Menopause, HRT And The Importance Of Staying Curious

I want to share some thoughts on menopause, HRT (hormone replacement therapy) and a new narrative in the UK that most if not all women should be on HRT for menopause issues and long term health, because of HRT’s potential preventative impact on heart disease, osteoporosis and Alzheimer’s.

It’s evident that systemic and localized (vaginal) HRT can be enormously helpful for many women in managing their menopause, but I don’t believe, unless absolutely necessary, most women need to be on systemic HRT long term.

Davina McCall presented a ground-breaking documentary about menopause. In it she talked of having two episodes of shame around menopause, the first when she was initially diagnosed and the second when she took HRT. It’s tragic that she felt shame over either of these and I commend the program for exposing this as something which simply shouldn’t happen anymore. There is nothing shameful about menopause nor taking HRT to help with it!

I too experienced these kinds of shame.  After failing to conceive a long hoped for second child, I was told I had gone through early menopause at 41. It was crushing.  I gave in to taking HRT at 44, because I was found to have borderline osteopenia in my hip. I felt I was succumbing to a narrative of downhill to the end.

At the time, menopause specialist, Dr Nick Panay, and his early menopause team were looking after me and had been advising me to go on HRT until average menopause age of 51, to give my bones and heart the extra 10 years of estrogen protection they’d missed out on because of early menopause. It took me three years to accept their advice.

I chose to come off systemic HRT as advised and at 53, another bone density scan showed no worsening in my bones. Now I occasionally take localized vaginal estrogen to help with vaginal dryness. I use a cream as vaginal pessaries come with individual plastic dispensers which I consider unnecessary plastic waste.

Women are rightly indignant they’re not getting the care they need from our National Health Service (NHS).  The documentary was a powerful reminder of the sad state of play and lack of awareness both within the medical profession and for women themselves. 

One thing about the documentary I do struggle with though, is that it failed to mention the obvious, that menopause is a natural and transformative life stage. To not highlight this reality underpins the emerging narrative that menopause is a bad thing and that HRT is the answer.

Peddling HRT as the ‘must have’ for all women in menopause, such are its life-saving properties, protecting against heart disease, osteoporosis and Alzheimer’s, AND that most women should be on it well beyond menopause, smacks of snake oil sales with bells on. Women are now even asking if they need to be on HRT to protect themselves from dementia!

This narrative is taken up by some leading menopause professionals who, to my mind seem to be as damaging as the doctors who prescribe anti-depressants for menopausal women. 

The narrative needs balance. Diet and life changes are probably more important for menopause issues and long-term health than defaulting to synthetic drugs. Sadly, the documentary was void of any discussion regarding the impact of diet or lifestyle on hormonal balance and only passing comment on lifestyle in terms of fitness.

One-sided narratives from the evangelical can have darker sides. ‘Champions’ and ‘goddesses’ deserve scrutiny and the simplest and probably the clearest form of scrutiny is the financial trail. HRT and hormonal insecurity is lucrative business. We are in a culture of wanting our cake and eating it. Excess without consequence. We will pay anything for a panacea.

How many of us swallowed the lies of the cosmetic industry and have felt reduced by body image, hair type, greying hair, wrinkles, spots, skin colour or felt guilt for eating the wrong things, drinking too much or being the weaker, fairer softer sex? 

Billions have been made by creating insecurities and ‘needs’, then exploiting them. We have been crushed, silenced, side-lined and lied to. Sadly, we do have a tendency to be shaped by the nonsense we are told.  I was.

From puberty women live on a hormonal and societal roller coaster. By our 50s many of us have had and raised children, tried to make safe homes, we’ve been undervalued, objectified, underpaid. We’ve juggled, loved, strived and known fear. Menopause is a gift that takes us off the rollercoaster. Perhaps HRT keeps us its slave?  

Menopause is a transition as major as puberty. It is not to be feared. It is not a permanent state. It is a gateway that takes us into deep calm waters where we can thrive in new ways.

Why am I passionate about diet and lifestyle changes? After my early menopause, I went to see a nutritional therapist who put me on a special diet. I was to have no alcohol, sugar, caffeine, dairy, processed foods, eat as organic as possible and eat a healthy source of protein every three hours to make sure my blood sugar levels were balanced.

Within five weeks of changing the way I ate and what I ate, I had a menstrual bleed, and a further hormone test showed I was back to being pre-menopausal. This only lasted another nine months, but it was a wake-up call that showed me the impact of diet.

I did not conceive and the effects didn’t last, I was just too late. Eventually I slipped back to a less healthy diet, although I’m still caffeine free, I eat better and exercise more. I don’t live an abstemious life! It was similar dietary and lifestyle changes that allowed me to transition off systemic HRT at 51 with no adverse side effects. I’m now post-menopausal and celebrating the liberation it brings. 

Hippocrates (460-370 BCE) is perhaps a thorn in the flesh for ‘modern medicine’ and the HRT industry, as his wisdom regarding health tends to mindfulness, which is free, as opposed to intervention, which is costly and profitable. ”If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” “Let food be your medicine and medicine be your food.”

Food for thought?

On reflection, my resistance to HRT was bound to resisting the negative sexist and ageist narratives about women and ageing.  Like most women, I was never taught about health, perimenopause, menopause and being post menopause. As a consequence, my work has now become sharing what I’m learning, being alongside other women experiencing menopause and living life beyond, and to help challenge the narratives that enslave us.

With HRT it is women with money who pay to go private and keep paying, if that is the only way they can access HRT. The more women can be persuaded HRT is the golden ticket, the more money can be made.

What about UK women who can’t afford to see a private doctor to get their (long term) supply of HRT? Why is menopause so difficult that many women need HRT to get through it? Why don’t we ask more questions about why British women reported having the worst experience of menopause?

HRT clearly has a crucial role in menopause care and should be more readily accessible in the UK, but why are we now told most women would benefit from taking it to keep us healthy into older age? We can do other things to keep ourselves healthy. What about women in countries without money for basic medical care let alone hormone therapy? Will women worldwide be lead to believe HRT is crucial for their long term health? That will lead to a lot of insecurity but also new untapped markets…

In her 2020 book, The XX Brain, The Groundbreaking Science Empowering Women to Prevent Dementia, Dr Laura Mosconi, PhD, Director of the Women’s Brain Initiative and Associate Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College (WCMC)/NewYork-Presbyterian Hospital, says:

“Let me underline that the primary indication for MHT (HRT) remains relief of hot flashes, night sweats, and vaginal dryness. MHT is not recommended for prevention of heart disease, Alzheimer’s, cognitive decline, or any other conditions.”

Dr Mosconi goes on to say:

“I must reiterate that prescription medicines come with many potentially dangerous side effects of their own, and the last thing any of us needs is to accidentally exchange one negative side effect for another. Another reason to look beyond estrogen replacement is the fact that estrogen is not always a friendly and helpful substance—especially when it’s not your own. It doesn’t cost much to start with the safer strategies that focus on ameliorating hormonal levels by means of diet, exercise, and other natural therapies. These methods are known to boost hormonal production in the brain as well as in the body, while improving memory, sharpening our minds, and supporting resilience, all the while reducing risk of dementia for all women, no matter what stage of the game they’re at.”

After doing some research, I found evidence that HRT may help prevent and treat osteoporosis, for example, but even that research says:

“Therefore, in postmenopausal women at risk of fracture and younger than 60 years, or within 10 years of menopause, HRT can be considered as one of the first-line therapies for the prevention and treatment of osteoporosis-related fractures. Conversely, the initiation of standard HRT after the age of 60 years for the exclusive reason for fracture prevention is not recommended since the potential risk of long-term complications, namely breast cancer, can outweigh the benefits [24]. Thus, the extension of HRT after the age of 60 years must take into account potential long-term benefits and risks of the specific dose and route of administration, compared to other proven non-hormonal therapies [24].”

Marco Gambacciani and Marco Levancini  2014 Hormone replacement therapy and the prevention of postmenopausal osteoporosis

We now know the breast cancer risk is much less than previously reported and current forms of HRT are safer than early versions, but are still not without risk. Some practitioners say HRT breast cancer risk is no more than drinking alcohol or being overweight. But what if you’re on HRT, drinking too much and overweight? Your risk load could get quite high.

Some say women need HRT now because we didn’t live long past menopause in the past. In parts of the world, some women have lived past menopause for hundreds of years. In 1680, life expectancy for a woman at age 15 (having survived childhood) in England and Wales was 56.6 years, rising to 64.6 years by 1780.

Women in the Blue Zones, where people live the longest, don’t rely on HRT for their long healthspan. I believe it pays to be wary of big bold claims, stay curious and continue to ask questions. We are all guinea pigs when it comes to long term use of HRT. No one knows.  

I’m increasingly skeptical about studies that make big claims about drugs and menopause. I want to know who conducted the research, who paid for it, was it published and peer-reviewed, and even whether it actually happened.

My recent research found a 2016 survey attributed to British broadcasting entity ITV, who claimed to have worked with women’s research charity Wellbeing of Women. The latter told me that survey never took place. There’s an article on the ITV website claiming that one in four women considered leaving work because of menopause symptoms, based on a non-existent survey.

That statistic has become fact and even been quoted by a member of the UK parliament. Why is that false fact still on the ITV website? Probably because it helped get viewers to their program then and helps bring advertising revenue now. They don’t care about setting the record straight. I’ve asked for this to be looked at but no response. I’ve asked to see the source of the statistics in the latest Channel 4 documentary too, but no one has responded on that yet either.

In her book, The New Hot, Meg Matthews includes the menopause experience of Buck Angel, a transgender man. He talks about how taking testosterone for 10 years atrophied his reproductive system…

“…causing my uterus to fuse with my cervix, creating an infection in my uterus. That was the cramping I had been experiencing all these years… After three months on intensive antibiotics to get rid of the infection, I then had a full laparoscopic vaginal hysterectomy… All of this could have been prevented if any one of my endocrinologist would have given me an estrogen supplement… How can doctors be giving a very powerful hormone like testosterone without understanding the need to balance this out… I almost died because of the lack of medical knowledge, yet the doctors give testosterone out with little concern about the long-term effects.”

I’m not suggesting that long-term use of systemic HRT for women could cause similar issues. Of course not. I am suggesting there’s not enough knowledge about the long term effects of any hormone therapy, for practitioners to be so confident telling women it’s okay to be on it long term or even forever. We won’t know whether that’s true, until I probably turn at least 75, in another 20 years.

The narrative that most, if not all women, will benefit from being on HRT long term, also presupposes that life with our pre-menopause hormonal profile is universally better than being off the estrogen rollercoaster as an older woman. I don’t want older women to be split into those who believe good health into older age can best be achieved if we have the same hormonal profile we had pre menopause, and those who don’t.

Some people believe we should be able to replace the hormones we’ve lost through menopause. But that suggests menopause is a disease that needs to be fixed (some want it rebranded as Female Hormone Deficiency) not embraced for the powerful changes it naturally brings.

This harks back to the misogynist book Feminine Forever written in 1966, which affirmed a narrative about women being subpar post menopause and that we need to be on estrogen long term ‘to stay agreeable and attractive for our husbands’. We’re not less anything post menopause and can be healthy without synthetic hormones. I don’t want older women (let alone younger ones) to believe they are in any way less because of menopause, or in danger healthwise without HRT.

There are abundant natural sources of plant hormones, amongst many other things, that we can add to our healthy diets to help achieve hormonal balance and long-term health. These work for many women and are often important traditional components of the diets of women in places like Japan and China, where menopause often appears to be less of an issue than it is for Western women.

And, she whispered… are we not just a little entitled and privileged demanding a drug long term whose effect can often be replicated for a large proportion of women by living a healthier lifestyle? When NHS resources are at their most stretched and we are already so lucky to have free healthcare in the UK.

Did you want to keep on with the 5 cups of coffee a day to keep you going, lots of sugary food, burning the candle at 6 ends, smoking, drinking too much booze to wind you down, using products laden with 100s of potentially hormone-disrupting ingredients, sitting down all day, not sleeping well because of the sugar, caffeine and booze, and not dealing with your stress, but take HRT to stop those your hormones screaming for attention?

I see many midlife women doing that and wondering why their body is rebelling. We’d rather demand a fix-all, than get curious about other ways to feel better, longer.

Around 25% of women suffer badly with menopause. That’s bad enough, but you’d think it was more. I talk about that with Jackie Lynch author of The Happy Menopause on my podcast. The ones who suffer shout the loudest and often it’s celebrities in the public gaze, who are living stressful lives that can make menopause worse, who speak up about their experience.

I’m grateful to them for raising awareness, but I’d like a more balance, more discussion about other options and less reliance on HRT to mask symptoms, rather than sorting out underlying issues. I don’t want to terrify women coming up behind so that an awful menopause becomes a self-fulfilling prophecy. Be prepared not scared is my motto.

I think of menopause symptoms as the body’s early warning system, the canary in the coalmine, telling us we need to make changes if we want to live a long healthy life. We can take HRT and it may make us feel better. We may also miss the chance to make the changes our bodies are telling us to make, if we’d just start listening.

What is different about us or the way we live to make our menopause experience different to elsewhere or other women? To what extent does our society’s view of older women impact how we experience midlife and menopause? How is life different now to in the past? We need to talk about menopause more. And much earlier too.

The medical profession is woefully under-resourced for helping menopausal women. We need to increase medical and public education so doctors recognize perimenopause and women aren’t fobbed off with anti-depressants, or fear they have Alzheimer’s when it’s hormonal brain fog. Doctors in the UK need to understand the latest NICE guidelines for prescribing HRT and not withhold it unnecessarily from those in need.

I’d also like doctors to know about the role of diet, lifestyle, environmental toxins and stress when it comes to managing menopause. I want an holistic approach. I’d like women to see menopause as a chance to adopt a healthier lifestyle and embrace the different hormonal profile we’re supposed to have post menopause. Then we will find the true healing power and magic of menopause.

If you liked this post, you’ll probably like my book – Magnificent Midlife: Transform Your Middle Years, Menopause and Beyond.

You may also like: Menopause Matters – Resources To Help