Women need expert help in making the correct choice

HRT HAS liberated thousands of women from the debilitating side-effects of menopause — be it hot flushes, night sweats, mood swings or more — that can cause such bleak despair. And there are hundreds of thousands more who could benefit, too.

Years of medical research have clearly demonstrated how the benefits of HRT outweigh any risks, not least in what has been a prevailing concern: breast cancer.

We now know there is little or no change in the risk for women if oestrogen-only HRT is taken, and the risk with combined HRT (oestrogen and progestogen) is small. What’s more, there is no arbitrary time limit — it can be used for as long as a woman feels the benefits outweigh the risks.

All of which amounts to a huge step forward for women, giving confidence to those who need it — and the GPs who prescribe it, a far cry from how things were 20 years ago. Through my work as a doctor and founder of informative website Menopause Matters, I know the suffering that lack of access to HRT when desperately needed can cause.

So proposals to reclassify one form of HRT — vaginal oestrogen — as an over-the-counter treatment are, in theory, to be broadly welcomed, not least given current pressure on GP availability.

Common consequences of menopause are vaginal dryness and bladder changes, which can cause significant distress. Women often find the topic embarrassing to discuss with their GP, but these changes can be effectively treated by vaginal oestrogen, which is available in a number of forms and is not linked to the risks associated with other types of HRT. So this is a good move.

But what if this heralds an era in which all forms of HRT are one day available to buy without a prescription? This would need serious consideration.

If HRT were to be made available over the counter, it could not be introduced overnight in a crude, tick-box manner. For such a policy to work, there would need to be a huge information campaign, mobilising hospitals and surgeries, social media and other platforms to help women make an informed choice.

You see, HRT is not a one-sizefits-all treatment, to be taken at the first hint of a night sweat. Consideration must be given to the type, dosage and route of HRT, all of which influences doctors’ advice.

HRT is available in different formats; oestrogen can be taken as a daily tablet, a twice weekly or weekly patch, daily gel or implant. Sometimes tweaks are needed to give optimum benefit to a woman’s very individual combination of menopause symptoms.

A woman’s medical history is another thing a doctor will always consider.

What would worry me if other treatments were available over the counter is that it would be incumbent on the individual to do the research and to have all the relevant information available.

Obviously pharmacists could offer some basic advice — perhaps explaining that HRT isn’t suitable for someone with a history of blood clots or high blood pressure — but they wouldn’t have your medical history to hand.

A woman would therefore have to be knowledgeable about her own situation, and what treatments might be suitable — and you can’t expect women to know the ins and outs of all this automatically.

I believe increased access to HRT is great progress. Too many women battle with menopausal symptoms when the solution should be within their grasp. We just need to make sure any future open-door policy is safely and effectively deployed.

A pharmacist wouldn’t have your medical history to hand