Very interesting thread - and has been covered quite a lot recently.
There is a lot to reply to but I can't concentrate on all of it at once!
First of all those of you who are not yet 50 - well really don't worry at all!!! The most important thing is to make sure you take oestrogen until at least the average age of natural menopause - 51 in UK. By the time you reach 60, recommendations, practice and guidelines will have changed dramatically.
There was mention about out of date guidelines - many of you will have seen on this site that a group has been set up to revise the Nice guidelines on menopause - the Menopause Guidelines Development Group which Heather Currie informed us about. Menopause Matters is one of the stakeholders - consultees on the guidelines. They are due to be published I think in 2015 and when the draft guidelines have been prepared I am sure Dr Currie will post on this site for comments - so this will be your chance to have an input. The scope of the guidelines has already been prepeared so may not cover all the areas you are interested in.
Someone mentioned her doc reporting the addition of progesterone to HRT post-menopausally as outdated
"She said that the she believes that women do not need progesterone beyond menopause. She thinks the reason it is still prescribed to prevent the build up of the uterus is merely outdated advice. And this makes sense to me. I can well believe that it isn't good for us to keep on taking synthetic progesterone", The GP is surely mistaken? It is incontrovertibly the case that oestrogen works by stimulating the uterus lining with a blood supply which causes it to thicken. Reliable trials have confirmed this mechanistic explanation in practice. There is definitley an increased risk of endometrial hyperplasia from unopposed oestrogen, which can lead to cancer.
Re synthetic progestogens - I quite agree. These are definitely alien to our bodies and I would not want to take these for any length of time.
Re all the trials and long term effects of HRT. As already discussed there is a multiplicity of factors which can increase the risk of cancer as we age and it is difficult to establish causal relationships and correct for one effect in any trial data. However the trials on which the risk date are based were carried out using conjugated equine oestrogens ( the Premique/Premarin type) and synthetic progestogens - and were shown to be flawed. There are additional more recent studies - in Denmark for example - using bio-identical HRT which come to different conclusions. I am sure there will be more of these over the coming years.
Regarding out of date advice - unfortunately GPs are not up to date on all matters and anyone who encounters out-dated thinking would do well to ask to be referred to a menopause clinic - and to ask to see a gynae not a nurse. The view now is that women should be allowed to stay on HRT as long as they wish, provided the risks have been explained, and there is no other medical reason why not.
Here is the most up-to-date statement by the British Menopause Society and Women's Health Concern
http://min.sagepub.com/content/19/2/59This website too lists the risks as equal to the benefits between the ages of 60 and 70.
http://www.menopausematters.co.uk/balance.phpRegarding hormones and post-natal depression - it is illuminating to read the work of Prof Studd who attributes this to a decline in oestrogen levels
http://www.studd.co.uk/http://www.studd.co.uk/postnataldepression.phpRegarding John Lee's theories - we have to remember that the health care system in America is very different from ours and has led to a plethora of different therapies, and supplements, many of which are the subject of dubious claims and lack the scientific credibility of the products available in UK. The US themselves through the FDA also have trouble sometimes with regulating some of these products, which of course make a lot of money.
This website reviews some of the available information and studies on the use of progesterone at various points in a woman's life:
http://www.2womenshealth.com/Progesterone-Supplementation-Cream-Suppositories-Gel.htmAmongst the references quoted, here is a fairly recent assessment of the use of progesterone for post-menopause from a UK university:
J Obstet Gynaecol. 2007 Oct;27(7):655-9.
Transdermal natural progesterone cream for postmenopausal women: inconsistent data and complex pharmacokinetics.
Elshafie MA, Ewies AA.
Faculty of Health Wellbeing and Science University Campus of Suffolk, UK.
Transdermal progesterone cream (PC) is propagated as a possible alternative to hormone replacement therapy (HRT) in the management of menopausal symptoms and treatment of osteoporosis. Nonetheless, considerable concerns were raised regarding the inconsistent results and the credibility of some studies that were not peer-reviewed. Further, the complex nature and diversity of the pharmacokinetics of progesterone led to difficult interpretation of the findings. Given the current best available evidence, using PC for postmenopausal therapy regimens should be considered as an unsubstantiated treatment option, and its clinical applications must be restricted to well-designed interventional trials that assess its efficacy and safety.There is a lot more I could say but I think that's enough for now - got a bit carried away!
Hurdity x
