‘Why I’m not on hor­mone re­place­ment ther­apy’

Fairlady - - CONTENTS -

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.

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