From patches to lifestyle changes, all your questions on the HRT crisis answered
WOMEN are resorting to desperate measures to get their hands on life-changing hormone replacement therapy.
Whether bartering with neighbours, paying over the odds to online pharmacies or considering trips abroad, the HRT shortage is putting immense pressure on women.
More than a million of us are thought to take HRT, with prescriptions now twice as widespread as five years ago.
And menopause awareness is better than ever – thanks in part to our Menopause Matters campaign.
But the shortage is expected to stretch into the summer, with ministers imposing a three-month prescription limit on some HRT drugs, including Oestrogel.
Health Secretary Sajid Javid has held crunch talks with suppliers and pharmacists in a bid to tackle the crisis, while members of the Government’s Vaccine Taskforce are being redeployed to HRT.
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In the wake of Davina McCall’s second Channel 4 documentary on the topic – Sex, Mind & Menopause, which aired last Monday – the Scottish Medicines Consortium is set to reassess menopause drug Utrogestan, which it has previously rejected.
We have been inundated with questions about HRT from worried Sun readers.
Here, Fab GP Dr ZOE WILLIAMS addresses some of your biggest concerns.
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Q) CAN I take HRT only every other dose if I’m running out and can’t get any more because of the shortages?
Dr Zoe says: By skipping doses, you are effectively lowering the overall dose of HRT that you are taking.
This could mean you start to experience menopausal symptoms again. A more advisable solution would be to seek help from your GP and temporarily use an alternative preparation if there is no stock of your usual one.
For example, if patches tend not to work well for you and you usually prefer gel, putting up with the patches might be less of an inconvenience than having your symptoms return.
I would advise speaking to your GP. Or you could also have a chat with your pharmacist, who may be able to advise which alternatives would be best for you.
Q) I THINK I am in peri-menopause. My GP has done blood tests and scans and said I just need to lose weight. Is she not prescribing me HRT because of the shortages?
Dr Zoe says: Perimenopause is the period of time before the menopause when symptoms start to occur and periods tend to change in nature or regularity.
There is not a blood test or any other test for perimenopause. It is considered on symptoms alone. I would advise you to monitor your symptoms and complete a questionnaire.
Balance Menopause () has one on its website, or you can monitor symptoms on its free app. Sometimes having all of the information in one place is useful for healthcare professionals to get a full picture of what you are experiencing. With all this information, you should go back to your GP for this to be reconsidered.
It might be worth asking if there is a doctor or nurse at your GP surgery that specialises in menopause. Sometimes the only way to know if your symptoms are caused by depleting hormones is to try HRT for a few months and see if it makes a difference.
Q) I’VE had to go on to patches because of the gel shortage. What does that mean for my symptoms?
Dr Zoe says: The gel contains the hormone oestrogen. Taking oestrogen replacement via a patch is similar to taking it as a gel. Both methods of delivery are transdermal, meaning they are absorbed through the skin. And both are effective ways to take oestrogen replacement.
The choice is usually down to personal preference. For example, some people find the patches irritating, while others feel gels messy. So a temporary switch to a patch is a good solution to the current shortage.
Your GP will try to match the dose and this will hopefully mean that you do not notice any significant change in your symptoms.
Q) I CAN’T get my usual HRT. Is there anything lifestyle-related I can do to help?
Dr Zoe says: It is important for me to be honest and say that while lifestyle measures can certainly help you to be healthy, feel better and in some cases even combat some menopause symptoms, they will not combat the underlying issue of hormone deficiency.
So it is crucial that, in addition to looking at lifestyle measures, you investigate alternative types of HRT while your usual type is not available.
When it comes to lifestyle advice, there are so many ways we can look after ourselves, from movement to nutrition to sleep and meditation. There is a great resource on the Menopause Charity’s website ().
If I were to advise one thing, it would be to move your body every day. If you are starting out, this could be a 20-minute brisk walk, squats every time you boil the kettle or a yoga class on YouTube.
Movement is crucial for physical health and mental health. It also makes you feel confident, improves self-esteem, aids sleep and gives a sense of achievement.
Q) MY neighbour has extra HRT. Should I just take some of hers while I am unable to get my prescription?
Dr Zoe says: The national HRT shortage has caused so much distress.
If you are running out or are unable to get your usual HRT, it is important to speak to your doctor and pharmacist to find out what alternatives are available.
While these may not be ideal, as a short-term measure it is better to switch to a different preparation — such as from a gel to a patch — than to stop altogether or risk taking medication that was not prescribed for you.
Q) I FEEL like I should ask for HRT but I have a history of breast cancer in my family. Is it right for every woman?
Dr Zoe says: There is no strong evidence that having a family history of breast cancer puts you at any higher risk of getting the disease if you take HRT compared to women who do not have a family history of breast cancer. This means women with a family history of the disease, including those women with a BRCA gene, can still usually take HRT safely.
Q) I AM 41 and watched Davina’s documentary which suggested that women should start HRT in their forties. I don’t have symptoms but do I need to speak to my GP about starting now?
Dr Zoe says: If your periods are normal and regular and you are without any symptoms, there is no need for you to seek HRT now.
The point is that many women who are struggling with the symptoms of perimenopause or menopause don’t seek help or support because they think they that are too young.
Although the average age of the menopause is 51 (the definition of menopause is when there have been no periods for a year) many people will experience perimenopausal symptoms in their forties, thirties and sometimes even their twenties.
Women experiencing symptoms they think are due to hormone deficiency should feel able to approach their GP, irrespective of their age.
Q) SO why is body identical HRT such a postcode lottery?
Dr Zoe says: Body identical HRT is available on the NHS. But it cannot be guaranteed that this will be the first type of HRT that will be offered to you. You need to ask for it specifically to ensure you get it. Many private clinics are using bioidentical hormones.
These are not the same as the body identical hormones and are not available from, or advised by, the NHS because they are not regulated and are not subject to any quality control.
Q) IF you take HRT, do you ever really finish going through menopause?
Dr Zoe says: Menopause can be thought of as a hormone deficiency, which lasts for ever. So whether you take HRT or not, the loss of hormones is a permanent thing.
Q) I’VE been on HRT since I was 30. I’m now 42. Should I still be taking it?
Dr Zoe says: I assume from your question you have premature ovarian insufficiency (POI) — meaning menopause starts earlier than it should. Around one in 100 women under the age of 40 in this country have POI and it affects one in 1,000 under 30.
Some women do not realise they have it. So if you have irregular periods, or your periods have stopped, it is important that you talk to your doctor about having a test for POI.
Sometimes the reason for the ovaries no longer working well is more obvious — for example if they have been surgically removed or if a woman has received treatment for cancer, such as chemotherapy or radiotherapy, that has affected their function.
Our hormones are crucial for the health of our entire bodies, especially our hearts, bones and brains. So being without hormones from such a young age increases risk of diseases. It is vital POI is diagnosed and appropriately treated with HRT. It is advised that the HRT is continued at least until the average age of natural menopause, which is 51.
Q) I HAVE been on HRT for approximately two years but I get prolonged periods of bleeding. Why?
Dr Zoe says: Any vaginal bleeding after menopause requires a trip to the doctor. This is called postmenopausal bleeding and should be investigated to rule out cancer of the womb as a cause. Taking HRT may produce irregular bleeding or spotting for the first four to six months of treatment.
If bleeding persists beyond six months, it becomes heavier or occurs after a spell of no bleeding, inform your doctor.
Q) WHICH HRT do you suggest when you have a growth hormone deficiency?
Dr Zoe says: This requires specialist consideration by your endocrinologist.
Q) I HAD breast cancer ten years ago with a full mastectomy, so my GP won’t let me go on HRT. I’m at a loss as to what to do. Can you help?
Dr Zoe says: HRT can sometimes be used to treat menopause in women who have previously had breast cancer. It will depend on several factors, such as whether your breast cancer had spread anywhere, the type of breast cancer (whether it was oestrogen receptor positive) and if you are taking medication to prevent your cancer from returning.
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For every woman, when it comes to HRT an assessment should be made of the risks versus the benefits. There are many factors to consider, including the severity of menopausal symptoms and the impact they are having on your quality of life.
Women who have previously had breast cancer should ask their GP to refer them to a menopause specialist clinic.
Fabulous Menopause Matters
An estimated one in five of the UK’s population are currently experiencing it.
Yet the menopause is still whispered in hush tones like it’s something to be embarrassed about.
The stigma attached to the transition means women have been suffering in silence for centuries.
The Sun are determined to change that, launching the Fabulous Menopause Matters campaign to give the taboo a long-awaited kick, and get women the support they need.
The campaign has three aims:
- To make HRT free in England
- To get every workplace to have a menopause policy to provide support
- To bust taboos around the menopause
The campaign has been backed by a host of influential figures including Baroness Karren Brady CBE, celebrities Lisa Snowdon, Jane Moore, Michelle Heaton, Zoe Hardman, Saira Khan, Trisha Goddard, as well as Dr Louise Newson, Carolyn Harris MP, Jess Phillips MP, Caroline Nokes MP and Rachel Maclean MP.
Exclusive research commissioned by Fabulous, which surveyed 2,000 British women aged 45-65 who are going through or have been through the menopause, found that 49% of women suffered feelings of depression, while 7% felt suicidal while going through the menopause.
50% of respondents said there is not enough support out there for menopausal women, which is simply not good enough. It’s time to change that.