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

- By Sarah Vine Health · Women's Health · Medications · Medicine · Lifestyle · Healthy Living · National Institute for Health and Clinical Excellence · National Institutes of Health · Granite State Electric Company · Pharmacology

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.

 ?? Pic­ture: ALAMY ??
Pic­ture: ALAMY
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