Insomnia, joint stiffness, anxiety and low energy levels can make everyday tasks inaccessible – menopause can be not only unpleasant for some women, but downright debilitating.
And that’s why for many menopausal women who take hormone replacement therapy (HRT), it can be a revelation.
What it does is elevate the levels of estrogen and progesterone – either by itself or in combination. Falling levels of these hormones cause symptoms that can include palpitations, depression, and memory problems.
So news this week of proposals to end the fee for HRT – it costs £9.35 per prescription in England – should be a source of relief to many of the UK’s 3.4 million menopausal women.
But greater access to HRT has never been about money. Eventually, low-income women should be eligible for free prescriptions.
The problem is far more subtle and far deeper. 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 deal with menopause symptoms. And I speak not only as a gynecologist and former president of the British Menopause Society, but from personal experience. Now 62, I’ve been taking it for ten years.
Insomnia, joint stiffness, anxiety and energy levels so low that it can make everyday tasks inaccessible – menopause can be not only unpleasant for some women, but downright debilitating (stock image) Is.
While many GPs provide excellent support for their patients, based on emails I received through Menopause Matters, a website I set up, 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 the two largest studies of HRT users were conducted. One claimed that HRT may increase the risk of breast cancer, although later findings showed that the original studies were flawed.
As a result, a group of doctors ‘grown up’ with the idea that HRT equals risk. Of course, HRT isn’t risk-free – in 2019, a study at Oxford University based on data from more than half a million British women, 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 increased risk of breast cancer quickly returns to non-users. Meanwhile, research has uncovered additional benefits of taking HRT: It reduces the risk of osteoporosis and, in some age groups, even protects against heart disease.
Doctors should consider prescribing HRT if the benefits — alleviation of severe and permanent symptoms — outweigh the risks. And for some women, such as those with a family history of hormone-dependent cancer, the risk may not be guaranteed.
But some doctors are unsure about prescribing HRT, despite women’s desperation to try it. And without it his ‘brain fog’, night sweats and other symptoms continue to rule his life. Any GP reluctant to prescribe HRT should seek further advice rather than simply rejecting treatment.
So news this week of proposals to end the fee for HRT – it costs £9.35 per prescription in England – should be a source of relief to many of the UK’s 3.4 million menopausal women (stock image)
HRT comes in several forms: Most women take a combination of estrogen and progestogen, but women who do not conceive (after a hysterectomy) can take estrogen on their own.
There is a definite desire for better instruction among GPs, with many academic meetings being subscribed and the 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 additional training requires time and effort. But it is worth the investment. Look at the time wasted unnecessarily due to lack of knowledge about prescribing HRT. A survey of 5,000 women showed that 18 percent 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 gram panchayats need support to break free from the fear of the past. British women deserve no less.
- Curry is a Gynecologist at NHS Dumfries and Galloway, and founder of the website Menopause Matters.
Interview by Angela Epstein