To HRT or not to HRT - that is the question

Happy Valentine's Day everybody!

Whether you're into this over hyped, commercial holiday or not*, today is a great day to think about love in all it's shapes and sizes. Love for the friends and family in your life. Love for your pets, or your home, or your job. And of course, love for yourself and your lady bits.

*Scrooge alert - I am very much in love with a man who treats me like a queen, BUT hate that we have to prove it by spending money on this one day, and reeeeally hate everyone's need on social media to outdo everybody else. "My Valentine is better than your Valentine"....hmm, doubt it, it's just that every relationship is different and I might be secure enough about mine that I don't need to justify it to the world with filtered photos on Facebook. And I certainly don't need to hint at the crude hanky panky that could occur, just so you know I'm getting some. Yawn, you're boring, unfollow.

All that said, I do like a card and pressie. It's complicated.

A couple of weeks ago, I trundled off to my GP following my lovely Christmas Eve letter telling me that my latest blood test showed I was post-menopausal and I should start hormone replacement therapy (HRT). I finally got to meet with the doctor who has been receiving a copy of all my hospital letters since day one - a mad professor looking chap who I liked very much, but did make a couple of comments that he probably shouldn't have, like "well we have shrivelled your ovaries". You sure have.

I told him that I really didn't want to take anything I didn't need to, or put any kind of medical concoction in my body that shouldn't be there. Probably a bit late to be worrying about that, after all the very unnatural things I've let doctors do to my body over the last couple of years. But now I have a bit of control over it and the time to weigh up my options, I want to make sure anything I do is absolutely necessary.

Another thing that adds to my wariness is having had the contraceptive implant for 6 years. Although I had it removed a year or two before I was diagnosed, I wonder what effect that had on my body, and more importantly, my cervix. Someone I used to work with sent me a message when I was first 'with Bob' and advised me that if I was taking any kind of contraceptive pill I should stop immediately. She'd been diagnosed with bowel cancer and her oncologist had advised her the same, as there were studies that showed these pills are linked to cancer. Although I never looked in to it fully, I did have a look at the side effects of the Nexplanon implant on the little info sheet they give you (that no one ever looks at, right?) and, shock horror, would you believe it - an increased risk of cancer. It was only a very small percentage, but it was still something that may have caused or encouraged my cancer. And I don't remember that being discussed when I asked for the implant.

Perhaps things have changed, but as I try to research it more now, I can't find this listed as a side effect on any of the official websites Nexplanon direct you to for more information (including the NHS choices and fpa websites). Talkchoice (not picking on them, there are many similar lists available) use a quick and easy comparison diagram to help you choose which contraception is right for you. This is great as an overview of their ease, but pretty inadequate when it comes to your health.

What makes it more complicated to research is that the implant brand changed from Implanon to Nexplanon during my 6 year stint, so I've had one of each.

The patient information leaflets for both implants that are available online now (although not that easy to find and both dated 2016, so different to the ones I was given) state that you shouldn't have the implant if you have or have had a genital cancer, but there is no mention of the contraceptive causing one. Nexplanon.com does talk about potential risk for those who have had breast cancer, but interestingly it is only the US version of the Implanon website that states "Some studies suggest that the use of combination hormonal contraceptives might ... increase the risk of cervical cancer..." about half way down it's list of Selected Safety Information.

Confusing, right? Considering the contraceptive implant works by thickening the cervical mucus, it's of course going to have some impact on it in the long term. But it's really bloody hard to find out what impact this little match stick is going to have on your hoo-hah's future health.

Maybe this is something that needs to be addressed - a bit of clarity on the link between the contraceptive implant and cervical cancer, if there is one, and perhaps some kind of combination of the implant and your smear test. Considering the implant is only effective for and needs to be changed/ removed every three years, wouldn't it also be the perfect time to offer a smear test? Perhaps if more people were aware that this contraception could increase their risk of cancer they might be more open to the idea. Plus it might be a welcome distraction from the sounds of a scalpel scratching and scraping through your arm and scar tissue to try and remove a well-stuck implant (makes my tummy flip even now, thinking about it. Vom).

My GP was very understanding of my concern, but told me the main reason I was being advised to take HRT was to protect my bones and reduce the chance of osteoporosis in the future, as I'm having my menopause at such a young age. It would also help with any menopausal side effects I might have - so far I've only been hit with some hot flushes, but even this I've managed to master, touch wood. I've worked out I need to layer up and when I feel my body starting to get to that hot stage, strip. Scarves are particularly handy, as my shoulders and the back of my neck are the main areas I can feel the hot build up. So I can whip off a scarf quickly and cool down easily. It's not a guaranteed fix, and there are the odd moments of face-on-fire, but no sweats and no beetroot face. All in all I've been very lucky so far, considering the other common symptoms are night sweats, mood swings, reduced sex drive and vaginal dryness (I'm sure you'll all be thrilled to hear my sex life hasn't been too badly affected so far, but more detail will be saved for another blog).

Our meeting finished with the doctor giving me a prescription and telling me to take some time to research the pills before deciding what to do. He also advised me that if I do decide to try them, to persevere through the side effects for a while. Oh for God's sake. More shitty side effects.

The tablets have been sat in my handbag for 3 weeks now, whilst I put off research in favour of my week-long birthday - birthday holiday, my actual birthday, a birthday celebration weekend... - and now waiting for my 6 month check up with my oncologist next week (err, where did those 6 months go?! Half way to that year mark though, hooray!).

I figure there's no point starting them now if they're going to find something scary at this next appointment and I'll have to stop taking the HRT anyway (ever the optimist). Plus, I don't want a new side effect from the tablets to get confused with a symptom of Bob returning and getting me all confused before my check up. Once I know that things are OK (because they will be!!), I can then feel reassured that anything new and weird that happens to my body is down to the HRT and not Bob.

So even though I'm not going to start taking the tablets yet, here is what I have found from some research into the pros and cons of HRT -

Cons

I need to take it until my natural menopause would have occurred, so until I'm around 50 years old. 20 years of tablets. Boo.

The pennies! I would need to take a combined HRT tablet, which provides a replacement of both of the female hormones (oestrogen and progestogen) usually produced by the ovaries, as I still have my womb in place (women who have had a hysterectomy only need one of these hormones). This means that I have to pay for 2 drugs, and therefore 2 prescription charges. That's £17.20 every 3 months, which doesn't sound like much but for another 20 years? That's £1376! I know I haven't had to pay for any treatment, but I've worked full time for nearly all of my adult life to pay for that. And I know that the NHS pot isn't bottomless, but grr it's annoying.

Lots of lovely potential side effects, including

* bloating

* breast tenderness or swelling

* swelling in other parts of the body (seeing as my feet blow up when it's hot now, I dread to think what else will swell!)

* nausea

* leg cramps

* headaches

* indigestion

* vaginal bleeding (FFS, surely there should be a perk to your lady bits not working any more, now my periods might come back?!)

* headaches or migraines

* mood swings

* depression

* acne

* tummy (abdominal) pain

* back pain (what, like the symptom I should be looking out for if my cancer has come back?!)

Increased risk of blood clots

INCREASED RISK OF BREAST AND OVARIAN CANCER. Brilliant. But surely the benefits of HRT will out weigh the risks? Well, wait for it...

Pros

Prevention and management of potential menopausal side effects...that I don't have.

Prevention of osteoporosis - this is the biggy. The NHS website describes osteoporosis as "a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a minor fall or sudden impact causes a bone fracture." They do list hip fractures as one of the more common breakages that occur, and I suppose having had radiotherapy beams targeted at my hips they're probably weaker than most.

But, the NHS choices osteoporosis "treatment" page also says this -

GAAAAAAAAH!! What the hell?!

I am so confused, and even more convinced than I was before that I really don't want to put this in my body.

But what are my alternatives?

A quick google found betterbones.com - a website that looks at natural ways to strengthen your bones through diet and exercise. Seems simple enough! I do know I need to do more research before I give anything else a go, but for now my brain is completely fried about the whole thing. I'll wait until my appointment and ask my oncologist for her thoughts, even though she's the one who wrote the referral letter in the first place, so that one's a pretty poor excuse and she'll probably just tell me to take the tablets.

Has anyone got any thoughts? Any experience in taking HRT following an early menopause? Or any different ideas?

This is exhausting.