Lots of interesting points here many of which we have discussed before.
Cubagirl - the main point is - what do you want to do? I see you are on a quarter strength from what I see ie cutting 25 mcg patches in half - which is very little indeed. You also say that you agree with your husband that quality of life is important.
The big question is - are you happy to continue as you are - ie is your quality of life good enough or are you making do? Can you manage your job/work as you are now? This is not just a question of coping with flushes but are you able to do the things you want to do? It does sound that you are one of the few women (I suspect there are several of us on here) for whom flushes mught well continue indefinitely, if they have returned when you have reduced the dose, and tried to come off it before.
If you can cope and are happy then of course you should carry on as you are. If you are finding your quality of life and ability to cope has decreased noticeably over the past year then yes I agree why not go back to your previous dose of 25 mcg. You don't have the progestogen component to worry about which is what many of us are concerned about - the results from the only large study carried out ie the WHI study show the addition of progestogen increases the risk of breast cancer slightly.
Even so the absolute risk of cancer is very small - and according to this website other health factors are equally important ie body weight (if you are overweight) alcohol consumption, smoking, diet and exercise. You can reduce the breast cancer risk of HRT by making sure you do everything possible in the other categories to reduce cancer risk. The information on this website gives benefit = risk for age 60 to 70
http://www.menopausematters.co.uk/balance.php This is what I go on at age 61.
I agree with peegeetip - it is and should be your decision made in full appreciation of the facts/evidence as we know them, and the risk. I didn't have to sign anything at my practice but GP practices will differ as will consultants judging by your experience at the meno clinic Taz?
Regarding the article that peegeetip linked to - I prefer to go directly to the article which led to the change in view. The article in Medical News Today is contradictory which you spotted Taz. The recommendations from the British Menopause Society (which the MNT article links to) says that arbitrary limits shold be placed on HRT. The 5 year limit is out of date but is what many doctors are still using. Here is the BMS article:
http://min.sagepub.com/content/19/2/59Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks. Re stroke risk - the latest paper produced for World Menopause Day by the International Menopause Society states this:
As with men, hypertension in women is the single, most important, treatable risk factor for stroke.
and this:
.
..in women on average 64 years of age, MHT non-significantly increases ischemic stroke and reduces hemorrhagic stroke (18% for CEE + MPA and 36% for CEE) in relation to placebo. All of these foregoing events are rare, 5-11 events per 10000 women per year of MHT. Importantly, the risk of stroke is statistically non-significant and rare in women who initiate MHT when < 60 years of age. This is from result of the WHI study which was with equine oestrogens (CEE) and synthetic progestogen (MPA). MHT = Menopausal hormone therapy.
At the end of the paragraphs on stroke it said this:
In conclusion, the risk of stroke from MHT is rare and of the same magnitude as seen with other medications such as statins and aspirin used in the prevention of CHD in women. When initiated in women < 60 years old and/or < 10 years since menopause, the benefits of MHT outweigh the risks, as MHT statistically significantly reduces CHD and all-cause mortality, two important outcomes not demonstrably proven to be reduced with statin and aspirin therapy, but each of which carry similar risks as MHT 62,63, when used for the primary prevention of CHD in women.http://www.imsociety.org/downloads/world_menopause_day_2014/white_paper/wmd_white_paper_english.pdfNo-one should have to go privately to be able to continue with HRT but I can underastand why some women have gone down this route. However not everyone can afford it.
Retirement age is a crucial issue and it's time GPs woke up to this as Stellajane mentioned. Taz your GP's comment made me cross however lovely she is!!! I mean really! Any GP that suggests this (even if you did give up work) is condemning many women to a life of an invalid - well almost so if symptoms continue to degrade quality of life. Why should we spend maybe 30 years miserable or unable to make the most of life? Just "there there" and put your feet up and flush away quietly for the next 30 years!!
If I am unlucky enough to get breast cancer in the next few years that would be horrible, but I wouldn't know if it was as a result of HRT or not. I will know that I had done all I could to lower the risk of getting cancer through lifestyle means, and nothing could take away from me the 8 years of good quality work and life I've had since starting HRT.
Got carried away again here - hope someone manages to read it and find it helpful.... sure I've missed some typos!
Hurdity
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