Have you been told no to hrt if you are 10+ years post menopause?

Posted by gravity3 @gravity3, May 16, 2024

Starting hrt 10 years post menopause and the flawed Women's health initiative study.
I have been told no and yet the current findings seem to indicate that hrt can still help.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

Profile picture for chiefsmom @chiefsmom

I am 66 and asked about HRT and Bioidentical hormones and she said it would take 6 to 8 years to see any improvement in bone density.

Jump to this post

@chiefsmom I was told HRT would not improve my BMD but would keep it from getting worse.

REPLY
Profile picture for gravity3 @gravity3

@lilac2025

At 76 I started bhrt for a number of reasons. My primary was not "curing" my Osteoporosis. I have take bone meds for quite awhile with good results. However I also knew that it could offer some support to my bone health. I have had wonderful results for my libido, urine incontinence, senile purpura, muscle resilience, mood, sleep among others.

Jump to this post

@gravity3 - are you taking testosterone, too? Creams? Patches? Oral?

REPLY
Profile picture for singingbones @singingbones

@gravity3 - are you taking testosterone, too? Creams? Patches? Oral?

Jump to this post

@singingbones

Testosterone/estradiol pellet, vaginal estradiol cream, progesterone caps.

REPLY
Profile picture for mayblin @mayblin

@pattiel

Thanks for sharing your thoughts. The key in deciding on HRT is individualized risk assessment with shared decision-making.

It’s true that oral estrogen carries different risks than transdermal forms, which is why many clinicians prefer patches nowadays.

From what I understand, there isn’t a strict guideline that prohibits starting HRT more than 10 years post-menopause - timing is a factor, but not an absolute rule. A low CAC score isn’t an automatic stop either; for example, mine was 38, but it was evaluated and deemed safe for me to use HRT. Your PFO though might be a factor that shifts your personal risk–benefit balance.

That said, clinical practice can vary widely, as many members here have seen. When in doubt, getting second opinions could help. I had additional consultations with both cardiology and gyn specialists to make sure HRT was appropriate for me 11 years after menopause. And of course, the endocrinologist managing osteoporosis also has a say in whether HRT is an appropriate option.

Jump to this post

@mayblin

Could you please clarify 2 things:
1. The statement that a 'low' CAC score is not an automatic stop (for hrt.) I would have thought a high CAC score would be more troublesome.
2. What is 'PFO?'

REPLY
Profile picture for mahonlye @mahonlye

Cardiac health risks, risk of stroke, risk of blood clots and breast cancer risk are all looked at prior to approval to start on HRT at any time but especially if 10 yrs or greater into post menopausal period

Jump to this post

@mahonlye

Would it be possible for you to provide the medical/scienfic authority for this list of risks looked at prior to HRT approval?

I am an ovarian cancer survivor and was told over 10 years ago, when I mentioned the possibility of estrogen replacement to the oncologist who is responsible for me still being alive , absolutely not.

He moved to another state so not someone I can easily consult at present and i have never found another gynecological oncologist of similar expertise.

REPLY
Profile picture for rjd @rjd

@mahonlye

Would it be possible for you to provide the medical/scienfic authority for this list of risks looked at prior to HRT approval?

I am an ovarian cancer survivor and was told over 10 years ago, when I mentioned the possibility of estrogen replacement to the oncologist who is responsible for me still being alive , absolutely not.

He moved to another state so not someone I can easily consult at present and i have never found another gynecological oncologist of similar expertise.

Jump to this post

REPLY

I’m thinking for you having a gyn cancer diagnosis is why you would be a NO for HRT. Wouldn’t your cancer be affected by estrogen?

REPLY
Profile picture for rjd @rjd

@mayblin

Could you please clarify 2 things:
1. The statement that a 'low' CAC score is not an automatic stop (for hrt.) I would have thought a high CAC score would be more troublesome.
2. What is 'PFO?'

Jump to this post

@rjd
Any CAC score above zero indicates the presence of calcified plaque, which reflects a later stage of atherosclerosis. At the same time, a CAC of zero doesn’t guarantee there’s no plaque at all, it simply means there’s no calcified plaque; soft plaque may still be present.

I was replying to @pattiel because she mentioned her CAC score was 24. Like her, I had a small reading of 38 before considering HRT. At first, not knowing the full scope of assessment, I thought my chances of being on HRT were very slim due to having advanced atherosclerosis. But after evaluations by two cardiologists, I realized they consider many factors, including but not necessarily limited to: family history and genetic markers such as Lp(a), metabolic health, blood pressure, lipid panel (LDL-c or ApoB), CAC score and other heart conditions. All of the information is used to estimate overall cardiovascular risk, with or without HRT.

So to my understanding, neither a low nor a high CAC score is an automatic stop. A very high CAC score will certainly shift the conversation and influence the discussion to some degree. Ultimately, the score must be interpreted in the context of the complete picture of cardiac health.

@pattiel mentioned she has a patent foramen ovale (PFO). I’m not fully familiar with the specifics, but I suspect her cardiologist was considering potential increased clot risk if she uses HRT. Other conditions, like Afib, also increase clotting risk and may influence HRT decisions in some cases.

REPLY
Profile picture for mahonlye @mahonlye

Thank you, yes, exactly… you have to be pro- active and find out all the info , risk factors and where you are in that scenario. It’s very individual. There are so many new, updated views on this very complex treatment and the former research had to do with Premarin and not the patch which is now considered much less a risk.. since I am 10 yrs post menopause, but low risk in all the other health considerations, my GYN Dr at Yale brought my case to the GYN board there to discuss and the experts on this GYN board overwhelmingly agreed they would start me on HRT ….

Jump to this post

@mahonlye , good for you! My doctor has not caught up with the new findings, so he tells me no, just take calcium and D. Sadly, another study recently came out basically saying elderly women in nursing homes that were in the study, who took calcium from supplements were most likely to have heart attacks! I have quit my calcium supplements and am trying to eat foods high in calcium. Luckily, I like kale. Going to run this past my endocrinologist, who is a woman, next month. Just curious, is your doctor male or female?

REPLY
Please sign in or register to post a reply.