HRT: Should women seek chemical intervention or should they face menopause head on?

Should women be taking HRT in later life? Two experts, Sue Leonard and Margaret Carragher debate the pros and cons of chemical intervention.

Twice as many women should be taking HRT, it seems, but Sue Leonard eschewed chemical intervention, accepting the menopause as a natural phase of life.

THE National Institute for Health and Care Excellence, (NICE) in England, has decided that twice as many women should be taking hormone replacement therapy (HRT).

At least, I think that’s what they recommend, but their report is so wishy-washy it’s hard to say for certain.

While reassuring women as to the benefits of HRT — it relieves symptoms and helps prevent osteoporosis — they warn about the long-term risks, which include a higher incidence of breast and ovarian cancer.

Doctors are being encouraged to discuss the issue with their patients, but ultimately women should be allowed to decide for themselves, they say.

However, is that fair, when cancer experts have voiced disquiet, meaning the jury is firmly out?

I’ve been through the menopause, and I never considered HRT.

Why would I? Menopause isn’t an illness.

It’s a stage of life, and if I didn’t relish this sign that I was getting older, I can’t say I was sorry to see the end of periods.

That first sign of fertility had been a tad troublesome.

So had the spots that dogged my teenage years, but we don’t medicate for puberty.

Neither do we describe a teen’s mood swings and broodiness as ‘symptoms’ of something.

A doctor’s daughter, I was brought up to believe that stoicism is a virtue.

In our house, you didn’t complain.

Colds were ignored; we had to spring a good fever if we had any chance of staying home from school.

I’ve carried that attitude to adulthood, and don’t like stuffing myself with any medication that isn’t totally necessary.

Could all this be led by drug companies?

The cancer scares that caused a decline in the number of women taking HRT hasn’t gone away, the report is just a change of emphasis.

Up to 20% of menopausal women suffer greatly. HRT makes huge sense for them, but are the rest of us too quick to run to this panacea?

Doesn’t a change of diet, exercise, and a more-healthy lifestyle make more sense?

Yes, I was lucky.

My ‘symptoms’ weren’t too bothersome. I wore layers and carried water to combat the hot flushes, and slept nude under a sheet to deal with night sweats.

Vaginal dryness? KY jelly became my best friend.

As for the sleeplessness; that was a massive bonus. I’d write through the night, or catch up on a DVD box set.

For some women, menopause is a sad time. They must accept that they will be forever childless, and mothers grieve over their empty nest.

HRT can help this, NICE said, but so can cognitive behavioural therapy (CBT).

Menopause heralded an exciting new phase for me.

My eldest daughter was married and pregnant, and my fourth child had left home for college.

Relishing ‘me’ time, I threw myself into journalism, working 12-hour days and penning five or six features each week. That didn’t leave time to agonise over any ‘symptoms’.

Looking back on it now, I would do things differently.

I’d be less accepting of my thickening waist and the slow but sure start to some weight gain.

I’d cut carbs, and not wait until I’d piled on loads of pounds to take myself in hand.

I’d take up running — something I’ve now got round to. Brilliant for the body, it’s better than mindfulness for one’s mood.

I’m now not just as fit as I was before the menopause; I’m a whole lot fitter.

If someone as tough and successful as Margaret Thatcher needed HRT, then I could also benefit, says Margaret Carragher.

IN THE 1980s, when she was at her most powerful, Britain’s then prime minister, Margaret Thatcher, was reported to be on hormone replacement therapy (HRT), an oestrogen replacement-medication prescribed to relieve menopausal symptoms and protect against osteoporosis and heart disease.

I was surprised — not that Thatcher had opted for such treatment, but that her decision had become public knowledge.

This was a woman who, by dint of determination, ambition and unwavering self-belief, had become the longest-serving British prime minister of the 20th century, and the first female one; a woman flattered by her Iron Lady soubriquet, and more amused than bemused by her portrayal by left-wing satirists as a terrifying, cigar-smoking man-in-a-suit.

Surely, the menopause and its symptoms had no place in such a woman’s carefully cultivated public image?

It was one thing Thatcher exploiting her femininity, as she often did to great effect in her dealings with world leaders, such as Ronald Reagan and Francois Mitterand; another thing entirely to be associated, however tenuously, with its flip side of mood swings, hair loss, vaginal dryness, and the like.

Perhaps it is precisely because of such widespread, hard-wired views — even from an exponent of HRT like myself — that the menopause continues to be one of society’s last big taboos.

In a culture that values youth, sex appeal and marketability above everything (when did you ever see a bikini-clad octogenarian as the love interest in a Bond movie, or promoting the ‘Next Best Thing’ in Grafton Street?) it would take a brave woman indeed to publicly discuss, much less extol, a condition replete with symptoms she might be reluctant to share even with her nearest and dearest.

Which is why the latest findings of the UK’s National Institute for Health and Care Excellence (NICE) are to be welcomed.

In its first guideline on menopause to prevent women from suffering in silence, NICE has published wide-ranging recommendations for the NHS on the support, information and treatments needed to address the often debilitating symptoms that women suffer.

Its case studies include Debbie Keatley, a NICE guideline developer whose sudden menopause was caused by breast-cancer treatment.

“The treatment I had for breast cancer hurtled me into menopause,” Keatley reported.

“I wasn’t prepared for the long-term effects on my relationship and sex life ... I’m very pleased that the NICE guideline recommends more help for women in my situation.”

In the report, Dr Imogen Shaw, a GP with special interest in gynaecology and NICE guideline developer, said: “The effects of menopause are often misunderstood and underestimated... I hope that this new NICE guideline will empower women ... and provide them with information on the range of options that could help”.

Commenting on the NICE guideline, Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, said: “This ... is a milestone ... we hope [it] will not only support healthcare professionals, but also provide women with the necessary information to ...make informed decisions about their choice of treatment.”

Personally, my decision to embark on HRT, several years ago, was a no-brainer.

Why tolerate symptoms that could instantly be alleviated by a simple little pill?

And while it is impossible to quantify its benefits — who’s to know how much less pep I’d have in my step without it? — I have no intention of coming off it any time soon.

My decision to embark on HRT several years ago was a no-brainer.

Why tolerate symptoms that could instantly be alleviated by a little pill?