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[Hurdity]

I certainly feel much, much better post meno.  My last two years of peri were pretty bad but as I have never taken HRT I can't comment on how that makes anyone feel.

What I would say though is that there is an awful lot of women out there that don't take HRT and I have seen no evidence that they are disadvantaged by not taking it (post meno wise).

It would be interesting to read any evidence, both research and individual experience, if there is any.

Blossom60 - I am glad you are feeling well post menopause. However - you ask for evidence/research - the possible consequences of oestrogen deficiency are well documented as Stellajane has said.  You can start by looking at the information on this website eg
Osteoporosis http://www.menopausematters.co.uk/osteoporosis.php
http://www.menopausematters.co.uk/benefit.php
Vaginal and bladder problems
http://www.menopausematters.co.uk/vaginalsymptoms.php
Heart disease – possibility
http://www.menopausematters.co.uk/cvdhrt.php

In addition there was a paper produced for World Menopause Day in October and published in Climacteric. Unfortunately it doesn't seem to be freely available as full text any more – well I can't seem to get it - but the abstract is here:  http://www.ncbi.nlm.nih.gov/pubmed/24969415 There is a vast body of evidence about the role of oestrogen.

Here is the abstract in full:

Women may expect to spend more than a third of their lives after menopause. Beginning in the sixth decade, many chronic diseases will begin to emerge, which will affect both the quality and quantity of a woman's life. Thus, the onset of menopause heralds an opportunity for prevention strategies to improve the quality of life and enhance longevity. Obesity, metabolic syndrome and diabetes, cardiovascular disease, osteoporosis and osteoarthritis, cognitive decline, dementia and depression, and cancer are the major diseases of concern. Prevention strategies at menopause have to begin with screening and careful assessment for risk factors, which should also include molecular and genetic diagnostics, as these become available. Identification of certain risks will then allow directed therapy. Evidence-based prevention for the diseases noted above include lifestyle management, cessation of smoking, curtailing excessive alcohol consumption, a healthy diet and moderate exercise, as well as mentally stimulating activities. Although the most recent publications from the follow-up studies of the Women's Health Initiative do not recommend menopause hormonal therapy as a prevention strategy, these conclusions may not be fully valid for midlife women, on the basis of the existing data. For healthy women aged 50-59 years, estrogen therapy decreases coronary heart disease and all-cause mortality; this interpretation is entirely consistent with results from other randomized, controlled trials and observational studies. Thus. as part of a comprehensive strategy to prevent chronic disease after menopause, menopausal hormone therapy, particularly estrogen therapy may be considered as part of the armamentarium.

The issue about just taking HRT for symptom control is a whole different matter – many (lucky?) women just get a few flushes and sweats during the peri-menopausal years and then they disappear so they have “got over it”. However the long term health implications are completely separate – as Stellajane says – and especially now as life expectancy continues to increase and we are spending a large proportion of our life post-menopause and in an oestrogen deficient state - as the paper recognises.

As I've said before -  I am actually pleased that I had really bad flushes and sweats which meant that I found out about menopause and decided to take HRT – because from the evidence that I have seen so far – this is likely to be better for my health overall, despite the possible small increased cancer risk – which I try to mitigate through lifestyle factors.

Of course it is an individual choice - but needs to be made in full possession of the evidence we have for and against - benefits vs risks - which we each need to weigh up. Your third reason, blossom60, for women not taking HRT - they just don't need to - cannot be answered except in retrospect. Personally I don't want to do the experiment on myself - because once you have found out - say age 80 that you needed to - or it would have been better if you had - it's too late!

Hurdity x

[Hurdity]

Thanks! Well my mum didn't have a bad perimenopause like I'm having but she said she felt alot better post meno and my sisters neighbours have said the same thing. They're all very active and it exhausts me just watching them! However, I guess as you say that initial boost will decline so maybe the energy is short lived. My mum does also now have osteoarthritis (she's 73) - although still more active than me of late!

On the other side, my aunt said she felt better on HRT but was made to stop it (when they had that 5 year rule).

I wasn't sure if once you'd let your oestrogen levels naturally fall and the testosterone rise, by not having or stopping HRT, whether you could take it later on or if there was a cut off if you let it slip too long.

I'm not sure if your question has been answered ( haven't read all the replies in detail!).

But yes there is a cut-off point. There was a study carried out re heart disease and HRT showing that there is a window of opportunity at which taking HRT is beneficial and does not cause any increased risk to the cardiovascular system. This window of opportunity is either within 10 years of menopause or under 60 (to start HRT). From memory this has something to do with the blood vessels, cholesterol and plaque formation such that if HRT is started after plaques form ( which is some time after menopause) this can lead to problems eg stroke. Sorry this is off the top of my head and not necessarily precisely accurate although the gist is correct. I'll find some more info later as have to go now!

Hurdity x

[dangermouse]

Thank you so much everyone - all very helpful! Most people I speak to seem to still be under the illusion that HRT is dangerous, probably because that's the last thing the media left in our minds as not much seems to be written about it now, unless you come to forums like this to research it.

At the moment I'm having to put up with artificial hormones from the pill as not sure the HRT could control the surges which caused debilitating nausea, I do miss my own hormones though as even when I had the worst days over the last 6 months pre-pill, I felt more uplifted in the evenings when surges calmed down. Its also a tricky time for me as I only have until the end of the year to make my business work as this was meant to be my big break where I finally could go full time working for myself, writing a book and studying for my masters after waiting years for redundancy - for my hormones to then cruelly floor me! So need to feel driven, creative, uplifted... and not feeling any of that on the pill, just very exhausted and demotivated 

Have to keep reminding myself how I was last month though, where my only priority was getting enough sustanance to avoid having to crawl back to A&E for yet another 7 hour wait for a drip! Hopefully, once the background surges calm down I can move onto HRT and feel more myself or may even try that sooner than later as, even though my GP said HRT couldn't control the surges of perimenopause, it seems to be working for some of you.

Agree its nice to hear all the positive stories for those who have come out the other end, with or without hormonal help!

[CLKD]

GP's don't understand The Change !  have a browse, make notes 

[Hurdity]

Hi Hurdity

Oestrogen declines drastically until it sinks to an all time low from approx 2 years post-menopause

This interests me - where is the oestrogen coming from after menopause (last period) ?

Do the ovaries still produce oestrogen even though we are not ovulating or having periods ?

Presumably it is not enough to stimulate the lining ...

pollie

Post-menopause the predominant oestrogen is estrone rather than estradiol (which is produced by the ovaries). This is produced by fat cells amongst other places and as far as I understand some oestrogen is also produced in other peripheral tissues ie not the ovaries. Women with more fat have more estrone. There is also interconversion between estradiol and testosterone and vice versa, and between estradiol and estrone - but it all seems endocrinologically complex from what I've read  (or rather skimmed!). Some hormones are produced by the adrenal glands even after menopause. As for the stimulation of the endometrium - I am not clear about this. On the one hand I read that fatter women are more at risk of endometrial cancer (thought to be due to higher levels of oestrogen), but I also read that there is some mechanism whereby post-menopause the structure of the endometrium changes so that it is not responsive to oestrogen - otherwise we would all have thicker and thicker endometria over the post-menopausal years and be bleeding regularly.

There is a lot of information out there but quite bitty and I haven't tamed it all yet (in my head) so that I am clear about what it all means - or maybe the scientific establishment isn't completely clear either!

Hope that explains a wee bit!

Hurdity x

[CLKD]

OK as a meander: I still have my uterus.  Peri came and went, leaving me without periods, no flushes - I get itchiness in various places, hair and skin OK otherwise.  So oestrogen and testosterone levels have dropped.  I'm OK health wise and have good levels of energy.

So those hormones which triggered my ovaries to release an egg which then went via the fallopian tube/s into the uterus ……… no longer active enough to encourage a monthly bleed.  That bit I get.

However: if a lady has a hysterectomy but keeps ovaries presumably initially there's enough oestrogen to trigger the egg? therefore, where does it go ………. the uterus has gone ………  .  Eventually the lady's hormone levels drop ……

[Taz2]

The egg floats around for a bit and is then absorbed back into the body. It's all explained here http://www.netdoctor.co.uk/ask-the-expert/sexual-health/a11258/what-happens-after-a-hysterectomy/

After hysterectomy the ovaries normally fail within five years so even if you are post meno you can notice symptoms worsening as the ovaries no longer produce even the tiny amounts usual in post meno. Not many consultants explain this and just assume that if you are post meno you wont need HRT.

Taz x

[CLKD]

   wonder how much hormone is included in the egg ?    After all, the uterus is a receptical without input to anything other than holding the baby.

[Pollie]

Thanks Hurdity your comments are always so knowledgeable

But ....

but I also read that there is some mechanism whereby post-menopause the structure of the endometrium changes so that it is not responsive to oestrogen

I have heard this too .. But then why the heck do we need progesterone ??!!

And here's another bit of the puzzle I just can't get;

Some women who use Mirena for contraceptive purposes before menopause continue to experience periods. All perfectly normal. Some do some don't. No rhyme or reason apparently.
After menopause that same group of women can use oestrogen hrt with Mirena and expect not to bleed or have a build up of lining. 

How so ??!!!?

Anyone ?

Pollie

[Mary G]

pollie, yes it is strange.  I can only give you my personal experience but I had a Mirena coil from 1998 (for contraception purposes) and before the menopause, I always had periods.  However, my periods stopped while I was part way through my second Mirena coil and I wondered why.  I thought perhaps the new coil had a slightly different formula but it transpired that I was post menopause.  I remember the doctor saying that as I had always had periods before with the Mirena, there was no reason for them to suddenly stop other than the menopause and that is why I had the tests. 

I then started using a 50mcg oestrogen patch with the Mirena coil still in place but I never had a period.  I didn't find the 50mcg patch very effective and it clearly was not delivering enough oestrogen for my needs but I imagine that had I been using the oestrogen gel like I am now, I would probably have built up enough lining to have periods.

I don't know if that explains it.

[skkb]

I have also wondered about the mirena coil, my daughter has it fitted, several years now, for contraception. She always had long heavy periods.....now, with the coil.....nothing, no bleed!! I've often talked with her about this and said " well if you can can have extra estrogen and no bleed why can't I ?" Why isn't the lining of her womb building up or does her body's natural progesterone deal with this. Sorry if I'm being dense but I don't understand that!!

[Taz2]

The mirena coil only contains progesterone skkb - was that your question? It works in two ways. It thickens the cervical mucus so that sperm have problems moving through it to reach the egg and it also thins the lining of the womb so that any egg which does manage to get fertilised is not able to take hold. In some women it also stops the egg being released. There isn't any oestrogen involved.

You can read how it works here http://www.nhs.uk/conditions/contraception-guide/pages/ius-intrauterine-system.aspx

Taz x

[CLKD]

 

[dangermouse]

Isn't it that when you withdraw the progesterone you have the bleed? So with the Mirena or taking the pill back to back you are still having progesterone to protect the womb, but without gaps for the lining to temporarily fall away.

As long as you are having the progesterone then you can have the oestrogen. The bleed is surely just a side effect of having a gap?

[Hurdity]

...

but I also read that there is some mechanism whereby post-menopause the structure of the endometrium changes so that it is not responsive to oestrogen

I have heard this too .. But then why the heck do we need progesterone ??!!

Anyone ?

Pollie

Sorry I can't reference the article (we are supposed to on here!) - it was one of those bits of information from my meanderings through the web - looking into stuff about the endometrium. However it was referring to the post-menopausal endometrium in its natural state, in the absence of HRT - the endometrium becomes atrophic and thin usually - so perhaps the oestrogen receptors eventually go dormant or something. There will be exceptions I presume which is why some women get endometrial cancer. Also the predominant oestrogen post-menopause is estrone so the endocrine balance/dynamics of all this presumably has something to do with it? Sorry that sounds vague and thinking aloud, but you can't find all the info easily in one place! The article didn't seem to explain the mechanism and it may well not be known exactly. We need progesterone when we add oestrogen as part of HRT because it continues to stimulate the oestrogen receptors and causes the lining to thicken - this is a different "unnatural" scenario ie reversing our oestrogen deficient state!

Hurdity x