Possible to take HRT when I already have had DVT? Options

[warsawite]

Hello all! I used to visit this forum a year ago when I had missed my periods and am ever grateful for the advise of all.
I am now 49 years old and my periods went erratic since last year and now have completely vanished since the last 60 days.

I went to a good doctor here in Warsaw where I live and she did tests where my FSH is above 35. Also they found a small FIBROMA which she says is very small so not to worry!

Well she wants to start me on some form of HRT tommorrow when I go to her but I am very worried as I have already had a DVT once 7 years ago.

I was wondering is it really possible to just let ones periods end without doing anything? Or do any of you have any experience of taking HRT with a history of DVT?

She is calling me to the hospital tomm and she will give me HRT only after consultation with a GP but after reading the horror stories about the problems with increased risk of blood clots I am worried. (I also have a gall bladder stone as well)

I used to take Birth control Pills earlier on and maybe the DVT was caused by those (but no one knows for sure)

Please give me some advise as I wonder if its possible to just let the periods stop and do nothing else or is that harmful as well?

Thanks

[bchgrl65]

Hi warsa, I am definitely no expert here but lots of women go through menopause without taking any form of HRT. I know also that a lot of women who cannot take the horrid symptoms of going through menopause do take HRT as a last resort. I guess what am trying to say is how do you feel? Do you feel really horrible that you need the HRT route or do you think you can go through it without it. Is there a reason she wants to start you on HRT? I personally would be scared to take HRT or birth control pills if I have a history of blood clots. I would rather feel crummy for a while than be dead from a blood clot, but that is just my opinion. Hopefully others who are more informed in this area will be able to give you some advice. I am just in the beginning or middle stages of peri so not there yet. Please think about it before making a decision. Good luck.

[bchgrl65]

Both my mother and oldest sister have gone through the change without any form of HRT whatsoever. My oldest sister never even gave it a thought as an option and my mother, God bless her, probably never even heard the word HRT. She is now in her 70's and doing well.

[NiteOwl]

According to the ESTHER studies, HRT in a transdermal form (patch or gel) can be taken without any increased risk in developing blood clots. Whether you decide to take HRT is up to you - you'll need to consider your symptoms, lifestyle and the risks to your health with & without adequate hormones. It is an important decision so you may want to educate yourself on all the facts for both sides.

[warsawite]

Right now I dont have any symptoms as its only 60 days. But I am not very well informed as well as upto now was only in the Peri stage and always felt that the periods just stopped and we went on with our lives!

BchGrl 65 yes I am very worried mainly about the risk of blood clots so its nice to your family didnt use any HRT and are doing well. I am sure my mums also not used any as she is 79 now.

Nite Owl- Thanks for the tip about the patch.

Basically all she mentioned was that she wanted to restart my periods and that she wanted to give me hormones for the raised FSH which may give me hot flushes later and something about the uterus lining being or getting too thick?

I took the PILL for 10 years for Birth Control and never bothered about the fine print as felt that millions of women were taking it and surely it had to be safe!!!

[NiteOwl]

Did you have a transvaginal ultrasound to measure the thickness of the uterine lining? Although it is not unusual to skip periods during peri, periods can stop because you are not producing enough estrogen to build up a lining -or- because you've stopped ovulating and are therefore low on progesterone. You can build up a thickened lining if you continue producing enough estrogen without ovulating so taking a round of progestogens would slough off the excessive lining by bringing on a period.

[warsawite]

Nite OWL - Thanks for giving me this information. Yes I did the Ultrasound where this came up and also the FIBROMA. I am going to see her today and will post later what medication she advises.

[Floater]

Be very careful of synthetic hormones and particularly oral ones. Niteowl is right that transdermal is a better choice if blood clots are an issue. The study says there is no increased risk with the transdermal, no higher than taking nothing.

I also wonder why she wants you on hormone replacement before you are in a terrible state. I wouldn't have chosen to use them myself, if I could have avoided it. In my case, there really was not option.

[warsawite]

So I finally went to see her and she is giving me oral tablets for 10 days to induce the period.

But she has told me to go to a nurse and take CLEXANE injections for 10 days as well to prevent blood clots.

So she seems to be doing the right thing I guess for the moment.

Floater -Thanks for your post. Will keep it in mind.

I am not keen to start HRT for the long term and dont want to use blood thinning for life either!
But am not very well versed with Menopause either.
That is why I am hoping to be guided by the experiences of you all.

[warsawite]

The oral tablets she gave me are DUPHASTON 10 MG -1 TABLET DAILY
AND ESTROFEM MITE- 1 MG HALF TABLET DAILY FOR 10 DAYS.

When one read the literature about ESTROFEM its frightening!! But since she wants me to take blood thinners I am hoping I will be fine.

[NiteOwl]

Hi warsawite - It sounds like your doctor has it covered. It is only a 10 day course and it is the progestogen that will start your cycle. A day or two after the 10 days treatment you should begin a period. The doctor is adding a small dose of estradiol because often when your progesterone is low your estrogen is low too. Hopefully this will help you have less side effects while taking the progestogen...increased hot flashes, etc. The blood thinner is to help reduce your chance of forming a clot, of course. I don't think the doctor would keep you on this same therapy every month, it is basically to "jump-start" a period and therefore reduce the current uterine lining build-up (hyperplasia.) After the round of treatment, you will have to see what is suggested beyond. Let us know how it goes!

[warsawite]

Nite Owl- Thanks for your post. It sets my mind to rest about why she is doing this treatment.
You have taken a lot of trouble to explain so clearly to me as well.

I am just wondering what I should do eventually for the long term treatment? Do you have any idea if its possible to avoid HRT?
Considering I already have a old DVT, a small Fibroma and a gall Bladder stone!!!

And it seems HRT aggravates all of the above.

Yes I will definately let you all know how it goes.

[NiteOwl]

Hi [b]Warsawite[/] - Yes, there are many thousands of women who do not use daily HRT. The main reason most turn to hormone replacement is because the symptoms become too much to bear - especially when estrogens drop very low and hot flashes, brain fog, vaginal atrophy, anxiety, and insomnia set in. Some do not seem to be as bothered with symptoms as others....some have a hard time but struggle on hoping symptoms will lessen with time....but others are just not able to function without a higher level of estrogen. There are potentials for risk with & without HRT so that has to be taken into consideration too. If you are getting along well without HRT you can reassess as you go along...just make sure you keep a check on your bone health and cholesterol levels once you have reached menopause as other interventions may be needed once your protective estrogen is gone.

[RoundRobin]

Hi warsaw: You'll know if you need HRT...believe me! I went almost 2 years post without taking anything (except vitamins) and thought I would make it, but my estrogen levels were so low that I couldn't function.

I would take nothing unless you are so miserable that you can't stand it. The good news is that most women don't suffer that badly with menopause...then there's the rest of us. Good luck..

[warsawite]

So its morning now and I just took the first Clexane injection and popped the pills! I prefer morning time as its easy to remember them.

Night owl- Thanks for reverting once again. I used to think NOT opting for HRT would mean a lot of bleeding while going through menopause or even some form of cancer etc.
If its mainly for when estrogen levels fall too low then I would much prefer to wait it out and see-- since my DVT history is more worrying.

Round Robin- You have a very sweet name.
Am glad to know you gave it a shot for 2 years.During those 2 years did you just sit back waiting for your periods or did you keep going to the doctor after a while?

What I mean is my periods are delayed by 50 days for the first time. And so I went to this doctor.
(Resulting in a pretty severe form of treatment for me )
So is there some form of waiting it out during the first one or two years? After how long should a person go to the doctor?

[warsawite]

I was reading many posts where women are puzzling over taking hormones or the Birt Control Pill and so I am just adding my advice here since I was on the Birth Control Pill for 10 years called CILEST when I got DVT in my right lower calf.

I was always very particular with my yearly checkups and not once did my doctor mention that there were risks involved.

Yes I did read the fine print once in a while on my own and worry. Then I felt with so many of us so called highly educated baby boomers around we couldnt be doing something wrong!
That doctors would never allow something so dangerous to be produced in this day and age.

This clot was a nightmare for me in every sense of the word. I had to undergo 6 months of blood thinning.
Even today my life is not the same. My lower ankle swells up if I fly or sit for too long.

Please dont be flippant about your lives as I am sitting on the other side of the fence.


I was a non smoker , slim and exercised. I still resent the fact that the seriousness was never spelt out to me by my gynaec.I could have tried the LOOP instead.
Even today I am a positive person but the DVT looms over everything. I have to take Blood Thinning inections in my stomach for a small dose of HRT as you know now.

I also worry that all this Blood thinning may not be good eventually in the long run.

[aprillv68]

The last time i took synthetic hormones, in the form of BCP's to regulate my periods, i developed a major DVT in my leg, the recovery period took a total of 2-3 years (my leg is darker than my other one plus is still a little swollen) Never again for me.

[Rehma]

My mother worked with a girl who died in her early thirties from a blood clot which was attributed to the fact she was on BCP but she was also a smoker, so it does carry risks. She had two young children and it was such a tragedy, so it proves that everything carries risks although she being a smoker would of increased her risks.

Warsawite, considering your history, in the long run you may feel more comfortable seeing how you go through the transition without adding hormones to the mix, particularly if most of your symptoms are manageable. Unless you intend being on them for life you will eventually have to stop them anyway and go through hormone withdrawal one way or the other so perhaps in your case with your history, natural may be better.

I have been on HRT (transdermal patches) and BHRT (troche) for about 6 yrs. I stopped the BHRT 8 weeks ago. Even whilst on them I never felt that great and still had various problems. Since coming off the BHRT I've noticed a nagging pain I had on my right side under my rib cage has disappeared. The Dr. suspected this pain was from a cavenous hemangioma I have on my liver which they think is aggravated or caused by estrogen.

A lot of women have no or only minor symptoms going through menopause and just let nature take it's course. Unfortunately others have a really tough time and need help. You have already experienced problems from extra hormones, even though you were a non smoker, slim and exercised. I would try the natural route first in your case and give it more time and then if further down the track it becomes unbearable you could try low dose transdermals.

[larafalcon]

The last time i took synthetic hormones, in the form of BCP's to regulate my periods, i developed a major DVT in my leg, the recovery period took a total of 2-3 years (my leg is darker than my other one plus is still a little swollen) Never again for me.

Hi April:

Sorry to hear about your DVT - how long had you been taking the pill before this happened - also was it a high estrogen pill? were you a smoker? - also do you have genetic tendency to get blood clots - I have been taking the pill for 4 years now and I am very happy with it - my blood pressure is low and so is my cholesterol - before I went on the pill I got myself tested for blood clots - there is a test you can do called FACTOR V LEIDEN - and I think every woman should have that done before they take any kind of hormones.

Lara Falcon

[warsawite]

April- I am sorry to hear about your bloodclot taking so long to clear up. Yes even one leg of mine is thicker.

Rehma- Thankyou for your post.Your advise is absolutely right.
I hope the pain under your rib cage gets better soon!

I only want to ask you one question? As this is the first time my periods got delayed I went to the gynaec .
(Which was just as well as she did the hormones test,PAP smear,USG etc.)

If I want to try a natural menopause then how often does a person need to go to the gynaec? Meaning if there are no periods for a bit does one run off immediately or wait it out?

[Rehma]

Warsawite,

In the perimenopausal years there can be a lot of variations to your normal cycle ie. heavier, lighter, longer, shorter and missed periods (sometimes for months) and it can go on for years. If anything is worrying you check it out with the Dr. but during the peri years it is not unusual to miss periods.

Cheers,
Rhema

[warsawite]

Rehma- Thanks for replying.

[warsawite]

Hello! Can someone help me?

I took the HRT tablets for 10 days and felt the period would come once I finished taking them.

But on day 8 I have started a period whilst eating the tablets? Is this normal?--

Thanks

[NiteOwl]

Yes, this happens. It just didn't take a full 10 days of the progestogen for your lining to start breaking down.

[aprillv68]

Hi April:

Sorry to hear about your DVT - how long had you been taking the pill before this happened - also was it a high estrogen pill? were you a smoker? - also do you have genetic tendency to get blood clots - I have been taking the pill for 4 years now and I am very happy with it - my blood pressure is low and so is my cholesterol - before I went on the pill I got myself tested for blood clots - there is a test you can do called FACTOR V LEIDEN - and I think every woman should have that done before they take any kind of hormones.

Lara Falcon

I had been on for 6 weeks, before that my last time taking on a regular basis was from 1986 to 1991. The name of it was Necon, (the one that gave me the DVT) it contains estradiol and i think estrogen but i can't remember how much. I have had no genetic tendency whatsoever and still don't (i had blood tests to confirm that, maybe it was the one you mentioned? I don't know) I am a non-smoker. When i was in my 20's i took the pill off & on and never had a problem.

[larafalcon]

I had been on for 6 weeks, before that my last time taking on a regular basis was from 1986 to 1991. The name of it was Necon, (the one that gave me the DVT) it contains estradiol and i think estrogen but i can't remember how much. I have had no genetic tendency whatsoever and still don't (i had blood tests to confirm that, maybe it was the one you mentioned? I don't know) I am a non-smoker. When i was in my 20's i took the pill off & on and never had a problem.

Hi April:

Thanks for the info

I googled Necon - and its a pretty high estrogen pill - and estrogen can cause clots in older women - at our age low-dose contraceptives are recommended - did you take the same pill in your twenties - BTW how old are you?

[warsawite]

Night owl- I was hoping that my post would catch your eye as you seem VERY knowledgeable and helpful.

Thanks for replying.

Today is my last dose and my tummy is purple from the injections!!

I had gone to see another doctor just to get another opinion and he was suggesting LIVIAL daily for 30 days saying it would not interfere with my DVT history.

I am puzzled as to why all of them suggest Hormones straight away.

Anyway for now I am sticking to my current doctor as she is very methodical and meticulous. Will let you know how things go .

[NiteOwl]

Hi Warsawite - if you need to take hormones for symptoms or if you want to take it for the preventative effects ie. bone, cholesterol, etc. then I would really recommend asking about a non-oral form. Even if you don't have Estrogel available, there should be some type of estradiol patch that can be ordered.
You are at no increased risk for clots with the transdermal forms than someone who is not taking any estrogen at all, according to studies done. I know Livial is used in Canada & many European countries...the FDA would not approve it for use in the USA due to a higher risk of stroke.

[warsawite]

Night Owl- Yes I had read about LIVIAL and the stroke risk so did not start taking it.

I will definately ask about this PATCH that you are recommending.Do you know any brand name as such?

Thanks

[NiteOwl]

I use Estrogel instead of a patch, but any patch that is 17-beta estradiol should be fine. I don't know what brands are prescribed in your country but some of them here are Vivelle Dot, Alora and Climara patches. Then you need to use something like Prometrium for the necessary progesterone to protect your uterus or a synthetic progestin, if progesterone is not available.
If you are not having a hard time getting along without hormones it may be best to just hold off on using any. Many women continue to produce enough estrogen on their own (estrone through fat cells) that they can get by comfortably without starting any HRT. It is a decision that is entirely up to you in consult with your doctor.