THE HRT STIGMA

As it’s de­clared safe by Har­vard, SARAH VINE asks why so­ci­ety has been so quick to de­monise women try­ing to re­tain their youth and health

Daily Mail - - News - by Sarah Vine

THey say noth­ing in life is cer­tain ex­cept for death and taxes; but if you’re a woman, that’s not strictly true. there is one other grim in­evitabil­ity to add to that list: the menopause. And when it does fi­nally hit you, you’re never quite ready. All you can do is stand there, some­what stunned, con­tem­plat­ing the bi­o­log­i­cal P45 that the uni­verse has just handed you.

Of course, you al­ways knew it was com­ing. Once you get to the age of 40, the no­tion is there, in the back of your mind, a dis­tinct — al­beit still dis­tant — in­evitabil­ity.

But if you’re any­thing like me, it’s not un­til you find your­self at your doc­tor’s, some­what at the end of your tether, feel­ing ut­terly ex­hausted and wretched but not en­tirely sure why, that the re­al­i­sa­tion fi­nally dawns: you’re not ill, you’re menopausal.

Ev­ery­one takes the news dif­fer­ently, but I took it quite hard. Partly, I sus­pect, be­cause it came early, a cou­ple of years ago when I was around 47 and my youngest was still at pri­mary school.

I guess I still had a vague no­tion that I might have an­other baby in me. But the re­sults of a blood test put paid to that idea — that par­tic­u­lar train had long left the sta­tion.

there is never a good time to be told that you’re a spent force. that, re­gard­less of whether you want to or not, you can no longer get preg­nant.

Even for a woman who has cho­sen not to have chil­dren, this is a seis­mic shift, both phys­i­cally and from a psy­cho­log­i­cal point of view. Af­ter all, there’s a big dif­fer­ence be­tween not want­ing to do some­thing and not be­ing able to do it.

some women, it has to be said, find it lib­er­at­ing. they long to es­cape the tyranny of their own fer­til­ity, and the change their body is un­der­go­ing brings lit­tle or no real dis­com­fort. they are the lucky ones.

For oth­ers, like my­self, it can feel a bit like the be­gin­ning of the end, a pre­lude to death it­self.

Ad­mit­tedly, I had the full gamut of symp­toms. Ex­treme tired­ness (I of­ten felt com­pelled to go to sleep for a cou­ple of hours dur­ing the day, as though I had been drugged), stub­born weight gain, hot flushes, night-time in­som­nia cou­pled with gen­eral be­fud­dle­ment and glum­ness.

AND yet life was as busy as ever. two young chil­dren, a busy job, a busy hus­band, a house to run, gro­ceries to be bought, food to be cooked.

Far from slow­ing down, my life seemed to be get­ting more and more de­mand­ing. I needed to be at peak out­put, not slid­ing gently into the twi­light. I sim­ply couldn’t af­ford to be mal­func­tion­ing in this way.

this was why, for me, hRt was such a sal­va­tion. It gave me a new lease of life, re­stored my flag­ging en­ergy lev­els, sharp­ened my mind, stopped my joints from aching, evened out my emo­tions; in short, it made me feel — in­ter­nally — ten years younger.

With­out it, I’m not re­ally sure how I would have coped.

there was, of course, the worry about side ef­fects. I had read about the link with breast can­cer, knew that it car­ried a num­ber of risk fac­tors — and was con­scious of a gen­eral ques­tion mark hang­ing over the use of hRt. so when my doc­tor asked me whether I wanted to try it, I was ini­tially un­cer­tain.

But she must have read my mind. ‘For­get all that non­sense about hRt be­ing bad for you,’ she said. ‘Fact is, un­less you have a ge­netic pre­dis­po­si­tion to breast can­cer, the risks are neg­li­gi­ble — and in any case, the ad­van­tages out­weigh the dis­ad­van­tages.’

By ‘all that non­sense’, my doc­tor was re­fer­ring to the two ma­jor stud­ies in 2002 and 2003 that raised doubts con­cern­ing the use of hRt, link­ing it with an el­e­vated risk of breast can­cer, heart at­tack and stroke.

th­ese stud­ies, ex­plained my doc­tor, had been over­played. the re­sults were based on the use of hRt by much older women — in their 60s and 70s.

By then it was too late for the ad­van­tages — pre­ven­tion of crum­bling bones, pro­tec­tion of the heart — to have any real ef­fect, the dam­age wrought by the menopause had al­ready been done, while the risks of the med­i­ca­tion still re­mained.

the think­ing now among the med­i­cal com­mu­nity, she added, was that the ear­lier women start tak­ing hRt, the bet­ter the long-term re­sults, since it re­ally does pro­tect against the ill­nesses of old age, such as os­teo­poro­sis and heart dis­ease.

If she had her way, she told me, she’d start ev­ery woman on it from the age of 45.

she’s got a long way to go. For although the health watch­dog NICE is­sued ma­jor new guide­lines in 2015 say­ing GPs should pre­scribe hRt to up to 400,000 women with se­vere menopause symp­toms, a sur­vey con­ducted by this news­pa­per in con­junc­tion with Lloyds Phar­macy ear­lier this year re­vealed that only 17 per cent of women who had been through the menopause used hRt.

the ma­jor­ity of women, it seems, are still sus­pi­cious of hRt and would rather bat­tle the menopause alone.

All of which is why the re­sults of a new Amer­i­can study from har­vard of 27,000 women over an 18-year pe­riod re­leased this week will come as such a re­lief for mid­dle-aged women ev­ery­where. they show pre­cisely what my gy­nae­col­o­gist had al­ready told me: that for the ma­jor­ity of women, the ben­e­fits of tak­ing hRt far out­weigh the neg­a­tives.

Ladies, re­joice: af­ter years of un­cer­tainty and stigma sur­round­ing the is­sue, it is of­fi­cially OK to take hRt.

this study is not the first of its kind, ei­ther.

Ear­lier this year, a Los An­ge­les sur­vey of 4,200 women over a pe­riod of 14 years con­cluded that hRt re­duces the risk of early death in post­menopausal women by as much as 30 per cent, thanks to the pro­tec­tive ac­tion of oe­stro­gen on the heart and choles­terol lev­els.

this change of di­rec­tion rep­re­sents a turn­ing point. It means that the next gen­er­a­tion of menopausal women will not have to suf­fer un­nec­es­sar­ily.

But it also, for me, raises a few ques­tions. Not just about how and why those two orig­i­nal, con­dem­na­tory re­ports be­came so firmly lodged in the na­tion’s con­scious­ness; but also about why, as a so­ci­ety, we seem so quick to judge women who take hor­mones to re­lieve the menopause.

At the time of those land­mark hRt stud­ies, I re­mem­ber so­ci­ety’s re­ac­tion to them seemed al­most Bi­b­li­cal. As though the

uni­verse was some­how pun­ish­ing us for our van­ity. As if our de­sire, as mid­dle-aged women, to re­main fully func­tion­ing mem­bers of the hu­man race was, in some way, an in­tru­sion on the nat­u­ral or­der of things. Once again, we were be­ing un­cer­e­mo­ni­ously thrown out of the Gar­den of Eden.

HOS­TIL­ITY against older women who try to out­stay their bi­o­log­i­cal wel­come is, of course, noth­ing new. it’s ex­isted for years, in su­per­sti­tion, myths, paint­ings, plays and books, and even in child­hood fairy­tales.

the idea of the old hag prey­ing on the young beauty (snow White), the im­age of the cor­rupt step­mother des­per­ate to over­shadow her in­no­cent ri­val (Cin­derella), the jeal­ous witch leech­ing off young love (Ra­pun­zel) — it is deeply in­grained in our con­scious­ness from a very early age.

Older women are cast, at best, as fig­ures of fun, to be mocked and ridiculed, or ob­jects of fear and loathing, the ul­ti­mate ex­pres­sion of wicked­ness, greed and self­ish­ness.

this at­ti­tude, so em­bed­ded in our con­scious­ness that we’re not al­ways even aware of it, is, i think, one of the rea­sons why ques­tions around the safety of HRT caught hold so firmly in the first place.

it was as though the un­nat­u­ral magic, the med­i­cal voodoo that women had been us­ing to pro­long their youth­ful­ness had been proven to have a high price tag at­tached.

the pun­ish­ment for our van­ity was can­cer, heart at­tack and an early death. that hag­gard old por­trait in the at­tic had fi­nally been ex­posed.

the back­lash was crude but ef­fec­tive: this is what you get when you mess with the nat­u­ral or­der of things. the fol­low- up was in­evitable: why can’t women just let na­ture take its course?

What’s wrong with grow­ing old grace­fully? Why so des­per­ate, old woman?

to get a sense of how uni­ver­sal this no­tion is, it’s worth not­ing that even the sup­pos­edly lib­er­ated fem­i­nist tV se­ries sex And the City, which took off in the late Nineties, bought into this myth.

in the sec­ond film spin- off, sa­man­tha, the show’s res­i­dent cougar, is hu­mil­i­ated at air­port se­cu­rity by hav­ing to give up all her many pots of bio-iden­ti­cal hor­mones. the look of panic on her face when she re­alises she is go­ing to have to spend a week on hol­i­day with­out her HRt is price­less.

the look of pity on her younger friends’ faces as they ob­serve her dis­tress speaks vol­umes. there is, of course, some truth in this. Mut­ton dressed as lamb is never a good look. But that is not what HRt is for, and that is not why most women take it.

it can’t turn back the hands of time. And yet that is how it is of­ten char­ac­terised. But it is a medicine like any other, in­tended to re­lieve some very un­pleas­ant and po­ten­tially dam­ag­ing symp­toms.

Just as a di­a­betic must in­ject in­sulin, or a per­son with a bac­te­rial in­fec­tion needs peni­cillin to get bet­ter, a menopausal woman needs HRt to feel well.

it’s not a moral de­ci­sion, it’s a med­i­cal one. As Dr Mar­ion Gluck, a lead­ing ex­pert in the field of women’s hor­monal health, puts it: ‘Women who need HRt need it. it’s sim­ply said but that’s the case. But there’s also a rea­son for the need.

‘Hor­mones reg­u­late ev­ery­thing in our bod­ies. We know oe­stro­gen is very im­por­tant to main­tain bone den­sity. it’s very im­por­tant for sleep and cog­ni­tion. Pro­ges­terone and testos­terone are also hugely im­por­tant for bones and the mood and mind.

‘We are liv­ing much longer and our re­spon­si­bil­i­ties are not get­ting fewer as we age.

‘Hor­mones help us to age in a health­ier way. We age more healthily when we have a good, func­tion­ing en­docrine sys­tem.’

this no­tion of mood is key. Be­cause it’s not only the phys­i­cal symp­toms of the menopause that HRt al­le­vi­ates, it’s the men­tal ones, too. As i know from my own ex­pe­ri­ence, the menopause af­fects the mind as much as the body.

‘Women who need HRt and who don’t get it are of­ten mis­di­ag­nosed with de­pres­sion and of­fered an­tide­pres­sants,’ says Dr Gluck.

‘if you look at the rise in the use of an­tide­pres­sants fol­low­ing the de­crease in the use of HRt, you see how it’s con­nected. the tragic thing is we have a huge com­mu­nity of women who are on an­tide­pres­sants who just need HRt.’

it does seem ex­tra­or­di­nary that we would rather fill our bod­ies with an­tide­pres­sants than sim­ply re­place the hor­mones that our bod­ies pro­duce any­way.

But then, isn’t it the case that when it comes to women’s bod­ies, so­ci­ety isn’t al­ways that ra­tio­nal? in par­tic­u­lar, it re­ally strug­gles to sep­a­rate moral­ity and medicine.

Just as science has now mod­i­fied its ad­vice on HRt, the Na­tional Child­birth trust ( NCt) has re­cently rowed back on decades of dogma sur­round­ing the way women are sup­posed to give birth in this coun­try.

Four­teen years ago, when i was first preg­nant, i was — like so many women — told in no un­cer­tain terms that any­thing other than a ‘beau­ti­ful, nat­u­ral’ birth would mean i was let­ting my baby down. Our fuzzy preg­nant heads were filled with a no­tion of ‘na­ture at her bril­liant best’, of be­ing guided by our bod­ies t o do ‘ what they were de­signed for’. At my NCt class, we were shown po­lit­i­cally cor­rect images of Na­tive Amer­i­cans squat­ting and sub- sa­ha­ran ladies with ba­bies strapped to their backs to show how other cul­tures did it. there were a lot of very point­less ex­er­cises in­volv­ing beach balls. the over­all mes­sage was this: we Western women are too re­liant on mod­ern medicine.

WHAT ut­ter baloney. When push came to shove (and boy, did it), i had a thor­oughly un­pleas­ant labour, not helped by the fact that the mid­wives com­pletely failed to spot that my daugh­ter was the wrong way round.

Af­ter my emer­gency Cae­sarean, i was made to feel like a to­tal fail­ure, and when, not long af­ter, i be­came preg­nant with my sec­ond child and de­manded an elec­tive Cae­sarean, it was as though i had told them i was go­ing to sell the child into slav­ery. Ad­mit­tedly, i had a bad ex­pe­ri­ence. there are many bril­liant mid­wives who do their jobs ad­mirably and with an open mind.

But when even the one pro­fes­sion that is meant to nur­ture and pro­tect women at one of the most im­por­tant but also po­ten­tially trau­matic times in their lives is prey to prej­u­dice and in­com­pe­tence, it’s hardly sur­pris­ing that, as women, we end up feel­ing con­fused and con­flicted about our own bod­ies.

the fact is, med­i­cal science ex­ists to im­prove the health prospects of ev­ery­one. the no­tion of what is ‘nat­u­ral’ has long been su­per­seded by what is pos­si­ble. twenty years ago, a baby born at 24 weeks would have needed a mir­a­cle to sur­vive; now it’s a dis­tinct prospect.

sim­i­larly, a di­ag­no­sis of can­cer meant an al­most cer­tain death sen­tence; now out­comes are im­prov­ing all the time. Day in, day out doc­tors per­form small acts of med­i­cal magic that are any­thing but nat­u­ral, but that does not mean they are wrong.

that is why any no­tion that the menopause is a nat­u­ral process and that, there­fore, its symp­toms should be sim­ply en­dured, be­longs, quite frankly, in the mid­dle ages.

this is the one prob­lem that af­fects all women and that we can solve — cheaply and ef­fec­tively. What’s not to like about that?

i shall leave the last word to an ex­pert, Kathy Aber­nethy, chair of the Bri­tish Menopause so­ci­ety and se­nior nurse spe­cial­ist at the Menopause Clin­i­cal and Re­search Unit at North­wick Park Hos­pi­tal.

‘HRT is a low-risk treat­ment for most women who need it,’ she says. ‘it gets rid of symp­toms com­pletely and puts them back to feel­ing nor­mal.’

Frankly, at my time of life, nor­mal will do just nicely.

Picture: GETTY

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