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HRT is hailed as the wonder drug of menopause, transforming women’s lives after the hell that can be menopause. “I have got my life back – it is wonderful,” says a woman on one site, while another says: “I feel like my old self again,” and a third “can’t remember the last time I cried.”
Even my journalistic hero Mariella Frostrup is full of praise. “HRT opened my eyes, and gave me my life back,” she says in The Guardian.
A month after leaving the surgery I was a new woman, or returned to my old self at least… HRT seemed to have levelled out the mood swings from fury to low-level depression and put me back on a more even emotional keel.
Sounds brilliant, eh? Who wouldn’t want to take it if it leaves you feeling that amazing?
Except I’ve been on it for nine months and I’m feeling crap. There’s no other word for it – well, no other word that wouldn’t have my mam telling me off for being a pottymouth.
Far from feeling like a new woman – or even my old self – I feel as if someone has wrung me out, folded me in half, wrung me out again and then forced me through the mangle just to make sure.
As for never remembering the last time I cried: it was at 11.54am yesterday morning, when I had my shower.
I know just how she feels…
This isn’t new – I wrote over Christmas about how the HRT shortages and not being able to get the right mix was affecting me. But it’s now reached such a level that psychologically, I feel as if I’m right back where I started: shaking a couple of hours after leaving the office as I worry about imaginary mistakes; waking up at 2am raging at the world; worrying that friends really hate me; wanting to push everyone away…
I have the power…
What is different now, however, is that I know the power to change this is in my hands. Which is why I’m wondering whether HRT is really for me or not – and this shows how bad the debate around HRT really is.
It seems there are two camps: those who think HRT is the must-have drug for every woman and prescribe it religiously and those who feel it is the devil’s work and that women are being brainwashed by big pharma into imagining menopause symptoms. (“Japanese women don’t get menopause symptoms,” they cry. Except they do; they just don’t complain about it.)
Well, I know fine well I’m not imagining the itchy skin and paranoia so I’m not in that camp. And then I look at my mam, who is 89 and never had HRT in her life. Nor had all the amazing women I met in Spain in their 80s, 90s and over who were living brilliant, independent lives. So I’m not in the “doom and gloom without HRT” camp, neither.
But this is the 21st century and I’m an educated woman. (I’m also a cynical hack with 30 years’ experience of looking behind the argument for any possible ulterior motive and my Scooby sense does prickle at times when it comes to people making money from menopause.) Which is why I’ve put together the pros and cons of HRT to help us make our own minds up:
HRT: the pros and cons
- Bone health: As we get older, our bones naturally become thinner, which can be exacerbated by the drop in oestrogen during menopause. Oestrogen helps protect our bone strength so by restoring its levels, we help protect against the bone loss that can lead to osteoporosis and fractures.
- Heart health: Oestrogen can offer some protection against coronary artery disease, so reducing the risk of a heart attack. It also helps control your cholesterol levels. HRT helps restore the falling levels and so offers the support we’re losing.
- Body fat: We all hear about midlife spread, but a study found that women on HRT tended to have less body fat. Dropping oestrogen levels could also make your body more resistant to insulin, so restoring it may be of benefit to people with diabetes.
- Relieving symptoms: HRT can offer relief from the likes of hot flushes, night sweats, mood swings, vaginal dryness, lower libido and more.
- Reduced risk of some cancers: Researchers have found that HRT can lower the risk of some cancers, such as colon (or bowel) cancer.
- It can make you feel great: So many people have told me how much HRT helps and I know women who won’t be without it. It can change your life for the better and makes you happier.
At my last NHS health check-up, my cholesterol ratio – the ratio between the good and bad cholesterol in your body – was 2.1, which apparently is very good.
I’ve always had good levels (I swear by Mediterranean diet we ate in Spain), but the nurse did say said the HRT could be helping that further.
- Increased risk of some cancers: We’ve all seen the reports about HRT and breast cancer. There is also evidence that HRT can increase the risk of womb cancer and ovarian cancer. However, I really, really want to emphasise that the risks are small, plus having a risk factor does not mean you will develop cancer. Do your own research and decide if it is right for you or not.
- Blood clots: Scientists at the University of Nottingham found a risk between taking HRT tablets and developing blood clots such as deep vein thrombosis (DVT). Again, the risks are small and the scientists themselves acknowledged that their findings did not mean using HRT tablets caused more DVT than using patches. Research is sadly lacking (a familiar refrain in the menopause world…)
- Stroke: By increasing the risk of blood clotting, HRT can increase the risk of stroke.
- You have a monthly bleed: And I’ve had almost 42 years of them. Non-stop. I’m tired of shoving a pad between my legs each month…
- It can take time to work – if at all: I’ve been tweeting a bit about my low feelings (I’m at @50Sense) and had several women contact me to say they are going through the same thing. Others have told me to persevere because it took them a year to find the right mix. It might have worked in a month for Mariella, but that’s not true for everyone.
- Price: Yeah, I don’t want to get all political about it – but I’m gonna (again). Most HRT costs £18, double the normal prescription charge, because it’s classed as two medications. Even though they come in the same box or blister pack and even though most women must take oestrogen and progesterone together. At the moment, I seem to be paying £18 every couple of months and yes, I know all about the prescription pre-payment certificate and I would have got it if I’d known I would have so much trouble. But I didn’t.
(A little aside here: every medication has some risk associated with it. Have you seen that episode of House where Amber takes a cold remedy and then she’s in a bus crash and her kidneys are damaged so she can’t process the drug properly and she dies in Wilson’s arms?
Heart-breaking – but you’re still taking flu medicine, aren’t you? Millions of women take the contraceptive pill because the benefits outweigh the risks. Lifestyle also plays a huge part. Ultimately it’s up to you, working with your GP, to decide what is the right level of risk for you.)
And telling women to pay in advance doesn’t combat the basic unfairness that after 35-40 years of being taxed on our towels and tampons, we’re now being punished for having wombs again.
You don’t even need to be going through menopause rage to be angry about that…
So what am I going to do?
I’m lucky in that through Pausitivity, I’ve met the wonderful Clare Shepherd, who runs Your New Life Plan offering help and guidance for menopause. Clare’s a nutritionist – a proper one, with all the qualifications and regulations to show for it – and offers a free 30-minute consultation to discuss what is right for you.
Knowing Clare, I knew I wouldn’t be fed any BS or dogma, but I was surprised by what she said.
She told me to continue with HRT for now.
Why? Well, progesterone drops off at a steady rate, while oestrogen goes up and down like a rollercoaster. “If you stop HRT on an oestrogen trough,” said Clare, “you’re going to feel absolutely terrible.”
Her advice was to give the HRT I’m on longer to work, as it can take 12 weeks for your hormones to settle. (Because of the HRT shortages, I haven’t been able to get a continuous supply. It is supposed to be back in stock and if not, I’ll see my GP – again – for an alternative.)
Clare said to keep going while making lifestyle changes to balance my hormones, then wean myself off gradually. Going cold turkey is not an option; even if I don’t feel the HRT is having an impact, I’m feeding hormones into my body and can’t suddenly cut them off.
Which is the way I’m going.
I have to add that behind my decision is the fact I don’t really like taking medication and I’ve always said I didn’t want to be on HRT for years on end. And at the moment, I don’t feel any benefit to change that thinking so if I can go natural, I will.
But having weighed up the pros and cons, if I find an HRT that truly makes me feel incredible and I can’t have that quality of life with lifestyle changes, then I will keep on it.
I have the power. And so do you.
