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[anais]

I'm hoping that someone who has been prescribed HRT specifically because of osteoporosis or osteopenia can advise me about how the effects of HRT on their bone density is monitored.

I have recently started on 2x Estrogel and 100mg Utrogestan daily after the consultant made a very strong case that systemic HRT was my best treatment for me at age 53, last period at 50. My DEXA scan T-scores were 2.3 and 2.4 in 2013. My last DEXA scan was in February but I don't know my T-scores yet but I'm expecting a diagnosis of osteoporosis.

My GP practice has been rubbish with my postmenopausal symptoms anyway. After my first DEXA scan I was led to believe that once my T scores reached 2.5 I'd be on biphosphonates but my consultant says its not the treatment of choice at my age, that HRT is the best option for me now so I have taken his advice and I will get my DEXA scan results at my next hospital appointment.

What I want to know is how is the osteoporosis monitored now I'm on HRT. I presume it is another DEXA scan in 2 years as recommended at the time of my first scan. The other thing I want to know is whether oestrogen levels in the blood are monitored, otherwise how do you know if you are on the right dose? My other menopausal symptoms of hot flushes etc have settled but my VA problems are pretty bad and despite Vagifem in the usual prescribed dosage for the past 6 weeks, including the loading phase. The addition of full HRT for the past 2 weeks hasn't shown much more than a very slight improvement.

The HRT is primarily to protect my bones, and the consultant seemed to say that it takes a long time for the bone density to build up again, so I'm assuming that means it all has to be monitored. I know all about what *should* be done to protect the bones. I was always aware of osteoporosis in the media etc, so I was always mindful of prevention but I had other risk factors and genetics were not in my favour. So here I am today on HRT for osteoporosis and just wondering how it's going to be monitored on this treatment regime.

My GP surgery has been pretty much useless and consultant's appointments tend to be over once a particular treatment strategy is up and running so it's a case of me having to tell the GP what to do. All advice welcome. Thanks.

[Dancinggirl]

Hi anais and welcome to MM.  So pleased to hear you are getting appropriate treatment for your bones.  The systemic HRt will also help all the other meno symptoms and over time the VA will doubtless improve as well.
I do think that along with the HRt you should endeavour to help your bones with diet, exercise and supplements - make sure you get enough calcium every day and take Vitamin D3 and Magnesium as well.  Doing some exercise, like brisk walking, is also essential and helps restore and maintain bone density.
There is so much you can do and monitoring is possibly be up to you - I'd ask for a scan this time next year to see if things have improved - I think we need to be very proactive when it comes to maintaining or improving our health. DG x

[Hurdity]

Hi anais

Just to add that as Stellajane says the minimum licensed dose for protection against osteoporosis is two pumps. The oestrogen dosage of HRT - whether by tablet, patch or gel - has been established through research and trials and will have looked at the effect of different doses on bone density and a whole host of measurements etc so it isn't necessary to monitor oestrogen levels in individuals. However there is quite a bit of variation in how well we absorb oestrogen from the different sources, but this will have been taken into account when setting the minimum dose. I would agree that it could be advisable perhaps to take slightly more than strictly necessary in the first instance - but I have no experience of this.

Hurdity x

[anais]

Thanks for your info. I've only just started Estrogel and Utrogestan so I expect I'd only be prescribed the minimum dose to start with anyway. We can't see or feel osteoporosis in the same way as we notice other menopausal symptoms. It's one of these problems we need tests and monitoring to know what's going on, and with the NHS being as it is, we have to be proactive in getting what we want. If we know what we need in the first place 

I will write down a list of questions to ask the consultant at my next appointment. I feel confident that I'm in the right place now as far as my treatment for these postmenopausal difficulties but the clinic has such a high demand and I expect they will pass me back to my laissez-faire GPs group practice. Apparently one of the practice nurses deals HRT but she never even mentioned it when VA made having a smear test impossible for me. You'd think she'd have said something but no, not a word about HRT.

I sometimes feel that women on HRT are in a sort of secret club, because it's impossible to get proper help!

[Mary G]

anais, I'm pleased you are finally getting the right treatment and HRT is definitely the best way to prevent and treat osteoporosis.

You are right, it is very difficult to get the right help and most GPs are pretty useless when it comes to the menopause and HRT and that is why I keep saying that Family Planning Clinics and Menopause Clinics need to merge to give women a joined up service.  There is a distinct overlap between the two and women could be monitored by a properly trained gynaecologist who can then smooth the transition between birth control and HRT. 

The gynaecologist at my old FPC used to fit coils and under a revised system she could also carry out uterline ultrasound scans and monitor women as they get near to menopause and get them started on HRT without them having to go to GP surgeries.  It would save a fortune in the long run and it would transform women's lives. 

Something has to change. 

[limpy]

It would be good if something did change, I was diagnosed with osteoporosis last year. The next time my bone density will be checked is in three years, I can't get it done sooner, not even privately. So, how do I know if any treatment is actually working?

[Pollie]

Quick response as I have no time - I googled this once - there is a uk recommended blood level of oestrogen for prevention of bone loss. I seem to recall it was 150 something or other .. 150 pmol ? I will try and find it again for you tomorrow.
Pollie

[limpy]

Gosh Pollie 150 seems high. But it does make sense, I've been on Evorel Conti for the last four years and the COCP pretty much constantly (less six months) prior to that. Still ended up with OP though. It would be good to be able to get bone density checked regularly   

[Pollie]

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312923/

Levels below 150 pmol/l were considered to be insufficient to protect bone.

CONCLUSIONS: More than half the women were inadequately replaced to protect against osteoporosis. Furthermore, the MSS was of no value in screening for those with low serum E2 levels. Serum E2 levels should be monitored in women on HRT for osteoporosis prevention and the E2 dosage adjusted accordingly.

Pollie

[limpy]

Thanks Pollie.

Will make an appt to speak to a GP with a brain.

[Hurdity]

Thanks for that link Pollie. It is an old paper and was obviously using information from another study to determine what level of serum estradiol was considered sufficient to protect bone, and the study showed that a proportion of women had levels below this amount. Unfortunately it didn't say what HRT doses the women were taking. I will have a trawl around and see what I can find on this but as I said before I imagine the dose of oestrogen licensed for HRT should be set at the range of values that have been shown to protect the majority of women against osteoporosis.

A reading of 150 pmol/l is most definitely not a high reading! I would say it is quite low and I would expect many women to acheive higher than this on 50 mcg patch I would have thought?

Hurdity x