Another week over and it’s certainly been an interesting one. In this post I’m finally following up on my promise to do my HRT update – going private in the UK but first I just want to refer back to last week. I think a lot of us are starting to look ahead tentatively, wondering what life is going to be like when we start to emerge from lockdown. Your replies to my question last week about how you were feeling were fascinating and they really illustrated just how different it’s going to be for each and every one of us.
Moving towards the end of lockdown?
Rushing to finish last Friday, I made a rather clumsy quip about raising a glass to Boris on my birthday because if the road map rolls out according to plan, the bars and restaurants will open up just in time for me to go ‘out out’. I think most of you knew that I was just being flippant, that it wasn’t intended as any kind of political comment but for a few it hit a nerve. There were two strong comments after the post from readers who I know quite well, I understand that they’ve each been hit hard by all of this and that they’ve been surrounded by sadness. There were also two emails and a DM that weren’t fairly written and left me feeling overwrought last Sunday.
It’s ok, I’m over it now but I think it’s important to raise it here because it was a vivid illustration of just how differently we’ve all experienced Covid and lockdown. As a result, the aftermath for every single one of us will be individual. When we go back out and meet up with friends and colleagues again we’re going to have to be very careful and feel our way. We’re going to need a high level of tolerance too because I can imagine that we’ll be going at varying speeds and we’ll all have different boundaries. Right now, as we remain in limbo feelings are running high everywhere and it means that all of us, but particularly people like me who are communicating outwardly to a lot of people, need to be sensitive to that.
Because we’ve all lived in such individual channels for so long now, it’s hard to know what other people are experiencing. We had a Zoom meeting with our accountant last week because we’re approaching the end of the tax year. We were quite surprised when he came on screen because he looked quite wild. When we asked him how he was he put his head in his hands and explained that he runs an accountancy firm because he likes the order and simplicity of numbers. He never imagined that he’d have to be a counsellor to so many people who are living through extreme circumstances. He’s finding himself pinballing from a meeting with someone who is losing everything that generations of their family have worked for to the next person who’s never had it so good. And life is going to be like that on so many levels.
So in the context of all of this I’ve recast the image of my birthday. If we do go out I’ll be celebrating more quietly, thankful that our friends and family are unscathed from a health point of view and that although it’s been tough financially, we’re ok. As I do I’ll be mindful of the fact that the person at the next table might be in a completely different situation so I’ll keep my voice down and metaphorically that’s probably going to be the best approach for a while. Anyway this is hopefully another thing for us to discuss in the comments – a few people said they felt they would need to ‘resocialise’ and actually I think it’s going to take a while for life’s wheels to be oiled again.
HRT update – going private in the UK
Moving on but before I start please remember that I have no medical training, everything that I’m about to discuss is from my personal experience only. All symptom and hormone related information comes from Newson Health and any other sources that I’ve used are attributed where appropriate.
Background
A lot of you have been in touch to remind me to talk about the changes I’ve made to my HRT regime over the last few months so today’s the day. It’s going to take a bit of explaining but I’ll be as concise as possible. To recap, I started taking HRT back in 2016. I’d spent a weekend with an old schoolfriend who is a doctor and of course we spent a lot of time chatting about life and how we were feeling. I’d been talking primarily about a drop in confidence, how I seemed to spend endless nights not sleeping, worrying about all kinds of random things and so as a result I often felt exhausted. As I left her she told me that she thought I ought to have a chat with my GP about HRT. At that point it hadn’t occurred to me that I might be perimenopausal – at the age of 49! So, I went along to see the nurse practitioner who was also a midlifer, she listened to me for a few minutes and instantly prescribed HRT in tablet form which made a difference very quickly.
Four years on
I’ve been on the same repeat prescription ever since but last year I started to notice a return of menopausal symptoms. At first I thought it was just lockdown malaise but then as lockdown started to lift in the summer, I still felt the same. Among other things my particular problems included:
- Loss of confidence or sense of ‘who I am’
- Loss of ‘grip’ – I couldn’t focus enough to plan anything
- Occasional burning hot nights – dry heat though rather than night sweats
- Feeling exhausted by the end of the week and spending weekends feeling as though I was recovering from flu with zero energy
- Persistent UTIs, one after the other
- Aching joints and easily triggered injuries
- Loss of words – this peaked in me being unable to remember Teddy’s name and repeatedly calling him Trevor(!)
Again it was a conversation with a friend that made me take action. You may remember me doing an exercise video with Sally last September. Afterwards she told me how much better she was feeling after going to a private clinic for an HRT overhaul so I decided to do the same. I registered on the waiting list for Newson Health’s Manchester clinic and heard back from them about a week later. We scheduled an appointment hoping that I’d be able to go into the clinic itself but then of course Tier 3 happened and so we had to do everything by Zoom. I wasn’t particularly keen on doing something as intimate as this virtually but actually it was fine. I completed a questionnaire in advance which gave me a score of 30 on their menopause symptom scale. I ‘met’ with Dr Zoe Hodson and as we chatted about how I was feeling it was like watching somebody do a Rubik’s cube as she allocated different symptoms to particular hormone groups. (I should add that I paid for my appointment like anyone else, this isn’t sponsored or gifted in any way).
The most enlightening thing she told me was that we have oestrogen receptors in every cell in our body so when the levels of oestrogen drop, it can affect you in all kinds of different ways. As a result it’s worth asking the question ‘is it menopause related?’ about any new health or wellbeing change you experience. I have friends who’ve found that HRT has relieved things as random as chronic sinusitis, hearing problems, excruciating abdominal pain and cramping feet.
Up until this point I’d been relying on an oestrogen pill taken orally and progesterone from a Mirena IUD that we realised had expired a while ago. Zoe switched me over to oestrogen gel so that I could play around with the dose and monitor how I felt. I started with 2 pumps to mirror the dose of the tablet I’d been taking, moved on to 3 which felt better and then tried 4 but that left me feeling as if I was pregnant with a nausea like morning sickness that lasted all day. Now that we’ve settled on the right dose, I’m moving on to patches which will be less of a faff every morning. The benefits of oestrogen include regulating mood, temperature and cognition. It protects the arteries, stimulates bone growth and improves strength and muscle mass. She then added in an oral progesterone tablet primarily as protection from womb cancer but it has an added effect of making you feel sleepy so it’s recommended that you take it at night.
The most exciting new addition was testosterone which is another of the hormone levels that falls during menopause. Symptoms of low testosterone include:
- Diminished sense of wellbeing, dysphoric mood and/or blunted motivation
- Persistent unexplained fatigue
- Sexual function changes including decreased libido, sexual receptivity and pleasure
- (Potential) bone loss, decreased muscle strength and/or changes in cognition/memory
It’s very difficult to get a prescription for testosterone on the NHS and if you do, you will be prescribed a male rather than a female version. This may change now that we’ve left the EU but at the moment it’s still only available privately. It comes as a cream and I rub a pea sized amount into my thigh every morning. This is the one that I think has really helped me to click back into place in terms of personality and drive – or just gumption as my mum would have put it.
Finally, to help with the constant UTIs I was getting she prescribed a topical oestrogen pessary. This helps to rebuild thinning tissue which is one of the reasons that so many women over 40 get UTIs and as you may know from your mother, the older you are the worse they can get, often landing elderly ladies in hospital.
Learning more about perimenopause and the post menopause years
Newson Health are great educators, they’re on a mission to improve knowledge about menopause at both an individual and an NHS GP level so that they have a better understanding of how to treat it. The problem at the moment is that medical training on menopause is minimal and apparently the WHI curriculum hasn’t been updated since reports linking HRT with a high risk of breast cancer were invalidated in the early 2000s. As a result a lot of NHS GPs automatically associate HRT with breast cancer and so are extremely reluctant to prescribe it.
Zoe gave me a list of websites, books, Facebook groups and even Instagram accounts to follow as part of my own educational journey because of course our bodies continue to change beyond menopause. If we decide not to replace it, lack of oestrogen will keep on impacting our bodies over the years ahead and it’s important to understand how. When I said I was going to write about all of this, Zoe asked me to explore Jane Lewis’s work to raise awareness of Vaginal Atrophy which is also known as Genitourinary Symptom of Menopause (GSM).
You hear people mention Vaginal Atrophy, laughing about ‘use it or lose it’ but I had no idea just how many women are affected by it and for anyone who is unlucky enough to suffer with it badly, just how life limiting it is so I want to draw your attention to it. 1 in 3 women will get Vaginal Atrophy in some form. It starts with dryness and itching and can progress all the way to the complete loss of the labia and clitoris. Jane’s written a very funny but factual book called ‘Me and My Menopausal Vagina’ where she describes her own journey as well as offering tips and advice for anyone who is suffering with VA. It makes shocking reading – her experience started with her noticing one day that she was uncomfortable sitting on a cinema seat and progressed to the point of her being unable to work or even tolerate underwear. She explains,
“I have or have had stabbing pains in my vagina, burning in my vulva, constant soreness, micro-cuts on my perineum, thinning skin that leads to splitting (including from my episiotomies) seemingly never ending UTIs, itching, ulcers, a painful clitoris and very, very sensitive skin… wearing any knickers or trousers was excruciating and sex? Ha! Forget it. That ship has sailed.”
Jane Lewis, My Menopausal Vagina
If you have any symptoms, even if it’s just recurring UTIs, it’s worth having a check-up because topical oestrogen used early enough may well help you not to end up in the same situation as Jane. As I’ve been learning more about everything menopause related and the way women’s bodies age, I’ve come to understand so much more about the silent plight of many elderly women. By the time they reach their 70s, about 70% of women are suffering with Vaginal Atrophy and there’s very little acknowledgement of it as a life limiting condition, especially in care homes. Many of them can’t sit comfortably because their vulvas are too sore; they rely on incontinence pads which are a breeding ground for bacteria and UTIs yet they feel unable to discuss it or ask for help. Some general discomfort and incontinence issues could be mitigated by topical oestrogen and if you think this might be affecting someone you know, you can read more here.
I know this has post has covered some very intimate subjects but awareness of all of these issues has to be raised. I hate the thought that any of us might be like the women in Jane’s book and on her (closed) social media forums, unable to sit on the ground for a picnic… or on a plane… or to have sex… or ever wear jeans or trousers again… and then find that it gets worse and worse as the years go on.
I’m aware that I’m coming across as very pro-HRT and that some of you will have a different standpoint but if you’re someone who’s wondering whether it would make a difference, all I can say is that it certainly has for me. My most recent score on the menopausal scale is 9 – down from 30 just 3 months ago. My latest blood results show that everything is in balance and so I can now continue with this regime for another 12 months. Of course you must make your own mind up and do what’s right for your life and your body but do give it some thought because the younger you start, the more effective it will be for you. If you have fears about the breast cancer study that was a big issue 20 years ago, you can find up to date information about the risks from the NICE guidelines here.
I’m going to pull this to a close with another extract from Jane’s book because she articulates things so well:
HRT stands for hormone replacement therapy – this is because it replaces hormones lost as a result of menopause. The key word is replacement, a concept often overlooked. If something is replaced it simply means it is being substituted by something of the same, or very similar, kind. Usually this is because the thing being replaced is very important, otherwise we’d just forget about it and not bother.
Take Type 1 diabetes for example. When someone doesn’t produce enough insulin naturally in their body they’re given it artificially because there’s an understanding that insulin is a hormone needed in order for the body to be healthy.
The same goes for menopause.
When we reach menopausal age, our biological purpose of growing, birthing and feeding babies ceases and with it go the hormones necessary to aid that reproduction. But of course these hormones were not only essential in the creation and maintenance of new life, they were also vitally important in the maintenance of your life…
… oestrogen is vital in the building and maintaining of other areas of our body, not least our bones… as well as our bones and bleeds, oestrogen helps to keep the rest of our bodies fit and healthy: from the maintenance of our skin and hair to the proper functioning of our pelvic muscles and brain cells, affecting not just the mechanics but also the mood of the body and mind. In short, chronically low oestrogen levels can make us feel pretty grotty, both physically and emotionally.
The same goes for testosterone.
It might surprise you to learn that testosterone is actually a pretty big deal in women’s bodies. Low testosterone levels in a woman’s body have not only been linked with bone and muscle loss, potential cardiovascular and cognitive problems but also issues with the vagina, including atrophy and loss of libido.
It’s no wonder that without some of these essential hormones our bodies start choking and find it difficult to function and so someone thought it would be a good idea to come up with something to fix the mess.
Enter HRT stage left. Like fertiliser to a dying plant, it was realised that if we wanted to stay healthy and strong we might need to give ourselves the right nutrients to do so. Otherwise we might just start wilting.
HRT, then, simply acts as a replacement to those hormones lost through menopause, the very hormones that we’ve just seen as being integral to the proper functioning of our bodies. The job of HRT isn’t to fill our bodies with hormones it’s not used to; on the contrary, it aims to refuel our bodies with the hormones it’s not used to being without.
Jane Lewis, My Menopausal Vagina
It goes without saying that you need to discuss your situation with your own doctor – and more often than not it won’t be easy. I went to The Newson Clinic because I felt guilty about taking up an NHS appointment while Covid was raging. My consultations and first prescription were private (and expensive) but I just wanted to get going. They then gave me a letter for my own GP so that in terms of further prescriptions, I could go forward with the NHS. To say that the reaction from my GP surgery was hostile would be an understatement. The first GP very derisively refused to action the letter, implying that it had come from a hocus pocus clinic so I asked to speak to another doctor, suggesting that surely as a multi-surgery practice that covers lots of local villages they must have someone with a particular interest in menopause. A few days later a very harassed sounding GP called me and when I asked if she was the menopause specialist she harumphed, saying that she enjoys obstetrics “so everyone keeps dumping menopause on me too!” That conversation didn’t progress very well either…
I’ve had to really fight to get my HRT prescription on the NHS (excluding testosterone) and in fact it’s taken until this week, over four months later, to succeed. As it happens one of the senior partners is a dad I know from the primary school playground, he’s high up at the BMA so I’m planning to tackle him on the attitude towards menopause just as soon as the Covid crisis is over – I’ll give him a break until then!
If we want to have the choice to take HRT we have to fight the cause. 50% of the population will reach menopause and then live post-menopausally at some point so it’s up to those of us who want HRT to carve the path ahead. In the meantime I suggest you arm yourself with knowledge so that you know what to expect over the years ahead. Here are some of the resources that Zoe recommended to me.
Books about menopause
The Haynes Manual to Menopause (yes really) Dr Louise Newson (small independent bookshops)
Me & My Menopausal Vagina Jane Lewis (small independent bookshops)
The Hot Topic Christa D’Souza (small independent bookshops)
Is It Me Or Is It Hot In Here? Jenni Murray (small independent bookshops)
In Your Prime India Knight (small independent bookshops)
Websites about menopause
Facebook Groups about menopause (private but you can ask to join)
Harley Street At Home – Menopause (run by Nigel Denby – dietician but with other very good professional contributors)
Private Menopause Clinics (currently operating by Zoom)
HRT update – going private in the UK – Costs
I know somebody will ask about the costs of going privately for HRT treatment. There are usually price lists on the websites but this is how much I paid:
- Initial consultation and charge for writing first prescription £310
- Follow-up appointment and second prescription writing charge £250
- Private blood tests £100
It isn’t cheap but I see it as an investment in my health and wellbeing and far better than spending money on something like face fillers. Going forward I’ll have one follow-up appointment and a set of blood tests every year.
Next week
We’ll be back to clothes again next week. Have you seen this weeks’ new collection from Boden? I’d say it’s the best one I’ve seen since 2006. Most retailers have played this season so safe that I’m not seeing much that lifts my spirits but this really does, they’ve excelled themselves. I suspect it will sell out quickly so I thought I’d point it out to you just in case. I’ve ordered a few of the more dramatic pieces so I’ll be doing a try-on next week if you’re not sure how they’ll look on a non-model body.
I have to say that I feel more upbeat this week than I have for a while. Things really seem to be starting to move again; we’ve had tentative work enquiries… the boy goes back to school next week… and there even seems to be progress on our apartment. It feels strange to be very busy again, a bit like when you haven’t exercised for a while and you get breathless but I suspect it’s something we’ll all be getting used to over the next few weeks. Assuming there isn’t another one, I wonder if we’re going to look back on lockdown with nostalgia in a year’s time… stranger things have happened.
‘HRT update – going private in the UK’ is not a sponsored post
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