Number of women on HRT to double

Health watchdog says cancer scare has led to more than a million suffering in silence

MORE than one million menopausal women “suffer in silence” and the number of those taking hormone replacement therapy should double, according to new guidance from the NHS.

The National Institute of Health and Care Excellence (Nice), the health watchdog, said far more help should be offered to women suffering debilitating night sweats and hot flushes.

The number of women taking HRT has more than halved since a major study linked it to an increased risk of breast cancer, more than a decade ago.

Today, Nice says GPs should give women more information about the possible risks and benefits of treatment – not just expect them to “grit their teeth and get on with it”.

The advice is the first guidance from the watchdog on treatment and diagnosis of the menopause.

Each year, around 1.5 million women experience menopausal symptoms, including almost 400,000 who suffer them to a “troublesome” extent, estimates indicate.

But just one in 10 of those going through the menopause is currently prescribed hormone treatment, despite it being the most effective treatment to manage the symptoms of oestrogen deficiency, Nice said.

The watchdog suggested that at least twice as many should be talking to their GP about the potential benefits of HRT, and that help should be offered to any woman struggling with symptoms.

Senior doctors said too many GPs and patients had been frightened off hormone treatment by the 2002 study linking it to a breast cancer risk.

The risks had not been properly balanced against the significant benefits the therapy could offer to those who could otherwise be left in “unbearable” misery, experts said.

Dr Imogen Shaw, one of the authors of the guidance, said she hoped more women would now seek advice about treatment, and GPs feel more confident prescribing it.

The concerns raised by the 2002 study meant that women tended to think “HRT is scary”, she said. “Women should not feel they have to suffer in silence when menopause is affecting their daily lives at work and at home,” said Dr Shaw, a GP specialising in gynaecology.

The effects of menopause were often misunderstood and underestimated, with a significant impact on long and short-term health, Nice said.

“Menopause can cause unbearable hot flushes and night sweats. Some of my patients describe being woken up several times during the night by hot flushes, and being so drenched in sweat that they have to change the bed linen,” Dr Shaw said.

Other side effects include low moods, brittle bones and gynaecological problems. The authors of the guideline stressed that HRT would not be suitable for all those suffering menopausal symptoms, and that for some, risks

JILL was in her early 40s when she had a hysterectomy. She was put on HRT to counteract the night sweats and extreme tiredness.

After two years, she was advised to come off the hormones. The sweats, mood swings and exhaustion came thundering back. Jill’s GP advised her to “go into a corner of the room when you feel like screaming, and scream”. How very thoughtful of him.

Jill recalls: “When I pointed out that it was rather difficult to scream when interviewing people for a research project, the doctor reinstated my treatment. I am now 70 and leading a full and active life. I am under pressure from my young doctor to stop HRT, she keeps warning me about the latest research, all of which I take with a pinch of salt. I’m going for quality of life not quantity. If I had listened to all the scare stories over the years, I would have lived a life of pain and misery instead of one of interest and excitement.”

Jill is just one of the hundreds of readers who emailed me after I wrote about my own decision to start taking bio-identical hormones.

Like many women of my age, I though HRT was a no-no because a study had linked it to an increased risk of breast and ovarian cancer. However, two years of debilitating exhaustion and erupting like a human Krakatoa whenever husband or child put a cup in the wrong place made me seek help in Harley Street. Reading all those readers’ emails, I frequently found myself in tears. Actually, I was enraged. How was it possible that in this country so many women had to literally beg their doctor for medication which could transform their mental and physical health? Julie spoke for many: “I am reduced to a gibbering wreck by doctors who make me feel I am the most wicked woman alive for even contemplating taking HRT.”

Maureen reported the “hostility” she felt at her local surgery when she went for her regular check-up. “It was as if they actually resented the fact that the HRT was clearly working brilliantly for me when they’d told me to come off it.”

When I went to see my own GP and mentioned the bio-identical hormones, highly recommended by American friends, she said that she had never heard of them and would certainly not recommend I start HRT. I was lucky enough to be able to afford to go private. As I found out, the ignorance in the medical profession about the menopause is staggering. We were stuck with a comic, Les Dawson, Ooh my mother-in-law view of that time of life, all hot flushes and voluminous nighties. But the withdrawal of oestrogen, which has made you feel like a woman since you were in your early teens, can change the person you think you are. It’s devastating.

“I am either very, very sad or I want to bite people,” said Suzanne. “I just want to feel like myself,” said almost everyone.

Not all doctors were blind to the troubles middle-aged women faced, nor convinced about the anti-HRT stance that was triggered by one flawed study. Professor John Studd, a leading authority on menopause, told me he saw countless patients who had been misdiagnosed, informed they were bi- polar and put on anti-depressants, which made them feel worse. Within weeks of starting the hormones, they were back to their old selves.

Dr Richard Quinton, a consultant and senior lecturer in endocrinology at Newcastle University, took the time to put me straight on a few things: “Even women who can’t afford to see a private sector ‘Dr Libido’ can get great advice and treatment on the NHS by self-referring themselves ( just a phone call to make an appointment, no need to see a GP first) to their local Community Sexual Health Centre,” he said.

“There, they’ll be able to have a consultation with a community-based gynaecologist, or a GP-with-special-interest, and I’m sure they will get a very sympathetic hearing and a prompt offer of treatment.” Why was this service not more widely known about? Not a single woman I spoke to had heard of it. It was further evidence of how badly British women have been let down and betrayed. For decades, the party line of the medical profession has been that most women “sail through” the menopause and only a small minority suffer any ill effects. Like hell we do. Doctors knew that, mostly, they could rely on stoical middle-aged females to just get on with it, no matter how wretched they felt. The taboo around ageing, combined with women’s shame at losing their youth and sexual currency, prevented any serious challenge being made to this complacent consensus.

Well, the new guidance from Nice finally proves what those readers who wrote to me knew all along: HRT is a fantastic aid to keeping mentally sharp and physically vital. Nice says it could benefit another million women: everyone going through the menopause should take it, in my view. Doctors who denied their patients HRT had better get with the programme, and sharpish.

At the start of the 21st century, women are not prepared to go gentle into that good night: instead of raging at the dying of the light, we can take HRT, which will rekindle the fire. And, once again, feel gloriously like ourselves.

‘Instead of raging at the dying of the light, we can take HRT which will rekindle the fire’