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[HorsesHorses]

Hello everyone
I've finally seen a Gynae after 2 years of symptoms and various gp visits and tests and she has says there's no doubt I'm in early menopause. (I'm 38 and 4 blood tests have come back high (90) fsh and very low oestrogen.) So she has prescribed me Eleste duet Conti and wants to see me again in 3 months.
I understand why I should go on HRT but I'm really nervous about it. Since this whole thing started I've become extra worried about my health (one of the many typical meno symptoms I've learnt) and I'm not sure I'll be able to take HRT without freaking out about every little thing. I just know I'm going to convince myself I've got a dvt at some point. I've already done that without being on HRT.
Currently my flushes have calmed down and I did mention that they come and go, sometimes staying for weeks then easing off again) but she still seemed happy for me to take the HRT. I asked for the lowest dose and she said the non period one would be better for me as I used to suffer from heavy bleeding before they started going funny. The longest I've gone without a period to date is 7 months. Oh and she said there's no reason I couldn't stay on it till I was in my 50s (I was surprised by this as my sister had breast cancer when she was 29.)
Anyway, to get to the point, I can't make up my mind about taking it. I want to I guess but I'm really anxious about it.  My family say I should but I'd really appreciate your opinions if you wouldn't mind please.
Thank you 
HH

[Dancinggirl]

Why and conti HRT?  I would always start with a sequi HRT to see if the progesterone in a particular HRT type suits you. Having said this, I can see the reasoning behind trying the conti.  You may do really well in this HRT but if it doesn't suit you then do try Femoston.  At your age HRT is advisable - if it was only your sister who got breast cancer - not your mother - then there may be no reason for you to worry and I'm sure you monitor your breasts anyway - early detection is the key.  The risks of BC don't really kick in till 60 when using HRT and in fact your will be more at risk of oestrogen deficiency, without HRT, and this has long term consequences for the bones, heart, bladder function, VA etc. 
Don't be nervous - I think HRt is the right way to go for you.  Dg x

[Hurdity]

Hi HorsesHorses - I can appreciate your dilemma re your sister - but do you know the type of cancer your sister had? As Dancinggirl says, HRT is not necessarily precluded, and it is important to take oestrogen if you are deficient and you are having a premature menopause under the age of 40. There are far more health risks of early menopause and consequent oestrogen deficiency. Re the bleeding, you might be better off having a Mirena coil fitted - which would lessen or even stop any bleeding if you haven't yet reached menopause, and then you could add oestrogen in the form of patch or gel. It could be that your flushes have calmed down due to fluctuations in your cycle and perhaps a period might be on the way - definitely a sign of increased oestrogen anyway.

Hurdity x

[HorsesHorses]

Hello Hurdity and Dancing Girl
I was offered the coil but I didn't like the idea of that and I've heard yucky things about that from some women. What other long term effects of low oestrogen are there Hurdity? I know the heart should have oestrogen and the bones too but I do walk a lot daily (I'm a dog walker) and so am keeping fit and trying to fend off osteoporosis in a natural way. Could certain vitamins help me, you know to up my calcium?
I'm not trying to be irritating to others by not taking HRT which i know I'm lucky to have been offered seeing as how so many others really struggle but if I'm honest, I wasn't trying to get it. I really wanted a gynae to listen to me and explain it all and mine didn't even want to hear my symptoms or erratic period patterns. She also didn't answer my question that isn't it risky to be taking HRT if my oestrogen is still fluctuating? Won't it mean that some months I'll end up with too much in my system and that's when I'll end up being at risk?
HH

[Cider]

hi Horses,

I am a bit older than you (45) and also trying to avoid HRT, I have similar concerns to you about taking it and am trying to get through this thing using a natural approach, diet and exercise. My doctor "recommended" a supplement called Menopace, I'm not keen on taking supplements so I bought a packet, read the ingredients and basically sought to ensure I was getting those nutrients through my diet. Many of them I already was as I appear to have a serious Avocado addiction and they contain almost every vitamin known to man as well as healthy fats. I have a fairly healthy diet and exercise routine anyway but this had slipped over about 18 months due to the menopause symptoms I was unknowingly having. Getting back on that wagon has been hard because my motivation is severly lacking these days, but I am doing it and getting good results when I stick with it.

Including strength training into your exercise regime is important to help counteract osteoporosis and also to maintain a healthy weight. Buiding muscle supports your bones and also increases your metabolism because your body works harder when you have lean muscle. I really find exercise helps so much with the mood swings and feelings of depression and anxiety, I don't get hot flushes but it is supposed to be good for that too.

It's worth chatting to your doctor about alternatives I would say, mine is very supportive of my decision not to take HRT at this time. If you are not happy with your doctor, which it sounds like you are not, try a different one who might be more willing to listen to your concerns and take the time to explain things to you.

Good luck

[Lizab]

By non-period did she mean continuous or birth control pill? It's generally advised to start with sequential, you would have a period, if you are still having periods occasionally. Some women with early menopause use birth control pill, then you wouldn't have to worry with contraceptive. With premature menopause, I understand that we can have a spontaneous ovulation pop up even after the standard "one year without a period". The birth control would override your natural hormones and you wouldn't have those fluctuations. With continuous hrt, I think the fluctuating hormones is what leads lots of women to have unpredictable bleeding in the first year. With sequential, you'll still have a period, but ideally you can line it up with your own cycle to where you're topping off your existing hormones. Unless you are consistently getting too much estrogen, month after month, the progesterone element of your hrt should protect you from the risks to your uterus, in spite of a blip of high estrogen now and then. I think if it became a consistent problem, you would feel side effects of too much estrogen, so I wouldn't worry about that.

[Lizab]

Forgot to mention, I am 39 and have recently started hrt for symptom control as well as the health benefits. However, my mother was in her early 40s, didn't have hrt, is now nearly 70 with no heart or bone issues. The studies and data and such are nice, but do what feels right for you. Who's to say what's best for one is best for another?

[Dancinggirl]

HorsesHorses - If your oestrogen level has seriously dropped (which I think your blood tests are showing) then using HRt is the best option.  I had a premature menopause which started in my mid 30s and I had HRT from the age of 37 even though I was still getting the odd period. As Hurdity suggested, a Mirena coil would be a good option for you as it would control bleeding and protect your womb.  I have always used Oestrogel for the oestrogen and it allows flexibility - so you could start on just one pump per day as you are still producing some oestrogen at times and then only increase if needed.
Whilst diet and exercise can help to keep bone density, I'm afraid oestrogen is still vital and even if you use HRT till you are 50 then this would help protect your bones for the longer term.
The other preventative aspects of HRT relate to the bladder and the whole vaginal area.  Despite using systemic HRT I have still experienced quite nasty vaginal atrophy and bladder problems - these things are as a result of oestrogen deficiency - I used a very low dose of oestrogen in my 40s, when I had gone into post meno, which clearly was not enough. These rather unpleasant side effects from oestrogen deficiency are not widely known about and in fact many GPs are really not clued up about the distress caused by these complaints. I don't want to frighten you but knowing what I know now I wish I had been given extra local oestrogen alongside the systemic HRT back in my 40s so I wouldn't be struggling with this now I am 60. I am still using systemic and local HRT to keep these VA and bladder issues user control and also to enable me to keep working. I am vegetarian, eat a good diet, walk a great deal (even my job involves a lot of walking a climbing stairs), however my bones were borderline even in my 30s so I really worry about osteoporosis - it is such a debilitating problem. 
The guidelines are quite specific - if a women experiences premature ovarian failure (before 40)  then HRT should be the first line of treatment. Unless there is a very strong history of women in the family having an oestrogen responsive breast cancer, then I believe HRT is still recommended until 50. 
My mother had a premature meno the same as me and didn't have HRT - though she has remained fit and active, she has shrunk by at least 4”, has high blood pressure and has had vulva cancer - not sure whether vulva cancer is as a result of vaginal atrophy but I'm sure the lack of oestrogen didn't help.  She is very slim and walks a lot but I hope to be in a better place than her if i get to her age.
Do weigh up the pros and cons - I think we will see a day when all women will be advised to use HRT (even for a few years) as a preventative to maintain better health in old age. Having said all this - using HRT is still a personal choice.  DG x

[Mary G]

I realise HRT is a personal choice but I think NOT taking HRT is a big risk.  Ignore all the scare stories, they are all on the back of a couple of deeply flawed and outdated studies using outdated HRT products.

Oestrogen acts like a control centre for so many vital bodily functions and without it, lots of things start to go wrong over a number of years.  HRT is not just for immediate symptom relief, it protects you against the endless list of nasties that arise from years of oestrogen deprivation. 

I am sorry to be blunt but you cannot compensate for all the effects of oestrogen deprivation by diet and exercise alone.  You might be lucky and avoid one or two things on the long list by diet and exercise but what will you do about the rest of the symptoms?  Things like VA and bladder problems become irreversible if not treated within a certain time span and then there are things like declining cognitive skills and short term memory loss all of which are caused by oestrogen deprivation.

Ask yourself this, would you refuse birth control or blood pressure medication?  As far as I am concerned, if I wasn't using HRT I would have to be using some form of birth control which is not that different really although I have been much happier with HRT now I have finally got it right.   

I think within the next 5 to 10 years all women will be urged to take HRT unless they have a very serious underlying health problem.

Please give it some very serious thought and don't leave it too long.

[CLKD]

Presumably because 'we' aren't having symptoms therefore the body isn't as depleted as it might be? = no real danger to bones etc., or maybe because 'we' are more active etc., our bones aren't at risk?

[Dancinggirl]

I thought we were discussing the use of HRT when premature ovarian failure is depriving the body of vital oestrogen? So, if a women is oestrogen deficient in her 30s and 40s, the benefits of HRT far outweigh any very small risks - the development of health problems from this early deprivation of oestrogen may not be felt until ones 70s.  Once we get to the average age of menopause e.g. 52-54, then HRT may well not be necessary and with appropriate diet and good exercise things like osteoporosis may well not develop till we are in our 80s.  I must however highlight the plight of a friend of mine who is only 57 - she has always had a good diet, is slim and very active but a couple of years ago she slipped down and broke her sacrum. She then had a scan and it was found she had advanced stage osteoporosis.  She had sailed through her menopause at around 54 with barely a flush so hadn't considered HRT - sadly she also developed aggressive breast cancer at the same time, so HRT hasn't been an option for her!!!!!  It baffles me as to why we get breast screening when a bone scan could highlight bone problems early on and appropriate treatment put in place - not necessarily HRT.  DG x

[Cassie]

I can highly recommend the gel, its so necessary at your age, I also went onto it around then and am still going strong many yrs later, the Utrogestan 100mg used for 12 days per mth is your answer, I would choose that over the coil, but of course your decision, its a life changer, your body should not have to go without for so long. The gel is transdermal so much friendlier and a safer option.