Menopause Discussion > Alternative Therapies

future problems from HRT that are not made clear to patients

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Eliza H:
I am one of three sisters, all now in our sixties. My two sisters went down the HRT route and are now struggling to stop using them. One recently did the cutting down/ weaning off route over a long period, but without success as symptoms came back so severely that she had to give up.
I managed with herbal remedies, taking soya products from my mid forties, and supplementing them with different extras like sage, red clover etc as I went along. As soon as one extra seemed to be losing its effect I swapped. All I get now is too warm at night/ poor sleeping, but at least I'm not now facing a struggle to wean myself off a drug that I no longer want to take. As far as I can see HRT is offered as a quick fix without all the future problems it brings being properly spelled out to people. Who wants to deal with all the menopause symptoms late in life?

Mary G:
Eliza H, I am going to take HRT for life, it is a decision I made a long time ago.  There is no longer a time limit for using HRT as there was years ago because it moved on and the newer bio identical brands like transdermal Oestrogel are much safer than the older versions used 20 odd years ago.  All HRT risk is in the progesterone component and again, things have moved on a many of us on here use localised vaginal micronised progesterone which has minimal risks and doesn't damage your breasts.  So there is no longer any need to look upon HRT as a short term solution with a view to weaning yourself off after a few years. 

The NICE guidelines changed a couple of years ago but the new information is taking a long time to filter through the system.  The good news is that the deeply flawed HRT studies carried years ago have been discredited and more or less consigned to the garbage bin of history.  The outdated oral HRT forms used in those studies were heavily laden with synthetic progesterone and women don't use that type of HRT now.

Shadyglade:
I think what Eliza is saying is that she is now mostly sympton free so would not need HRT. Where as her sisters have bad effects when they try to stop. Sounds like a dependance problem and I can see her point.  I also used alterative treatments and 5 years post meno am symptoms free (though sometimes hot at night). No matter how good HRT might be I would not like to be trapped into taking it for life. That, for me, would have been to high a price to pay.

Hurdity:
It is really time we permanently laid to rest some of the more common misconceptions about HRT.

Firstly you do not go through menopause twice (if you go through menopause during the normal age range) so taking HRT does not delay the menopause.

Menopause occurs when the ovaries pack up and is preceded by the peri-menopausal transition characterised by wildly fluctuating hormones levels, mood swings often with irregular and erratic periods over several years. Some women suffer debilitating hot flushes and sweats as well as other symptoms and HRT is prescribed to enable them to achieve a better quality of life and ease them through this time until hormones stabilise. In many women this is essential to function and not simply a quick fix in the same way that taking an aspirin for a headache might be if you don't know the underlying cause of the headache. There is no virtue in powering on through and suffering.

So even if you only take it for a few years and you stop when you estimate you will be post-menopause, your hormones will have stopped surging and your ovaries will have packed up so you do not have years of symptoms due to this.  Looking at the most obvious symptoms of flushes and sweats that drives most women to seek help - research is increasingly showing  that some women (those who have not taken HRT) continue to experience hot flushes for many years after menopause – which can be up to 14 years. You cannot predict in advance if you are going to fall into this category, and nor can you predict the course and severity of your menopausal  symptoms from that of your relatives eg sisters, although there is a correlation between age of menopause and age of your mother's menopause. 

Still keeping to the flush issue – those who  have gone through menopause and whose flushes have subsided – have been lucky – but you don't know in advance whether, if you start HRT you will be one who would have stopped. In terms of coming off HRT – some research suggests that tapering off HRT slowly might prevent the worst of the rebound effect – ie sudden recurrence of flushes – but not everyone will experience a resumption, and of those women some may experience them for perhaps 9 months or so and then they stop. This is much less time than the years of flushes they might have had, if they had not taken HRT.

Added to that you cannot take away the years of benefit you will have had while on HRT - the quality of life and your health, and the additional years of bone protection to give an obvious example, as well as protecting the cardiovascular system.  Post menopause and associated oestrogen deficiency is for ever – so it is not just about symptoms like flushes and sweats. The long term benefits of taking replacement oestrogen are becoming increasingly recognised as we live longer than ever before, perhaps up to 40 years post-menopause.

The current view is that up to the age of 60 the benefits of HRT exceed the risks, from 60-70 there are approximately the same and only beyond the age of 70 do possible risks potentially begin to outweigh the benefits. I say potentially because there has not been sufficient research into long term HRT use in over 70 and particularly of the bio-identical type ie estradiol and progesterone – which are the same as our own body's hormones.

Other factors put women more at risk from things like breast cancer or stroke than taking HRT – for example being overweight, smoking, drinking alcohol over recommended limits,  taking insufficient exercise, eating a poor diet – all put us at risk of various cancers. If you aim to keep yourself as healthy as you can post 50 especially, but continue to take HRT – you are minimising these other risks – and of course improving your overall health and quality of life.

Phyto-oestrogen supplements and in the diet may have a weak effect and help some women's symptoms  a little at some point during menopause (perhaps very early and post-menopause?) although evidence is not conclusive – but they are no substitute for replacing oestrogen.

Some women who have had breast cancer  are unfortunately unable to take HRT and there are other prescribed medications available to relieve symptoms.

“As far as I can see HRT is offered as a quick fix without all the future problems it brings being properly spelled out to people.”

Many of us would like to see the future problems and possible health consequences of NOT taking HRT– (cardiovascular problems, osteoporosis, vaginal atrophy and more) properly spelled out to women.

Those who continue to take it into their 60's (like me) know what they are doing and choose to continue to maintain oestrogen levels as long as they can, health permitting - and especially to try to stave off osteoporosis which besets many elderly women. Personally I may decide at some point to stop - but not yet  - and I certainly don't feel trapped! :)

Well I got that out of my system!!  ::)

Hurdity x

Shadyglade:
Wow. Okay.
Glad you are happy Hurdity.
Each to their own.  :)

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