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[joziel]

It's also more than just relief from symptoms. HRT:

Reduces the risk of osteoporosis hugely.
Reduces the risk of dementia hugely (by 73% according to a recent study).
Reduces the risk of bowel cancer.
Reduces the risk of heart disease (which is the leading cause of death for women).

Whilst breast cancer is a very common cancer for women, it is highly treatable and detectable and 95% of women with it survive it. Not so all those diseases above...

[Marchlove]

Good post joziel! Thank you for reminding us of all these benefits xx

[Dee]

This is all strengthening my resolve to get hrt l intend to hold out for it  .will have lots of information to discuss with him thanks for help will let you know what happens
Dee xxx

[Bebbo]

I apologize for my lack of attention; I did not realize when I made my initial post that this is a UK-based forum. I am in the US, so some of your kind advice regarding your system does not apply. Still, much of the information and suggestions applies, and as often medical approaches on your side of the Atlantic seem more progressive and common-sense than on ours, having your perspective and experience is invaluable. I thank you all again for your responses.

To the lady who asked specifically what HRT I have been on: until about a year ago I was prescribed .45 mg Premarin and 500 mg prometrium daily. Did wonderfully well, no side effects. Concurrent with insurance company halting coverage of Premarin, which would have resulted in cost going to nearly $500 per 90 pills (3 month supply) was the new gynecologist’s insistence on lowering dose, whereupon she switched me to .5 mg estradiol, alternating one pill with 1/2 pill every day, which was effectively only a slight reduction in dosage. Most recently she is insisting I further reduce to 1/2 estradiol pill per day (no change in prometrium), which is nearly half of long-time successful dosage. Beginning to feel slight effects — more stiffness, mild night sweats, difficulty sleeping, etc.

[joziel]

Bebbo, my husband is from the US and all his family is over there and a lot of our friends. Plus my brother and his wife and kids 

Which is all to say, the main difference is that the UK is currently ahead of the US on the HRT subject. I think this is because the UK is used to having a standardised approach to things (as in the NICE guidelines) so once something has been approved, it spreads rapidly amongst doctors and (on the whole!) they all get roughly on board with the same approach. Whereas the US is like the wild west in that there is no standard approach and a bazillion doctors doing their own very individual things. So there are going to be doctors who can help you out there but you might need to do more research to find one than in the UK. And maybe travel further.

I don't know where you are based, but there is a Newson Health podcast interview here where they interview a US based menopause gynae and she mentions many different centres for menopause and doctors and of course herself as well and it might be you can find something there - or even email her and ask for a recommendation or a way to find someone, near where you live. They also talk about the different products available a bit too: https://podcasts.apple.com/gb/podcast/newson-health-menopause-society-podcast/id1608917458?i=1000559072824

Hope that helps - keep looking! Ditch your current gynae!!

[Dr. Heather Currie]

Feeling the need to clarify a few points!
For most women, HRT does provide more benefits than risks, and there is no arbitrary limit to the duration--it can be taken for as long or as little as each woman feels the benefits outweigh the risks.
There is a small increased risk of being diagnosed with breast cancer if combined HRT (estrogen and progestogen) is taken for more than 5 years after the age of 50, which is duration dependant. That known risk is small but needs to be balanced against the benefits to the individual. HRT is mainly taken for symptom control and at some point it can be stopped as a trial to see if symptoms are still present and, if so, what impact they may be having.

Estrogen only HRT should not be viewed as reducing the risk of breast cancer-- the Women's health Initiative trial showed this, in women who had had a significant gap between becoming menopausal, and then started HRT as part of the trial. It is believed that when introducing estrogen after a significant gap (several years), the breast cells react differently than if estrogen is taken from menopause onwards. However, estrogen only HRT does seem to be associated with a lower risk of breast cancer than combined HRT.

HRT is helpful for bone health, and the benefits do last beyond the time of stopping HRT, and, if started within 10 years of the menopause, or under the age of 60, is believed to be helpful for heart health. However there is not yet enough evidence to confirm that it reduces the risk of dementia.

This is all summarised in a joint statement published today, by the British Menopause Society, Royal College of Obstetricians and Gynaecologists, and the Endocrine Society.
I hope that this is helpful.
Best wishes
Heather

[joziel]

This is the statement from the BMS: https://thebms.org.uk/wp-content/uploads/2022/06/Optimising-the-menopause-transition-Joint-position-statement.pdf

I feel that statement is just so conservative, it's hard to believe. Things like stating that testosterone should only be prescribed for low libido when bazillions of us know (first hand) that it improves cognitive function, mental clarity and muscle/bone strength, for example.

And the statement about dementia... when this paper out last month, looking at 400,000 women in the US, found that transdermal estrogen is associated with a 73% reduction in risk of dementia: https://pubmed.ncbi.nlm.nih.gov/34027024/

What on earth does it take....?

And the obvious criticism of Dr Newson (not by name) for comparing it to thyroid hormone deficiency and stating that menopause shouldn't be seen as a deficiency or compared to that.... Clearly there are loads of politics at play here and a huge resentment of the stage that Louise Newson has - and a fear of the messages and reach that she has, as an individual. There is some sort of counter-effort now to be super-conservative in response. As if doctors aren't already extremely confused, now they have to deal with a personality war too.... Can we not just put personalities and feeling-threatened aside and look at the science? Because there is more of it than is included or referred to in that BMS statement and even when it is patchy or incomplete, it is possible to look at the bigger picture of multiple studies and what they altogether suggest. I am just a (well-read) casual bystander in all this and that much is clear even to me.

[pepperminty]

This is the statement from the BMS: https://thebms.org.uk/wp-content/uploads/2022/06/Optimising-the-menopause-transition-Joint-position-statement.pdf

I feel that statement is just so conservative, it's hard to believe. Things like stating that testosterone should only be prescribed for low libido when bazillions of us know (first hand) that it improves cognitive function, mental clarity and muscle/bone strength, for example.

And the statement about dementia... when this paper out last month, looking at 400,000 women in the US, found that transdermal estrogen is associated with a 73% reduction in risk of dementia: https://pubmed.ncbi.nlm.nih.gov/34027024/

What on earth does it take....?

And the obvious criticism of Dr Newson (not by name) for comparing it to thyroid hormone deficiency and stating that menopause shouldn't be seen as a deficiency or compared to that.... Clearly there are loads of politics at play here and a huge resentment of the stage that Louise Newson has - and a fear of the messages and reach that she has, as an individual. There is some sort of counter-effort now to be super-conservative in response. As if doctors aren't already extremely confused, now they have to deal with a personality war too.... Can we not just put personalities and feeling-threatened aside and look at the science? Because there is more of it than is included or referred to in that BMS statement and even when it is patchy or incomplete, it is possible to look at the bigger picture of multiple studies and what they altogether suggest. I am just a (well-read) casual bystander in all this and that much is clear even to me.

Well said,

there is more risk with smoking and drinking and being over weight than combined HRT and it is the older progesterone's .  Utro or dygessterone , which are more breast friendly.


PMXX

[Joaniepat]

And a "well said" from me, too!
JP x

[Bebbo]

Again, so appreciative of all the information and support. I promise, I will not just roll over and do what the doctor says, when there is so much evidence that goes against the standard age-related advice. I feel I know my body better than anyone, and while I respect a doctor’s years of training and experience, I feel every patient is an individual and should be treated as such and that my healthcare should be a partnership between myself and the doctor. And I will, if I must, keep looking until I find a doctor who feels the same way, and at least listens to me before making a recommendation rather than simply parroting the standard approach.

[KarineT]

My view is that HRT is good for some and those who want to take for as long as they live is their right.

But let's face it.  Menopause is a natural part of ageing for women and it should be accepted as that. I understand that we have symptoms and they can be horrible at times, I, myself, am not symptom-free, but we shouldn't try to medicalise the menopause because it's not a disease. Thyroid dysfunction is and it can cause serious problems, same as an adrenal disorder, which is potentially fatal if not treated.

As for all the health risks associated with a lack of oestrogen such as osteoporosis, heart disease and dementia, I know a lot of ladies who don't have these and they are well past the menopause.  I believe that, as men and women age, there are inevitable physiological changes in the body as we age, allowing for potential disease to develop, there are also a hereditary factor and an element of luck of whether we will develop any of these diseases or not.  I refuse to beleive that a lack of oestrogen contributes to diseases and I get the impression that the menopause takes the blame for everything.

[joziel]

If you refuse to believe that a lack of estrogen contributes to diseases, then there's not much more to be said really. There is now endless research that it does contribute to all kinds of health conditions and no one is even debating that.

What does it matter if menopause is a 'natural' part of ageing? Death is also 'natural'. So is cancer. So is suffering. 'Natural' doesn't mean 'good' and we need to stop equating these two words. Women didn't even live past the age of 60 until about the turn of the century, on average - that was 'natural', too.

As for whether or not it's a disease, I can't see that that really matters. It's a physical process which speeds up ageing and other diseases. So whilst not being a disease in itself, it's something it's desirable to address medically. There are many other changes the body goes through as it ages which are not 'diseases' but can be treated and reduced. And, in fact, many researchers do consider ageing itself to be a disease which one day we will understand better and be able to largely prevent.

Of course there are women past the menopause who don't have heart disease and dementia. Just like there were many people who smoked 60 a day and didn't get lung cancer. It's not evidence that something is okay just because you can come up with some unaffected people... That's why we have science and research.

[McPeri]

I apologize for my lack of attention; I did not realize when I made my initial post that this is a UK-based forum. I am in the US, so some of your kind advice regarding your system does not apply. Still, much of the information and suggestions applies, and as often medical approaches on your side of the Atlantic seem more progressive and common-sense than on ours, having your perspective and experience is invaluable. I thank you all again for your responses.

To the lady who asked specifically what HRT I have been on: until about a year ago I was prescribed .45 mg Premarin and 500 mg prometrium daily. Did wonderfully well, no side effects. Concurrent with insurance company halting coverage of Premarin, which would have resulted in cost going to nearly $500 per 90 pills (3 month supply) was the new gynecologist’s insistence on lowering dose, whereupon she switched me to .5 mg estradiol, alternating one pill with 1/2 pill every day, which was effectively only a slight reduction in dosage. Most recently she is insisting I further reduce to 1/2 estradiol pill per day (no change in prometrium), which is nearly half of long-time successful dosage. Beginning to feel slight effects — more stiffness, mild night sweats, difficulty sleeping, etc.

I think what strikes me as slightly odd, Bebbo, is that from what you say she is reducing your estrogen but not your progesterone (Prometrium/Utrogestan in UK). It does sound like it is being led by age and money rather than a sound assessment of your needs. Is she suggesting that you stay on the Prometrium, or will she just want you to ditch that once the estrogen is at zero?

Your estrogen dose is very low, as you have explained, and you were not on a particularly high dose to begin with. The Prometrium is high in comparison. A second opinion would be useful.

[Hurdity]

If you refuse to believe that a lack of estrogen contributes to diseases, then there's not much more to be said really. There is now endless research that it does contribute to all kinds of health conditions and no one is even debating that.

What does it matter if menopause is a 'natural' part of ageing? Death is also 'natural'. So is cancer. So is suffering. 'Natural' doesn't mean 'good' and we need to stop equating these two words. Women didn't even live past the age of 60 until about the turn of the century, on average - that was 'natural', too.

As for whether or not it's a disease, I can't see that that really matters. It's a physical process which speeds up ageing and other diseases. So whilst not being a disease in itself, it's something it's desirable to address medically. There are many other changes the body goes through as it ages which are not 'diseases' but can be treated and reduced. And, in fact, many researchers do consider ageing itself to be a disease which one day we will understand better and be able to largely prevent.

Of course there are women past the menopause who don't have heart disease and dementia. Just like there were many people who smoked 60 a day and didn't get lung cancer. It's not evidence that something is okay just because you can come up with some unaffected people... That's why we have science and research.

Great post joziel!

Hurdity x

[Hurdity]

I apologize for my lack of attention; I did not realize when I made my initial post that this is a UK-based forum. I am in the US, so some of your kind advice regarding your system does not apply. Still, much of the information and suggestions applies, and as often medical approaches on your side of the Atlantic seem more progressive and common-sense than on ours, having your perspective and experience is invaluable. I thank you all again for your responses.

To the lady who asked specifically what HRT I have been on: until about a year ago I was prescribed .45 mg Premarin and 500 mg prometrium daily. Did wonderfully well, no side effects. Concurrent with insurance company halting coverage of Premarin, which would have resulted in cost going to nearly $500 per 90 pills (3 month supply) was the new gynecologist’s insistence on lowering dose, whereupon she switched me to .5 mg estradiol, alternating one pill with 1/2 pill every day, which was effectively only a slight reduction in dosage. Most recently she is insisting I further reduce to 1/2 estradiol pill per day (no change in prometrium), which is nearly half of long-time successful dosage. Beginning to feel slight effects — more stiffness, mild night sweats, difficulty sleeping, etc.

Hi bebbo

To add to the other posts.

First Premarin is one of the old-fashioned types of HRT ( made from pregnant horse urine for those how don't know) and is the oestrogen that was used in the controversial Women's Health Initiative trials whose results (in terms of increase in various health risks) led to drastic reduction in HRT being prescribed until relatively recently. Judging by posts on this forum it is rarely prescribed now in UK, rather, the bio-identical estradiol is recommneded and available in several methods of delivery and dose.

Second - there is no exact comparison between estradiol and premarin as the latter is a mix of horse oestrogens (including estradiol). However looking at the dose chart here: https://www.menopausematters.co.uk/treatafter.php, 0.45 mg premarin  is somewhere between low and medium dose whereas what you are now taking - in effect 0.37 mg per day, is ultra low dose  - look at Femoston here: https://www.menopausematters.co.uk/postmeno.php (0.5 mg estradiol per day). Given the same absorption, then the equivalent tablet estradiol would be approx 1.5 mg so yes it is understandable that you are noticing an increase in symptoms.

Thirdly - 500 mg  prometrium is a HUGE dose. No gynae or menopause specialist would prescribe this amount (except for fertility indications). I'm amazed you've been able to function at all! I would be more worried about this in terms of potential increased breast cancer risk then the tiny amount of estradiol you are now taking. The standard daily dose of Prometrium (which is the same as our Utrogestan I understand) for continuous combined HRT is 100 mg - yes you see it - 100 mg! This can be increased (to 200 mg) if it does not control bleeding though with low doses of oestrogen it is less likely to happen (ie poor control of bleeding).

Fourth - here in UK, the recommendation for women post 60 taking HRT is to use transdermal HRT ie patch gel or spray - because of increased stroke risk and cardio-vascular problems in older women, especially if you have other risk factors such as High BP, excess weight etc.

So in terms of the standard approach - you're not getting it - neither before nor recently!

Take a look at the options available in uk that I linked to - HRT preparations for post-menopause, and the separate oestrogens (transdermal) and progestogens, There will be the equivalent in US - many patches are available....

As for the age thing - I have nothing to add to that - I am approaching that age myself and don't intend to come off HRT provided there are no heath reasons that mean it would be advisable (to stop).

Incidentally it is heartening to read of other women approaching and post 70 still on HRT - including especially those who still have a uterus as this is more challenging, due to the need to take progestogens.

All the best bebbo - do let us know how you get on

Dr Currie - thanks for alerting us to the new statement by BMS - and joziel for the link must have a read....


Hurdity x