HOT TOPIC:

‘Why I’m not on hormone replacement therapy’

Idecided not to go on hormone replacement therapy (HRT).

There are facts that inform this whole HRT debate, and then of course there are the shouty opinions, reflections and viewpoints that further bedevil or throw light on it – according to where each of us stands. The facts are that taking HRT has helped a significant number of women to weather menopausal storms. The facts are also that taking HRT has been significantly linked to cancer and strokes.

I’m writing this very much from the particular lens through which

I see the world. My own decision

not to take HRT meds was based not on an assemblage of facts and medical opinion by experts, but on my expertise around my own complexities. I didn’t know the answer (and still don’t) as to whether HRT is worth the risks, but I did know how I felt, thought and behaved around important issues regarding managing my health.

In among the plethora of known facts, research findings, hypotheses and anecdotal reportage, I understood that unless I could fully accept the logic of going on HRT, I would never be able to have faith in its ongoing efficacy or consistently maintain its medical protocols. In short, I knew myself well enough to know that unless I was 100% convinced, I would take on HRT only in a thoroughly burdensome, stress-puppy, half-arsed way.

Although I’m aware that genetics accounts for a very small percentage of probability, I have ‘genetic loading’ for some of the side effects associated with HRT: cancer and strokes. By nature, I’m risk-averse. (Bangbroek.)

My maternal grandmother had a double mastectomy and my mother died relatively young at 60 from stomach cancer that had metastasised from primary uterine/ovarian cancer. I am also desperately afraid of having a stroke – my father had several.

Against this canvas, once

I’d entered menopause proper, I weighed up the benefits and risks of HRT. I wanted the protection of heart and bones (lots of adverse genetic loading there too) that my gynae at the time was adamant HRT would give me, but I was too scared that if I took it I’d be more at risk of developing cancer or that it would increase the likelihood of bringing on a stroke. Without the prospect of peace of mind, I knew I wouldn’t sustain being on HRT.

A decade earlier, a bone density test indicated I was osteopenic. I’d decided not to go on bone density protocols because I believed – for myself, not for everyone – that the side effects of the medication would outweigh the benefits. I made these decisions not because I don’t understand the immediate benefits of allopathic medicine, nor that I feel it’s all a conspiracy by Big Pharma, or that I don’t respect the many years my doctors had spent specialising in their field. It was personal.

During all the years of what is called the ‘menopause transition’, I’ve continued to have regular medical screenings (mammograms, bone density tests, pap smears, colonoscopies, gastroscopies, etc.), despite my ambivalent relationship with allopathic medicine. I say ‘ambivalent’ because I actually love the scientific gaze and its powerful lens; I deeply admire some of its rigour, and I’m grateful for the entire scientific endeavour that’s added so much to the humane quality of life we now enjoy in the 21st century. But at times I’ve also experienced mainstream medicine as narrow, closed and dogmatic.

Without being able to integrate insights from other disciplines, and from other traditions, it seems to me that mainstream medicine is sometimes unable to see or comprehend its own limited gaze.

Ileft my original gynae because I wanted to find one less irritated by my decision not to take HRT medication. Perhaps it’s only fair to this first gynae to mention that

I must have been frustrating to treat – she fully believed in the benefits of HRT, and that the risks could be managed. Eventually I found a gynae who understood that I appreciated her overall expertise but needed her to work with the fact that I’d probably never go on HRT.

I wanted a more integrated approach that would take into consideration not just the isolated parts of my body that needed treatment, but also how that treatment would interact with treatments other parts of my body were receiving – in particular how one kind of treatment might adversely interact with another being looked after by a different medical expert. And yes, I also wished to engage with my own peculiar psychology of fears and resistance, based on the ecology of my own mind-body self, however ‘illogical’.

If this piece reads as if I wasn’t experiencing intense menopausal symptoms, then let me say that I was suffering. Over the years

Without the prospect of peace of mind, I knew I wouldn’t sustain being on HRT.