Hormone Replacement Therapy (HRT) for Women

[Annalisa Eschmann]

I live in Fayetteville TN. There is no help here for Hormone therapy. I am suffering a great deal with menopause. I was on Veozah which helped all my symptoms. Through insurance It no longer covered my cost. I take a product called Hott Mama over the counter ( 2 weeks in). There is no relief. I am on estradiol cream and that is it. I have hot flashes, night sweats, my nerves are shot, I used to be patient. I am not the same and want to feel normal again. I heard the Huntsville area is where to go or Doctor's in Nashville or the virtual way. Small Town physician's are afraid to try the new way of medicine when it comes to hormones. Can anyone help me?

 

[engineernerd]

Whoa...any reason they won't prescribe estradiol and micronized progesterone? Those are very far from being a "new way of medicine," and the estradiol works great. 1 mg, don't let them give you the 0.5 mg pills.

I take 1 mg estradiol and 100 mg micronized progesterone each day. I pay $16.13 for 90 estradiol pills and $28.43 for 90 micronized progesterone capsules. The need for the progesterone is arguable; it's intended to reduce uterine-cancer risk.

I tried to tough it out at first, but then I read that the average duration of hot flashes is 7 years! It's 10 years for Black women!

And that stupid study (Women's Health Initiative, or WHI) that scared so many women and their doctors about traditional HRT should not have scared off any women who actually need it. Maybe not even any women at all.

 

[pacergal]

Did you stop HRT because your insurance won't cover it or because your PCP will not longer prescribe it? I am not clear from your post.
It is unusual for a medical provider to not RX HRT for menopausal women if they request it.
Are you using the max amount of the estradiol cream or can your dr up the dose?
If your dr will not prescribe, I would call your insurance to ask for a new GYN.

 

[engineernerd]

Are you using the max amount of the estradiol cream or can your dr up the dose?

The cream doesn't help at all with systemic symptoms, just with vaginal dryness.

 

[Jerry1]

I live in Fayetteville TN. There is no help here for Hormone therapy. I am suffering a great deal with menopause. I was on Veozah which helped all my symptoms. Through insurance It no longer covered my cost.

I looked up Veozah and it’s an expensive drug for sure. The site I looked at had the following recommendations to reduce the cost:

• Check if your insurance plan covers Veozah
• Use a manufacturer discount card
• Check if you qualify for a patient assistance program
• Use a pharmacy coupon

I’m on a very expensive drug and can tell you that the above steps are a good start. First, appeal to your insurance plan. My drug had to be authorized and with some help from your doctor, it’s possible that you can get it approved. Second, using a manufacturer discount card or patient assistance is another good step. When I was on commercial insurance, the manufacturer gave me a discount card and that eliminated my co-pay (they’re not allowed to offer that for Medicare patients, only commercial insurance). When I moved to Medicare, I went on patient assistance for one month last year because based on my income and the very high Medicare out of pocket amount, I qualified. On patient assistance, they gave me the prescription. Now that the Medicare out of pocket is “only” $2K, I don’t qualify for patient assistance. Hence, I paid the $2K max out of pocket and will have no further co-pays for my meds this year. As for the pharmacy coupon (like GoodRx), they would help, if available, but likely it will still be very expensive going that route.

I assume you’re on a commercial plan (not Medicare Part D). Try the appeal process and if you get the approval, combine that with the manufacturer assistance.

 

[engineernerd]

Link to a helpful overview of the history of HRT:

The Controversial History of Hormone Replacement Therapy

The history of hormone replacement therapy (HRT) started in the 1960s, with very high popularity in the 1990s. The first clinical trials on HRT and chronic postmenopausal conditions were started in the USA in the late 1990s. After the announcement of the first results of the Women’s Health...

www.mdpi.com

Unless I'm missing something, there is no need to use expensive new drugs, with all the unknowns they bring to the table. Pay more and be a guinea pig, or pay a lot less to get drugs that have been successfully used by millions of women, with an overall minor effect on their general health outside of the symptom relief.

 

[Koolau]

As I recall when DW was on HRT, it was cheap and effective. She and her Dr. were aware of the literature suggesting cancer risks. The relief was worth the risk. She eventually went off the drugs and transitioned almost instantly without many side effects.

I hope you find what you are looking for. DW suffered greatly until she found HRT with her Dr. Blessings.

 

[RetiredHappy]

Have you tried Estradiol 1mg? I was on it the moment my ovaries were removed, although I really did not need it for menopausal symptoms. I went on it for protection of the brain. I have since dropped to .5mg.

$0 copay.

 

[Live Free]

I live in Fayetteville TN. There is no help here for Hormone therapy. I am suffering a great deal with menopause. I was on Veozah which helped all my symptoms. Through insurance It no longer covered my cost. I take a product called Hott Mama over the counter ( 2 weeks in). There is no relief. I am on estradiol cream and that is it. I have hot flashes, night sweats, my nerves are shot, I used to be patient. I am not the same and want to feel normal again. I heard the Huntsville area is where to go or Doctor's in Nashville or the virtual way. Small Town physician's are afraid to try the new way of medicine when it comes to hormones. Can anyone help me?

I would look to online providers for HRT if you don't want to keep going to different doctors trying to find one that will prescribe what you want. Try looking through the Menopause subreddit on Reddit for others experiences with different online providers. I've seen many posts about this and I think you'll find good information there.

My gyn wouldn't prescribe HRT (just kept saying that this is part of life and eventually I would be out of it). So I asked friends going through the same thing if they had a doctor who would prescribe HRT. That's how I found my current gyn who is much better versed in menopause treatment, took my symptoms seriously, and got me to a much better place. HRT has been life changing for me in all the best ways.

 

[landover]

I guess now local doctors like Obgy/PCP should be able to prescribe HRT, FDA updated its guidelines.

HHS Advances Women’s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy

 

[landover]

I would look to online providers for HRT if you don't want to keep going to different doctors trying to find one that will prescribe what you want. Try looking through the Menopause subreddit on Reddit for others experiences with different online providers. I've seen many posts about this and I think you'll find good information there.

My gyn wouldn't prescribe HRT (just kept saying that this is part of life and eventually I would be out of it). So I asked friends going through the same thing if they had a doctor who would prescribe HRT. That's how I found my current gyn who is much better versed in menopause treatment, took my symptoms seriously, and got me to a much better place. HRT has been life changing for me in all the best ways.

It is so frustrating, argued with Hormone doctor (endo**st), he wouldn't agree on it, probably because not updated with lastest findings or not taking risk as it is not part of an established protocol, will try to sway opinion with FDA update and some excellent podcasts on uTube.

 

[ugeauxgirl]

I kept looking for a doctor who would listen to me. I eventually found a Dr i just love. I can't tell you how much better i feel now that i sleep well! My sister used one of those telemedicine docs, and eventually (after a few tries) got meds that made her more comfortable. Don't give up- HRT is really important for cardiovascular health!

 

[Cujet]

A man's point of view:

I miss the person my wife was pre menopause. And who she was on HRT, she stopped 10+ yrs ago, love life gone. Now she has many broken bones, shoulder replacement surgery from a fall, broken elbow, ribs and so on from another fall and broken foot from car crash. She went from vibrant woman to terrified (of more broken bones) old lady and won't leave the safety of the couch. HRT in high doses used to worsen some cancers, and while this is no longer as serious an issue, it can still be used as justification to avoid HRT. The alternative can be pretty tough to take also.

The two of us full of life, loving adventure nearly instantly morphed into a caretaker situation for me and near depression for her. In my opinion, she should have continued HRT.

 

[Koolau]

DW was "early" and then on HRT for quite a while. Now that she's been off HRT 20+ years, she has osteopenia and is "shrinking" rapidly. She's also lost most of her stamina and (even though I'm relatively sedentary) she can not keep up with me walking or doing chores, etc.

 

[athena53]

I'm about to look into this. Using topical estradiol for dryness Down There and no other noticeable symptoms but I just got a fancy scale (BodyPod) that measures bone mass, fat %, and other measures by sending a mild electric current through your body. I had a Dexa scan maybe 6 years ago and they found osteopenia in the hips. Plenty of weight-bearing exercise and calcium and magnesium supplements apparently did not help because my bone mass is rated "Low". Fortunately there's a doctor in my church who specializes in hormone re-balancing. I need to make an appointment with her.

 

[Koolau]

DW is finding it very difficult to treat her osteopenia also. She has a PCP and an endocrinologist following her with no improvement.

I don't know if they ever consider HRT for the "elderly" just to treat OP. I'm gonna ask next Dr. visit.

 

[Cujet]

DW is finding it very difficult to treat her osteopenia also. She has a PCP and an endocrinologist following her with no improvement.

I don't know if they ever consider HRT for the "elderly" just to treat OP. I'm gonna ask next Dr. visit.

Older women, 60+ who start HRT late have a 30-40% reduced fractures, dose dependent. Women that stay on HRT from menopause are said to have dramatically reduced bone fractures, about 50%+ better.

Benefits exist even when starting after age 70. It makes sense some bone benefits remain after stopping HRT, if on HRT for more than 15 years. In other words, the strong bones remain strong.

Put another way, no other treatment is as effective.

I've been learning all about this, due to disaster.

 

[tmm99]

Older women, 60+ who start HRT late have a 30-40% reduced fractures, dose dependent. Women that stay on HRT from menopause are said to have dramatically reduced bone fractures, about 50%+ better.

Benefits exist even when starting after age 70. It makes sense some bone benefits remain after stopping HRT, if on HRT for more than 15 years. In other words, the strong bones remain strong.

Put another way, no other treatment is as effective.

I've been learning all about this, due to disaster.

It may have benefits, but risks are much higher if you start HRT long after menopause.


The general consensus now is that HRT is safest and most effective when you start it within about 10 years of menopause or before 60. Starting it much later tends to come with higher risks for heart disease, stroke, blood clots, and in some cases cancer.


I started mine BEFORE my period stopped due to perimenopausal symptoms. I’m now 66 and my family doctor in Ontario recommended I stop when I turned 65. I figured he’s just a family doctor, so I asked to see a menopause specialist, and the specialist told me that I could stay on it as long as I still benefit from it, regardless of age. He said he wouldn’t start someone my age on HRT for the first time, and when I looked into it, what he said matched what I found: you want to start soon after menopause; otherwise the risks are high.

I read a book called Screaming to Be Heard, which debunked the flaws in the earlier studies and the interpretations of the results, and decided to get on bio-identical HRT at an earlier age even though a lot of women were getting off it in previous years. I’m glad I did.

I'm not saying you shouldn't start at 70+; you should just weigh the risks against the benefits carefully.

I feel for women who’ve been toughing it out without any HRT. I tried to get off it at the urging of my family doc before I met with my menopause specialist, and I was miserable. I was depressed, anxious, and dry everywhere (including down there), and the hot flashes were horrendous. I felt wrinkly and old, and it felt like my body was preparing to die.

 

[gattara]

I was very lucky to finally get a gynecologist prescribe me cream, estrogen patches and oral progesterone last year. At 57, I had been dealing with insomnia, dryness and anxiety for a few years since menopause at 52. She said the earlier I start, the better, due to the many positive health effects, especially with bones. She told me she has no issue with me staying on them for life if I remain a good candidate. She recommended the book The Menopause Manifesto by Dr. Jen Gunter, who sifted through evidence-based studies to determine that HRT should definitely be prescribed for women who need it. The benefits outweigh the risks for many. I’ll be darned, much of what the FDA Commissioner said a couple weeks ago mirrored what she wrote in her book. I highly recommend her book.

I am grateful to be under 60 and able to start HRT. I truly feel for older women who missed the window due to the gross inaccuracies of info over the last couple of decades. Shameful.

 

[gattara]

I'm not saying you shouldn't start at 70+; you should just weigh the risks against the benefits carefully.

I feel for women who’ve been toughing it out without any HRT. I tried to get off it at the urging of my family doc before I met with my menopause specialist, and I was miserable. I was depressed, anxious, and dry everywhere (including down there), and the hot flashes were horrendous. I felt wrinkly and old, and it felt like my body was preparing to die.

We seemed to write at the same time and had similar thoughts and circumstances. It will be interesting to see if doctors start prescribing to those older than 60. I think many older women will seek it and I can’t say I blame them. But whether it will be prescribed? Hmmm, time will tell.

 

[athena53]

It may have benefits, but risks are much higher if you start HRT long after menopause.

The general consensus now is that HRT is safest and most effective when you start it within about 10 years of menopause or before 60. Starting it much later tends to come with higher risks for heart disease, stroke, blood clots, and in some cases cancer.

Well, THAT's not good news on my side. I never really considered HRT because my symptoms were not that bad. I figure this doc will be on top of the age issue and will definitely ask her thoughts on it.

 

[engineernerd]

It may have benefits, but risks are much higher if you start HRT long after menopause.

The general consensus now is that HRT is safest and most effective when you start it within about 10 years of menopause or before 60. Starting it much later tends to come with higher risks for heart disease, stroke, blood clots, and in some cases cancer.

Too much of the current science around HRT ignores or minimizes osteoporosis and fragility fractures, and too much of the current science around osteoporosis and fragility fractures ignores HRT.

In this study, they found there were more hospitalizations for osteoporotic fractures among women 55 and older (4.9 million) than hospitalizations for stroke (3.0 million), myocardial infarction (2.9 million), or breast cancer (0.7 million):

Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States - PubMed

These data provide evidence that in US women 55 years and older, the hospitalization burden of OFs and population facility-related hospital cost is greater than that of MI, stroke, or breast cancer. Prioritization of bone health and supporting programs such as fracture liaison services is needed...

pubmed.ncbi.nlm.nih.gov

So when your doctor warns you to stop or avoid HRT because of increases in those other risks, he or she is not serving you well IMHO. Especially since current HRT drugs are likely to increase those risks less than the older drugs for which those increased risks were studied.

There seems to be almost no research into bone-health benefits of HRT for women much past age 70 or so. I did find the following, which is only a small short-duration study looking at bone density published in 2001:

https://jamanetwork.com/journals/jama/fullarticle/194094

 

[badatmath]

YLE had a brief article about removing the black box warning on this last week. Beyond the black box: What women deserve to know about menopause hormone therapy

 

[engineernerd]

Thanks, but I think that YLE article still reflects too much of the WHI (Women's Health Initiative) authors' anti-HRT bias. The WHI study found, without comment, that there was no difference in all-cause mortality between the HRT and placebo arm. Other researchers have since pointed out that the type of breast cancer that HRT increases women's risk of is non-aggressive, very treatable, and has a very high survival rate.

The most infuriating thing about WHI is that they totally ignored osteoporosis. They could have tracked it alongside their breast cancer, heart disease, and stroke risk, but nope.

 

[Koolau]

Thanks, but I think that YLE article still reflects too much of the WHI (Women's Health Initiative) authors' anti-HRT bias. The WHI study found, without comment, that there was no difference in all-cause mortality between the HRT and placebo arm. Other researchers have since pointed out that the type of breast cancer that HRT increases women's risk of is non-aggressive, very treatable, and has a very high survival rate.

The most infuriating thing about WHI is that they totally ignored osteoporosis. They could have tracked it alongside their breast cancer, heart disease, and stroke risk, but nope.

Hip fracture mortality is incredibly high (something like 30% of women with HF die within a year). I think that alone would suggest HRT might be a suitable treatment for osteopenia/osteoporosis but I'm not a doctor.