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[Lochpark]

Hi everyone,

I am new here, just joined in desperation as the recent hot weather has triggered a series of hot flushes and sleepless nights which has left me feeling miserable. I am 48, started having irregular frequent & heavy periods about 18 months ago which have now tailored out to 4 in the past year with the record being nothing for 6 months. I have gained 3 stone in the past year despite walking the dog around 5kms per day and swimming once a week. My diet is not perfect by any means, however I am now a regular at wholefoods and as a Health professional I have read all the research I can put my hands on and tried every "natural" remedy out there to no avail.

I am astounded by the lack of knowledge from my medical and GP colleagues on this subject and the NHS reluctance to continue supporting research in this area, however I am lucky to have a menopause clinic where so far I have encountered only one Doctor whom I deem with any credibility sadly, my FSH was just under 30, oestrogen low, thyroid "normal" despite the weight gain. I was offered Femostan 1/10 however I have not taken it due to my concerns over breast cancer ( I work in oncology and on breast cancer trials - not one patient does not have a history of HRT / OCP use)  and my concerns over even more weight gain/ thrombus risk.

BP is normal, no history of breast cancer(  but mother died at 50 from stroke) , friends on mirena coil have had their symptoms disappear, however I am nulliparous and won't consider this, few on progesterone only pill also finding improvement in symptoms without the need for oestrogen input, however recent studies suggest best to take cyclical HRT within the first year to prevent osteoporosis/ heart disease etc.

To take or not to take.... All suggestions welcome please help! 

[Hurdity]

Hi Lochpark

 

I can appreciate your dilemma being a health professional and I am sure that will skew your thinking over HRT generally.

Have you read the latest thinking on this website re breast cancer, HRT and the relative risks in general?

I don't want to teach grandmother to suck eggs so I will assume you have found it or can find it, but if you need help looking for the relevant articles please let us know.

One I always direct members to is this page where the risks and benefits are weighed up depending on age:
http://www.menopausematters.co.uk/balance.php

Obviously lifestyle, and weight play a part in terms of risk.

I am surprised to hear that you have put on so much weight in a year, and would suggest perhaps that menopause has taken you by surprise and you may need to drastically cut down on your portions and perhpas reduce fat/sugar/alcohol. Apologies if you have already done this.

I became aware that I was putting on weight more easily as my metabolism slowed, during peri-menopause and I have permanently changed my diet and portion size compared to my younger days.

There are mixed views about weight gain, lifestyle and HRT which are discussed here:
http://www.menopausematters.co.uk/diet.php
http://www.menopausematters.co.uk/weightgain.php

The general view is that it is beneficial to take HRT at least until the natural average age of menopause of 51/52 to protect heart and bones as you recognise. Recent research also points to a 10 year window when starting HRT under 60 or within 10 years of menopause confers an advantage ( re heart I believe but can't remember off hand!).

Not sure why being nulliparous precludes Mirena coil? Anyway I would not use Mirena alone for menopausal symptpoms - it provides a localised synthetic progestogen only (minimal systemic absoprtion) to the uterus with the sole purpose of preventing endometrial thickening, and when becoming post-menopausal can cause over thinning and ulceration of the endometrium. It is ideal for use with oestrogen only HRT though and I know some members on here swear by it.

For myself - I have only used bio-identical HRT - oestrogen patches and micronised progesterone, as being the safest and most natural - I am 61.

Hope this helps and I am sure others will be along with their views!

Hurdity x

[Dancinggirl]

Hi and welcome Lochpark
I'm not surprised you are frightened after encountering all the breast cancer patients in oncology - this would frighten anyone. I know 3 ladies who recently went through the whole breast cancer treatment and none of them had used HRT, they were slim and fit. One of them has now been diagnosed with advanced stage osteoporosis at 55!!! Interestingly none of them had problems with the menopause - just sailed through with not so much as a flush.
There are so many factors that contribute to the cancer risk - stress being one of them and probably the worse one to control.  The stress of coping with menopause symptoms can be enormous and I think it can be easy to just say "Well you took HRT of course you got breast cancer". Statistics show it is a very, very small risk.  If you suffer badly with meno symptoms (between 50-70% of women do) there is a far bigger risk of getting depression, osteoporosis, heart disease and basically a poor quality of life as a result of not taking HRT. On this site, we are very fond of saying "Quality of Life is everything".
Do read up all the info under the headings to the left of this screen - you are sooo right about the medial profession knowing little about the menopause and the many problems that arise.
I think you do need to weigh the benefits versus the risks when considering HRT but if you are experiencing peri meno in your mid to late 40s this is considered early menopause and the long term risks of osteoporosis and heart disease due to oestrogen deficiency far out way any breast cancer risk at your age.  The breast cancer risk (which is very,very small) when taking combined HRT only kicks in at 60 and recent studies are even questioning this.
You need to be 2 years without a period to be considered post menopausal or over 53/4  -  before that you are peri menopausal and must use cyclical HRT. Femoston is tolerated well by many women so is a good one to try to start with.  Many of us have to try various HRTs till we find the right one.
Personally if I were you at your age it's a no brainer - take the HRT. You lead a busy life and you need to protect your heart and bones. When you get to your mid 50s then you could review.
If herbal remedies worked then they would be prescribed on the NHS!!!!! They will certainly not protect your bones!!!
Weight gain is an issue around the meno and frankly I eat about 30% less than I did 10 years ago but I've still put on weight.  I came off HRT 9 months ago (I'm 58 so needed a break to see where I am) and I've put on more weight despite being really careful and taking extra exercise.
I'm sure others will be along with their thoughts.  DG x

[Lochpark]

Well, thank you both for the quick and very helpful responses! As I sit here flushing every 30 mins ( is that excessive?) I am inclined to agree it is a no brainer... I have read all the research and info on this site and the risk/ benefit analysis doesn't really help as I am already at increased risk due to the obesity now? I agree that it has crept up on me and I didn't really appreciate just how bad the weight gain was until recently, so I am watching my diet  with my fitness pal app and fitbit tracker which so far is not making any difference! I don't smoke and I don't drink alcohol anymore as even one sip of wine causes the flushes to start and I am really ill the next day - I was never a big drinker anyway so I think I may have been over compensating with snacks etc. which hasn't helped, however I am terrified the HRT will make it even worse....

I mentioned the mirena as I have 3 friends who swear by it, it's not recommended by the manufacturer for nulliparous women and most Gynae's  I know won't insert one without a GA for this group, so I have already discounted it for me, I have also been  suffering from recurrent UTI's and thrush for the past year which I suspect is all linked to Peri so not  a good idea for me!

The Dr at the menopause clinic told me they did not believe in bio identical HRT, did not distinguish it from regular preparations & were not allowed to prescribe the licensed versions on their local formulary! So interesting to know this is being prescribed elsewhere in the UK... I think I'd have been happier waiting until my first mammogram before starting but that's not likely now due to the unbearable symptoms! Also, because there is a history of stroke in my family this concerned me as well in the risk/ benefit analysis , it's such a shame we are being left to work out what to do ourselves, one GP said to me tell me what to give you and I will - we have no training on menopause now and you obviously know more than me, another told me to just get on with it it was my age and yet another told me I was far too young for it to be the menopause! quite unbelievable...

[Hurdity]

How appalling! ie the "get on with it" and "you are too young"

I must clarify about what is meant by bio-identcial HRT. It is important to distiguish between "BHRT" ie Bio-identical Hormone Replacement Therapy as practised and prescribed in US and bio-identical hormones which are available both in US normally and UK.

Your doctor is right in that  bio-identical preparations are available on NHS (ie estradiol and progesterone) and are as listed in the green menu on the left under HRT preparations.  All the oestrogens except for the ones beginning "PRE.." contain estradiol - which is bio-identical oestrogen, and progesterone is available in micronised from as Utrogestan.  As for not being allowed to prescribe these licensed producst - that is rubbish! As I understand it is your right under NICE to be prescribed whatever licensed product you need for your condition.

Here is a post I made about this a few months ago:

http://www.menopausematters.co.uk/forum/index.php/topic,24333.msg371939.html#msg371939

I will copy the extract from that post:

The practice cannot refuse to prescribe you HRT (both systemic and local ie vaginal) at all if there is no medical reason that YOU cannot be prescribed it, as long as the HRT is an approved product, which all the ones on this website are.

I would definitely make another appointment and if they refuse then ask to be referred to a menopause clinic, because clearly they do not have your interest at heart and have probably only read selected papers - not an overview. The one I always refer to is the 2013 paper from Women's Health Concern and British Menopause Society which gives their recommendations -
http://min.sagepub.com/content/19/2/59

Here is a recent article by the Chairman of NICE ( National Institute of Health and Care Excellence) who says patients (sadly) need to be more pushy with their doctors (difficult when you are feeling hormonal)!
http://www.telegraph.co.uk/health/nhs/10595806/NHS-patients-should-be-pushy-with-GPs-about-treatment-and-drugs-says-health-chief.html

In it he says this:

Patients should adopt “American” attitudes and be more pushy with their doctors about drugs to which they are entitled, the head of the NHS rationing body has said.

Professor David Haslam, chairman of the National Institute of Health and Care Excellence (NICE), said British patients should become more assertive and see themselves as “equal partners” with their doctors, with legal rights.

He said patients in this country needed to learn from the Americans, who are far more confident about entering into dialogue with family doctors about their health, and taking an active role in managing their health.

Prof Haslam said too many patients were not being offered medications approved by NICE – and should learn more about their conditions and ask for drugs which should be prescribed for them.

In an interview with The Telegraph, he said: “When products have been approved for use by the NHS by Nice, patients have a legal right to those drugs - as long as they are clinically appropriate. The take-up should be much higher than it currently is." ......

The article is much longer ....

I would say that I was like you when I was first thinking about it ( age 52 -ish) and tried all sorts of what I thought were natural remedies until symptoms got the better of me, I read up on it and then went down what is the most natural route - that is replacing missing hormones that were identical to my own, in the most natural way ie transdermal so that they don't have to go through the liver (ie nil by mouth).

Great that you are beginning to really look at your diet and start on a slow weight loss programme, - at least you are keeping fit which is even more important as we approach meno.

If you are flushing every 30 mins  - yes that is excessive - but only if it is difficult for you!

Personally at your age I would not be worrying - especially once you've got your weight down a bit.

In the meantime I would definitely consider vagifem or other local oestrogen to help with bladder/urethral problems.

Keep posting!

Hurdity x

[Dancinggirl]

Bravo Hurdity    Fab post as usual.
Lochpart, Hurdity is a font of knowledge as she has a science background so gives really sensible advice.  I am appalled that the menopause clinic said they didn't believe in bio-idnetial HRT!!!!!! Don't they know that most of the oestrogen's in HRT are already bio-identical - as Hurdity explained.  The ignorance is staggering. I'd be tempted to stick with your GP who simply said they would prescribe whatever you asked for.
Do you think you would find dieting and exercise easier if you weren't flushing so much and felt more energised? HRT might actually help you loose weight or at least incentivise you to keep the healthy diet and exercise going?
You are too young to be suffering like this.
Keep us posted.  DG x