The rich go private for their hormones. The rest struggle to get any help at all. It’s shameful

This is what I knew about the menopause a few years ago: “Periods stop. Full stop. Not a problem. And whatever you do, don’t take HRT.” I was so wrong I wrote a book about it, and made a myth-busting menopause documentary with Davina Mccall.

Doing nearly three years of research, I’ve discovered the huge inequalities in access to knowledge of the menopause, and access to the safest forms of hormone replacement therapy (HRT). Particularly in Scotland.

My own menopause journey was not just a car crash, but a full Thelmaand-louise off-the-cliff moment that affected my health, my relationship and my job, and I don’t want to sit around watching other women getting into the same mess.

I started getting sudden heart palpitations in my late-forties, and would wake up at 4am panicking and anxious. I thought I was going crazy. My GP sent me for an electrocardiogram. My heart was fine – I’m a runner. Her diagnosis was “too much coffee”. In fact, the palpitations were caused by my hormones estrogen and progesterone behaving like they were on a rollercoaster before they ran out at menopause.

It was only after I started reading scientific papers about menopause that I discovered 11% of perimenopausal and menopausal women get heart palpitations. But my GP didn’t know that because menopause is still not a compulsory separate module on the curriculum.

My palpitations stopped forever when I started taking HRT – estrogen gel through the skin, a

Utrogestan micronised progesterone pill every night, and a blob of testosterone cream. Not all of these are easy to get on the NHS in Scotland. My hot flushes and sore joints also disappeared but, for me, the most important effect of the HRT was on my memory.

In surveys, over 60% of women complain of brain fog around menopause. When I was 52, I was the film critic for a national newspaper, watching and remembering 350 movies a year, so I realised I might have the occasional lapse. But one Saturday I was writing a shopping list thinking “must shave my legs” and I wrote down the word “shaver”. I couldn’t remember the word “razor”.

I was terrified I was getting Alzheimer’s disease. My mother, Ella Muir, who was a personnel manager in a Glasgow department store and later worked for the Citizen’s Advice Bureau, died of Alzheimer’s in 2015. Her memory was always great – then suddenly she started being unable to remember simple nouns, then names, then facts, and then me, as the disease progressed.

So I was overjoyed when I realised the positive effect estrogen and testosterone

had on my brain – my memory came back, razor sharp.

I realised that getting women access to HRT was not just about hot flushes, but long-term brain and bone health. One in two women get osteoporosis, and HRT stops your bones disintegrating.

The new body-identical HRT available on the NHS, which I use, is far safer than the old combined estrogen and progesterone pills. The new natural progesterone and transdermal estrogen is an exact copy of your own hormone, extracted from plants, and since the estrogen is taken through the skin, there’s no risk of causing blood clots, and indeed estrogen helps prevent cardiac disease.

A French five-year trial showed body-identical HRT did not cause breast cancer, and had a lowto-no risk over 10 years.

But everyone still seems to think HRT is dangerous when, in fact, the famous 2002 WHI study linking it to an increase in breast cancer was on the old, combined, synthetic pill. The best NHS menopause clinic in London gives 95% of its patients the new body-identical HRT.

So the safer form of HRT is good news – but

not enough women know about it. The divide between the Have-hrts and the Have-not-hrts is shameful; the rich get their hormones privately at an expensive clinic, while the poor struggle to get any help at all.

Some old-fashioned NHS GPS, educated before the new, safer hormone treatment, still refuse to prescribe HRT altogether, and it is women already struggling with compromised health that need it most.

As Dr Kate Pickering, a GP in Glasgow for three decades, explained to me: “If you’re 10 floors up in a council flat in Easterhouse and you’re a grandmother getting up to look after a baby because the mother is looking after the older kids and you’ve got night sweats – well, HRT should be bog standard to help. Menopause is a big issue and there’s not enough information available. No one ever talks about working-class women and it’s a real inequality.”

I also talked to Dr Helen Smith, who works in the Kilmarnock area, which has one of the worst mortality rates in the country, and she said: “A lot of middleclass women will do their own research and ask for what they want. So many of my patients come from a very different place, with significant adverse childhood experiences, domestic abuse, alcohol and significant drug issues.

“If they can’t afford data on their phones to educate their children, they won’t be downloading a menopause app, will they?”

And a study from Warwick University showed that in the UK, women who live in the most economically deprived areas are less likely to get HRT and, even if they get HRT, they’re more likely to be given the old, riskier combined pill.

Let’s just look at what’s on the Greater Glasgow area NHS formulary – the list of drugs they advise doctors to use. The top three entries are all for Elleste combined pills. Only at number four is there a transdermal estrogen spray. But the real road block in Scotland to safer HRT is that the bodyidentical progesterone Utrogestan is not even on the formulary – GPS who care like Dr Smith have to prescribe it off-licence.

But in London and the South, Utrogestan is readily available. (Another safer option for women refused Utrogestan is the Mirena coil.) Why don’t Scotland’s women deserve the best health options too?

Maybe that will change. Caroline Phipps-urch, a yoga teacher who runs workshops as part of The Menopause Sisters, has launched a petition for NHS Lothian to make micronised progesterone available to patients. As for testosterone, which is also a female hormone and helps with energy, memory and libido, that’s usually only available from a specialist clinic.

But, for most women, getting the best-tolerated and safe HRT is a problem. We’re making our follow-up to the Davina Mccall: Sex, Myths And The Menopause documentary at Finestripe Productions in Glasgow, and there are five women on HRT on the production team – including me. Two were still on the old combined pill, and changed to safer Utrogestan and transdermal estrogen after they read the science papers researching the programme. One has waited a year to get an appointment at an NHS menopause clinic in Glasgow for progesterone.

The call for change has to come from women up, because it’s not coming from the medical establishment down. Carolyn Harris MP has campaigned for women to get free HRT prescriptions in England, bringing it into line with Scotland, but we need someone at the top to take a long, hard look at the science.

A study of the health records of 105,000 women in the UK over 32 years, showed those taking HRT of any kind were 9% less likely to die early. It’s a no-brainer for savings to the heathcare system – and for saving women’s sanity.

One last note. It turns out you can take the safer HRT for life – and start it late. The woman who commissioned our

menopause programme at Channel 4, Paisley-born

Dorothy Byrne, decided to start taking HRT at the age of 68. “I wondered why I felt different, and I realised I was no longer waking up three times a night,” she told me. She is now the president of Murray Edwards College, Cambridge.

As we live, on average, to the age of 83, why shouldn’t those later years be healthy and productive? We need to talk about HRT and the menopause at the highest level. Now.

Everything You Need To Know About the Menopause (but were too afraid to ask) by Kate Muir, out now from Gallery Books