HRT Safety

Thanks, Debbie,
I never would have read the study https://journals.lww.com/menopausejournal/fulltext/2024/05000/use_of_menopausal_hormone_therapy_beyond_age_65.3.aspx
I'd been so happy to be free of estrogen.

As a person who had breast cancer driven by estrogen and progesterone, I of course have concerns about this approach to HRT over 65. One in eight women get breast cancer, and 80% of those cancers are hormonal- and these stats come from a population that is apparently skewed older.

I though it was interesting that oral HRT is not the preferred route of administration anymore, so maybe that helps, along with different dosing.

I had to treat my cancer with an aromatase inhibitor that reduces estrogen (from the adrenals) below deductible levels. I went through menopause at 50 and had breast cancer at 63 and the meds cause a super menopause. So I get that there are discomforts.

I hope more studies are going on.

Gently, thanks for posting the direct link to this study which I didn't think to do. Yes there is a wide range of personal experiences with estrogen with different medical histories and conditions involved. I have only recently began looking into HRT and could never have imagined this possibility prior to my severe diagnosis 6 months ago as I too was so influenced by the WHI study. I am so grateful for all the invaluable information I've gained from this site. I have experienced bad, sometimes intolerable, side effects with majority of medications I've taken so wish to explore every option before considering OP medication. If I can at least stop the bone loss this would be a victory.

@debbie1956 have you read "Great Bones" by McCormick, the resource often cited here? If your DEXA scores aren't too bad, HRT might be worth trying, but that approach is apparently not strong enough to reverse more severe osteoporosis (according to my doctor and McCormick).

I am sensitive to foods and many many meds but was able to take Tymlos when I started at a low dose and ramped up. It works through the parathyroid so is also a hormonal approach, if you will. Just a thought from a fellow traveler who tried it too late- after fracturing.

Thanks for recommending "Great Bones", Yes I have read the entire 700 page book which was worth every page! That book has a vast amount of vitally important information I couldn't navigate this situation without. I know Keith McCormick doesn't promote HRT for women my age, with such low score and recommends it for prevention rather than regaining. There seems to be new information lately about the benefits and safety of HRT even for women long past menopause. I recently watched an interview with McCormick in which he states he has changed his position somewhat on HRT. I'm not hopeful the HRT can reverse my loss but hope it may stop the progression. My REMS Echolight fragility score showed incredibly that my bone quality was still on the border of green zone low fracture risk which may explain the mystery of why I haven't fractured yet with spine at -3.5! The REMS results were similar to DXA at -3 spine and -2.6 total hip compared to DXA at -3.5 spine and -2.5 total hip. I'm hoping with some quality of bone remaining and avoiding a fall I may be able to cope. I hope to start HRT in the near future with naturopath who specializes in it and menopause, but haven't consulted with her yet so not sure what she will recommend. I will have another DXA in 6 months, a year from my last. The internal medicine doctor from the Osteoporosis Clinic in Vancouver recommended Evenity which is at least an anabolic I would want. I would have wanted Tymlos if I chose a medication, but it appears Tymlos isn't available in Canada. I have read many of your posts on Tymlos which have been so informative and helpful for me. Thank you so much for sharing all your experience. The doctor said Forteo is available for a mere $12,000.00 a year! Evenity costs $8000.00. But even the cost is not my first reason for wanting to try all my options first. I may eventually book a video appointment with Keith McCormick if he still offers this. (Far less expensive than the medication costs!) Thank you again for responding.

Thank you! I’m under age 65 and intend to start HRT, as soon as I can get through my B12 deficiency crisis and find a provider to help me.

@debbie1956 those expenses are daunting but it seems you are considering medications at some point. I was confused about whether the REMS was reassuring or close to the DEXA!

For years I had a false sense of safety. I thought, as long as I don't fall. But at -3.7 spine, it just took one unfortunate movement to fracture 3 vertebrae in my lumbar spine. At the time I felt strong and powerful (McCormick says the same thing) . So that's just a caution. Lifting, twisting, opening windows etc. etc. are all risks.

I am more leery than most about HRT for anyone because my breast cancer was fed by hormones. But having gone through both menopause and the super menopause from cancer meds, I understand that people are uncomfortable, sometimes very uncomfortable. And the other angle of using HRT for bones makes sense. In my early days of osteoporosis I tried things that were milder approaches, including calcitonin- which is very weak!

I was not able to tolerate meds and tried for years. I could not tolerate Fosamax or Forteo and tried to get on a trial early on for Tymlos. I was so grateful to finally get on Tymlos with its adjustable dose. I could not tolerate Evenity and stopped at 4 months. We all tolerate different things and we should not have to suffer financially while we try!

Good luck and thanks for understanding that I only post because of my fracture experience 🙂 I hope you will share your experiences, whether with HRT or a med.

So happy to hear this, as I'm about to go in for a HRT consultation this week. It was suggested I start Tymlos, due to osteoporosis in my spine, but I am less afraid of HRT and encouraged to hear that it may be a good option to strong meds! (While I continue to pray for a CURE or more natural 'medicine' to keep our bones strong and healthy!)

@oitsu62 I was reviewing McCormick's book last night and again, he expresses the idea that HRT might maintain density but most likely won't increase it. I think fear drives a lot of decisions. For obvious reasons (cancer) I am way more afraid of HRT than Tymlos (especially since the dose of Tymlos can be played with). But what your post leaves out if the fear of fracture. I was way way more afraid of more fractures than Tymlos.

The hard part about osteoporosis, which I think sometimes increases our risk, is that it does not have symptoms. We feel fine, even strong. Fractures are not only painful but affect lungs, GI function, and ability to do things for oneself. They don't just happen from falls.

I am not sure why taking HRT after menopause ( a natural event) is more "natural" than using another kind of hormone, the parathyroid, to grow bone. People say strontium is "natural" but the therapeutic dose is 300 times the daily requirement, I just read.

Tymlos works- at least for many of us, and you can do bone marker tests to make sure it is working for you. You can start at 1/4 dose and move up. My spine went from -3.7 (severe) to -2.5 (borderline) and continues to improve.

If your DEXA's are better than -3.0 and your FRAX score is low, it is very reasonable to try HRT, diet and exercise so I am only posting for those with serious osteoporosis.

Thank you very much @gently, for posting this link! I found it being a very informative read.