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[MicheleMaBelle]

Met with her yesterday- she's a professor, very nice indeed and considered to be a leader in her field.
Some of her thoughts:

HRT can be hugely beneficial if it works and you feel better on it. If you don't feel better after a while or trying different regimes, come off it. You shouldn't feel worse on it. At the end of the day, it just doesn't suit everyone.

It's easy to blame the menopause on every little niggle and ache and pain and all the strange things happening to our bodies to the point of becoming obsessive about it. Part of it will be down to ageing and sometimes we just need to adopt and more positive attitude and get on with it.

Utrogestan for HRT is designed to be taken orally and she never recommends vaginal application. It's nonsense to think that it causes fewer side effects by taking it vaginally ( although one of her colleagues recommended vaginal application to me )

There have been some promising trials carried out in France that using Utrogestan as a progesterone doesn't increase the risk of breast cancer compared to other progesterones but the data is currently limited and she's on the fence about it at present.

She was extremely nice but as you may tell, she was certainly no nonsense and didn't mince her words. I liked her., she did say things I didn't necessarily agree with ,but I thought her comments were interesting enough to share. X

[CLKD]

Go on, Name and Shame 

Some do find that vaginally suits them better.  Unless she has spoken to every woman that uses HRT she can't make sweeping statements 

[Perinowpost]

Yes, as she actually tried it herself MicheleMaBelle?x

[CLKD]

 . reading your name I now have an ear worm  which rather dates me 

[MicheleMaBelle]

Well, it's not something I was going to challenge her on was it?  I take it vaginally.  But, for the past few months I've more or less taken it orally and I've not had a repeat of the side effects I had when I first tried a couple of years back. TBH totally fed up with the whole bloody carry on so I'm thinking of  chucking it.
I won't name and shame. I thought she was lovely. I understand that she played a large part in putting together the current NICE guidelines on HRT prescribing.

We've just got to do what we think suits us best as long as it's safe and we aren't taking any  medical risks. If shoving the tablets up your fanoosh works, keep doing it girls!

[Hurdity]

Interesting feedback MicheleMabelle!

I know who you mean now you mention the NICE Guidelines! However I am surprised at what she says about oral vs vaginal utrogestan.

There is published research which states that the number of metabolic by-products from oral intake are far greater than for vaginal use due to going through the liver, and it is some of these which are responsible for some of the adverse sdie effects. There is greater systemic absorption ( again from some published research) showing higher systemic levels of progesterone itself from vaginal use compred with oral use of the same dose - so sdie effects due to the progesterone ( acting on progesterone receptors) may well be higher for vaginal use - but usually women are able (with support from their medical professional) to take lower doses vaginally than orally because of going to the womb first and not the liver.

Taking it vaginally means more is absorbed. Plus hormones should not  bypass the liver and taking them orally means they are.
I'm glad you found her reassuring and trustworthy. unfortunately, there are plenty of noteworthy doctors who say the opposite about hormones used orally, and this is just one example of why dealing with menopause and imbalance is such a head f8ck!

I think you mean the other way round Birdy!! Hormones (prog) used vaginally DO bypass the liver (ie straight to uterus and into bloodstream), and taking them orally means they are NOT (bypassing the liver) - ie they go through the liver first....

What are docs saying the opposite about - sorry - a bit puzzled here?! (I agree that some docs are often ill-informed though!!).

Hurdity x

[Ladybt28]

Hah hah, reading that do you know what I want to know (hee hee you all probably don't!)  anyway.....I think we should make it a forum policy for all members to ask any so called female menopause health professional they meEt, if they are menopausal and whether they take hrt???   I really like to know how many of them who spout on, actually have any physical experience in the subject?   

The only saving grace seems to me to be that here on the forum we end up seeing different consultants who all seem to have different opinions and so I suppose we can learn about different options.  Mind you, wouldn't it be so much easier if they all stuck to the same line?  "discuss"??

[MicheleMaBelle]

Yeah I was surprised as well Hurdity. She also said the Oestrogel shouldn't have given me a rash but it did, wherever I used it. In fact, when I started the Utrogestan initially my whole torso was covered in a horrible rash too.

It's all a mystery to me...

Ladyb- that's a good idea. It was on the tip of my tongue to ask but I bottled it in the end ( first time meeting, didn't want to appear too cheeky)

[Ladybt28]

See the oestrogel giving you a rash Michele, probably the ethanol (alcohol agent) in it that caused the problem. Anything with that in it can be quite hard on sensitive skin, like toner or face stuff with alcohol agents in it and it's easy to be allergic to things like that when absorbed into the skin and it doesn't need to be localised either.

….make sure you ask her next time  I'm dying to know!

[Tc]

When my gynae said "utrogestan is well tolerated, its unusual that you dont get on with it"  I said "not according to my menopause forum".  Well....youd think I just insulted her mother.!!
So called "experts" dont seem to like the idea of "people power" or in this case ",women power"  which we gain from being able to share experience and info.

And they do not like being challenged which is incredible when you think about it. It's a science. And science only progresses through ideas and research being challenged. It's at the very core of every single advance in medical history.

How do we know how many women have been sent away from their doctors for being "atypical" when it comes to HRT with no further investigation. It could be enough to warrant challenging the current guidelines, vagifem being a case in point, but we wont know as its not being reported and data is not being collected on it by each doc who has a patient reporting this. How can there then be an accurate  overall picture.

To me it would stand to reason that. If a treatment is clinically trialled but then is prescribed exponentially to huge numbers of people then the "adverse" reactions may be far more than is reflected in the original trial.. Too simple?
 
Surely part and parcel of going into the medical profession is to accept and even actively require received wisdom to be  constantly evolving . Otherwise we'd all be sitting here with leeches stuck all over us and being lobotomised with ice picks for PMS.
You realy got me started now 
 

[MicheleMaBelle]

Tc- I'm googling medical grade leeches as we speak - I fear the lobotomy has already happened and I was unaware of it at the time as I was scratching my rash and attempting to insert the Utrogestan without them falling on the floor. Maybe, that's what's happened...the cats had a lick of the discarded ones, ( I've forgotten to dispose of them ) and I've got mad pussy disease! 🙀

[Sheanie]

"sometimes we just need to adopt a more positive attitude and get on with it" sounds like something my dad would say! 

Re progesterone and breast cancer, I've read numerous research articles and am still confused! But this might be the research she's referring to. https://www.ncbi.nlm.nih.gov/pubmed/17333341 They found that progesterone is less associated with breast cancer risk than progestins. Compared with no HRT use, oestrogen alone risk = 1.29, oestrogen and progesterone = 1.00, and oestrogen and progestin = 1.69. So, if you are taking HRT, you are safer taking oestrogen and progesterone than oestrogen alone or oestrogen and progestin.

This study comes to the same conclusions re women taking HRT but also concludes that there is less risk of breast cancer amongst women exposed to HRT of any type than not exposed! "The incidence of new breast cancer cases was 0.64% in the exposed group and 0.70% in the unexposed group." https://www.ncbi.nlm.nih.gov/pubmed/17701770

Can anyone shed light on this area? I'm trying to put a presentation together on HRT and want to present the risks and benefits accurately. 

[Saffy]

To me it would stand to reason that. If a treatment is clinically trialled but then is prescribed exponentially to huge numbers of people then the "adverse" reactions may be far more than is reflected in the original trial.. Too simple?
 

Interestingly, many drug trials have a 'drop out period' at the start where those who suffer side effects are removed or remove themselves and the trial 'proper' then starts  . It certainly happened with the Statin trials.

[Maryjane]

Pretty certain I know who this expert is.

[MicheleMaBelle]

Sheanie- I cant quote you any research papers but my understanding is that the risk associated with HRT is greater if you take both oestrogen and progesterone. If you only take oestrogen, the risk is no greater than the general population who don't take HRT.

Have a look at Louise Newsons website. She has some excellent articles on HRT that are easy to understand and they contain links to further research. They would be a good starting point for your presentation. 👏