WHY ARE DOCTORS DENYING WOMEN HRT?

Prescriptions have plunged by two-thirds – and behind it, says this expert, lie ignorant and out-of-touch GPs who are leaving thousands suffering needlessly

LAST WEEK, a new patient wept in front of me as she described the hellish existence she said she’d been enduring for the last two years. Suzan had quit her job, given up on her relationship and admitted she now spent most afternoons asleep on the sofa. She was convinced her problems — which included overwhelming fatigue, anxiety and low libido — were due to the menopause. But her GP disagreed. Diagnosing her with depression, he had given her antidepressants.

‘I do feel depressed,’ Suzan, who’s 52, wailed. ‘Who wouldn’t if their life had fallen apart the way mine has? But that’s only because of the way the menopause is making me feel.’

She said her doctor had refused her hormone replacement therapy (HRT), citing outdated scare stories of an increased risk of breast cancer. ‘He insisted I would have to brave it out, and said that the antidepressants he prescribed would probably help,’ she told me.

Suzan didn’t need antidepressants — she needed a prescription for HRT, which is what she received from my clinic.

That she’d had to travel all the way from Scotland to my private consulting rooms in Stratfordupon-Avon to get that is nothing less than a travesty.

Her doctor had deprived her of medication that would have cost the NHS just £4 a month, and has the ability to give this woman her life back. And all because he wasn’t clued up on the menopause — a condition that every woman in his practice will experience sooner or later.

I wish I could say that Suzan was an unusual case. However, sadly she is typical of so many of the women who seek me out for treatment to help them cope with the menopausal symptoms that are destroying their lives. And that’s no exaggeration. I see women week in, week out who, like Suzan, have given up their careers because their menopausal brains feel so befuddled they can’t trust themselves to make the right decisions at work.

Some have memory-loss problems so severe that they honestly believe they might have dementia; in some cases their doctors think so, too, and send them for tests.

Many are struggling to maintain their relationships because they are permanently short-tempered with their partners and have zero sex drive.

They can’t sleep, they’ve gained weight, and they feel permanently anxious. Basically, they don’t recognise themselves any more.

AND

the answer to all this is staring GPs in the face: HRT.

This is the most effective treatment available when it comes to relieving the hot flushes, night sweats, mood swings and bladder problems that menopausal women can experience.

Taking HRT is simply replacing hormones. In a similar way, we prescribe thyroxine for women with an underactive thyroid gland.

Research has also shown HRT can actually lower the risk of heart disease (including heart attacks), osteoporosis, type 2 diabetes and dementia. All of these common conditions are costing the NHS billions of pounds. So why on earth are women being denied this treatment when it is clearly so cheap and effective?

The crux of the problem lies with data from the Women’s Health Initiative (WHI) study in 2002, which was misinterpreted and yet is still often quoted in the media.

THE

report claimed that hormone replacement increased the risk of heart problems. But when the data was analysed properly, this study, and subsequent research, has shown that women starting HRT in the first ten years following their menopause reduce their risk of a heart attack by around 50 per cent — that’s more effective than treatment with statins or blood pressure-lowering drugs.

The other concern so many women and healthcare professionals have about HRT is the breast cancer risk. But the reported increased risk supposedly discovered by the WHI was so low as to not be statistically significant.

Meanwhile, there are many other factors that pose a greater risk for developing breast cancer than HRT: being overweight, not exercising and alcohol, for example.

Yet today, doctors continue to be fixated by the idea that HRT, cancer, blood clots and heart problems go hand-in-hand. And never mind the fact we’ve had several studies published since 2002 that have debunked so many of the issues the WHI study appeared to raise.

For example, in 2015, the National Institute for Health and Care Excellence (NICE) guidelines on menopause clearly stated that, for the majority of women, the benefits of taking HRT outweigh any risks.

With such clear indicators that HRT can be a good choice for so many women, it’s astonishing that so many GPs — and their patients — remain fearful of it. Clearly, we need improved menopause education for the medical staff certain to encounter menopausal women throughout their careers — so that’s doctors, nurses and pharmacists.

I regularly lecture at the Royal College of General Practitioners and provide e-learning sessions for doctors. It’s great to be able to bring their understanding of HRT up to date, because so many of them qualified in an era when HRT was demonised and, as a result, they still don’t have the confidence to prescribe it.

I’m not going to claim that HRT is a panacea for each woman’s every menopausal symptom. But for women like Suzan, and so many more of my patients, a prescription for HRT can give them their life back.

Just as countless women have sat and sobbed in despair in my office, many more have returned a few months later and wept with relief and joy over feeling well again.

The tragedy of this is that their GPs didn’t properly understand HRT and how it could have helped them in the first place.