My message to women is: you are NOT going crazy. You can’t help it - nor can you help it if those around you don’t understand
pitch up at GPs’ surgeries with symptoms of anxiety, fatigue, insomnia or just not feeling like themselves and the response is often a diagnosis of depression, especially after the patient has ticked all the right boxes on the depression questionnaire every GP has handy on his or her desk.
They may need only as few as eight questions, all of which are very broad, such as: How much pleasure do you take in life? Do you feel depressed? Do you have trouble falling asleep or have little energy?
The apparent remedy is antidepressants, anti-anxiety medication or sleeping tablets — or all three!
YET hormonal imbalance often causes exactly the same symptoms. Hopelessness, apathy, anxiety, lack of enthusiasm, fatigue or low energy, poor appetite or overeating, lack of confidence, lack of concentration, low libido, insomnia, even suicidal thoughts — all of these can be the result of the maelstrom of fluctuating hormones that often accompanies perimenopause.
Sometimes, those women then come to me as a last resort. They know they are not depressed and do not want to take the drugs they’ve been given, some of which are physically and psychologically addictive and have side- effects they do not want to endure.
Faced with a perimenopausal woman, an open-minded doctor should consider the strong possibility of hormonal imbalance rather than depression, yet too many do not.
There is another important statistic here, one I believe proves how women’s symptoms in midlife are routinely under-investigated and misdiagnosed.
In the decade between 2005 and 2015, the number of antidepressants prescribed in the UK more than doubled. Today, more than 67 million prescriptions are being issued every year, at an annual cost of £280 million to the NHS.
TRUTH BEHIND THAT BREAST CANCER STUDY
IT IS no coincidence that this shocking rise occurred in the wake of a 2002 U.S. study that seemed to link HRT — the medical replacement of naturally occurring hormones — with breast cancer.
We all remember this study. It began in 1993 and was funded by the American government after much lobbying from the women’s movement. Called the Women’s Health Initiative (WHI), it involved 161,808 women between the ages of 50 and 79 and was supposed to provide definitive answers on the subject of HRT’s safety.
It was meant to last decades, but was halted in 2002 because of ethical concerns. The results were alarming: a dramatic increase in breast cancer, as well as strokes and heart attacks among the women taking the HRT combination of Premarin and Provera.
Premarin, which is made using horses’ urine — PRegnant MARes’ urINe — was the standard synthetic form of oestrogen at the time and the bestselling drug in the U.S., and Provera is a synthetic progesterone substitute still prescribed today.
What had long been anticipated and feared was finally proven: synthetic hormones were deleterious to a woman’s health.
Hundreds of thousands simply stopped taking HRT the next day.
The results of the WHI study have been contentious ever since, causing disarray among doctors over hormone treatment protocols, and disillusionment among women. The study created a climate of fear surrounding hormones and HRT, which spread to all other forms of hormone balancing or replacement therapy.
Panic caused a sharp decline in HRT prescriptions during the first decade of this century, with women again suffering the consequences of hormonal imbalance. And what happened alongside that? A dramatic increase in prescriptions of antidepressants. Sadly, in the wake of the WHI study, the medical profession turned to antidepressants to combat the symptoms of menopausal hormonal withdrawal, such as mood swings and anxiety, instead of searching for healthier, safer alternatives to treat hormonal imbalances.
WHY BIO-IDENTICAL HORMONES WORK
THoSe alternatives, I fervently believe, can be found in bio-identical hormones, sometimes called body-identical hormones, which have a chemical make-up that exactly matches the natural hormones your body produces.
BHRT was at the heart of my approach two decades ago, and today there is increasing scientific evidence to show bio-identicals have fewer side-effects than their synthetic equivalents.
It may come as a surprise to learn that the oestrogen and progesterone you get in regular HRT are different from those you make naturally. Your doctor is unlikely to tell you this because they don’t fully appreciate or understand the difference.
I believe that if you are replacing something in a system as complex and sophisticated as the human body, it makes sense to use a likefor-like formula that has evolved over millions of years, rather than a synthetic version of the same.
Take Provera as an example. Used in regular HRT, Provera is another name for progestin, the widely-used substitute for the female sex hormone progesterone. But progestin differs in several small but crucial ways from the natural version of progesterone.
Indeed, progesterone and progestin can have very different effects and sometimes even the opposite effect.
For instance, progesterone is the hormone produced in large amounts in pregnancy and is given to women having IVF treatment because it improves their chances of becoming pregnant.
In contrast, doctors are warned against giving progestin to pregnant women because it can cause miscarriage.
Regular HRT is taken in a number of different ways. The HRT that shows the effect of progestin most clearly contains just oestrogen for the first two weeks of a cycle, followed by oestrogen and progestin for the second two.
THOSE second two weeks, which would normally be a time of calmness hormonally, are often described as being deeply unpleasant, with symptoms including headaches, nausea, breast tenderness and mood swings.
In fact, there is evidence that progestin can cause a range of very serious problems, including heart disease and cancer.
Yet in my experience of more than 10,000 patients, the best treatment option is a hormone replacement therapy derived from plant hormones found in the Mexican yam and soya — a safer treatment with considerably fewer side-effects.
Progesterone is the best example of this. What’s remarkable about this natural version is that it’s licensed in the UK for fertility treatment — progesterone is a pro-pregnancy hormone, and the safest, most female hormone that exists — but is rarely prescribed on the NHS for the symptoms of menopause.
If you ask for HRT on the NHS, you are most likely to be prescribed progestin as a progesterone substitute, with all those nasty side- effects! This is due to the remarkable refusal of the UK obstetrics and gynaecological community to recognise the difference between the two and its implications.
In fact, because there has been no distinction made between natural bio-identical hormones and synthetic HRT, women have been deprived of confidence in hormone therapy in general.
In America, bio- identical hormones are more mainstream. Indeed, almost half the prescriptions for menopausal hormone therapy in the U.S. are ‘ custom compounded bio- identical hormones’, which means dosages are tailored to each individual.
We can only look forward to similar developments in Britain, and to a time when women in midlife aren’t routinely handed antidepressants as a treatment for symptoms that are actually due to a hormone deficiency or imbalance. Anything less than a full investigation — and proper diagnosis — of those symptoms does women a great disservice.
I’m proud to have brought the customisation of hormone treatments to the UK in the past ten years. With more awareness and education, I hope to empower women to be able to choose the right treatment available to them, and get the best care they deserve.
Adapted from It’s Not My Head, It’s My Hormones by dr Marion Gluck (Orion Spring, £14.99). © dr Marion Gluck 2019. to order a copy for £12 (offer valid to december 22, 2019; p&p free), visit mailshop.co.uk or call 01603 648 155.
The sharp decline in HRT prescriptions coincided with a dramatic rise in antidepressant use