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Just trying to get clear guidance on HRT is enough to give you hot flushes Just trying to get clear guidance on HRT is enough to give you hot flushes
(about 3 hours later)
Forgive me if I don’t get too excited about the latest official advice on the menopause and hormone replacement therapy. Even before I read it, I knew it would be about as clear as mud. And I was right.Forgive me if I don’t get too excited about the latest official advice on the menopause and hormone replacement therapy. Even before I read it, I knew it would be about as clear as mud. And I was right.
In its first guideline on the subject, unveiled today, the National Institute for Health and Care Excellence (Nice) said HRT should “not be immediately dismissed”. The official health watchdog says doctors should be “more prepared to discuss” HRT as a “possible treatment” for the menopause, even though some studies have linked it to cancer and heart disease, because HRT “could” be effective.In its first guideline on the subject, unveiled today, the National Institute for Health and Care Excellence (Nice) said HRT should “not be immediately dismissed”. The official health watchdog says doctors should be “more prepared to discuss” HRT as a “possible treatment” for the menopause, even though some studies have linked it to cancer and heart disease, because HRT “could” be effective.
Related: What women should know about menopauseRelated: What women should know about menopause
The irony of giving menopausal women advice as confusing as that would be funny if it were not so serious. Despite the almost total ambiguity of its stance, Nice has the cheek to claim that its report aims to “stop women suffering in silence”. I don’t know about suffering in silence. I have so far suffered very loudly. I have screamed and shouted about the menopause since it started for me about three years ago, when I was 40, because I simply could not believe how awful it was. And how little help was readily forthcoming.The irony of giving menopausal women advice as confusing as that would be funny if it were not so serious. Despite the almost total ambiguity of its stance, Nice has the cheek to claim that its report aims to “stop women suffering in silence”. I don’t know about suffering in silence. I have so far suffered very loudly. I have screamed and shouted about the menopause since it started for me about three years ago, when I was 40, because I simply could not believe how awful it was. And how little help was readily forthcoming.
How could something this debilitating not have a tried and tested cure by now? How come I got as many different answers to my questions as experts that I asked?How could something this debilitating not have a tried and tested cure by now? How come I got as many different answers to my questions as experts that I asked?
I suspect this is because the same screwed-up rules apply to coping with menopause as apply to childbirth and breastfeeding. The medical profession simply expects women to get on with it while navigating their way through a morass of conflicting advice.I suspect this is because the same screwed-up rules apply to coping with menopause as apply to childbirth and breastfeeding. The medical profession simply expects women to get on with it while navigating their way through a morass of conflicting advice.
Like childbirth and breastfeeding, the menopause is beset by politics and infighting. My own experience is tinged by encountering women who banged the drum for HRT quite as if it were a feminist issue and I was letting the side down by not taking it. I was not always against it, mind you. Like childbirth and breastfeeding, the menopause is beset by politics and infighting. My own experience is tinged by encountering women who banged the drum for HRT as if it was a feminist issue and I was letting the side down by not taking it. I was not always against it, mind you.
I begged my doctor for HRT when I first got symptoms. I was sweating buckets, afflicted by crippling panic attacks and almost total insomnia. I was in such a state I told the GP only half jokingly that her concerns about small but significant cancer risks were irrelevant because, if she didn’t put me on it I might contemplate suicide. I begged my doctor for HRT when I first had symptoms. I was sweating buckets, afflicted by crippling panic attacks and almost total insomnia. I was in such a state I told the GP only half jokingly that her concerns about small but significant cancer risks were irrelevant because, if she didn’t put me on it I might contemplate suicide.
The GP said that in her experience, HRT would give me such an edge I would want to be on it for everThe GP said that in her experience, HRT would give me such an edge I would want to be on it for ever
But the doctor shook her head. I was too young. I had started the damn thing early, like my mother and grandmother, and so I might end up on HRT for too long, which would raise my risks too high in her view. Fine, so I’ll come off it in a few years, I implored. But she said that in her experience, it would give me such an edge I would want to be on it for ever.But the doctor shook her head. I was too young. I had started the damn thing early, like my mother and grandmother, and so I might end up on HRT for too long, which would raise my risks too high in her view. Fine, so I’ll come off it in a few years, I implored. But she said that in her experience, it would give me such an edge I would want to be on it for ever.
Reluctantly, I went away to consult Google, alternative therapists and friends. To my surprise, I got great results with yoga, which all but cured my sleeplessness, while magnesium did wonders to combat the rapid weight gain around my midriff.Reluctantly, I went away to consult Google, alternative therapists and friends. To my surprise, I got great results with yoga, which all but cured my sleeplessness, while magnesium did wonders to combat the rapid weight gain around my midriff.
But the hot flushes and panics remained a problem. I went to see another GP who prescribed a blood pressure medication that much reduced them. I was delighted. But researching an article on my triumph, I rang a leading Oxford expert and received a stern telling-off. “You need to get yourself on HRT,” she snapped. “If you don’t, your bones will crumble. HRT is marvellous.”But the hot flushes and panics remained a problem. I went to see another GP who prescribed a blood pressure medication that much reduced them. I was delighted. But researching an article on my triumph, I rang a leading Oxford expert and received a stern telling-off. “You need to get yourself on HRT,” she snapped. “If you don’t, your bones will crumble. HRT is marvellous.”
There was something in her voice that was truly zealous. I found myself wondering, though I didn’t dare ask, if she was on it herself. I had noticed that friends on HRT had been somewhat hysterical about my decision not to have it. Was it possible that women drawing strength from hormone replacement secretly wanted other women to make the same choice?There was something in her voice that was truly zealous. I found myself wondering, though I didn’t dare ask, if she was on it herself. I had noticed that friends on HRT had been somewhat hysterical about my decision not to have it. Was it possible that women drawing strength from hormone replacement secretly wanted other women to make the same choice?
The expert had worried me though. Fretting about my risk of osteoporosis, I had a bone scan. It came back normal. The consultant advised me to keep eating healthily from all the food groups, with plenty of calcium.The expert had worried me though. Fretting about my risk of osteoporosis, I had a bone scan. It came back normal. The consultant advised me to keep eating healthily from all the food groups, with plenty of calcium.
Related: Tracey Emin could have exploded a lot of menopause myths – but she blew it | Joanna MooreheadRelated: Tracey Emin could have exploded a lot of menopause myths – but she blew it | Joanna Moorehead
Basically, I now had my menopause symptoms fairly under control without hormone treatment. But would my bones fall to pieces one day? Desperate for someone to mediate, I rang the National Osteoporosis Society. I can wholeheartedly recommend calling them if you are as confused as I am. They explained the risks in a rational, calm way. If you are genetically predisposed to breast cancer then it may not be worth risking HRT, especially not long-term or combined HRT, which carries the greater risks.Basically, I now had my menopause symptoms fairly under control without hormone treatment. But would my bones fall to pieces one day? Desperate for someone to mediate, I rang the National Osteoporosis Society. I can wholeheartedly recommend calling them if you are as confused as I am. They explained the risks in a rational, calm way. If you are genetically predisposed to breast cancer then it may not be worth risking HRT, especially not long-term or combined HRT, which carries the greater risks.
However, if you are genetically predisposed to brittle bones, or have risk factors which expose you to it, like smoking or poor diet, then it may not be worth risking brittle bones by not taking HRT, and a small increased cancer risk may be worth taking to avoid the horror of bone crumbling.However, if you are genetically predisposed to brittle bones, or have risk factors which expose you to it, like smoking or poor diet, then it may not be worth risking brittle bones by not taking HRT, and a small increased cancer risk may be worth taking to avoid the horror of bone crumbling.
On the other hand, if you are not genetically predisposed or at risk of brittle bones – and healthy women who eat well, don’t smoke and exercise regularly should not be – then you may conclude that it is not worth running any increased risk of cancer, no matter how small, in order to offset the risk of brittle bones when that is even slighter. And you must preface all that by knowing that HRT only gives your bones protection for as long as you take it. As soon as you stop, the protection disappears.On the other hand, if you are not genetically predisposed or at risk of brittle bones – and healthy women who eat well, don’t smoke and exercise regularly should not be – then you may conclude that it is not worth running any increased risk of cancer, no matter how small, in order to offset the risk of brittle bones when that is even slighter. And you must preface all that by knowing that HRT only gives your bones protection for as long as you take it. As soon as you stop, the protection disappears.
And now I began to understand. I made an objective assessment of my risk factors and decided to stick with my strategy, tweaking a few things here and there. I have long taken vitamin D, and have now added vitamin K for even better calcium absorption. To my mind, my curmudgeonly GP isn’t looking quite so daft now for refusing to put me on HRT. But it’s a scandal that I only stumbled on the answers.And now I began to understand. I made an objective assessment of my risk factors and decided to stick with my strategy, tweaking a few things here and there. I have long taken vitamin D, and have now added vitamin K for even better calcium absorption. To my mind, my curmudgeonly GP isn’t looking quite so daft now for refusing to put me on HRT. But it’s a scandal that I only stumbled on the answers.