'We regularly see women who think they are going mad' - two women reveal why they opted for alternatives to HRT for menopause
Two women tell Emily Hourican about their menopause experiences and why they opted for a different approach
It might just be the last taboo. In a society in which women now happily share their conception stories and talk about being 'period positive', there is still a tendency to drop the voice when discussing menopause, to shroud it in silence, secrecy, even shame.
It's an attitude that - for all the fascinating advances at the extreme edge of research (including a recent breakthrough that could see women freezing and storing part of their ovaries in youth, then transplanting the tissue back into the body later, to kick-start natural hormone production, delaying the menopause and expanding fertility) - unfortunately often reflects a certain on-the-ground medical reluctance too. There can be a lack of understanding from some doctors confronted by women complaining of the many broad, often disparate symptoms of menopause and, increasingly, perimenopause (the years preceding menopause). Even the techies are slow to get in on the act. Fem-tech, as it's called, has so far been more active in the area of menstrual health and pregnancy, with only a handful of companies targeting menopause. Where these exist, they largely rely on symptom tracking and personal assessment of mood, offering treatment plans that include nutrition and lifestyle recommendations. Add to this the fact that we are, by virtue of increased longevity, dealing with something relatively new - average life expectancy means we can now easily expect to notch up 30 post-menopausal years.
It is, clearly, time to rethink our approach.
Loretta Dignam (56) had a successful career in marketing before starting the Menopause Hub clinic (themenopausehub.ie). "My periods stopped the month before I turned 50, and from there, it was like a slow puncture. All the vitality drained out of me. I had 20 to 30 hot flushes a day, my energy levels dwindled," she says. "I tootled on, trying all sorts of over-the-counter remedies. At one point, I was wearing magnets in my knickers."
She didn't try hormone replacement therapy (HRT) then. "I had heard there was a link with breast cancer. I decided to just power through." After three years however, her symptoms were no better. "By then I had such dry eyes that I ended up in A&E three times. I had bad pain in my ankle joints. I could see no end. Eventually I went to my GP, who did a blood test and told me I was post-menopausal." The GP recommended Loretta start HRT (at its most basic, this is the replacement of female sex hormones, oestrogen and progesterone).
Loretta however is progesterone sensitive. "I could never take the pill. It left me feeling bloated and horrible. After three weeks on the HRT patch, I tore it off."
Loretta did further research and found a doctor who worked with bioidentical HRT, which are man-made medications containing hormones that have the same chemical formula as those made naturally in the body, and, like standard HRT, come in a variety of forms.
She began to take a prescription that includes bioidentical oestrogen, progesterone, and testosterone. "I got my vitality and confidence back. And I knew I wanted to help other women feel as good as I did."
Loretta isn't a doctor - although the Hub obviously employs doctors, alongside a physiotherapist and acupuncturist - rather, she is driven by a determination to use the latest research to support women through what is, for many, a tough time, physically and emotionally.
"We regularly see women who think they are going mad. Who have been prescribed anti-depressants and sleeping pills, or who have been told 'it's natural, get on with it," Loretta says. GPs may also be too bound by the results of blood tests that show levels of FSH (follicle-stimulating hormone), the standard test to establish if a woman has reached menopause. This is effective, but limited, failing to take into account dips in oestrogen and progesterone in the peri-menopausal years.
"Replacing your hormones is the most effective thing you can do," Loretta says. "Both for short-term symptoms, and long-term considerations like bone health and heart health. We offer this via bioidentical HRT."
Uptake of HRT fell off a cliff in 2001/2002, following a study - since largely discredited - that suggested links with breast cancer and blood clots.
The most recent research, as laid out by the British Menopause Society, suggests that, from an average population baseline of 23 cases of breast-cancer per 1,000 women aged 50-59, there will be four extra cases in women on combined HRT, and four fewer cases in women on oestrogen-only HRT. To put that into context, this compares with four extra cases in women on the pill, five extra cases among women who drink two or more units of alcohol per day, and 24 extra cases in women who are overweight or obese. Those same figures suggest that there will be seven fewer cases among women who take at least two-and-a-half hours of moderate exercise per week.
But the message is slow to filter down, to doctors as well as women.
Asked what she considers the most significant recent advance in the way menopause is treated, Shirley McQuade, medical director of the Dublin Well Woman Centre, says: "The publication of the NICE guidelines on Management of the Menopause in 2015. It produced very clear guidelines as to the risks and benefits so doctors have a robust framework to work from. Many GPs in the early 2000s stopped prescribing HRT and have had no interest in revisiting their decision."
At the Well Woman clinic, Shirley says, "We are now seeing more women coming in to talk about menopause, and they are more open to taking HRT to control symptoms."
Many women tolerate standard HRT perfectly well, and find it answers their needs. But for some, that approach isn't enough.
For skincare specialist Leah Kennedy (thenakedface.ie), there was never a debate about taking HRT. "I was officially diagnosed as being in menopause at 38," she says. "But I think my symptoms began when I was about 36, soon after the birth of my third child."
Because of her age, Leah was strongly recommended to begin standard HRT. "It was fine for a few months, and then I started to feel horrendous. Later it turned out that I had been taking too much progesterone. I completely lost myself. There was no joy in the world. I even thought about killing myself. I was impatient with my children and my husband, and deeply unhappy. I didn't associate my mood with the HRT."
Two or three terrible months went by, until Leah, who is now 41, had coffee with a friend who talked about her own good experience with bioidentical HRT. "I went to Dr Magovern at the Drummartin clinic," Leah says. "He sent me for a barrage of tests, made me stop the HRT I was on, which I was taking orally, and, after the results of my tests came back, started me on transdermal gels instead. I now take bio-estradiol, bio-progesterone, and testosterone." The effect, she says, "was unbelievable. I started to feel like the 26-year-old me again. I have always been a calm person, it's one of the things I like about myself, and I got my calm back."
But, she adds, "it's not all sunshine and roses. Hormones are complicated. Levels need to be adjusted. It's an ongoing process."
Dr Magovern offers "a 360 approach to medicine." He practised in Northern Canada for years, and came back to Ireland in 1996. "Unexplained illness is my main bag," he says. "I began to see a lot of female patients with chronic fatigue, who said their symptoms were worse around the time of their periods. That led me into hormones. Fifteen years ago I went to Germany to learn about bioidentical hormones."
He is careful to point out that "it's not just a matter of prescribing hormones. I want to look at the whole picture." However, he is passionate about the role played by oestrogen. "It boosts serotonin levels, which affect optimism and vitality. We are starting to realise that what doctors once dismissed as 'empty nest syndrome' is not in fact lifestyle-related, it's bio-chemical.
"We constantly fine-tune the treatment plan, and within the first three to six months, we tend to see the disappearance of negative symptoms - the hot flushes and so on. From about six months, we see women saying 'I feel like myself again.'" He is equally passionate about listening. "Forty years ago, I would have thought I knew it all. Now, I know that disease is only a map, and a map is not the territory. You need to listen. It's time to de-stigmatise menopause so that women can continue to be the best versions of themselves, rather than limping along."
What is bioidentical HRT?
Most women taking HRT take a preparation that contains an oestrogen and a progesterone. Some types of HRT use synthetic hormones. In bioidentical (or bio-available) HRT, hormones are identical in molecular structure to the hormones women make in their bodies, and are made from plant chemicals generally extracted from yams and soy. However, just to confuse matters, many standard HRT therapies also now contain bioidentical hormones. Despite personal testimonies from many women, bioidenticals have not been formally proven to be any more effective or cause any fewer side effects than the non-bioidentical preparations. Like conventional HRT, bioidentical hormones may not be right for everyone, such as women who have had breast or endometrial cancer, or blood clots, for example.