Last week, a new patient wept in front of me as she described the hellish existence she said she’d been enduring for the last two years. Suzan had quit her job, given up on her relationship and admitted she now spent most afternoons asleep on the sofa.
She was convinced her problems — which included overwhelming fatigue, anxiety and low libido — were due to the menopause. But her GP disagreed. Diagnosing her with depression, he had given her antidepressants.
‘I do feel depressed,’ Suzan, who’s 52, wailed. ‘Who wouldn’t if their life had fallen apart the way mine has? But that’s only because of the way the menopause is making me feel.’
She said her doctor had refused her hormone replacement therapy (HRT), citing outdated scare stories of an increased risk of breast cancer. ‘He insisted I would have to brave it out, and said that the antidepressants he prescribed would probably help,’ she told me.
Suzan didn’t need antidepressants — she needed a prescription for HRT, which is what she received from my clinic.
Menopause specialist Louise Newson examined the number of women being refused HRT as GPs cite outdated scare stories, Janine Sim, 44, (pictured) visited her GP on four separate occasions and wrote a complaint letter before doctors would listen to her request for HRT
That she’d had to travel all the way from Scotland to my private consulting rooms in Stratford-upon-Avon to get that is nothing less than a travesty.
Her doctor had deprived her of medication that would have cost the NHS just £4 a month, and has the ability to give this woman her life back. And all because he wasn’t clued up on the menopause — a condition that every woman in his practice will experience sooner or later.
I wish I could say that Suzan was an unusual case. However, sadly she is typical of so many of the women who seek me out for treatment to help them cope with the menopausal symptoms that are destroying their lives.
And that’s no exaggeration.
I see women week in, week out who, like Suzan, have given up their careers because their menopausal brains feel so befuddled they can’t trust themselves to make the right decisions at work.
Some have memory-loss problems so severe that they honestly believe they might have dementia; in some cases their doctors think so, too, and send them for tests.
Many are struggling to maintain their relationships because they are permanently short-tempered with their partners and have zero sex drive.
They can’t sleep, they’ve gained weight, and they feel permanently anxious. Basically, they don’t recognise themselves any more.
And the answer to all this is staring GPs in the face: HRT.
This is the most effective treatment available when it comes to relieving the hot flushes, night sweats, mood swings and bladder problems that menopausal women can experience.
Katie Taylor, 49 (pictured) was misdiagnosed and given antidepressants before being put on HRT when her father suspected her low mood was hormonal
Taking HRT is simply replacing hormones. In a similar way, we prescribe thyroxine for women with an underactive thyroid gland.
Research has also shown HRT can actually lower the risk of heart disease (including heart attacks), osteoporosis, type 2 diabetes and dementia. All of these common conditions are costing the NHS billions of pounds. So why on earth are women being denied this treatment when it is clearly so cheap and effective?
The crux of the problem lies with data from the Women’s Health Initiative (WHI) study in 2002, which was misinterpreted and yet is still often quoted in the media.
The report claimed that hormone replacement increased the risk of heart problems.
But when the data was analysed properly, this study, and subsequent research, has shown that women starting HRT in the first ten years following their menopause reduce their risk of a heart attack by around 50 per cent — that’s more effective than treatment with statins or blood pressure-lowering drugs.
The other concern so many women and healthcare professionals have about HRT is the breast cancer risk. But the reported increased risk supposedly discovered by the WHI was so low as to not be statistically significant.
Meanwhile, there are many other factors that pose a greater risk for developing breast cancer than HRT: being overweight, not exercising and alcohol, for example.
Louise Newson says many doctors are fixated by the idea that HRT could cause cancer, blood clots and heart attack despite studies debunking the theories (file image)
Yet today, doctors continue to be fixated by the idea that HRT, cancer, blood clots and heart problems go hand-in-hand. And never mind the fact we’ve had several studies published since 2002 that have debunked so many of the issues the WHI study appeared to raise.
For example, in 2015, the National Institute for Health and Care Excellence (NICE) guidelines on menopause clearly stated that, for the majority of women, the benefits of taking HRT outweigh any risks.
With such clear indicators that HRT can be a good choice for so many women, it’s astonishing that so many GPs — and their patients — remain fearful of it. Clearly, we need improved menopause education for the medical staff certain to encounter menopausal women throughout their careers — so that’s doctors, nurses and pharmacists.
I regularly lecture at the Royal College of General Practitioners and provide e-learning sessions for doctors. It’s great to be able to bring their understanding of HRT up to date, because so many of them qualified in an era when HRT was demonised and, as a result, they still don’t have the confidence to prescribe it.
I’m not going to claim that HRT is a panacea for each woman’s every menopausal symptom. But for women like Suzan, and so many more of my patients, a prescription for HRT can give them their life back.
Just as countless women have sat and sobbed in despair in my office, many more have returned a few months later and wept with relief and joy over feeling well again.
The tragedy of this is that their GPs didn’t properly understand HRT and how it could have helped them in the first place.
Janine Sim, 44, recalls feeling angry and tearful from the moment she woke up until she went back to bed before she begun HRT (file image)
OUR GPs JUST WOULDN’T HELP
I felt like I was laughed out of the surgery
Janine Sim, 44, is a yoga therapist from Bury, Manchester. She’s married to Ewen, a police officer, and they have four teenage children. She says:
Three-and-a-half years ago, when I was 40, I hit the menopause. I knew that was what it was as my Mum had gone through it at the same age.
Rather than going to my GP and asking for HRT, I tried alternative therapies first, which worked for a while.
Then my symptoms started getting worse. I was angry and tearful from the moment I woke up to the moment I went to bed; I felt like the life was being drained out of me; some days I couldn’t be bothered to get out of bed.
I went to see the GP in late 2016 and asked for HRT. She took one look at me and smiled. ‘You can’t be menopausal,’ she said. ‘You’re my age.’
I went through my symptoms and told her the family history, but she refused to listen. I felt like I was laughed out of the surgery.
For two years, I went back again and again, begging for help. Every time I saw a different doctor, and every time they said no. My family despaired. I could just about summon the energy to get up and go to work, but when I came home I’d slump on the sofa and weep.
Janine says within a few weeks of getting HRT she was back to her normal, happy self (file image)
I was only sleeping for around two hours a night and when I woke up the sheets were drenched in sweat. I didn’t clean the house for 18 months.
After my second GP appointment, I was asked if I wanted to go on antidepressants. No one would listen. I felt like they were treating me like a mad woman. They just wanted to tick a box and get me out of their surgery.
It took four separate appointments, a letter of complaint — and for me to bring my husband into the surgery with me, to act as my advocate — for the GP to listen.
Within a few weeks of getting HRT last September, I was back to my normal, happy self. I feel like I’ve woken up from a nightmare.
Misdiagnosis meant I lost four years of life
Katie Taylor, 49, runs the lattelounge.co website for women over 40. She lives in London with her husband Hugh, 53, who works in the hotel industry. They have four children. She says:
When I was about 45, I went to my GP because I didn’t feel ‘right’. I was very teary, very low. I felt like I had brain fog.
The GP said I was probably stressed and depressed. I was working full-time, with four children — perhaps I should take some time off or take antidepressants?
I thought I’d simply try going to the gym a bit more or eat more healthily, but nothing helped. So I tried antidepressants. They didn’t help. They numbed everything. I felt as if I was plodding through life but not really enjoying it. I was sent to heart specialists because I’d complained of palpitations. The doctor even suggested, as I was forgetting words and not thinking straight, that it could be early dementia. I put on weight, became something of a recluse and felt like a failure. Yet not once did the GP mention HRT.
Katie Taylor, 49, says within a month of being on HRT she was off antidepressants and felt like a new woman (file image)
After four years of going to and fro from the GP, it was my father, Professor Michael Baum, a surgical oncologist who specialises in breast cancer, who suspected my low mood was hormonal and sent me to one of his consultant friends. Straight away, she deduced that I was going through the peri-menopause and put me on HRT. Within a month, I was off antidepressants and feeling like a new woman. I remember watching TV and thinking: ‘That’s the first time I’ve laughed in four years.’ I felt very angry that I’d lost four years of my life.
I know the risks, but it should be my choice
Sandra Wright, 50, a college lecturer, lives in Glasgow with her husband. She says:
I was at a prestigious awards ceremony. It was the sort of glamorous black tie event I would have loved just a few years ago.
But I spent the entire evening in a paroxysm of dread — petrified of making a sweaty spectacle of myself. My hot flushes are so bad — each one an internal volcano erupting up to 20 times a day.
The nights are even worse. I consider four hours a night to be good. My days are spent in a fug of exhaustion and anxiety. It’s a living hell.
And still my doctor refuses to prescribe HRT. I’ve been begging for nearly three years, to no avail.
Sandra Wright, 50, revealed a doctor prescribed her an antidepressant despite arguing that she wasn’t depressed and refused to prescribe HRT (file image)
Despite me arguing that the only thing making me stressed and panicky were my hot flushes, she put me on antidepressants.
I started getting symptoms in 2016 when I was 48. When I went to the doctor in 2017 her response astounded me. She thanked me for ‘being brave’ then went on to explain that, as I had no children, I was at a higher risk of developing breast cancer and she had an ethical duty to ensure my safety.
Then, even though I assured her I wasn’t depressed, she prescribed an antidepressant, Venlafaxine.
I was too upset and confused to argue and the flushes worsened.
After three months I asked to see a different doctor. He agreed to take me off the antidepressants but refused to prescribe HRT.
I know the risks, but I have the right to make my own decisions.
REPORTING TEAM: Tessa Cunningham, Jill Foster, Rachel Halliwell and Sarah Rainey
Q&A: What is HRT? by Thea Jourdan
WHAT IS HRT AND WHAT DOES IT DO?
HRT does the work of oestrogen, levels of which plummet after the menopause. Women usually take a combination of synthetic oestrogen and a second hormone, progesterone.
‘Most women in the UK take combined HRT because taking oestrogen on its own can increase the risk of developing cancer of the womb,’ says Kathy Abernethy, chair of the British Menopause Society. ‘Oestrogen-only HRT is usually only given to women who have had their wombs removed.’
ARE THERE ANY RISKS TO CONSIDER?
A major U.S. study in 2002, from the Women’s Health Initiative USA, was the first to ring alarm bells that HRT may lead to an raised risk of heart disease and breast cancer. As a result, many doctors stopped prescribing it overnight.
But the study was found to be flawed — the average age of the women in the study was 63, when the risk of breast cancer naturally rises anyway, and half were smokers.
‘The risks were overestimated for women of normal menopausal age between 50 and 60,’ says Kathy. ‘For most women under the age of 60, and for many over age 60, the benefits of HRT are clear.’
SO DOES HRT REALLY CAUSE CANCER?
Any risk comes with longer use, says Kathy.
Cancer Research UK says there is strong evidence HRT can cause breast, womb and ovarian cancer, but the chance is low compared to other risk factors. To put it in perspective, while minimising HRT could prevent 1,400 cancer deaths per year, keeping to a healthy weight could prevent 13,200 and stopping smoking could prevent 22,000.
ARE THERE OTHER SIDE-EFFECTS?
‘Women who take HRT may have side-effects including breast tenderness, headaches, nausea, indigestion, tummy pain and vaginal bleeding,’ says Professor Kamila Hawthorne, Royal College of GPs’ professional development vice-chair. Taking HRT as tablets (not patches or gels) may slightly raise the risk of blood clots.
WHO SHOULD NOT BE GIVEN HRT?
Those who have a personal or family history of hormone-sensitive cancers, such as ovarian and breast, and women who have had deep vein thrombosis. High blood pressure should be controlled before starting HRT.
WHAT ARE THE ALTERNATIVES?
Non-hormonal options include Tibolone (Livial), derived from the Mexican yam, which mimics oestrogen. Blood pressure medication Clonidine, which affects the dilation of blood vessels, can alleviate hot flushes and night sweats.
Bio-identical hormones, derived from plant oestrogens and prescribed by private clinics, are said to be similar to human sex hormones. But he NHS does not recommend these as they are not regulated.