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[Meg]

Over the last couple of days I have met two womenand we were talking fairly briefly about menopause.  One had been taken off oestrogen after ten years, she had been on it since a hysterectomy.  The other lady said that she thought that late fifties was too old to start HRT and that  most GP's would not give it to you at that age and that most GP's wont prescribe it for more than 10 years.  I wonder if it is the case that guidelines for GP's in the NHS are laying rules down about no more than 10 years.  Do you think doctors are more willing to prescribe anti-depressant medication maybe as an acceptable possible long-term alternative and clondine.  Is HRT worth starting if there is a cut-off time after which symptoms may well reappear.  All this is pretty problematic and women are just desperate for some immediate symptom relief to help them be well and keep going with a decent quality of life.  Any thoughts?

Meg

[Dana]

I'm hoping to be able to stay on it long-term. I want to be the one who decides when or if I stop taking it, and not have some doctor or timetable tell me when it's time. I've had experience with both ADs and benzos, and they will never be an acceptable substitute for bioident HRT, as far as I'm concerned - I don't care what some doctor tells me.

[Cassie]

I fully agree with you Dana, if I may enquire what Bio Id HRT are you on?

[Dancinggirl]

Have a look at my latest post on 'The Burning Club' under Private Lives - Heather Currie gives me good  and reassuring info re. long term HRT and bio-dents.
DG x

[Hurdity]

Meg - I made a detailed post a while back quoting the latest on starting HRT and age, on your thread here:
http://www.menopausematters.co.uk/forum/index.php/topic,22963.msg348363.html#msg348363

Whatever the women say, late fifties is not too old to start HRT as I said before - but of course with GPs who are not up-to-date you would need to quote or print-out the relevant statements. However I would not delay because it will become harder to persuade them to start HRT post 60 which seems to be the magic age - even so many doctors are sensibily considering on a case by case basis.

I don't know where the 10 years comes from. As far as I can make out there are no NICE guidelines on menopause at the moment and these are being developed (due 2015). There is plenty of advice though.

Here is what it says on patient.co.uk:
http://www.patient.co.uk/doctor/hormone-replacement-therapy

Prescribing hormone replacement therapy[2]

The dose, regimen and duration of HRT need to be individualised. There is no maximum duration of time for women to take HRT; for the women who continue to have symptoms, their benefits from HRT usually outweigh any risks.


This is an excellent article.

Unfortunately it seems that some GPS who are not up-to-date do tend to prescribe ADs rather than HRT,  so in these cases, until the guidelines are developed, it is up to us, with the aid of the published information, the information on this website, and the combined experiences of and advice from women on this forum, - to push for what we need.

Many times on here recently women are questioning whether it is worth starting if you will get symptoms when you stop. This is never an argument not to start! Your body will benefit from raised oestrogen and the protection it gives to your bones, not to mention symptomatic relief, all the time you are onit. By the time you stop - if you do - you should be well post-meno and your hormones will no longer be fluctuating. Any symptoms you get will be due to withdrawal of oestrogen temporarily ( ie flushes) or permanently - effect on mood, bones, bladder, vagina and everything else....

There really is no argument re the above ( ie putting off symptoms) - if there is no medical reason for you not to take HRT.

As I have said before - quality of life for a few years (however you long you want) or a miserable slide into old age beset by unpleasant symptoms! I know what I have chosen - and prepared to take the small risks....

Hurdity x

[andius]

Well, for many years it was a long term solution for most and it has still been for those who refused to stop it.

The trick is finding a doctor who is willing to let you continue to use it....or who will let you try the bioidentical hormones rather than the synthetic ones or non-bioidentical ones that caused all the issues in the WHI study, which resulted in the warnings to doctors and patients that are printed out on all the hormone leaflets now. Unfortunately it is like everything else, if something causes harm to some, it is viewed with skepticism to all!  Hormone therapy is so individual that the thinking on this really needs to change and I hope it is starting to.  Just like we should not all be taking blood pressure medication just in case, we should not all be taking hormones "just in case".  It should be for those who need it to live a normal life and I don't feel it should not be denied to them based on statistics or a certain age....just my thoughts! What if you don't start having life-altering symptoms until 61? Risk versus reward is the key here!

My mother and grandmother both took hormones into their early 80's and mother is still alive and doing well although I have noticed a decline in her since she stopped per doctor request.

[Taz2]

I agree although it is very important that the risks are spelled out to you before you decide to continue with HRT so that should you indeed reach the life-altering-symptoms stage (which are cancer and stroke) you can accept the fact that HRT may have caused the illness without feeling hard done by. Throughout life we have to make life changing decisions and the key is always to be able to weigh up the pros and cons. Hopefully GP's will continue to update their knowledge of HRT so that it is not automatically withdrawn at a certain age.

Taz 

[andius]

Well, by life altering symptoms I actually meant intractable VA, UTI's (not controlled by local estrogen), fractures (osteoporosis), depression, decreased mental alertness, intractable anxiety, insomnia...ect. that some women may experience as they move further into menopause. I expect this can be a real problem if you are working in your 60's.

If your doc treats all this with individual meds (not HRT) and it works ok for you, that is great! Do you have to take them for the rest of your life?  But what if it doesn't work well or you have a whole set of different side effects to deal with that adversely effect your quality of life? If Hrt can resolve the issues, why shouldn't it be discussed and not automatically ruled out, even if you are close to 60 or over. Lower doses and different kinds of HRT are available now.

[Taz2]

I can only speak from experience. I have been under the care of a menopause clinic for a few years and both they and the GP have explained to me the perceived risks associated with continuing with HRT after the age of 60. The menopause clinic would not continue to prescribe but they referred my care back to my GP who, it seems, will prescribe as long as I am aware of the risks i.e. breast cancer and stroke.

I agree that it is better to have a good quality of life but we also do have to be aware that we may be one of the few who find that continued use of HRT leads to either stroke or breast cancer. Once we have been given all the facts then we can make that decision and deal with any consequences which might arise.

Taz

[Meg]

Thanks for your tremendously well thought out answers, food for thought indeed. On a personal note, I have this feeling that I may be one of those women who will possibly continue, for some reason, to experience symptoms for years.  Having had hot flushes etc etc now for nine years since ceasing to menstruate I just see no forseeable end.  I experimented briefly with both sequi and conti types several years ago.  The conti, I would not wish to try again and the question is with having a womb, would I want to have to shed the lining into old age maybe and could I get a progesterone which would be tolerable. Another possibility is not to look too far into the future and go for possible immediate relief, this is hard to do psychologically.  I appreicate your input ladies as you put so much thought into replies and I know the subject has been aired before.  These steroid hormones are so powerful and so bound up with the aging process that we could certainly do with better help and advice form the very hard pressed NHS.  In the long run I think that better help would save money in terms of helping women to lead healthier and happier lives through whatever means after their own sex hormones take a dive. It sometimes surprises me how little many women know about the impact that diminishing oestrogen has on so many aspects of their physical and mental wellbeing.

[Dancinggirl]

Meg - I do agree with what you and many other struggle with.  Conflicting info and a general lack of an holistic approach ( not to mention the lack of knowledge from many in the medical profession ) make it sooooo difficult to be objective about what is best.  Thank goodness for this site.  I have gained so much knowledge it  has enable me to formulate  a way froward fro me.
DG x

[Dana]

I fully agree with you Dana, if I may enquire what Bio Id HRT are you on?

I've just recently changed over to estradiol patches. I also use Utrogestan every month for 10 days x 100mg x vaginally, although I would like to experiment with using it on alternate days. I did that once before, but I kept getting break-through bleeds, but maybe I just wasn't patient enough, and didn't give it enough time to settle in.

[Dancinggirl]

Dana  - can you tell us more about your regime?  i assume you are post meno? What strength patch are you on?  10 days of 100 mg utrogestan is quite a low dose to keep uterus lining thin. I suspect, from what others have said, that alternate days with utrogestan is not a good way to go.  Hurdity uses patches and Utrogestan and may be along with advice.
Out of interest, did you get this HRT combo from a NHS GP or clinic?   Many women find their GPs and clinics won't offer this regime!
DG x

[Rose]

I was just wondering that if I switch to bio-identical HRT, will I have to come off the HRT that I am on, for a while so they can see what my hormonal levels are like to tailor make the best dosage for me? I got the impression that the doc needs to know what is the 'correct' dosage to suit you but if I'm on synthetic hormones, won't that mess up my hormone level readings? To be honest I'd hate to have to come off HRT as I suffered so badly before they put me on it.

[andius]

Rose,

If the HRT you are on is estradiol, they can test your level and it will be accurate.  If you are taking a progestin (synthetic), they cannot measure the progesterone....but they will be able to figure out what you need based on the estradiol level. Check out what is in the HRT that you take! 

Andius