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Friday 31 May 2019

Menopause Myths Dispelled

Staying active is key to tackling the menopause as described by over-50s blogger Gail Hanlon shown here on bike

Until recently I didn't talk about the menopause. It was the BBC's week of broadcasting about it that changed my mind. My husband said it was useful to know more about menopause because men are largely kept in the dark. Heck, 50% of the population will go through the menopause and I found it disconcerting how little there was on the internet when I first started "the journey."

I'm also keen to share my positive HRT experience, to show that you can get ordinary tablets from the GP and you don't necessarily need all the "bio identical" stuff which some bloggers talk about. And in fact the phrase "bio identical" is a complete con, as I will cover in this post.

Firstly, everyone's experience of menopause is different.  I have been dismayed by some of the comments of women on Twitter who seem contemptuous of others who have suffered badly and resorted to HRT rather than natural remedies. They seem to sneer about the UK having worse menopause experiences than any other country. If you had problem periods, you will probably have a difficult menopause. The same applies to whether or not your mother had an early menopause and/or a difficult one.

My symptoms started at age 50 and I was in total denial.  I had a very challenging and difficult job and I was irrational at times with startling mood swings. Plus I wasn't sleeping very well. But I put this down to stress.  My mum kept telling me gently it was probably the menopause, but I had put that to the back of my mind because I fully intended to sail through it, adopting "mind over matter" as I do with most illness, and only taking natural remedies.

Natural remedies didn't work

Eventually after some shaming instances where I yelled in a meeting, sobbed over a Christmas dinner and sat in Sainsbury's car park scrutinising emails because I felt sure male colleagues were trying to destroy me, I did succumb and bought "the natural remedies". These include black cohosh and red clover. I also took to eating more soya products and other foods recommended for the menopause. None of it made any difference.

It was time to speak to the doctor to get a HRT prescription. He had to consult the manual because, he said, he was so rarely asked for it. This was the legacy of a flawed survey a few years ago which damaged perceptions of HRT so badly that a generation of women had to go without.

He prescribed Prempak C tablets, one of the older forms of HRT and often derided for being made from mare's urine.  It had a combination of oestrogen and progesterone, the latter being needed by women with a womb. I got on with it very well - and let's face it, I'm sure our biological makeup is more akin to a horse's than it is to a yam's. I was gutted when it was discontinued. I was then put on Elleste Conti Duet, which is also a combination formula.

On HRT I had all my normal energy and joie de vivre back. I slept like a baby and reverted to being generally sunny and content with no alarming mood swings.

Unfortunately, Elleste has been suffering from supply shortages. So the GP recently had to switch me to Femoston.  He sneakily lowered the dose at the same time. Femoston has the body identical version of progesterone which makes it easier to handle for some women who have side effects from synthetic progesterone.

A surge of interest in the menopause in the UK has led to greater awareness which is good news, as reported by Is This Mutton's Gail Hanlon

It's body identical that counts, not "bio identical"

Note my use of the phrase "body identical."  Bio identical is a phrase invented largely by private practitioners who make a fortune creating bespoke doses in their own labs and charging for endless blood tests. More worryingly, the bio identical market isn't regulated.

The lower dose meant some of my symptoms came back.  My job is still stressful, although it shouldn't be, but normally I cope with it. But now I was suddenly having palpitations, a racing heart beat and sleepless nights. I felt depressed.

After two months on Femoston I went back to the GP - and he agreed to return me to Elleste Conti Duet, also prescribing the generic version (Kliofem) in case it was still unavailable.  It is not yet back in stock and interestingly, two other women were at the pharmacy begging to be notified when it's available. The manufacturer (Mylan) need to increase their production!

The nurse at the surgery, who takes my blood pressure and weighs me every few months, is not a fan of HRT and is always asking me when I plan to come off it. I usually say, in a vague manner, "when I retire."

More myths dispelled

The NICE guidelines no longer direct doctors to take a woman off HRT after five years.  The drug is beneficial against osteoporosis and has been associated with better heart health.  The risk of increased breast cancer is higher than it is for taking HRT if you are overweight or drink more than the recommended number of units.  I rarely drink, keep fit and aim to eat healthily 80% of the time. That's the agreement I have with myself, in order to qualify for HRT now than my menopause has happened.

My advice to anyone considering HRT is that GPs seem more clued up about it now and they are sympathetic to reviewing your prescription if the formulation is not working for you.

As for coming off it:  once we stop taking it, the symptoms may come back, as I discovered with the lower dose. I will probably come off it when I retire but in a gradual way. But I'll cross that bridge when I come to it.

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