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[laszla]

Hi ladies,
Current status since 2018: 54 y.o., Oestrogel x2 pumps a day, 100mg utrogestan for 8-10 days monthly internally, and a tiny splodge of testogel a few days a week, I still have a monthly bleed.
I requested HRT from GP not because of the more common symptoms such as hot flushes (which I still have never had) but for terrible mood/brain fog and preventatively for heart and bone protection (mother has problems in both areas so want to pre-empt problems in these areas).
I pretty much assumed one could carry on with it for years so was horrified last week during my GP phone appointment (not with usual GP but someone covering for her) to be told that "we" should start looking at taking me off it.

I was shocked, I'm not having any problems with it but she was saying it as if this is the normal trajectory, ie. you take it to tide you over any bad symptoms but then should be weaned off it. When I told her that I didn't have hot flushes etc she practically barked at me 'what on earth are you taking it for then?'.
I was very put off and did not pursue the conversation but am worried now. My usual GP is lovely but by her own admission does not know much about HRT and is just happy to prescribe what I request.
I wondered if there is a status quo in the UK about stopping HRT as quickly as possible - I somehow don't think so and I also know that in some countries women carry on taking it forever?
Also, and excuse my ignorance, but I got the impression that this GP was saying that at this point I am probably only getting a period because I am taking the HRT. I have no idea what effect the regimen has on menstruation, if it artificially causes monthly bleeding and therefore if I stopped taking it I would no longer have periods (as I type this I realise how ridiculous this level of ignorance is).
I'm not in favour of private medicine and can't easily afford it but if I get no support from GP will go for at least one consultation as clearly these decisions affect the rest of a woman's quality of life.
Does anyone think that the blood tests clinics such as Louise Newson's offers are worth it (they include FBC, Kidney Function, Liver Function, Lipids, Ferritin, Thyroid function, HbA1c, Oestradiol, Testosterone, SHBG, Vitamin B12, Folate, Vitamin D). I could probably get some of those readings from a GP blood test, if they agreed to give me one but am not sure the hormonal ones would be included and I seem to remember GP thyroid tests only read some but not all thyroid elements).
Thank you so much for any advice on any aspect of this.

[Taz2]

Hi laszla. I can't answer all of your questions but, yes, your monthly bleed is caused by the withdrawal of utrogestan each month. It's actually called a withdrawal bleed and is not a natural period.

As for being asked to stop HRT at 54 your doctor is ill-informed. The new guidelines seem to be that women should be allowed to carry on with HRT indefinitely if they want to providing there are no health issues to prevent this. HRT is not prescribed purely to prevent heart and bone problems though but your brain fog symptoms can be due to low oestrogen. I started HRT at 53 and am still on it at 67 although I've had to be very persuasive with my GP on a couple of occasions 

Hope this is helpful.

Taz x 

[laszla]

Many thanks Taz, I am reassured and felt the doctor's response was very outdated (and she is much younger than my usual GP!) I see what you mean about the withdrawal bleed but if one still had normal periods at time of starting HRT as in my case, I suppose it's impossible to tell whether I would still be having natural periods now. But I don't suppose it's very important as I plan to take HRT indefinitely and clearly will need to find another provider.

[Taz2]

The only way to tell is to stop HRT but that's rather drastic and you may not get it reinstated if needed. Most GPs will consider you post menopausal by the age of 54 and, if you want, will change you to a conti regime which, after the initial six months when you can experience breakthrough bleeding, shouldn't produce a monthly bleed.

I hope you find a more sympathetic GP but don't ask for HRT merely for bone protection. Stress more any brain fog, fatigue, sleep problems etc.and general wellbeing. Are you sure you've not had a hot flush or two in the past? Meno can affect memory after all   

Taz x   

[sheila99]

Some women don't reach menopause til their early 60s so you can't assume you are at 54. I still had pretty regular bleeds when I went on hrt at 57. The NICE guidelines used to say stop at 60 but now there is no age limit, so to suggest you stop at 54 is well out of plumb.

[Cocobra]

Dear all,

if it can help I can pass on my mother's experience (though this is in Italy): she's on HRT and turned 80 this year! The reason for this is because at 46 she was diagnosed with a severe osteoporosis. As her daughter, I was put immediately on HRT as I reached perimenopause at age 42 or thereabouts and a bone density scan showed I have osteopenia. So, actually bone protection is a key reason for going on HRT!

[Petra]

This is a constant problem for women on HRT and I've had the same with my GP. I live in NZ and for ages, every time I went to re-up my script, I'd get the spiel about coming off it etc. etc. But having kept up with all the studies, followed Dr. Currie's work, I feel confident that there is no 'reason' I 'should' come off it if it's benefiting me (which it hugely is!), given my risk factors are so low.

I actually started to get a bit ticked about this, and have had to be firm and my GP has mostly give up on nagging me about it, though I still hate having to visit her, and I gird myself for the attitude. One thing I did with my GP was ask "why"? WHY should I come off it? I got replies about breast cancer (wrong!) and afew other things, but really she had no argument, especially when I pointed out how I have zero risk factors (in terms of weight, smoking, etc. etc.)... In the end, it turns out it's just one of those GUIDELINES the GPs are told they have to follow on NZ, and they are essentially obligated to say "this should only be for the short term" ... but there is NO satisfactory explanation as to WHY, in my view.

I think what really got me in recent years has been the huge rise in young people wanting gender transition, and at one point I said to my GP, (in a bit of a rage, admittedly) 'how come a teen could come in here and get hormones to transition, but I, an adult female who's read the studies, informed herself etc. etc. has to be treated like I don't know what I'm doing?'

Bottom line, if you've done the research and know what you want and need, and what your risks are, stick to your guns and if your GP won't provide what you need, get a new one.

[sheila99]

Well said. When 50% of their patients will go through this the level of ignorance makes me mad.

[laszla]

Are you sure you've not had a hot flush or two in the past? Meno can affect memory after all   

Taz x   

If anything, I am always freezing, even when it's hot!

Some women don't reach menopause til their early 60s so you can't assume you are at 54. I still had pretty regular bleeds when I went on hrt at 57. The NICE guidelines used to say stop at 60 but now there is no age limit, so to suggest you stop at 54 is well out of plumb.

I thought so too Sheila and although you hear horror stories here I was shocked that they were saying this.

Dear all,

if it can help I can pass on my mother's experience (though this is in Italy): she's on HRT and turned 80 this year! The reason for this is because at 46 she was diagnosed with a severe osteoporosis. As her daughter, I was put immediately on HRT as I reached perimenopause at age 42 or thereabouts and a bone density scan showed I have osteopenia. So, actually bone protection is a key reason for going on HRT!

My mother too is in her 80s and has osteoporosis (and is Italian!) so I think it is important to use HRT as a protective measure

This is a constant problem for women on HRT and I've had the same with my GP. I live in NZ and for ages, every time I went to re-up my script, I'd get the spiel about coming off it etc. etc. But having kept up with all the studies, followed Dr. Currie's work, I feel confident that there is no 'reason' I 'should' come off it if it's benefiting me (which it hugely is!), given my risk factors are so low.

I actually started to get a bit ticked about this, and have had to be firm and my GP has mostly give up on nagging me about it, though I still hate having to visit her, and I gird myself for the attitude. One thing I did with my GP was ask "why"? WHY should I come off it? I got replies about breast cancer (wrong!) and afew other things, but really she had no argument, especially when I pointed out how I have zero risk factors (in terms of weight, smoking, etc. etc.)... In the end, it turns out it's just one of those GUIDELINES the GPs are told they have to follow on NZ, and they are essentially obligated to say "this should only be for the short term" ... but there is NO satisfactory explanation as to WHY, in my view.

I think what really got me in recent years has been the huge rise in young people wanting gender transition, and at one point I said to my GP, (in a bit of a rage, admittedly) 'how come a teen could come in here and get hormones to transition, but I, an adult female who's read the studies, informed herself etc. etc. has to be treated like I don't know what I'm doing?'

Bottom line, if you've done the research and know what you want and need, and what your risks are, stick to your guns and if your GP won't provide what you need, get a new one.

Agreed Petra, I just find it ridiculous and demeaning that one has to play hardball to persuade GPs (in some cases) to prescribe HRT. I know also that in Scandinavia HRT is prescribed into the 80s and beyond and although perhaps a cliché there is certainly an image of Scandinavian countries being more progressive