Why I won’t stop prescribing (or taking) HRT

As a further study highlights the risks of hormone therapy, Dr Louise Newson urges menopausal women not to panic

For six months, I’d been feeling uncommonly irritable. I was tired, fed up and ready to throttle my poor husband, simply because his breathing annoyed me. My joints were sore and stiff and I kept waking up in the night. I feared there was something seriously wrong with me.

Although I was in my mid-40s, what hadn’t, at that stage, occurred to me was that my symptoms were perimenopausal. Once I had made the connection, I started taking hormone replacement therapy (HRT). In common with all of my patients, HRT made me feel more like myself again and gave me back my pleasures in life.

However, in 2016, a new study suggested that women who took HRT were almost three times as likely to get breast cancer. I read it in the news and panicked; my first thought was that I needed to come off the treatment straight away.

Then I took a step back. Did I really need to give up something that was keeping me sane, allowing me to work and enjoy life as before? Instead, I read the study very carefully, took advice from people in the know, and discovered the research did not tell us anything we did not already know.

Now, here we are again, three years on, with new research by Oxford University telling us this week that HRT raises the breast cancer risk by a third. The study, published in The Lancet, reviewed all the data on HRT and cancer worldwide and concluded that while the general risk of breast cancer for women aged 50 to 69

who have not taken HRT is 6.3 per cent, those on oestrogen plus daily progestogen – the most common form – for five years have an 8.3 per cent risk. The scientists even believe around one in 20 cases of breast cancer in the UK are due to HRT.

Once again, women are – understandably – panicking. The authors of the study say they “don’t want to be unduly alarming, but we don’t want to be unduly reassuring”.

But alarm is a natural reaction when you hear the words “breast cancer” in the same sentence as HRT, and my fear is that the headlines, and not the drugs themselves, will impact negatively on women’s health. I fear women will decide to come off HRT, or not to even start it. That would indeed be detrimental to the health of so many.

I don’t feel alarmed by the findings. They arise from an epidemiological study looking at numerous other studies undertaken in the past. It is not a randomised controlled study, which is the gold standard study to demonstrate cause and effect. There are so many different reasons why women develop breast cancer – obesity, not exercising and drinking alcohol are all independent risk factors. I personally don’t drink and don’t smoke. I lead an active life, which has been made possible by my HRT.

Numerous women I talk to tell me they have put on weight, due to both the metabolic changes that occur during the perimenopause and menopause, and also due to comfort eating to improve how they feel. Many admit they have had to stop exercising as their motivation is low, their energy levels reduced and their joints stiff and sore (common perimenopausal and menopausal symptoms). They repeatedly tell me they are drinking more alcohol to “numb” symptoms.

This means there are thousands (millions, even) of women who could be increasing their future risk of breast cancer without realising it. Yet they are often too scared to take HRT.

HRT is not just about breast cancer risk, in any case. Numerous quality studies have shown that women who take

HRT have a lower future risk of heart disease, osteoporosis, osteoarthritis, type 2 diabetes, depression, bowel cancer and dementia. All these diseases increase in women who have gone through the menopause and have low hormone levels in their bodies. Women are seven times more likely to die from heart disease than from breast cancer.

The women I see at my menopause and wellness clinic are constantly thanking me for “giving them their lives back”, their mood, concentration, energy, wellbeing and enjoyment of daily activities having improved on the treatment.

What really should worry us is that although every woman will go through the menopause, healthcare professionals still have no mandatory training in it. This lack of understanding means many medical professionals will be feeling just as confused about the most recent research as the patients.

In our menopausal and wellbeing centre in Stratford-upon-avon, we hear thousands of menopausal women’s stories, about how they have been misdiagnosed with fibromyalgia by rheumatologists, migraines by neurologists, depression by psychiatrists, palpitations by cardiologists and bladder infections by urologists. None of these many doctors they have seen have spoken about their menopause and how HRT could improve their symptoms, as well as improve their future health.

Everything in life carries some degree of risk. But making informed decisions means asking ourselves truthfully if the bad really does outweigh the good from any course of action.

I’ve been taking HRT for three years, and despite the scary-sounding headlines, I’ll not be quitting it any time soon.