Menopause

I have a problem with my blood which means I can’t take HRT so it was hot flushes, night sweats and not being able to take anything to help relieve this and being told, “Sorry, you’ve got to suffer it on your own.”

Oh, yes. I said, “I want HRT.” And he said, “You can’t have it. You cannot have it whatsoever.” And then I checked with my female GP when I went back for the test and she said, “You can’t.” She said, “We cannot give it to you.” She said, “There’s no low dose one or anything else.” She said, “You’re just going to have to go through it and hopefully it’ll reduce as you come through the other side.” And it hasn’t.

But I was told by my GP that it’s not that she wouldn’t prescribe HRT. I could have HRT as long as I knew what the risks were and she said that the risks overcome your need for HRT. She said, “It’s extremely serious.”

And you agreed with that.

I agreed with that because I want to be around for a few more years.

Several GPs I went to, this is out of the Army, after the Army. Some were better than others, some were sympathetic, some would say “HRT, take HRT”. And I didn’t want to take HRT but at one stage they got so bad I went back and I saw them and they said, “Look what are you worried about” and I said, “Well we’ve got a history of cancer in my family and” I said, “there’s that” and we talked, he talked me through it and he looked at the different types and he says, “Look” he says, “I think you should try this one”. So he gave it to me and I came away and I thought “Not sure about this” because I just think you’re putting something off, so I then went on the internet and looked it up and then realised it came from a pregnant mare’s [urine] and I thought “God, they’re keeping these and not giving them enough water and keeping them constantly pregnant and” I thought “Oh, I can’t take that”. They’re still upstairs in the cupboard not been touched. And I just think, I’ve spoken to lots of women and I’m not knocking HRT because it seems that for a lot of women they’ll stand by it, and they say it’s great. It’s only when it got really bad and the depression got bad and I thought I’ve got to take something but I just couldn’t bring myself to take it. Because I thought I’m just putting off the inevitable. I’ve got to go through it at some stage.

The first time I went I saw a female GP and I think that was quite useful, she put it into perspective for me. I was very afraid that if I went onto HRT I’d be on it for the rest of my life or I’d be on it for 15, 20 years and it’s still to a certain extent an unknown quality and quantity. She said, “You have to deal with the here and now, you have to deal with the 50 mile journey, the busy job, the two children going through their own problems, the husband with M.E.” she said, “Look upon it as a safety plaster to get you through the next two to three years”. She said, “Don’t think upon it that you’ve got to be on it the rest of your life, think upon it as a short term solution to get you through this period in your life”. And I think putting it into perspective like that I was more able then to consider it and give it a go and that’s what I did. And again, after five years, I just thought “Right let’s come off it, let’s see if I can manage” and I have and I am.

Did you have any concerns about the HRT, about going on it in terms of risk?

Yes I did because obviously it was big in the press at the time, the long term effects of it. I was quite concerned particularly six years ago, the year before I started going through the menopause, I had a lump on my breast removed which turned out to be benign. But having had that removed I was very conscious going onto HRT was I encouraging more lumps to come, would the next one be malignant. It was a big big decision for me to make and I was very anti the HRT for that reason. I think I was really concerned that I might get breast cancer from it. I think that was my biggest concern having had this lump removed. But I just got to the point well it was, I couldn’t have functioned without it and it was, well do I risk breast cancer or do I risk losing my job, my home, my family and everything else. So I felt at the end of the day I didn’t really have a choice to be perfectly honest.

I was at my wits end. And when I went to see the GP I think I sort of went in there and said something along the lines of “I’m menopausal, and this, and this, and this, and this is happening to me. Do something about it, do something about it now. I’m not leaving this room until you do something about it”. So it was really quite that surprised me that the symptoms didn’t come on gradually. It was as though I’d hit a threshold of hormone level and suddenly all these things appeared. So the GP I think I must have come across as a little bonkers but I’m sure the GP was used to that. And he looked at me very kindly and said, “Well it certainly sounds like you’re perimenopausal”. And I went, “It does doesn’t it”, and he said, “Look, here, I’m going to put you on HRT if that’s what you want me to”. Sorry we actually discussed that because I said, “Get me HRT now”. And he said, “I’ll find you a low dose but I’ll take some blood and get your hormone levels done so you can, don’t start taking your pills until I’ve spoken with you”. So a few days later he spoke to me, “Guess what? Your hormone levels are coming down and you’re definitely perimenopausal and start taking your pills and come back and see me”. My experience, and I’ve been on HRT for the last four and a half years.

My experience of HRT has been incredibly positive. If you threatened to take my HRT away, I’d probably kill you. It’s that positive. It has transformed, I mean I feel great. I think that’s all I can really say. I feel like the woman I was and what’s great about it is that I don’t get premenstrual, so my life is much more evened out but it’s a great even out. Not a bad even out. I don’t feel any of the symptoms that you hear about with the menopause.

Well, I suppose I started thinking about the menopause when I was in my forties because I read about it and HRT hit the headlines and at that stage, HRT was said to be wonderful and there didn’t seem to be any disadvantages. HRT was said to reduce osteoporosis, reduce cardiac troubles in those days. There was nothing negative about it so I think when I got to the age of about 50 and started to have just the odd hot flush my reaction was immediately to go on to HRT, partly because my mother had osteoporosis and other members of the family had had osteoporosis and I dreaded getting osteoporosis and I felt it was the right thing to do. I think I started, it’s quite a long time ago now so I think I started on some tablets and then I tried patches but the patches gave me some skin reactions so I went back to tablets. And there was no problem at all. I never had any side effects. I just felt great.

Then of course the headlines changed a little bit. There was more research on HRT, people started to talk about dangers of increased risk of breast cancer, dangers of increased risk of cardio-vascular problems. So I started looking at the literature and read articles in the BMJ [British Medical Journal] and the Lancet, the British Journal of General Practice, the newspapers, everything I could find. And it seemed to me that the dangers and the risks of HRT had been exaggerated in that people didn’t understand risk.

And for me, the advantages outweigh the disadvantages because I dread getting osteoporosis. The risk of osteoporosis is reduced, also I think the risk of bowel cancer is reduced when you’re taking HRT and the quality of life, for me, has been terrific on HRT so I’m carrying on still taking it.

What is your doctor’s attitude to you being on it for so long?

She’s terrific. She knows I look at the literature and have done the research and understand the risks and in fact I went to see her yesterday partly because I knew this interview was coming up. I thought I’d have a discussion about it since I’ve been on it for about 15 years now, and she agreed with me that the extra risk for breast cancer is actually quite small. And she said that you have a similar extra risk if you’re overweight. So we discussed the other reasons for having extra risk of having breast cancer and she was perfectly happy for me to go on with it.

Did you think about any link with the HRT you were on?

I did, I talked to the consultants about it and I talked to the GP about it. They all think it’s very unlikely that that was the cause of it. I accept what they say but I’ve still got a niggling suspicion that it might have been, because I didn’t seem to be a high risk in any of the other ways that they described. They asked me all the questions and I didn’t really seem to come up with much of a risk factor in any of the other respects. So, that was, it’s still a niggling doubt in my mind and I’m glad I don’t take it, well I can’t take it anymore because of the risk but again if I hadn’t taken it perhaps I’d have really dodgy bones by now so you can never tell what would have happened can you. I think given the choice, if I knew then what I know now, I probably wouldn’t have taken it but then other treatments didn’t exist when I was prescribed it so.

So I went back to him to talk about it, the GP, and I said, “The only thing that puts me off, I don’t really want to be having periods if I get to 80 and I’m still on it and I don’t want to be having periods. That’s ridiculous.” So he said, “Well, I could put you on another one where you don’t have the oestrogen.” And he said, “Most.” I remember him saying something like, “Most of the ladies that I’ve prescribed this find it much better and they don’t really have bleeding. Occasionally, you might get a bit of spotting.” So I said, “Fine.” So he prescribed this so I started taking that and I suppose I was taking it, I don’t know how many years, perhaps two three years, which was, on top of the previous years I’d been taking the combination one.

Well, I think it’s good medical practice to see your GP or whoever is prescribing your hormone replacement therapy at least once a year and understand the pros and cons. Because as you get older, you need less hormone replacement therapy than you do, for example, women who have a premature menopause, who are in their thirties or forties, need about five times as much oestrogen as a woman of 55. So as you get older it should be tailored down and changed because there are also a number of different preparations. When you’re in the perimenopause you should have a cyclical preparation. That means you cycle so you have a withdrawal bleed and then as you go through to the menopause and postmenopause you can have what’s called a continuous combined preparation of oestrogen and progesterone, which you don’t have a period with and that’s been shown to have less risk of womb cancer than a cyclical one. So again, as you get older beyond that, the dose needs to come down so you actually shouldn’t be stuck on the same preparation for years and years and years. What I talk to my patients about is the risk of breast cancer, make sure they’re having mammograms regularly, make sure they’re having cervical smears regularly as all women should be doing along the current national guidelines and talk through the pros and cons.

I said, “I am going through the menopause, I’m on HRT and I’m having a bit of trouble settling with the tablets”. I went back to the GP and she said, “Don’t worry Carole,” she said, “we’ll try you on another one”. Excellent I thought, so I tried another one, that was okay for a while but then the nausea came back again. So, bless my lady doctor, she’s got such patience, I went back again and she said, “Well let’s try patches, because they’d be absorbed through the skin rather than through the stomach and the liver”. So I went on Evorel 50, two patches a week on the thighs. Great. Fantastic. Relief. After about six months I started to get a reaction to the patches on my thighs. I would have square patches like that red raw, itching and I was using a different leg each time hoping that that red patch would heal before I got back to that side and I had at the end of about I suppose about another six or seven weeks I looked like a patchwork quilt. It did, it was red raw, it was stinging, it was itchy. I did a bit of research on the internet mainly with the help of Menopause Matters and one of the ladies on there suggested I might try a different patch but I went back to the doctors and she said, “It does sound like you’re allergic to the adhesive, although I was a bit apprehensive about that. But anyway she tried me on a Fem 7 patch. I put one on and it was even worse, it looked like somebody had got a Hoover, put it on suck on my thigh and just bluk, and it was within about one day. So that had to come off. So then I tried the gel which was top half of your arms, once a day and that was alright for about two weeks and then it all flared up again. Doctor said to me, “You’re probably allergic to oestrogen full stop.”

I liked being on it actually. It seemed to give me some kind of energy boost and it sharpened my memory. So I felt better on HRT. Anyway, all this story took about five years to come round. I went down to the GP. It was a female doctor who said, “Oh, you’ve been on it for five years I’m not going to give you another prescription for it.” And I said, “But I want to be on it.” She says, “Yes, but there’s research coming out what’s showing there’s a higher risk of breast cancer.” And I did say, “Well, I don’t smoke. I don’t drink a lot, maybe half a glass of lager or something a night, maybe five nights, four nights, nothing heavy. Could I stay on it?” But the doctor was adamant I couldn’t continue on that.

So I was brought off HRT and I found after that oh, it were terrible, absolutely. I were weepy. I were feeling depressed well, I’ve had depressed days. I just imagined this must be what depression feels like. I just couldn’t remember things. I were dull. I needed a sharp memory, a clearer memory in my job and it were terrible. So I went back to the GP and it were a male GP I got this time and I just begged, “Could I have HRT please?” And he said, “Well, we’d rather not.” And I said, “Well, I’ve got all the pressures from being a carer. I’m getting really weepy. I’m driving along the road and I just want to cry.” And he prescribed me some red clover and I tried that for about three months but it made no impact whatsoever.

So I just felt, this is it then. I’ve had my five years worth or whatever they consider you can have and I were just devastated. And I just think it was I’ve had my choice taken away from me. I wanted to stay on it. I felt better much better on it and I just couldn’t understand why somebody else had made that choice for me. They weren’t in my body and they weren’t living my life but yet a decision were made to sort of deny me a therapy which I found beneficial. And I did get the feeling somewhere along the line that it were viewed as women trying to clutch on to youth and really we should go into older age more gracefully, not need pharmacological, crutches or interventions. It were, “So get on with it”. And I’ve never been back since although I bet once a week at least I think, “Oh, I wish I could have my HRT.”

Is there a reason why you wouldn’t shop around and go elsewhere?

I would say in [city] there’s a culture of you stay with the same GP unless you move. I would say in [city] not many people do shop around, it’s often, “Oh, better the devil.” And then you hear shock, horror stories of other GPs and you think, “I’d better stop with mine.”

He doesn’t know yet but from the time I went on it I’ve been weaning off it, so going on was my weaning off programme. I take a full tablet every other day and the days in between I take half and in another month or so I’m going to cut that back a little bit more because I don’t really like being on it. When I very first went to see him in 2004 or whatever, he said, “You can have HRT.” And wanted me to have HRT, “For five years or until you’re 55.” Well, as I was nearly 50, five years and I did say, “What then?” And he went. So he said, “It might just get you over the hump of the worst of the menopause.” And I think now that demonstrates a total lack of understanding because if your own hormones are misfiring you’re making less progesterone and less oestrogen and you’ve got all these symptoms. What does he think is going to happen when you’ve had your five years of taking an artificial substitute and then you withdraw it? The same thing is going to happen. So what then? And if it’s nothing well, what’s the point in going on it, so I’m weaning off. I’m keeping a little stash of all these half pills and when he cuts off my supply, which is likely to be this September, a) he’s going to have a fight on his hands, b) I might go private and get it that way or c) I’ll take my little stash that I’ve got in the cupboard without his knowledge. But that’s it really.

And so I was referred by my GP in London to a specialist, I suppose they are obstetrics and gynaecology people but she was actually a specialist in managing the menopause, and she put me on HRT; which was like a miracle. I mean it was completely rejuvenating. I was still having occasional periods, maybe once every three, two maybe two, three, four months, and it was something called, “Do you want me to mention the name of the drug?” it was called Premique Cycle and I went on to that and it was like being rejuvenated. All that weight I was putting on dropped off, I felt my libido came back, my whole ambition, all that kind of I want to make my work really work. I was running a medical research charity at that time called [name], and it was a very very busy job and a lot of pressure with lots of staff and very hard work. And I felt I was capable of doing it again. It was really marvellous. So my experience of HRT was unfailingly excellent.

It was about six years ago when I came to live in [city] and when I was obviously transferred from my old GP to a new GP that she said she was very opposed to women staying on HRT and that I should come off and I’m an obedient woman and didn’t think twice and so I just simply stopped taking it. And it wasn’t until quite a lot later that I discovered that that was completely not the right thing to do and so all of those symptoms that I’d been complaining about previously, the hot flushes, the loss of libido, the lack of concentration, the weight gain, they all came back in such a massive rush I thought I was dying. I mean I thought I was literally on, I just couldn’t believe it. But I did cold turkey and I came through it.