Menopause for older women Archives - Balance Menopause & Hormones

HRT in later life or after menopause

kat keogh — Mon, 22 Jul 2024 00:00:00 +0000

Whether you want to start HRT or are wondering about staying on it for longer, we answer some of your frequently asked questions

Is it ever too late to start HRT?

Many women aren’t offered HRT when they develop symptoms of menopause. This might because your symptoms weren’t too bad, or you felt that you had to simply grin and bear your menopausal symptoms. You may have had significant concerns over the safety of HRT, or healthcare professionals may have advised you against it.

If, years later, you are revisiting this possibility and HRT is becoming more of an attractive option for you, it’s worth knowing that there is very little evidence regarding starting HRT for older women because this research has not been undertaken. However, most women who are otherwise fit and well do still gain benefits from taking HRT even if it has been more than 10 years since their menopause.

You may decide to start HRT now because your symptoms have worsened, or you were expecting them to have gone by now but they haven’t. You may be concerned about the long-term risks associated with low levels of hormones that occur during the menopause in later life such as the risk of cardiovascular disease (disease of the heart and blood vessels) and osteoporosis (bone weakening disease), as well as diabetes, dementia and depression. These are all valid reasons for wanting to take HRT at this point in your life. HRT can help with symptom control and has long-term health benefits.

It is important that you seek individualised advice and discuss all the treatment options available to you. If your regular healthcare professional will not consider HRT for you, you may wish to find an alternative healthcare professional who has a special interest in the menopause.

This information also applies if you were on HRT but reluctantly, and under doctor’s advice, stopped taking it. If you want to start HRT again, see another healthcare professional if you have to, and explain your reasons for wanting to start taking it again. The NICE guidelines are clear that women can continue to take HRT as long as the benefits outweigh the risks, and for most healthy women, this is for ever.

Are there any disadvantages to starting it later in life?

Cochrane data-analysis and long-term follow-up data from the Women’s Health Initiative (WHI) showed no increase in cardiovascular events, cardiovascular mortality or all-cause mortality in women who initiated HRT more than 10 years after the menopause [1].

Some concerns were with starting older types of synthetic HRT in older women but starting body identical HRT is generally thought to be safe as these hormones are the safe structure as hormones you produced when you were younger.

However, the decision to start taking HRT is individual, and should take into account your specific benefits and risks. It is essential to have a yearly review to ensure that it is appropriate for you to continue treatment.

Will I need a lower dose of HRT if I’m older?

Older women often need smaller doses of oestrogen than younger women, and there are preparations of lower doses specifically for older women. The safest way to take replacement oestrogen is through the skin in a patch, gel or spray. Even a small amount of oestrogen replacement can often alleviate your symptoms effectively and provide you with the bone and heart protection you need.

If you still have your womb (uterus) you will also need to take a progestogen, such as micronised progesterone, to protect the lining of your womb.

RELATED: HRT doses explained

I’ve been on HRT for years, how will I know when it’s time to lower my dose?

Each person is an individual and it is important that you have an annual review with your healthcare professional to ensure that you are on the correct doses and types of HRT to manage your symptoms. The aim would be to remain on the effective dose for you that maintains good symptom control and quality of life.

Does taking HRT just delay the menopause?

Many women think that taking HRT just delays the natural duration of the menopause in your body. This is not the case. If your symptoms return when you stop taking HRT it is not because you have been taking hormones, this is because you would still be having symptoms of the menopause at that time even if you had never taken HRT. An untreated menopause can cause symptoms for many years; the average length of time is around seven years but for many women, symptoms can last for decades.

I have taken HRT for several years so, when should I stop it?

Many women decide to take HRT for a much longer period of time than a few years. This is often because they feel better and have more energy, and have fewer or no symptoms when they take HRT; they also want to protect their future health from long-term conditions associated with low levels of oestrogen, such as osteoporosis and cardiovascular disease.

All women taking HRT should have an annual review with their healthcare professional. If you continue to be healthy and feel the benefits of taking HRT, there is usually no reason for stopping it. Women are often surprised when their menopausal symptoms return after coming off HRT, even those women who have taken it for many years. Symptoms of the menopause can last over a decade.

A recent study highlighted the benefits of older women taking HRT, especially body identical HRT [2].

There has been some evidence that showed a small increased risk of heart attack or stroke during the first year after stopping HRT. As always, decisions around your health should be made weighing up all the relevant information and deciding what is best for you, and in discussion with your health professional.

Why does my doctor say I can only stay on HRT for five years?

Previously women have been advised that they can only remain on their HRT for a maximum of five years due to concerns about breast cancer risk but this is not based on any good quality evidence and it is nor relevant for women taking body identical hormones. Now, the guidelines are that specific time limits should not be placed on duration of use of HRT. If symptoms persist, the benefits of using HRT usually outweigh the risks and an individualised approach should be agreed with your healthcare professional.

I want to stop taking HRT, what is the safest way to come off it?

If you have weighed up the information and decide coming off HRT is the right decision for you, it is usually recommended that you decrease the dose of hormones gradually, every few days, over a few weeks.

References

Hamoda H, Panay N, Pedder H, Arya R, Savvas M. (2020), ‘The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women’, Post Reproductive Health. 26(4): pp.181-209. doi:10.1177/2053369120957514
Baik, S. H et al. (2024), ‘Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses’, Menopause, vol. 31,5: pp.363-71. doi:10.1097/GME.0000000000002335

The post HRT in later life or after menopause appeared first on Balance Menopause & Hormones.

My story: I started HRT when I was postmenopausal

Natalie Millman — Mon, 22 Jul 2024 00:00:00 +0000

Fiona, 62, says her generation of slightly older postmenopausal women have missed out on being offered HRT, but could still reap the benefits

‘During my late 40s and 50s, I considered myself lucky that I did not suffer from any menopausal symptoms. But back then, I thought symptoms were limited to sleep disturbances and hot flushes.

‘I’m unclear on when my actual menopause was because in my mid-40s I had a Mirena coil fitted to control heavy bleeding, which I’d experienced for 10 years. I think my menopause was probably sometime in my early 50s.

‘When I was 47, we moved to Canada, where I registered and worked as a pharmacist. I am utterly amazed at how little I knew about hormones considering I worked in a pharmacy. It just seemed of no relevance to me, and I was busy navigating working in a new healthcare system.

‘Now when I reflect on this perimenopausal time, I can now see that I actually did suffer many issues, including recurrent UTIs, burning mouth syndrome, travel anxiety and a plethora of IBS symptoms, all of which were new to me. However, I didn’t realise their significance and I dealt with them myself.

‘We returned to Scotland in 2019 when I was 57 and all was well until November 2021 when I started to develop pelvic and abdominal pain radiating down my legs, which was severe enough for me to admit defeat and speak to a GP.

‘The GP thought I had developed diverticulitis and prescribed me antibiotics. This made me feel worse and did not resolve my pain. I knew it was not gut related. Over the next six months, I was sent for two ultrasounds, an MRI and a referral to gastroenterology. I was given multiple prescriptions for codeine and amitriptyline, hyoscine and mebeverine.

‘The pain in my thighs and legs was the worst symptom, but nothing was really helping. I didn’t take many of those medications as they didn’t help or just made me more tired.

‘By February 2022 I thought I was going to have to give up work, aged 60, but I struggled on and just came home to bed every night with a hot water bottle. It was a very grim time.

‘In May, I got a letter to say I’d been referred to the persistent pain clinic and a recommendation, in the meantime, to try the low FODMAP diet. I cried when I got that letter as I knew I had no gut issues and felt abandoned.

‘We went on holiday with my daughter’s young family and I remember sitting on the plane thinking I wouldn’t care if we crashed as at least the pain would be gone.

‘In July I was desperate for help. I have a good friend who is a GP and although I don’t like mixing friendship with health needs, he offered to see me privately. We had a great talk about persistent pain and got to the subject of HRT. At the same time, one of the pharmacy technicians I occasionally work with said to me ‘you need HRT!’ and told me to download the balance app.

‘My GP friend prescribed Oestrogel and Utrogestan and within a week, I was completely better! All my pain had gone and my life resumed! My palpitations, which I hadn’t realised were a symptom, disappeared too.

‘I was worried my own GP wouldn’t continue my HRT, but she agreed to continue it. She wouldn’t give me Utrogestan as she said it wasn’t transdermal and increased stroke risk – I knew she wasn’t correct, but I thought I’d rather have her on board than argue at this point.

‘I’ve been on Evorel Conti for almost two years and it suits me perfectly. Since I started HRT, I have lost about two stone with the Full Diet, but it was honestly pretty easy as I’m a very healthy eater. I feel full of energy too, so I’m not going to retire yet.

‘In autumn 2022, I did the Confidence in the Menopause online course as I realised I have so many opportunities in my job to help peri and postmenopausal women. Many of my friends have now got HRT as I can’t stop myself talking about it.

‘In Scotland, community pharmacists can prescribe Trimethoprim/Nitrofurantoin as appropriate for UTIs, however I find most of the UTI consultations I have involve women between 40 and 70 so I take this opening to discuss use of vaginal oestrogen and genitourinary syndrome of menopause (GSM).

‘I do worry about the 60-80-year-old group as they totally missed out and so many suffer from pains, insomnia and GSM. I know there isn’t much research in this age group but many are being denied even a trial of HRT if they are over 60.

‘I cannot believe I was so ignorant for so long, and I’m a bit ashamed of my lack of awareness. I am making up for lost time now though and spreading the word. I get colleagues calling me now asking for advice and am encouraging lots of conversations about it. I’m pretty passionate about all this and would like to share my tips with other women:

Talk to other women – a lot!
Educate yourself – balance is a great resource
Talk to the next generation down so they will recognise the less common symptoms.’

To find out about the Confidence in Menopause course see https://newson-health.teachable.com/p/confidence-in-the-menopause

Would you like to share your experience of perimenopause or menopause? Write to us at shareyourstory@balance-app.com

The post My story: I started HRT when I was postmenopausal appeared first on Balance Menopause & Hormones.

When menopausal symptoms persist, with Dr Anna Chiles

Caroline Roberts-Garth — Tue, 16 Aug 2022 08:10:15 +0000

Dr Anna Chiles is a GP and works in an NHS practice in Gloucestershire and at Newson Health as a menopause specialist. In this episode, the experts discuss the range of symptoms that can occur in the perimenopause and menopause and the impact of these on daily life, and they highlight what can be done for women when symptoms persist for many years.

Anna’s 3 tips for women who have struggled with symptoms for many years:

It’s never too late to start HRT and have that discussion with your health practitioner. If you choose to try it, you don’t have to continue with it if you don’t like it.
You don’t have to stop taking HRT when you reach a certain age
It’s so important to keep active, for your independence, your balance, joints, and muscle strength. This goes hand in hand with hormone replacement.

Episode Transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.

Dr Anna Chiles [00:00:46] So today in the studio I have with me Dr. Anna Chiles, who is a GP. She works in the NHS and she also works with us as well as a menopause specialist. Welcome, Anna. Thanks ever so much for joining me today.

Dr Anna Chiles [00:00:58] Thanks very much for inviting me.

Dr Louise Newson [00:01:00] So it’s probably officially the hottest day of the year for a long time. The thermometer I looked at actually got up to 38 degrees today and I didn’t actually have any hot flushes when I was perimenopausal. I got some night sweats. But actually today is making me realise how uncomfortable it must be for those women that do have vasomotor symptoms which we know affect about 75% of the population who are menopausal, don’t they Anna. And it’s really quite uncomfortable, actually. So I am thinking that. But actually, I’m also reminding myself of all the other symptoms, because we just looked at thousands of women who have been using the free balance app and then commonest symtom was brain fog actually. And we all know we slow down in the heat, but it’s more than that. So these symptoms of the menopause can vary. They can change with time and everybody’s individual. So we thought today we’d talk a bit about symptoms, how they can persist and actually what we can do when we’re a bit older as well, because there’s certainly a lot of women I see and speak to who they’ve missed out on individualised treatment because 20 years ago, nearly to the day the WHI study came out, everyone was told never to prescribe HRT. And these women who might have been 50 then are now 70, but some of them are still having symptoms. So I thought I’d talk a bit about symptoms and then a bit about what we can do with helping older women as well, because we see a lot of younger women and some very young women. But we need to talk about older women, too. So what about symptoms Anna, what are the things that surprise when you now see a huge volume of menopausal women? And what are the symptoms that perhaps 10 years ago you might not have thought about with the menopause?

Dr Anna Chiles [00:02:45] Definitely sleep disturbance, not just related to vasomotor symptoms. They’re not related necessarily to being hot or having night sweats. But just women and older people just accept that they’re going to be awake in the middle of the night and that’s just standard fare. ‘Oh, yes. Well, I’m always awake. I listen to my radio for 2, 3 hours, then I get back off to sleep.’ And that’s just seen as normal for ageing and I think that’s really important. I think also the brain fog that you talked about that people write lists, that’s normal for us to write lists, but actually sometimes it can be kind of more than that. And then I think one of the big things in older population is urinary tract infections and vaginal dryness and how people just accept that they get two or three or four urinary tract infections a year. That doesn’t necessarily need to be that way.

Dr Louise Newson [00:03:40] Yeah, very common symptoms and you’re absolutley right, sleep disturbance. I hadn’t realised how common it was because everyone just says, ‘Oh I’m a poor sleeper have always been’. And and it’s only because when we replace with missing hormones we often find that sleep is one of the first things actually that people thank me for. And you know, I know even when I wasn’t getting night sweats, I would often wake at early hours of the morning. Isn’t it when hormone levels are at their lowest, sort of two, three in the morning, I’d be wide awake and I say, ‘Well, I’m not really anxious. So it’s not anxiety that’s woke me up, but now I’m awake I am anxious because I know I’m going to really tired tomorrow’. And then I start to think about all the things that I haven’t done or that I need to do. And a lot of menopause and perimenopausal ruminate, don’t they? And they sort of catastrophize things and that’s very common in the early hours isn’t it.

Dr Anna Chiles [00:04:32] Yeah. And patients are forever saying to me, ‘Well you know, I’m awake, then I start worrying and then when I wake up in the morning, I think, why was I worrying about that? Actually, I can see the reality that it doesn’t really need to be worried about, but actually at two or three in the morning, it feels like the world is ending’.

Dr Louise Newson [00:04:49] Yes. And a lot of people worry about things that they would never normally worry about. So they worry about quite serious things actually, a lot of women have said to me they worry about the mortality of their children, they worry about their jobs. And then sometimes it’s smaller things. They worry that they’ll never be able to get the stuff together to pack a suitcase or pack a bag for work or their children’s packed lunch or what they’re going to do for supper and that sort of thing, which is completely out of character for them. And that can be really disabling. And we know lack of sleep is a form of torture isn’t it.

Dr Anna Chiles [00:05:21] Oh yeah.

Dr Louise Newson [00:05:22] I mean, I’m surprised by how little sleep some people survive on.

Dr Anna Chiles [00:05:27] Oh, I know. Sometimes some people will say… You’ll ask them, you say ‘How do you sleep?’ They say, ‘Well, it is disturbed. I probably get between two and three hours a night’ and I’m thinking, that sounds horrific. I wouldn’t be able to carry on the next day with two or three hours. And then you say, ‘How long’s that been going on for?’ ‘Oh five or six years’ and you think, ‘Oh my goodness, how have people managed?’

Dr Louise Newson [00:05:50] Yes. Well, of course, I mean, I graduated in the mid-nineties and we used to give a lot of Temazepam, actually, because it’s slightly longer acting. We would give Temazepam a lot to women in their fifties and sixties who would come with sleep problems. And then there was obviously the abuse side of Temazepam, so it was changed and we gave Diazepam and then there were the newer sort of sleep medicines like Zolpidem and other drugs, but they’re not very nice actually, and they’re highly, highly addictive. So then you have a lot of problems and I’m sure you have in your general practice, I saw a lot of women who in the seventies who would come for another prescription and then seek out the doctor that was more likely to say yes. And it’s usually a newer doctor and you’d spend longer in a consultation trying to get them off. But if I had my time again, I probably would have talked to them about the menopause. I don’t know about you but I didn’t even think about it.

Dr Anna Chiles [00:06:42] Yeah. And interestingly, when I first became slightly hormone obsessed about sort of three or four years ago, I did a little audit of a month of my appointments that I was seeing. And I encouraged anyone who was over the age of 40 and anyone who was female. And I didn’t have an upper age limit, actually, and I think it was something like between 75 and 80% were related to menopausal symptoms. It was huge. So it was that joint pains, which people just presume they had arthritis as they were getting older. It was sleep, so it was often a repeat prescription for either their sleeping tablet that they hadn’t been able to live without for 20 years or their antidepressants. And suddenly I opened this conversation about obviously sometimes if they were still sort of young enough for what’s happening with your periods or then I’d say, ‘And what age did you have your menopause’ if they were older, ‘did this start with your menopause?’ And they’d say, ‘Oh yeah, I used to sleep fine until my menopause. Actually, it was about that time’. And suddenly there was this big group of patients that I could certainly manage with their sleep disturbance, their mood, their anxiety, their palpitations, their joint pains with simple hormones actually giving them hormones back. And they sorted all these problems out for most of them. And then you can deprescribe. And that’s the key thing is actually deprescribing the nasty drugs just by giving them back the hormones that they would normally have had.

Dr Louise Newson [00:08:10] And that’s quite amazing, actually, because we know there’s been a lot of narrative over the last few weeks about the menopause being medicalised and how inappropriate it is and we know there’s been an article in the British Medical Journal about medicalisation of the menopause. But actually before I wrote the response on behalf of the society, I actually was thinking it is being medicalised already but actually with inappropriate medications. And you say as you say, it’s not just one medication, often it’s a number. So antidepressants, maybe drugs for palpitations, statins to lower cholesterol, blood pressure lowering medication, anti-inflammatories, painkillers, and then migraines. We see a lot of women who are on heavy duty drugs, actually epilepsy drugs sometimes to try and stop the migraines. So there’s layers and layers. And actually we know this whole thing about polypharmacy. So prescribing too many drugs is huge. So it’s not just about adding something in when we medicalised the menopause with HRT or hormone replacement therapy. Like you say it’s actually reducing the number of prescriptions. It’s really good, isn’t it?

Dr Anna Chiles [00:09:14] Yeah. And I quite often say to my patients, remember, this isn’t actually a drug. This is replacing your hormones that you’ve naturally got with body identical hormones that are the same as your own hormones. This is not like even taking a paracetamol or an ibuprofen. They are not naturally within your body. These are naturally within your body. And that’s what everyone’s sort of forgotten or is missing the point I actually think that actually this is not a drug. This is a hormone replacement. And that is all we’re doing is topping up your body’s hormones that they are losing and reducing or have stopped producing.

Dr Louise Newson [00:09:55] Yes. And certainly I know when I started doing a bit of menopause work, somebody said to me the average length of time for symptoms is four years. And then someone else said it was seven years. And I have seen countless women who have had symptoms for decades because they’re very clear that their symptoms started just after their ovaries were removed when they have a surgical menopause, it’s very black and white. And I see women in their seventies and eighties and some of the symptoms I know are related, like their flushes and sweats, other symptoms, like you say, quite rightly, could be due to other things like palpitations and joint pains. But actually when you give their hormones back, can take a bit longer sometimes in older people. But after six to nine months, majority, if not all of their symptoms have gone. So, you know, it’s related. And so there are decades of symptoms often, but they can change can’t they Anna. So they might start with flushes, sweats, and then they say, ‘Oh, I’m through the menopause because they only lasted six years. I don’t have any sweats now’. And then, like you quite rightly say, they have three or four antibiotic prescriptions a year for their urinary tract infections, they’re getting some discomfort, maybe sitting down or wearing trousers or whatever, and then they’ve got itchy skin. And there may be dry eyes, stopped wearing contact lenses, restless leg seems a really common symptom in older people as well, actually.

Dr Anna Chiles [00:11:12] Yeah, absolutely. And again, that disturbs their sleep. And I think you’re right. I agree that people are still symptomatic often forever I would say. That they just… And it’s not until you replace the hormones and they feel better that they realise that those symptoms are related to their menopausal symptoms and that hormone deficiency. And it’s often not until after you’ve replace the hormones and they’re feeling better that they suddenly say, ‘Actually there were a whole lot of other symptoms that I just put down to ageing or life’. And then when they begin to feel better they say, ‘Actually I suddenly realise that I can feel better’. But also they’re often a little bit grumpy, delighted but grumpy with themselves that they’ve missed these years of what they presumed was normal ageing. And they quite often will say, ‘I’m so frustrated with myself, I’ve missed 20 years of my life because I’ve been dominated by these symptoms’ and that’s really sad.

Dr Louise Newson [00:12:11] It is really, really sad. And I, I spoke to quite a few people, at quite high level meetings actually, who still say that sleep disturbance, joint pains, they’re just ageing symptoms and nothing to do with the menopause. And I find that very difficult to know and of course we don’t know, but actually we know that there are other benefits from replacing hormones and you know, no one is forced to take hormones, but actually if they want to try, often symptoms can melt away. It’s not a placebo effect, I’m sure, because we’ve seen it so often and people don’t always expect certain symptoms like joint pains, or restless legs to improve. So I think it’s very unlikely to be placebo, especially with the sheer number of women that we see. But there are also health benefits aren’t there. We’ve talked at length on the podcast before about the cardiovascular risk reduction, osteoporosis, probably dementia, type two diabetes, bowel cancer reduces the women who take HRT, all sorts of things. But there’s always been this thing about if you start HRT within ten years of your menopause or under the age of 60, that’s the time to do it. And that’s great if you’re in your forties or fifties. Yeah, absolutely. But what if you’re 61 or 71 or goodness only knows 81 or 91? Anna what do we do? Do we just say absolutely no? Or where has this come from?

Dr Anna Chiles [00:13:32] Yeah, I think it’s a hangover from the WHI study 20 years ago that the conclusion of that was if you really have to take HRT then you shouldn’t have it for longer than five years. And then if you really have to, you shouldn’t have it longer than ten years. And I think we both as patients, but also as medical professionals, presumed that that was the cut-off and we became rigid about that. And actually, we don’t spend long enough looking at our patients holistically, I think. And actually sometimes you need to step back and think about the patient as a whole. For instance, I have a patient who is in her sixties and has been diagnosed with Parkinson’s disease, and it’s only sort of recently that I thought about her more holistically and thought about her menopause. And I said to her, ‘Can I talk to you about when you had your periods?’. And she had really terrible post-natal depression to the point where she was almost hospitalised and she was terrible and she had a terrible menopause and she’d never have HRT. And I have we’ve talked about the potential benefits for her, both from an emotional point of view, but potentially with some impact on her nerve conduction and her Parkinson’s, because we know that there may be some stabilisation or some support that it can do for Parkinson’s disease. So I have started her on some HRT and she feels both emotionally but also physically better. And she was displaying signs of what they thought was Parkinson’s dementia. And actually I think it was testosterone insufficiency. And now that she’s got some testosterone on board, actually, she’s been able to go back on her electric bike that she hasn’t used for a year because her muscle weakness was getting worse, her brain is functioning better and she’s more stable emotionally. And so this is a lady who was in her mid-sixties who hadn’t had HRT. So it’s got real important benefits for the older patients. And my mum for instance, she was part of that typical WHI generation. She’s in her mid seventies and she had a hysterectomy. She was on some HRT. And then it was stopped because of the WHI. And I think she thought, ‘Well, actually, I’m fine.’ She has not slept well for 20 years until about two or three years ago. And I said to her, ‘Mum, I really think you ought to go and see your GP and ask for some estrogen and see whether it helps you sleep’. She has not had a disturbed night’s sleep since she started her estrogen and she never slept a full night’s sleep.

Dr Louise Newson [00:16:09] So that’s amazing, isn’t it?

Dr Anna Chiles [00:16:11] And that’s a significant factor on poor sleep. And we know that sleep is so important for your body cells to repair. It helps prevent heart disease, it helps prevent weight gain, it helps improve your recovery from illness and injury. And it’s better for you physically, but also psychologically. So actually even just improving people’s sleep as you get older, then actually you’re going to improve their wellbeing.

Dr Louise Newson [00:16:36] Yeah, absolutely. And I think what’s really interesting is there’s this whole thing about ageing and anti-aging and there’s a massive debate that longevity and what we can do. But when we talk about biological ageing, it’s about low grade inflammation that goes on in our body and it’s about these inflammatory processes that predispose us to diseases of ageing. So many diseases, as I’m sure of you know, that are associated with ageing are heart disease, dementia, osteoporosis, and these are actually low grade inflammatory conditions. And what’s very interesting is when you look at where they’ve done studies of women that have had their ovaries removed at an earlier age and then followed them up for diseases, all these ageing diseases increase, but there’s markers that you can look. So we’re looking at some of the epigenetics where our genes change with ageing, but also there’s ways you can look something called methylation where there’s some chemical changes that occur in the cells. And we know that women who have an early menopause, they’ll age a lot faster and we know that’s associated with these diseases. And it’s very difficult, isn’t it? So there’s lots of people who say ‘Well, at 70 you are going to be aged, you are older. And are you reversing the biological clock?’ And it’s a massive ethical debate, you know. And how far do you go in medicine? Do you say, ‘Well, heart disease is ageing, let’s not treat heart disease’ or, ‘Some cancers can be related to age so do we not do…’ And that’s so difficult isn’t it.

Dr Anna Chiles [00:18:01] Yeah, but I think the important thing is actually ageing and being strong physically. So it’s not necessarily just about your heart health, it is about your bone health, but it’s about your muscle health. It’s about actually remaining mobile, keeping your balance, being able to remain independent, being able to wash yourself and go to the loo on your way, to be able to get up from your chair, to get up from your bed and remain as independent as possible. So actually my argument would be actually this is not about necessarily extending your life length, it’s about extending your quality of life and your independence and actually reducing the burden on your family, the health service, and also creating a better quality of life for you, because actually you can remain independent for longer. You know, our muscles begin to melt away from the age of 30, you know, actually. And that’s what we forget that actually we are starting this ageing process and we can do something about that. And that doesn’t involve medicine, that involves lifestyle, that does, I would argue, involve your hormones actually, and importantly estrogen for your bone strength. Because actually if your bones remain strong, you can remain active and you’re less likely to get a fracture. But also, really importantly, your muscle mass, and that is improved by weight bearing, exercise, strength training with weights, but also is improved by testosterone and the muscle mass. And the muscle stamina is improved and in turn, what that does is it actually enables you to keep active, to work your muscles and to keep that muscle mass going. So it’s partly that it helps your muscle mass, but it also helps you be able to have the motivation and the energy and the ability to improve that muscle mass.

Dr Louise Newson [00:19:51] Which is so important and that’s not about disease. That’s just about absolutely keeping strong and fit and active. And we use this term, sarcopenia, which is basically loss of muscle mass, which does happen as we age. And, you know, it’s very interesting when you talk about testosterone as well, because I’ve been reading quite a lot about testosterone. And most of the studies, as you know, in women is about libido. But there’s some good studies in men looking at testosterone can rebuild the myelin sheath which is surrounding this conduction surrounding of the nerves that helps fire our nerve impulses. So if we touch something hot we’ll immediately put our hand away, whereas if the mind isn’t working very well, then it takes a bit longer. But also it’s the way our brains work and our function. And you know, you say this lady with Parkinson’s, you know, there’s all sorts of these. And it has also to be very anti-inflammatory in the brain as well. It’s a biologically active hormone. And time and time again, we’re told it’s only for libido. Well, why do we have receptors in our brains and nerves in our muscles? Who knows? Because no one’s researched it. But it’s about time we did. Because actually, if it is helping people regain their muscle strength and actually, even if it’s only improving by 5 or 10%, that means people can use their Zimmer frame independently. I really worry that I won’t be able to have a bath when I’m older. Some of you might find I worry about osteoporosis because I think osteoporosis in the spine is painful, but it’s very disabling as well. But actually, I want to be able to have a bath, I want to if I do have grandchildren, if I don’t, my friends might have them, I would like to be able to lift them and put them on my knee. You know, I’d lile to be able to hold a book in bed without feeling really tired. So these little things.

Dr Anna Chiles [00:21:32] It’s also chronic pain, isn’t it? Actually, you know, if you have crumbling of your spine from osteoporosis, you are in constant pain. It’s awful, it’s debilitating. And then you’re on a whole host of very strong medication, which has side effects, which affect your ability to think straight, to affect your balance and affect your bowels, get you constipated. And so actually, there are other implications of that pain medication that is a result of your osteoporosis.

Dr Louise Newson [00:22:04] Yeah. So we had a lady a while ago, actually now about six, maybe more months ago who came for her 90th birthday. She decided to treat herself and she’d been suffering for many years, and she didn’t know whether her symptoms were related. The doctor that saw her had no ideas, but she decided she wanted to treat herself to some HRT. And in fact, many of her symptoms did improve, especially sleep. And there isn’t any really strong evidence to say we shouldn’t be giving hormones back. When we talk about WHI study, I mean, that was with the tablet estrogen and the older type progestogene so usually and I’m sure you’re the same, that if we give HRT to older women, we usually start with lowish doses and we give it through the skin as a patch or gel, usually with a natural progesterone as well. And so they don’t have a clot risk, which is something we wouldn’t want to give because as we get older, we’re more likely to have a clot, aren’t we? And it hasn’t been shown to be associated with a cardiovascular risk. Some people worry that if they did have some heart disease, so some disease of the blood vessels, it could make things worse. But there isn’t any good data about that. And people worry that if there was a little clot as part of the atheroma there and the blood vessels dilated because that’s what happens with estrogen, it relaxes the blood vessels, then that clot could dislodge. But one of the treatments for raised blood pressure is drugs that dilate blood vessels far more isn’t so that argument, I think I’ve done quite a lot of cardiology in the past, it doesn’t really sit right. I don’t know how you?

Dr Anna Chiles [00:23:38] No, I would agree. And I think my experience of older women who start HRT when they’re older, actually, they don’t need very much very high levels. They need a little tiny bit to just control those symptoms. And also, I like to give them and make sure they’re having enough to protect their bones because if they’re going to take it actually, that’s one of the reasons that I would encourage people to be thinking about it is actually partly to control the symptoms, but actually for those long term health benefits in their bones. And absolutely, I think when you’re younger, you sometimes need larger doses, but actually often when you’re older, you just need a little bit to keep everything ticking over and feeling happy. And I like to… I often say to my patients, I like to think of estrogen as connect four counters. Do you remember those games? And I say to them that each cell has got a little cup that fits that connect four counter in it. And as you become perimenopausal, you lose some of your connect four counters and you’re topping up with your some extra counters with your HRT. And then when you become menopausal, you’ve lost most of those connect four counters and all those cells are sitting with those empty cups. And actually when you’re older, you just need a little bit of those connect four counters to fill in those cups and keep their cells happy. And I often think that the cells feel happy once they complete with the counter in their cup.

Dr Louise Newson [00:25:00] Yes, that’s a very good analogy I like that. Won’t be able to play connect four the same with those red and yellow counters. But the other thing we’ve obviously talked about HRT, which is systemic hormone replacement therapy, but there’s also vaginal preparations and we know we’ve already said that urinary symptoms, vaginal, vulval symptoms, pelvic floor, you know, incontinence. All sorts of symptoms are related to low hormones, low estrogen and sometimes low testosterone in that area as well. So one of the treatments it’s very, very common is vaginal hormonal preparations, isn’t it? And so women, whether they’re on HRT or not, might still have symptoms. And these are very safe because they’re not absorbed into the body. So women who’ve had breast cancer or are on treatment for breast cancer can still very safely usually use those preparations, can’t they? And they can really make a difference for a lot of people, can’t they?

Dr Anna Chiles [00:25:49] Oh, they can be. Yeah, absolutely. Well, one that can be transformational for reducing infection and actually if you’re reducing the risk of infection, actually, potentially, if you’re getting recurrent infections, those infections could become quite severe and you could end up urosepsis so a widespread infection, which is awful but also they’re debilitating, having recurrent urinary tract infections. And a lot of women put up with the symptoms of dryness or the symptoms of irritation or discomfort and feel that that is just normal part of ageing. And actually, you’re absolutely right that vaginal estrogen is very safe and is very easy to use and for anyone of any age actually. But as you get older, it’s still very easy to use. It can be just as a cream that you can even just wipe on the outside. It doesn’t necessarily mean it has to be on the inside and that can be used, you know, for yourself. But also if your housebound and you need carers or you’re in a nursing home and actually your carers can use that and that can be part of your self-care, but also it can help reduce your risk of incontinence and then you’ll reduce your risk of pressure sores or soreness from your incontinence, reduce the risk of you needing to use pads all the time. And that is, I think, should be available for women. That’s part of being a holistic patient care. And I think we regularly prescribe things like for the barrier creams, so, kavalan or prosheild, these are all some special creams that help protect. Actually, they’re brilliant. But actually we should be thinking that some of these women need some vaginal estrogen to improve their bladder function, to improve their pelvic floor, and then they wouldn’t need the barrier cream because actually their incontinence would increase.

Dr Louise Newson [00:27:45] Yeah, and it’s so important. I used to and when I was a GP, quite a few women who had dementia, they would be getting out of bed several times the night. Their sleep was disturbed, as we’ve already discussed, but they’d even have to get up to go to the toilet and they’d wake up their carer, they’d sometimes fall and the carers often it’s a long suffering husband, would be absolutely shattered because they were getting interrupted sleep. And it wasn’t when they’ve been woken it obviously wasn’t in their own sleep rhythm as well. So sometimes it’s a little extra little flexible silicone ring that lasts for three months. I would insert it every three months because I do usually see these people for their blood pressure and whatever else, and that would really make such a difference, not just to them but their carers as well, because they would sleep, less risk of falls, less risk of urinary symptoms and if someone with dementia sleeps better then their cognitive state often improves as well. So there’s a huge amount we can do. And I’m certainly, and I know you’re not, we’re not ageist. Just because someone’s got a date of birth, a certain number, it doesn’t mean that they can’t have some holistic menopause care. So it’s really important, I hope, for those of you that have listened today, can share it with your maybe elderly relatives or just yourselves, really, and think about it. So we’ve covered a huge amount of information and I’m very grateful for your time today Anna but just before we finish, you’ve got to do three take home tips. So sorry, but three take home tips for people who maybe have been struggling for many years or know people that have been struggling for many years. What could be done?

Dr Anna Chiles [00:29:16] Yeah. So I would say it’s never too late to start HRT and it’s never too late to have that discussion with your health practitioner, your nurse, your GP actually remember that it can cause a multitude of – your menopause, can have a multitude of symptoms, and if you choose to try it, remember that you don’t have to continue it if you don’t like it. So nothing’s ever forever. So that would be my first thing. It’s never too late to start. Never be told you have to stop HRT just because of your age. And I think that’s really important because actually lots of patients quite often ask me, ‘When do I stop my HRT? How long am I on this for?’ And I always say, ‘Well, I personally never want to stop mine, and I would really advocate that you would never stop yours, because I don’t want to give you the benefits of good, strong bones, good strong muscles, cardiovascular disease prevention for five or ten years.’ And then say, ‘I’m really sorry. I think you now need to just go it alone and not have those benefits. Actually, I want you to keep having those benefits, to have an independent, strong ageing process and to minimise the chance of a fracture and the consequences of that’. So that would be a bit of a long winded second. And third one is I would say it’s very important to keep active, keep active, to keep your mobility, your balance, your independence as you age. And I think some of that is about being able to keep active. So keeping your joints pain free, keeping your muscles strong and keeping your balance so that it’s actually you’re able to keep active for as long as possible. And the more you use your muscles, the stronger they’re going to be. So actually, it goes hand in hand, I would say, with, you know, taking some hormones to enable you to maximise the chance of keeping active and keeping that body strong and fit and healthy and able to perform for you to help yourself keep as active and independent as possible.

Dr Louise Newson [00:31:20] Excellent. Really good sound advice. And I think that’s really important way to end, and is about whether you take HRT or not, exercise, keeping active is really key for all of us. So we need to get off now and start to walk around even though we’re really hot. Thanks ever so much for your time today Anna and I hope that’s been useful for everyone. So thanks very much.

Dr Anna Chiles [00:31:41] Well, thank you very much for inviting me. It’s been a pleasure.

Dr Louise Newson [00:31:45] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.

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Taking HRT forever – Ann Newson and Dr Louise Newson

kat keogh — Thu, 23 Sep 2021 14:49:23 +0000

In this week’s podcast, Dr Louise Newson has an open discussion with her mother, Ann Newson, about her personal views regarding taking HRT. Over 30 years ago, Ann was experiencing symptoms of severe fatigue which were negatively affecting her ability at work, prompting her GP to give her a prescription for HRT. Ann was then told that she was going through “The Change” but had no idea what that meant! The menopause was never spoken about at that time and she was given no information about it. However, taking HRT gave Ann her life back and her energy levels vastly improved. Fast forward to today and Ann is delighted to have learnt so much about the menopause from her daughter, Louise. In this episode, Ann also explains how many of her friends have developed breast cancer over the years despite none of them taking HRT. She strongly feels that women should be given a choice regarding hormone therapy and how she plans to stay on her HRT forever!

Ann Newson’s Three Take Home Tips:

Carry on! If you’re happy with your HRT then you don’t have to stop taking it
If you are feeling low, don’t think that you’re not menopausal just because you aren’t experiencing hot flushes and night sweats.
Don’t be frightened of HRT, it can be life-changing!

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