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[babyjane]

I love reading all the threads but I don't comment on the HRT ones as I am not knowledgeable about it.  However there is a point that interests me although it is now far too late for me to do anything but ask curiously.

I have read quite a few times about the advisability of using HRt if you go into menopause before the average age of 52 ish to protect your heart and bones and this makes sense to me.

However if you have a hysterectomy with retained ovaries (as I did) well before your 50s and have no menopause symptoms that you are aware of (having no bleeding makes the whole thing difficult to read) then you are not going to be thinking about meno and HRT as I didn't.  I didn't have a clue when I started perimenopause after my hyster, I didn't even know such a thing existed.  My first clue was my first hot flush 7 years ago aged 52.

From things I have read I could have been peri before this but didn't know it so, of course, didn't seek any treatment as had no symptoms that I was aware of.

I can't be the only lady who had a hyster before their 50s and didn't take any HRT due to not having symptoms.  I just assumed my ovaries were still ticking away until my first night sweat/hot flush but they probably weren't fully functioning. After all you don't become menopausal overnight do you? 

Are ladies missing out on the protective aspect due to not knowing how menopausal they are if they keep their ovaries?

[CLKD]

Interesting point.

I think if a person feels generally well, they don't look for treatment therefore the body probably still continues to give enough protection until the first menopause symptom appears?  Then the patient starts to wonder.

Should your Consultant have discussed your future needs, then yes! Forewarned is forearmed.  Apparently it isn't common for patients in many Specialities to offer post-op. treatments, i.e. physiotherapy, unless the condition is likely to be live threatening.

[Hurdity]

Hi babyjane

Yes you are right that you don't have the trickle of periods to let you know what your cycle is doing - but at least you did have  the odd hot flush to tell you! If you retain your ovaries after a hysterectomy, then you will continue to ovulate so there is no need to take extra oestrogen - although apparently hysterectomy can trigger an earlier menopause - not sure how they know that though  (because how would one know when it was going to occur if you had kept your womb?).

Many women only start to get hot flushes when their oestrogen levels begin to drop so somewhere in peri-menopause which then come and go and maybe increase in frequency and intensity. Some women only start to experience symptoms  approx 2 years post-meno when oestrogen levels bottom out ( although some activity carries on at a low level apparently for a few years). Some unfortunate women get hot flushes even before mssing a period.

Let's say you are average - starting to get hot flushes when your ovaries start  to pack up and oestrogen falls quite a lot - in which case your menopause may not be until after the age of 52 because it often takes a couple of years or so from first hot flush to becoming menopausal. At worst you became post-menopausal at 50 but I would say in your case you most likely had oestrogen up until the natural average age of menopause.

The women I feel for are those you mention - who have early hysterectomy as you did and then never have symptoms - and then maybe suffer oestrogen deficiency without being aware. These women may well be missing out. As you say it is the periods which causes women to think about it - as well of course as the flushes.

Mind you I was no different in that I didn't think anything about it until I had flushes and sweats - and I thought my periods would just stop as would the flushes and hey presto I would be back to normal again - but with no bleeding!!! How little I knew....

By the way it really isn't too late if you are within 10 years of menopause and under 60 - there are several women on here who have started HRT late and women without a womb have more chances of success as it is the progesterone and the unwelcome bleeding that is the biggest stumbling block for most of us.

The main point about all this is to prevent long term problems caused by oestrogen deficiency and some of this is heritable - eg tendency to osteoporosis. If you are worried for example you could ask for a DEXA scan to check bone density (on the premise that you don't know when you went through menopause so your bones could be at risk - so they should offer you one and not wait until you break a bone!). Similarly heart problems - there are various tests I think that can be done and also cholesterol tests - simple blood tests. It is worth asking and exploring some of these issues with your GP. However it may well be that they refuse to do any investigations if there aren't any obvious symptoms - due to cost.

Does this make sense?

Hurdity x

[CLKD]

I had various types of scans every 2 years arranged via work …….. never a pelvic one though.

[Lizab]

I have issues with that advice too. If the average is 52, then obviously some will be younger and some will be older. I am taking hrt as I am 39 and prematurely going into menopause, but I don't absolutely intend to take hrt to 52 years. I may, I may not. I do intend to stay on it for a few years, to when I wouldn't have been considered "premature". The flip side to that protective effect is the risks, which are real, perhaps overblown at times, but real. I think if you didn't have symptoms, count yourself lucky that you were able to cruise through naturally without adding hormones!

[babyjane]

Yes it makes sense, of course it does  .

I am fortunate in that my endocrinologist asks for three yearly DEXA scans.  I have had three so far (last one last November) and all is well.  So too three yearly well woman clinic checks and my cholesterol levels are so low they don't feature on the scale so ok on both those counts.  Blood pressure also stable and good at 124/78.  I am not worried and have no desire to take HRT (apart from Vagifem which I have been using for 5 years now) and count myself fortunate that my experience has not been as devastating as some of the ladies represented here.

I think if you don't have the bleeding things are a lot easier to deal with. 

[star-mam]

I can understand where you are coming from Babyjane, I wonder about my bones  and heart as I didn't realise I was menopausal until recent blood tests which showed I'm actually post- menopause. I was in my late 30's when I started having some symptoms so I put them down to other things, until I went 7 months with no sign of a period.
I'm now on HRT to 'protect' my bones and heart but I do worry there may have been damage already done, if there are any problems will HRT improve them again or is that it? (I need to write a list of things to ask my dr when I go for my review!)

[dazned]

Another thing I thought about is....say for instance if 75% of women suffer nothing through peri/post meno and dont use hrt how come they dont all have heart problems and osteoporosis ? Is it just luck of the draw ? 

[babyjane]

star-mam it is my understanding, from my husband's case, that once osteoporosis is there then medication can only protect it from worsening.  Sometimes there can be an improvement in bone density, as he had in the beginning, but the damage cannot be totally reversed.

dazned I truly believe each individual is just that - individual. I have not used HRT and had a hysterectomy at 38.  My bone density is fine and as far as my check ups go my heart (cholesterol pulse and BP) are good.  My father had his first heart attack at 58 and his final one at 68 so I told my doctor I was concerned as I take after him in some ways.  However I have no heart issues or symptoms.

My mother also had a hysterectomy at 38 and had no HRT in those days and a DEXA scan at 80 showed no osteoporosis and she never had as much as a heart flutter as far as I know 

Another woman's experience will be different from our own and it is a mistake to try comparing ourselves to someone else or thinking we should be doing what they are doing 

[dazned]

I think thats what I meant in as far as if you don't use hrt you are at risk of x,y,and z ! I.e. as I have now stopped hrt I'm endangering myself 

[Hurdity]

As far as I understand it oestrogen replacement (as HRT) can be used as a treatment for osteoporosis to help re-build bone, and improve bone density even at small doses.

With all things it's a question of risk and individuals need to weigh up this for themselves. Of course not every woman will get osteoporosis in old age without HRT - but as discussed there are certain risk factors which can make this more likely. Genetics and lifestyle (including diet) are obviously critical as well as age of menopause etc!

Studies are all based on populations (of women) and provide information about the risk in general of something occurring or not (x,y, or z!).

Star-mam the whole point of taking HRT as a result of early menopause is it prevent damage (and reduce the likelihood of it) occurring due to prolonged oestrogen deficiency in post-menopause.

Hurdity x