Scottish Daily Mail
I know taking HRT has risks – but not taking it scares me far more
Reaching the menopause can feel like a living death, says SARAH VINE.And we shouldn’t have to endure it
Last thursday, I started taking HRT — the very day that the health watchdog the National Institute for Health and Care Excellence (NICE) declared the drug was fine for menopausal women to use and urged GPs to prescribe it more often.
the advice for women over the past decade has been very ANTI-HRT. In a nutshell, we were told that taking it raises the risk of getting cancer.
But there’s something else: a sense that HRT is a vanity; that the menopause is a natural process and that women who seek to delay it or avoid it altogether are rather sad cougar types, in denial about the ageing process; that the right and moral thing to do is let nature take its course and shuffle quietly into old age.
My suspicion is that those people are mostly men and, therefore, largely immune to the symptoms. In my case, I really felt I needed to explore the options.
By the time I booked an appointment to see my doctor, I wasn’t even sure I wanted to make old age. I’d been feeling tired, miserable, low and very snoozy for months.
In my heart of hearts, I knew what was wrong. I’m 48. Fair enough, I have a long-term problem with my thyroid, but that is carefully monitored and, for the most part, taken care of by daily medication.
But otherwise I’m pretty healthy: I exercise regularly, I eat well, I don’t smoke and I try not to drink too much.
at my age, I thought my symptoms could mean only one thing: the menopause.
My doctor was not convinced. He suspected it was probably my thyroid, but nevertheless agreed to run some blood tests. a few days later, he rang me to say I was right. I wasn’t producing any oestrogen whatsoever. the M-word.
In some ways, it was a relief. I always think a good diagnosis can be half the cure.
But part of me felt rather sad because, let’s face it, the menopause is, in stark biological terms, the beginning of the end for a woman.
Intellectually, of course, we all accept there’s much more to life than having children.
But that doesn’t change the fact that, in purely reproductive terms, a menopausal woman is a spent force.
as far as Mother Nature is concerned, once you stop producing eggs, it’s perfectly fine for you to curl up and die.
In fact, the sooner you can get on with doing this, the better. that way you won’t be taking up scant resources that could go towards the next generation. Perhaps that’s why the symptoms are so unpleasant. If mine are anything to go by, the whole process is enough to make anyone want to go to sleep and never wake up again.
With hindsight, it all began around a year ago, when my periods began to go haywire.
I became anaemic, with a tiredness so extreme I would be ready for bed at 8pm — rather like in the very early stages of pregnancy.
In the afternoons, I wasn’t so much experiencing a bit of a slump as becoming catatonic.
at weekends I would go for a post-prandial nap at around 3pm and be offline for the next four hours or until my rather worried husband brought me up a cup of tea. Or a gin and tonic.
Meanwhile, I was waking up in the middle of the night, plagued by throbbing headaches that seemed resistant to all painkillers. these would last most of the day and only subside towards teatime, leaving me exhausted since the rest of the world — work, children — didn’t just stop because I was incapacitated by pain. Despite regular exercise (and I am not lying about this, I am very strict with myself about the gym, since it’s the one thing that really helps with the dodgy thyroid), I had sore joints and stabbing muscle pains, as though I were permanently on the verge of flu. and then there was the heat. Not just hot flushes, with almost comedic amounts of sweat seemingly gushing from every pore, but a permanently elevated body temperature.
My husband said it was like sleeping next to a very small nuclear reactor, and he wasn’t exaggerating: you could have hooked me up to the National Grid and I would have easily powered a small village.
at night, I couldn’t tolerate any sort of bedcovers. Even on the coldest evening, the windows all had to be open.
the entire family would be shivering like wet puppies while I sat happily in the corner, basking in my own tropical eco-system.
My idea of heaven was a cool rain and a north-easterly breeze. I started taking cold showers for the first time in my life.
and then there were the mood swings, occasionally up but mostly down. strange, fraught dreams and nightmares, extreme anxiety, even the odd panic attack.
I developed tinnitus: occasionally a high-pitched noise, sometimes a low swooshing sound like the sea.
Both contrived to drive me mad in the dead of night when, awake and alone, I felt as though the sound of my own brain would drive me mad.
so when the doctor confirmed my suspicions, I felt relief, yes, but also a sense of loss. I had a little cry on the way home in the car. silly, I know, but it just felt like a bereavement, the end of something, as though by no longer having the wherewithal to have a child I was somehow taking a seat in death’s waiting room. I made an appointment to see Katy Clifford, an expert in HRT and menstrual disorders and a consultant gynaecologist at st Mary’s Hospital.
Clifford is a busy woman, so it took a while for me to get the appointment. as luck would have it, I saw her last Wednesday: the eve of this week’s important announcement from NICE on the benefits of HRT.
so after we’d discussed my symptoms and the results of my blood tests, there was only one question left: should I take HRT?
Clifford’s view was clear. Even though I am not fully menopausal — not having had a period for a year if you are over 50 or two years if you are under 50 — I should start it immediately, for the simple reason the benefits outweigh the risks.
Quite aside from the fact that HRT would alleviate and even eliminate all my horrible symptoms, oestrogen — the hormone I was no longer producing — is not just useful for making babies. It also helps protect the heart and bones, which is why heart disease and osteoporosis are common in older women, and worse in women who haven’t taken HRT.
Most interesting of all, though, is that the earlier you start taking it, the better it is for you, because by maintaining oestrogen levels you can protect your bones and heart for longer, which means fewer complications in later life.
taking HRT for the first time in your 60s may well not be worth the cancer risk, since the treatment won’t deliver benefits elsewhere. ON THE question of cancer, Clifford was unambiguous: there is always a risk, but it is no greater a risk than being obese, drinking too much alcohol, inactivity or smoking. ‘the benefits of HRT in otherwise healthy women under 60 years old appears to outweigh the risks,’ she says.
‘HRT controls the menopausal symptoms — hot flushes, night sweats and mood swings — protects against osteoporosis and reduces your risk of colon cancer. It may also offer some protection against cardiovascular disease.
‘But treatment of HRT should always be tailored for the individual, depending on each woman’s risks and requirements.’
a helpful website for calculating your HRT risk is manage my menopause.co.uk.
and so it was that on thursday I collected my prescription and applied my first dose of oestrogen, in gel form, before bed. On December 1, I shall take progesterone for 12 days. No change yet — it’s far too early. But I have no doubt that it will work.
as to the rest, we’ll just have to wait and see.