now. Emails will cost you nothing. Any votes made after the lines are closed may be charged and will not be counted!!!

Ting x

[Dancinggirl]

Dear Tingly
Going cold turkey is not good - no wonder you feel dreadful. Maybe give yourself a few more weeks - depending on how stressful your life is.
It sounds to me as though you want to go back on (l do too) but it's the dilemma of which way to go. I'm now 57 and at 49 I tried being without HRT for 3 years which was very tough and I should have gone back on sooner.  Are you post meno?
I've had the Mirena/Oestrogel combo for the last 4 years which hasn't given me the usual problems of the progesterone. I wasn't happy about having the mirena but it's been ok until recently ( it's now ready to come out).
With Oestrogel + 7 day utrogestan combo, I presume it is 200mg dose of ustrogestan?
I suspect you might need to keep the dosage of Oestrogel quite low with 7 day utro.  Hurdity might be able to help on this one.  Maybe you would do well on a lowish amount of oestrogel + vagifem + utrogestan?
I don't know if this helps!   DG x

[Tingly]

Hi dg

Dont know if i am peri or not cos been on hrt

Was peri at 43 so not sure

Dont fancy mirena...apparently recommended for people who had kids , which i havent

Not even sure if my doc will let me do the 6 day thing...hurdity says they give u norethstone (?) as th prog as its stronger

I wonder if taking it vaginally would help...but then again cud u do that at the same time as vagifem?

It all helps dg... Each experience is a bit more info

Did u get atrophy whilst already on mirena and oestrogel , and are u on them and vagifem at the same time?

Luv Tingly xxxx

[Hurdity]

Well you know the answer that I'm going to give Tingly - there is no contest. You are not yet 50 and in terms of risk (however small) the years on HRT don't even begin to count until the average age of natural menopause ie 51/52. I didn't start HRT until I was almost 54.

I understand about the progesterone. I would not do the 7 days except under consultation with a specialist gynae. As you are prog intolerant you should be referred to a specialist - but I presume your other advice re the hormonin etc was from a meno clinic or specialist gynae?

This is what Prof Studd says about the 7 day course at the bottom of this page under progesterone:
http://www.studd.co.uk/bioidentical_hormones.php

The best method of taking bioidentical hormones would in my view be Oestrogel 2-3 measures daily with the possible addition of transdermal testosterone gel and then Utrogestan 100 mgs daily for the first 7 days of each calendar month. This would bring about a regular scanty bleed on about the 10th day of each calendar month.

This is what he says on the page on hormones and depression:
http://www.studd.co.uk/dep_treatment.php

The patients will need progestogen to prevent endometrial hyperplasia and irregular bleeding, but because of the progestogen intolerance found in these women, a smaller dose of shorter duration is recommended, usually in the form of 2.5 mgs of Norethisterone or 100 mgs of Utrogestan for the first seven days of each calendar month; this will produce a regular withdrawal bleed on about day ten of each calendar month. Re-setting the periods in this way prevents abnormal bleeding ; instead normal , usually scanty bleeding occurs at a predictable time of the month. Another minor advantage of this regimen is that periods now occur 12 times a year rather than 13.

I can't find the info where he recommends regular scanning - his website is very basic (but informative) and has no search function. However this would be recommended.

Papers I have read show greater absoprtion of progesterone when used vaginally - it does not have to go through the liver and also goes straight to the uterus where needed so you might find that 100 mg for 7 days vaginally is sufficient.

I use Vagifem and utro vaginally. During the time I am using the Utro I put the Vagifem in approx 12 hours later. I am not sure whether the progesterone interefers with the benefical effect of the oestrogen and I can;t find any info on this. One thing - I do try to make sure I am well plumped up (!) before I start the Utro by popping in an extra pessary or so the week before ( but normally I use Orthgynest - only use Vagifem when using the Utro). This helps to minimise systemic absoprtion so i don't get too fuzzy headed on the prog!

My vote: beg for oestrogel (or patches...)

Hurdity x

[Dancinggirl]

Hi Tingly - As always Hurdity is the voice of reason and I agree with her. Even at 57 I would like to continues with HRT but I may be able to reduce my dosage a little.  I want the protection for my bones and prevent AV is possible.
Don't suffer unnecessarily unless there are real health issues you need to take into account.
Keep following Burning CLub thread.
DG x

[Tingly]

Thanx both. Will try n get docs appointment next week to sort out

I was on utrogestan 200 last time so lets hope a slightly reduced dose will therefore a. Not drive me mental b. not irritate my bladder c. Cure my atrophy.

Thanks again

You have given more time attention and support than i could have dreamed of

Luv tingly
Xxx