Oooh matron, this is a long one...
Heads up Dames, this is one of my longer posts and contains some personal information. It’s too big a topic to be fully covered here, so I’ve provided some further resources and readings at the end if you would like to go deeper.
Menopause is not a disease and for many women they simply stop getting their periods one day and that’s about it. Lucky buggers. For many of us though, it’s a flippin’ roller coaster of ups and lots of downs. A body that feels out of control and a brain that seems to have gone AWOL. And there’s a reason for that – during menopause our brains go through a major rewiring. That’s why we may experience poor sleep, irritability and for many of us, a massive shift in our ability to cope with stressful situations. In a nutshell, we’re coming down off some pretty powerful drugs. (Caitlan Moran wrote a wonderful article called, Caitlain Moran: me, drugs and the perimenopause).
The problem with Hormone Replacement Therapy
Just like menopause, HRT (or MHT as it is called now – Menopausal Hormone Therapy or Hormonal Therapy – HT) has had its own roller coaster ride. In the 1980s it was lauded as the elixir of youth – no more dry vaginas, less hot flushes and improved mood. This changed overnight with the termination of the Women’s Health Initiative (WHI) – a massive scientific study that claimed HRT caused breast cancer.
Once again, women’s health was confined to the too hard basket – damn our wandering wombs!!!***
It turns out that some of the conclusions of the WHI were wrong. “The study found a 26% increase in risk of breast cancer; however, this was for women who had started taking HRT long after menopause. When the data was re-examined to look at women who started taking HRT during menopause, there was no increased risk of breast cancer.”[1] (Mansburg, 2020, p14).
BUT WAIT, there’s more. The risk for older women on HRT was less than drinking two glasses of wine every night.
The other thing to consider is that the form of HRT used in these trials is one that most doctors would not prescribe these days.
Unfortunately, the damage was done (mostly by the media) and menopause treatment once again became a taboo topic, with doctors and governments warning women of the risk of heart disease, heart attack, stroke and breast cancer if they went down the HRT route.
Guess what? Those warnings are still in place today and many doctors are still reticent to prescribe HRT.
[1] Mansburg 2020. The M Word. How to thrive in menopause. Murdoch Books.
Hormone Therapy – should you???
Like most things in life, HRT is not without its risks, especially for older women on some forms of HRT.
Remember, menopause is a natural process that all women will go through and no two menopauses are the same – some of us will get severe hot flushes, heavy periods, whilst others of us will feel like our mental health has taken a tumble. It’s as variable and unpredictable as an English summer!
Fortunately, we have an arsenal of tried and tested remedies that can help alleviate many of the symptoms experienced during ‘the change’. It’s a matter of figuring out where you’re at and what you are experiencing, which may be vastly different from your BFF. It’s worth trying some naturopathic and nutritional remedies before heading straight to HRT as most of the time that’s all we will need.
As many of you know, I’m not a ‘this OR that’ practitioner. I have a foot in both camps. Do we tend to overuse allopathic (modern) medicine? Yes! But it has its place and I’m of the firm belief that if you are experiencing extreme symptoms with menopause, HRT may be just the ticket – especially if your mental health is suffering. Unfortunately, I’ve come across many clients who are prescribed anti-depressants when HRT could be what helps.
There are many types of HRT and it may take some tweaking to find what works for you. Most of them now are bio-identical, meaning the same as your body makes. I would caution you with regards to progesterone as it’s often synthetic (progestin) and will not confer the same mental health benefits as bio-identical forms – Prometrium is the name it goes by in Australia (the bio-identical form that is).
My HRT story
This is where I get a bit personal Dame. In the interests of research and my own mental health, I decided to give HRT a go.
I don’t know that you can truly prepare for menopause. It kind of creeps up and then hits you, well that is my experience anyway. I guess I knew at some point my misspent youth would catch up with me, but I thought I’d been looking after myself well enough over the past 20 years.
The thing with menopause for me, is that it’s a peculiar type of depression. One where I have never not been without hope. Depression in my youth was a hopeless, despairing kind. I can honestly say I’ve not felt like that this time around, but I wanted to retreat and I felt overly sensitive. Any little perceived criticism or knock would send me into my ‘lady cave’. This is evidence to me that my brain is rewiring.
Last year, after I launched Great Dames with a lovely afternoon tea, I decided I couldn’t do ‘it’ – I didn’t want anyone to look at me (not in an ‘I’m ugly’ kind of way). I knew things weren’t right, so I went to my GP (who’s been my GP since I was 16). When I told him how I was feeling, he ran a few bloods and said I was through menopause and ‘let’s test my adrenals’. Unfortunately, I’ve got no way of knowing because I had a hysterectomy when I was 41. I left there feeling deflated and unheard (an all too often refrain).
I found another GP who specialises in women’s health. I’d done my research Dame and felt like I needed some progesterone. She didn’t want to give it to me as I’d had a hysterectomy – not recommended – current research begs to differ. I was given a patch and some testosterone. I’m not sure I felt much better and my testosterone levels went through the roof.
Take three – I found someone who was willing to give me progesterone. Lots of bloods were done and I was prescribed something called a ‘troche’ (like a lozenge) that was compounded for me. I’ve been taking it for a few months now and it’s definitely taken the edge off. Can I say it’s the reason I’m feeling braver again? I’m not sure, but I do feel like the worst darkness has shifted on a subtle level. I stopped taking it for a month to see if there was any change and I started feeling a level of indecision return, so, I’m back on it.
Do I still do all of the other things? Yes! As I said earlier, this should not be a ‘this OR that’ approach. Quality rest, exercise, healthy eating and supplementation are still a big part of my life. At the moment the HRT just feels like the ‘cherry’ on top. Do I want to stay on it forever? Nup! Are there risks involved? Yep, but in my mind the benefits outweigh the risks, and most of us don’t give a second thought to popping a Panadol or over consuming alcohol (which is a proven greater risk).
A final note
Remember, you should not be doing menopause alone. I’ve got your back Dame (and your front and all those new squidgy bits in between). If you haven’t done so already, book yourself in for an appointment so we can discuss which options are best for you and make a plan that’s just for you.
See you soon.
Until next time, keep being great.
And remember, be kind to yourself.
*** Wandering wombs – I’m reading a fabulous book called, Unwell Women by Elinor Cleghorn, which discusses women’s health throughout the ages. For many centuries it was thought that the womb wandered about the body ala ‘no fixed abode’ and this is what caused all sorts of female maladies. The solution? Keep a woman pregnant.
Further reading:
Hormone Repair Manual: Lara Briden
The M Word. Dr Ginni Mansburg
The Feel Good Guide to Menopause. Dr Nicola Gates
Where Are We 10 Years After the Women’s Health Initiative? https://academic.oup.com/jcem/article/98/5/1771/2536695
Marnie
P.S If you haven’t already done so, make sure you download your FREE Survivor’s Guide to Menopause (did I say it’s free?).
P.P.S If you know someone who is struggling with all the changes, please share this with them.
