Racked by insomnia, stiff joints, anxiety and energy levels so low it can make everyday chores feel insurmountable — for some women the menopause can be not just unpleasant, but utterly debilitating.
And that’s why for many menopausal women who take hormone replacement therapy (HRT), it can be a revelation.
What it does is top up levels of oestrogen and progesterone — either on their own or in combination. Falling levels of these hormones cause the symptoms which can also include palpitations, depression and memory problems.
So news this week of proposals to abolish charges for HRT — in England it costs £9.35 a prescription — should be a source of relief to many of Britain’s 3.4 million menopausal women.
But greater accessibility to HRT has never been about money. After all, women on a low income should be eligible for free prescriptions.
The problem is much more nuanced and far more profound. In short, some women may miss out because some doctors and nurses lack confidence in prescribing it — even though HRT is the most effective way to tackle symptoms of menopause. And I speak not just as a gynaecologist and former chair of the British Menopause Society, but from personal experience. Now 62, I’ve been taking it for ten years.
Racked by insomnia, stiff joints, anxiety and energy levels so low it can make everyday chores feel insurmountable — for some women the menopause can be not just unpleasant, but utterly debilitating (stock image)
While many GPs provide excellent support for their patients, judging by the emails I receive via the website I founded, Menopause Matters, there are still some women whose doctors refuse to prescribe them HRT.
Many of today’s GPs were medical students or young doctors in the early 2000s, when two of the largest studies of HRT users were undertaken. One claimed HRT could increase the risk of breast cancer, though subsequent findings revealed the original studies were flawed.
Consequently, a cohort of doctors ‘grew up’ with the idea that HRT equals risk. Of course, HRT is not risk free — in 2019, a study at Oxford University based on data from more than half a million British women, found using HRT was associated with an increased risk of breast cancer, but the overall risk is low.
The study also found that when women stop taking HRT, their slightly raised risk of breast cancer quickly returned to that of non-users. Meanwhile, research has uncovered additional benefits to taking HRT: it cuts the risk of osteoporosis and, in certain age groups, even protects against heart disease.
Doctors should consider prescribing HRT if the benefits — eradication of severe and enduring symptoms — outweigh the risks. And for some women, such as those with a family history of hormone-dependent cancer, the risk may not be warranted.
But some doctors are uncertain about prescribing HRT, despite women’s desperation to try it. And without it, their ‘brain fog’, night sweats and other symptoms continue to rule their lives. Any GP reluctant to prescribe HRT should seek further advice rather than simply decline treatment.
So news this week of proposals to abolish charges for HRT — in England it costs £9.35 a prescription — should be a source of relief to many of Britain’s 3.4 million menopausal women (stock image)
HRT comes in many forms: most women take a combination of oestrogen and progestogen, but women who do not have a womb (after a hysterectomy) can take oestrogen on its own.
There’s definitely a willingness among GPs for better instruction, with many educational meetings oversubscribed and membership of the British Menopause Society increasing weekly.
A survey by the non-profit group Menopause Support found that 41 per cent of UK medical schools do not have mandatory menopause training on the curriculum.
Of course, any extra training requires time and effort. But it’s worth the investment. Look at the time needlessly squandered due to the lack of knowledge about prescribing HRT. One survey of 5,000 women revealed 18 per cent had visited their doctor more than six times before getting help.
And so while free prescriptions are a welcome bonus, we must tackle this bigger issue first.
Some GPs need support to break free from the fear of the past. British women deserve no less.
- Dr Currie is a gynaecologist at NHS Dumfries and Galloway, and founder of the website Menopause Matters.
Interview by ANGELA EPSTEIN