How are we supposed to know what to do about HRT when drs all give wildly different advice?

[Anonymous]

I have friends in europe whose drs all rx hrt for them in their 40s. they are thrilled. I'm in NYC and no gyn that I've consulted with will rx hrt for pre menopausal woman. All say the evidence connecting it to cancers is still too compelling. They will rx the pill.

then instagram also says - take a bunch of hormones.

Are they wrong? Are my friends drs wrong? is instagram wrong? help.

[Anonymous]

Anonymous wrote:I have friends in europe whose drs all rx hrt for them in their 40s. they are thrilled. I'm in NYC and no gyn that I've consulted with will rx hrt for pre menopausal woman. All say the evidence connecting it to cancers is still too compelling. They will rx the pill.

then instagram also says - take a bunch of hormones.

Are they wrong? Are my friends drs wrong? is instagram wrong? help.

OP please tell us that you aren’t serious about getting medical advice from instagram. Then we can have a meaningful discussion.

[Anonymous]

The science and the studies are complex. Have you read Dr Gunter’s book?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have friends in europe whose drs all rx hrt for them in their 40s. they are thrilled. I'm in NYC and no gyn that I've consulted with will rx hrt for pre menopausal woman. All say the evidence connecting it to cancers is still too compelling. They will rx the pill.

then instagram also says - take a bunch of hormones.

Are they wrong? Are my friends drs wrong? is instagram wrong? help.

OP please tell us that you aren’t serious about getting medical advice from instagram. Then we can have a meaningful discussion.

op - obviously not in a vacuum no! but i think it's of note that instagram is full of exhortations to take HRT for women 35+.

[Anonymous]

Anonymous wrote:The science and the studies are complex. Have you read Dr Gunter’s book?

op - i have not.

[Anonymous]

Docs being willing to Rx the pill is so insane. The hormone doses are so much higher!

[Anonymous]

Anonymous wrote:Docs being willing to Rx the pill is so insane. The hormone doses are so much higher!

i think pill controls your own hormones, hrt adds hormones. right?

'unlike typical HRT which supplements hormones in your body, birth control pills literally take over.

They override your own hormonal production — in effect, signaling your ovaries to take a breather and stop producing estrogen and progesterone — and supplant it with the hormones in the pills themselves.

In other words, you get just what is in the pill. You’re not adding hormones on top of what you’re producing on your own, but literally replacing them

It’s also a key reason why birth control pills are often prescribed if you’re perimenopausal and suffering with symptoms: In perimenopause, you’re still producing non-menopausal (that is, higher) levels of estrogen and progesterone on your own, so adding more hormones (as you would if you went on standard HRT) might actually make you feel worse.'

https://www.earlymenopause.com/information/topics/hrt-vs-birth-control/

[Anonymous]

Do you have a specific issue necessary to treat, OP? Or just menopause in general.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Docs being willing to Rx the pill is so insane. The hormone doses are so much higher!

i think pill controls your own hormones, hrt adds hormones. right?

'unlike typical HRT which supplements hormones in your body, birth control pills literally take over.

They override your own hormonal production — in effect, signaling your ovaries to take a breather and stop producing estrogen and progesterone — and supplant it with the hormones in the pills themselves.

In other words, you get just what is in the pill. You’re not adding hormones on top of what you’re producing on your own, but literally replacing them

It’s also a key reason why birth control pills are often prescribed if you’re perimenopausal and suffering with symptoms: In perimenopause, you’re still producing non-menopausal (that is, higher) levels of estrogen and progesterone on your own, so adding more hormones (as you would if you went on standard HRT) might actually make you feel worse.'

https://www.earlymenopause.com/information/topics/hrt-vs-birth-control/

Not quite:
“Currently, combined hormone replacement therapy (HRT) or the combined oral contraceptive pill (COCP), both of which contain estrogen and progestin, are commonly prescribed. HRT is often considered more “physiological,” because most preparations contain estradiol, which is found naturally, whereas COCPs contain the synthetic ethinyloestradiol and also higher doses of progestin. COCPs are recognized to increase the risk of venous thrombo-embolism (it is doubled with levonorgestrel-containing COCPs) and are also considered a risk factor for cardiovascular and cerebrovascular disease (11). Oral HRT also increases venous thromboembolism (12). Estradiol has less thrombotic effect than ethinyloestradiol (13) but its clinical effect in younger women has not been evaluated. In women under 60 HRT does not increase cardiovascular disease (12). However, many young women dislike the idea of taking a medication designed for older women and find the COCP more “peer friendly.” To date, only one small crossover trial has compared the effects of HRT vs COCP in POF (14). Most of the women included in this trial had Turner's syndrome or iatrogenic POF. No difference in bone density between the regimens was found, but only 18/34 completed follow-up, and each treatment was taken for just one year. No studies have compared HRT and the COCP in purely spontaneous POF. It is also recognized that there are a significant number of women who decline estrogen treatment in spite of the recommendation to take it (3, 15, 16), and we have no specific information on which to advise these women on the likely effects of this choice.”

https://academic.oup.com/jcem/article/101/9/3497/2806843#

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Docs being willing to Rx the pill is so insane. The hormone doses are so much higher!

i think pill controls your own hormones, hrt adds hormones. right?

'unlike typical HRT which supplements hormones in your body, birth control pills literally take over.

They override your own hormonal production — in effect, signaling your ovaries to take a breather and stop producing estrogen and progesterone — and supplant it with the hormones in the pills themselves.

In other words, you get just what is in the pill. You’re not adding hormones on top of what you’re producing on your own, but literally replacing them

It’s also a key reason why birth control pills are often prescribed if you’re perimenopausal and suffering with symptoms: In perimenopause, you’re still producing non-menopausal (that is, higher) levels of estrogen and progesterone on your own, so adding more hormones (as you would if you went on standard HRT) might actually make you feel worse.'

https://www.earlymenopause.com/information/topics/hrt-vs-birth-control/

Not quite:
“Currently, combined hormone replacement therapy (HRT) or the combined oral contraceptive pill (COCP), both of which contain estrogen and progestin, are commonly prescribed. HRT is often considered more “physiological,” because most preparations contain estradiol, which is found naturally, whereas COCPs contain the synthetic ethinyloestradiol and also higher doses of progestin. COCPs are recognized to increase the risk of venous thrombo-embolism (it is doubled with levonorgestrel-containing COCPs) and are also considered a risk factor for cardiovascular and cerebrovascular disease (11). Oral HRT also increases venous thromboembolism (12). Estradiol has less thrombotic effect than ethinyloestradiol (13) but its clinical effect in younger women has not been evaluated. In women under 60 HRT does not increase cardiovascular disease (12). However, many young women dislike the idea of taking a medication designed for older women and find the COCP more “peer friendly.” To date, only one small crossover trial has compared the effects of HRT vs COCP in POF (14). Most of the women included in this trial had Turner's syndrome or iatrogenic POF. No difference in bone density between the regimens was found, but only 18/34 completed follow-up, and each treatment was taken for just one year. No studies have compared HRT and the COCP in purely spontaneous POF. It is also recognized that there are a significant number of women who decline estrogen treatment in spite of the recommendation to take it (3, 15, 16), and we have no specific information on which to advise these women on the likely effects of this choice.”

https://academic.oup.com/jcem/article/101/9/3497/2806843#

1. This study was to assess the efficacy of the pill vs hrt to increase bone density in women with pof and
2. It doesn’t contradict the above. It mentions that the type of estrogen in each one is different.

[Anonymous]

No one knows yet, OP. The science is not settled.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have friends in europe whose drs all rx hrt for them in their 40s. they are thrilled. I'm in NYC and no gyn that I've consulted with will rx hrt for pre menopausal woman. All say the evidence connecting it to cancers is still too compelling. They will rx the pill.

then instagram also says - take a bunch of hormones.

Are they wrong? Are my friends drs wrong? is instagram wrong? help.

OP please tell us that you aren’t serious about getting medical advice from instagram. Then we can have a meaningful discussion.

Not OP but when I was on bed rest for several months I learned a ton about menopause and HRT from TikTok. There are a lot of great doctors who are trying to correct misconceptions about menopause and social media is the best platform those doctors have for that. I suspect that if it weren’t for those doctors raising awareness on social media, that recent NYT article about the risks of HRT being overblown wouldn’t have been published. Women’s health issues just don’t get as much attention in traditional media.

[Anonymous]

I would check out this website, OP. One thing to remember is that the way we define menopause—one year with no period—is totally arbitrary. The decision about when to start HRT should be based on the individual and not a rigid, arbitrary rule like one year with no periods.

https://thepauselife.com/

[Anonymous]

If HRT were dangerous, wouldn't women who go through menopause at later ages also be at risk for cancer? If doctors really cared about this risk, wouldn't they use imaging and biomarkers to mitigate the risk? Why suggest that all women should suffer?

[Anonymous]

I decided to trust my menopause educated physician and stick with her advice. Thus far I feel fabulous on it and do not have reasons to not be on it. As more research becomes available I will pivot, if need be.