HRT has been divisive for many decades now - first seen as a miracle to assist women through a period of their lives where symptoms can be debilitating, in the early 2000s, reports citing increased risks of breast cancers, heart disease and thrombosis were given undue media hype (makes a change!) and HRT became a villain. In the years 2003 - 2007, users of HRT in the UK fell from 2 million to under 1 million, entirely based on these reports and the subsequent headlines. Even 19 years on, there is still significant confusion and fear around the subject - I regularly see women on forums struggling desperately with a range of ailments, but their apprehension regarding taking a medication that could ease their complaints keeps them locked in the same pattern.
In the last 24 hours, I've had conversations with two different friends about HRT. Last night, a friend who is younger than me (lets say still in the earlier half of her 40s) was exclaiming in some disbelief that other friends of hers had recently started taking HRT, and was she missing something? Should she be looking into it? How would she know if she needed it? At this point I laughed. A lot. Although mine is not a typical menopause, when I was on the wrong HRT (and yes, it can be right and wrong), I felt like shit on a bike. Body aches; brain fog; insomnia; mood swings ('you're gonna make me do something that'll end up on the news!); and fatigue where I felt like I was dragging myself through drying concrete. And to be honest, I didn't even notice if my hair was falling out more, or my skin was dryer: I was just trying to get through the day!!! The second conversation was this morning on the school run, and friend told her that her Mum (who had worked in a pharmacy for many years) had point blank refused to take HRT at any point, despite being advised to do so. My own Mum was menopausal at the point that Dr's started to stop recommending HRT in the early 2000s, and I know that she really suffered during that time. She did try homeopathy, which she says did give some relief, but ultimately, she lost a chunk of her late 40s and 50s to feeling pretty rubbish.
Following on from the initial reports that cited a higher risks due to taking HRT, further research by the WHI (Women's Health Institute) started to concede that 'certain safety aspects had been 0ver-estimated'. Indeed, there was actually evidence of HRT being beneficial for women starting HRT in the 50 - 59 year age group - lower risk of heart disease; reduced risk of death from any cause; and no clear increased risk of stroke. By 2012, The Million Women Study showed no greater risk of thrombosis for those women using the transdermal (via the skin) route to receive the oestrogen form of HRT, and by 2020, the WHIs report was published with the findings;
'breast cancer incidence and mortality based on the study of 27,000 women up until 2017 had a reduced risk when using oestrogen only HRT, and those on the combined had a slight increased risk of breast cancer. This did not come with an increased risk of mortality.
For those women who started HRT within 10 years of the onset of menopause or when under 60 had a lower risk of cardiovascular disease or cardiovascular related death.'
It is however worth noting that the risks are increased with lifestyle choices such as smoking, and for women who are obese: but it also goes without saying that these are seen as being high - or having a higher mortality risk - anyway. And unfortunately, for those who have had either breast or endometrial cancers, or a history of blood clots, stroke or liver disease, HRT is still mostly* not advised.
So HRT is not actually the demon it was initially painted to be, although it goes without saying starting on any medication is something that needs to be approached via a conversation with your GP (or a specialist or even the pharmacist these days) to properly understand the benefits and risks. But as I know from personal experience, if it is suitable for you, it can offer significant relief from the symptoms of menopause. I was very lucky that my surgeon prescribed me HRT straight after my hysterectomy as my ovaries were removed at the same time (this = instant menopause**), but this is not the case for all women, many of whom are left without follow up prescriptions. I started on Oestrogel, a topical gel that had to be applied to the skin daily. It is not complicated to use, the only real directions being that it needed to be applied to either the inner thighs, or upper arms. I was prescribed two pumps which I did apply to my thighs to try and avoid the gel getting anywhere near my husband afterwards (apparently he didn't want to develop boobs and cry at Christmas adverts...) and all seemed to be going well.
About 10 weeks after my surgery, I hit a literal wall. Head on. I was tearful, angry, resentful, depressed and quite literally a total bitch to my poor husband. I dyed my hair a hideous mahogany colour in bloody mindedness, and ruined our half term trip away by being grumpy and stroppy for the entirety of it. The Air BnB was crap, smelt of damp and wasn't properly equipped; the zoo was lovely but exhausting; the race day was cold and boring. You name it, I was hideous about it! And the worst part? The hysterectomy and removal of my ovaries was supposed to have stopped this horrible, miserable, self destructive, quite frankly awful person, and yet here she was again.
When I got back home, I did an eConsult (brilliant if your surgery has it by the way - you get to add all the detail in writing that you might forget during an appointment!) pouring my heart out over how the hysterectomy hadn't worked, I was falling apart, my son and husband were fed up with this version of Mummy/ wife and JUST PLEASE HELP!!! Later that day, I had call back from a GP, and whilst I paced up and down and cried down the phone, she suggested that I might need a bit more oestrogen than I was getting, and that she was going to prescribe it for me in oral - pill - form. Weeping in gratitude, I raced to the chemist to pick up the pills, praying that they would make the difference. And they did. In about 48 hours, I was back to normal again mood wise. Interestingly, I don't remember any other 'typical' menopausal symptoms at that time - that's not to say they weren't there, but the emotional reaction I definitely remember.
For a few months, I felt amazing - absolutely bloody fantastic, on top of the world, flying high, full of energy, FAB-U-LOUS! I was now walking 4 + miles a day with my naughty - but much begged for - German Shepherd puppy; I was back riding a horse occasionally; I started a new part-time job from home; I was going to dog training classes - in the middle of a field with no loo (not something I could have imagined doing before when I was bleeding); my husband and son were getting the best me, rather than the grotty, tired, shouty me. And then I discovered that the pills I was on were made of pregnant mare's urine - from a Facebook memory that I had posted some 3 years previously! Premarin. Pre (PREgnant) MARe (mare) in (urINe). And it reminded me that the conditions that the horses are kept in whilst their urine is harvested is unethical, and cruel. As an animal lover, particularly horses which have always been my passion, I absolutely could not continue to take a medicine that supported this practice (and yes, I am also careful about cosmetics and beauty products too). At the time I was prescribed the medication, I was so damn grateful to have something that worked, I failed to do my research, something I am really cross with myself for.
So it was back on the old eConsult for an alternative to the pills. This time, I was prescribed patches - another skin absorption route - and so off we went again. The patches are actually a bit more complicated than the gel, in that you need to change them twice a week, on the same days each week, and it's very important that you change the location where you stick them each time. In addition, the actual positioning of the patches is very important, with the advice being that patches should be below the waist. That said, they are much better than the gel for giving your husband a cuddle in bed and not having to worry about getting too close to him! The biggest problem I had with the patches was that they fell off. All over the place. As a fairly active person (lots of dog walks where I do get quite hot and sticky) and also someone who is naturally quite a warm person, I just couldn't seem to keep the patches on me. It was a moment of high shame when one dropped out from under a long, floaty summer dress in the middle of the street one day! I mean, what does one do? "Oops, terribly sorry, that's my HRT patch - don't mind me!" or 'If I pretend to casually walk back down the pavement, maybe the B*stard thing will stick to my flip-flop, and I can retreat to a quite side alley, peel it off and shove it in my handbag.' A little like animal cruelty, I HATE littering. In the end, I pulled up my brave pants (luckily they hadn't fallen off too!) and swept back down the road, picked up the offending patch and shoved it in my bag, where it promptly stuck to my purse!
In the end, on a rather marvellous group on Facebook called 'Hysterectomy Sisters - look them up if you are having/ have had/ want to have a hysterectomy; as someone posted recently, 'here's to the best group of people I've never met (yet)' - a few people in the know suggested tattoo tape over the top of the patches. And boy did that work. Although if you follow this advice, make sure that the patch/ covering tattoo tape does not get too close to the pubic hairline. Unless of course you are ok with a quick self wax...
In the long run, the biggest issue I encountered with the patches - even when I had worked through the adhesion issues - was that for me, they didn't work. I was suddenly getting aches and pains, hot flushes where I poured with sweat, fatigue, and my son started taking the piss out of me for only half completing a sentence before I'd wander off again without actually completing what I was saying (although this might just be me anyway...). As I levered myself out of bed each morning and limped across to the bathroom, stiff, hunched over, with ankles and feet that didn't flex, tired from being kept awake by aching joints, I genuinely did think 'Shit. This is it. I am 46 and yet I feel 86. It's only going to go downhill from here.' But then I started to do a bit more reading up on HRT as I remembered that I HAD felt good only a few short months ago on the Premarin, and there must be an alternative that did not involve animal abuse, and I discovered that there were a few other oestrogen pills listed that were available in the UK.
So, back on the trusty eConsult to make my case - it really does have a great deal of value for listing EVERYTHING you need to tell your GP (and no, I am in no way connected with either the NHS or the developers of the software!) - this time telling them that I wanted to be prescribed the Elleste Solo tablet. Please. The pharmacist was excellent, and although he mentioned that I might not be able to take this long term, and that I would need regular blood pressure checks (this I can do), I was told I could pick up my new prescription later that day. Cue dancing all the way to the chemist to pick up my (hopefully) miracle pills, which this time were free from guilt.
I changed onto the Elleste Solo back in the late summer, and once again, I feel like a different woman. I'm no longer hobbling around like a bad pantomime witch, my energy is back to normal, I'm sleeping well again and the embarrassing, pouring off me sweating has stopped. I am still - occasionally - capable of walking off with a sentence hanging in mid air, but to be honest, I blame this more on trying to juggle two part time jobs, running the house, school runs and after school activities, mammoth dog walks and doing this! But in all seriousness, I do feel HUGE amounts better now that I am back on the oral oestrogen.
The one hormone I haven't mentioned in here so far is testosterone, which can help many women as the ovaries produce testosterone as well as oestrogen, and taking testosterone can help women who struggling with a low libido. I am not currently taking this, but I have discussed it with the pharmacist, and not ruled it out for the future - I have agreed to wait for a period of time for the oestrogen pills to settle before speaking to a specialist.
One of the absolute best people out there for advice on HRT in all its forms is Dr Louise Newson, aka The Menopause Doctor. She is also on Instagram (@menopause_doctor). She really does explain HRT - including the benefits and any downsides - in real detail and in language that is completely understandable for all of us non medical lot! NHS also has advice, as does Women's Health Concern, a charity that provides 'confidential, independent service to advise, inform and reassure women about their gynaecological, sexual and post reproductive health.' It is also well worth reading the information NICE (National Institute for Health and Care Excellence) as they are responsible for patient safety across the NHS.
And finally...
HRT isn't for everyone, and for some women, they might not need it. Others may not want to take it, and, of course, there are those that can't take it. But it is worth knowing that it is there, it does work - even if like me you have to play around with finding the right one for you - and unless you absolutely can't take it, it is now predominantly safe for the majority of us.
Please note that this article does not discuss HRT in progesterone form as if you have had a hysterectomy, you do not need to take progesterone. If you are going through a natural menopause rather than surgical one (i.e. you still have your womb), you will probably need to take progesterone as well as oestrogen as it reduces the risk of endometrial cancer. However, different forms of HRT may mean that you don't need to take progesterone too - as ever, speak to a specialist, GP or pharmacist.
* specialist consultants will discuss with women the risk vs quality of life HRT can provide these days, so it is not always a straight forward no.
** since starting to write this (which embarrassingly has taken weeks as I haven't had time...), I have started following @surgical_menopause_campaign_uk which highlights the very different HRT needs of women who have had a hysterectomy. Definitely worth a follow if you are having a hysterectomy.
Facts and figures regarding the WHI and MW studies I have cited the following website;
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