The M-word was once a horrible term that we used to use to describe the menopause. This has changed since celebrities and career women have opened up about their complicated menopause journeys.
What about the P-word, you ask? That’s the perimenopause, menopause’s evil little sister.
We need to know the truth about perimenopause, since it comes upon women by stealth, mostly in their mid-to-late 40s, when they’re still having periods and think everything is OK.
My downfall was perimenopause. Ignorance of it was why, after surviving menopause, I decided to write a book, investigating the medical science we need to understand for our health and sanity — and was astounded how little information was available for women . . . and their physicians.
The hormonal rot begins long before the official menopause declaration, which is usually one year after period stops. The hormones progesterone and oestrogen start to play bad cop/good cop in perimenopause before draining away forever.
I didn’t even know what the word perimenopause meant when I first tentatively raised the subject of the menopause with my GP, after getting a few hot flushes in my late 40s, writes Kate Muir
This hormonal change can lead to terrible sleep disturbances and outbursts like depression, anger, outbursts or rages, insomnia, dry vulva, exhaustion, and zig-zagging. I wish I’d known all that — but, in ignorance, I turned my life not just into a car crash, but a full-on Thelma And Louise disaster.
I was working full-time as a film critic and my mum was dying of Alzheimer’s disease at the same time I was going through perimenopause. My marriage, my kids, my career, and overall health were all affected. Although it seemed like everything was in order, beneath the surface, there was chaos.
The mental health aspects of perimenopause need to be better known — suicide rates peak at this time — and yet when we go to our GPs, we’re more likely to be offered antidepressants than hormone replacement therapy (HRT).
I didn’t even know what the word perimenopause meant when I first tentatively raised the subject of the menopause with my GP, after getting a few hot flushes in my late 40s. I began experiencing erratic, tsunami-like periods. Also, my nightly heart beats would become irregular. I’d wake in pure panic.
My GP’s response? ‘You’re too young to be menopausal. They can’t be hot flushes.’
I was sent by her for an electrocardiogram at some cost to the NHS. I’m a runner. It was all fine. The doctor’s diagnosis was ‘too much coffee’.
When I looked into the science further, I learned that 11% of menopausal and perimenopausal females experience heart palpitations. And once I started on HRT in menopause — which, at first, I had to get privately — they disappeared for ever, along with the hot flushes, anxiety and brain fog. Not all women will need or want HRT, but it’s estimated that 90 per cent of women suffer symptoms, some of which are utterly debilitating.
The lack of oestrogen in menopause can also contribute to a whole gamut of serious conditions, from heart disease to osteoporosis to Alzheimer’s. And some more bizarre symptoms — when I went through menopause, I had something that felt like it was from a horror movie: formication, which means an itchy feeling under the skin, like crawling ants.
As I’ve discovered over the past two years I’ve spent researching my new book on the menopause, and producing the Channel 4 documentary Davina McCall: Sex, Myths And The Menopause, many undiagnosed perimenopausal and menopausal women face huge hurdles in obtaining the medication they need to restore their health and wellbeing.
A survey revealed that almost 20% of women visited five hospitals or more before they were diagnosed with hormone issues.
A woman should consult with a doctor to discuss her specific medical needs. But as I found when I sought help from my own GP — I wasn’t offered HRT on the first two occasions — many doctors have a blind spot to the menopause and are, frankly, averse to prescribing HRT.
As I’ve discovered over the past two years I’ve spent researching my new book on the menopause, and producing the Channel 4 documentary Davina McCall: Sex, Myths And The Menopause, many undiagnosed perimenopausal and menopausal women face huge hurdles in obtaining the medication they need to restore their health and wellbeing
There’s a cocktail of reasons: from outdated beliefs about the safety of HRT to a lack of joined-up thinking on women’s medicine, which remains trapped in a silo of sexism. Drug companies won’t spend money on research since hormones are natural and cheap to make, so there’s no huge profit on patents. Doctors’ surgeries are paid extra for diagnosing depression — but not menopause.
The medical establishment’s resistance to HRT dates back to the 2002 Women’s Health Initiative (WHI) Report, which linked HRT to a small increase in breast cancer.
Millions of women quit HRT, and the hot flushes they experienced overnight returned. But that research was based on older post-menopausal, mostly overweight women — and today’s HRT is very different from the one examined by the WHI Report.
What most people — including me, until I began my investigations — think they know about HRT is wrong on two counts: every form of HRT is not the same, and the terrifying cancer-scare headlines referred to older, synthetic forms of HRT. They have been replaced by plant-based, body-identical HRT (made with yams).
They are identical hormones to those in your body, and they are readily available through the NHS. (They are not the same as privately available bioidentical compounded hormones, which are tailored to each person’s needs but are not officially regulated.)
Progesterone comes in two very different forms — natural progesterone like that in body-identical HRT, or the synthetic version, called progestin, as in the old HRT.
The majority of HRT pills may contain progestins — including medroxyprogesterone acetate used in the WHI study, or norethisterone, levonorgestrel and desogestrel — associated with a slightly increased risk of breast cancer while you are taking it, but the body-identical progesterone does not (in trials over five years).
‘The more you look at the WHI study, the more you see it is flawed,’ says Tony Howell, a professor of medical oncology at the Christie Hospital in Manchester. ‘The whole of HRT data suggests progesterone is not causing breast cancer . . . We should just get the good HRT stuff out there.’
Important reasons are that increasing your estrogen levels after menopause can make a huge difference in your overall health. Or, as researchers — who examined 162 scientific papers into the role of oestrogen — wrote in the journal Trends in Molecular Medicine in 2013: ‘We no longer believe that oestrogens are just sex hormones, but important therapeutic targets for preventing diseases as disparate as osteoporosis, heart disease and neurodegeneration.’
The oestrogen receptors in your brain, as well as every other part of your body from your joints and your vaginal area, are all present. Oestrogen acts by affecting the cells of the arteries. It keeps blood flowing steady and prevents clots.
We need to know the truth about perimenopause, since it comes upon women by stealth, mostly in their mid-to-late 40s, when they’re still having periods and think everything is OK
As a result, it is thought to reduce the risk of stroke and heart disease by 50 per cent — and even cut the prevalence of colon cancer and help prevent type 2 diabetes and high blood pressure.
All kinds of diseases will become apparent when you begin to see the world through your oestrogen-shaped glasses. It’s revealing just to consider your family’s medical history.
What about my mother’s cataracts? Or my aunt Grace’s blurred vision owing to macular degeneration? Did she suffer from the stress of teaching or an insufficient amount of oestrogen, as two thirds of cases of blindness are women?
Oestrogen can provide blindness protection and reduce the discomfort associated with dry eyes. It does. According to Maturitas’ 2016 study, HRT can reduce the incidence of cataracts in the lens and decrease the chance of macular damage.
As for oestrogen preventing osteoporosis, Professor David Reid, a consultant rheumatologist, told me: ‘Bones turn over all the time. In three to nine month, a small portion of bone will grow back. That renewal becomes a problem because oestrogen is protective to bone, and when it fails in menopause, the forming of the new bone can’t keep up with the breakdown of the old.’
Yet I was at a grand charity dinner for the Royal Osteoporosis Society in 2019, and there was the patron, HRH Camilla, Duchess of Cornwall, up on the big screen talking about her family’s struggle with fragile bones.
‘Sadly, as I grew older, I learned a great deal more about osteoporosis first hand, as I watched both my mother and grandmother suffer the pain and ignominy of this agonising disease,’ she said.
Not a word was said by anyone about HRT — apart from at my table, which was full of menopause doctors tearing their hair out in frustration. It seems the medical establishment as a whole remains mysteriously blind to oestrogen’s superpowers, stuck in its separate silos of cardiology, endocrinology, rheumatology, ophthalmology and gynaecology, unable to see the big picture.
It seems that there is no interest by big pharmaceutical corporations, or anybody else, to fund more research into body-identical HRT. This comes down to money. Hormones in their pure form are not legally patentable as they are ‘products of nature’.
Existing treatments for the other menopause-related conditions are also far bigger cash cows than HRT ever could be — just take osteoporosis medication, which can earn drug companies up to £9,000 a year for each woman, as opposed to the cost of just over £120 a year for body-identical HRT.
As for why doctors aren’t prescribing this new form of HRT, although organisations such as the British Menopause Society agree that body-identical HRT is more beneficial than the old HRT, the news doesn’t seem to have dripped through the layers of NHS bureaucracy.
I’m not here to blame GPs or obstetricians and gynaecologists — the system is at fault.
Menopause Support found that 41% of UK medical schools don’t offer mandatory education on menopause.
Dr Rebecca Gibbs, an obstetrician and gynaecologist at the Royal Free Hospital in London, told me: ‘When I trained in 2003-4, nobody took HRT because you were going to “die from cancer”. It was a topic that I attended one lecture in medical school. This could have been tied to things such as puberty. That was it.’
You have to be a detective to find ‘menopause’ in the GPs’ core curriculum. Dr Madeleine Lameris, a GP tutor at Cambridge University who is working on a new doctors’ curriculum, explains that GPs can update their knowledge with extra courses, but many just muddle along — ‘and they can be very defensive if women come in with information and they don’t know about it’.
Many women, perhaps unsurprisingly after complaining about low mood and anxiety to their doctors, end up buying antidepressants.
It’s not just a lack of education though. Because the use of antidepressants is embedded in the medical system, GPs’ practices are paid bonuses per patient — incentives for diagnosing all manner of illnesses such as depression, diabetes, high blood pressure and asthma. But they aren’t paid extra for diagnosing the menopause and perimenopause, or for prescribing HRT.
They will not conclude that you are experiencing the menopause if there is a financial incentive.
More than this, even if you are diagnosed with the menopause, your NHS HRT prescription is likely to be for the ‘bad’ old HRT containing artificial progestin. Private HRT is the best option.
Why? Nick Panay, a consultant gynaecologist at the West London Menopause and Premenstrual Syndrome Service, says: ‘The older HRT formulations are relatively cheap and big pharmaceutical companies will keep pumping them out until doctors and women ask for something better.’
Indeed, oral combined HRT costs the NHS about £30 per year, while transdermal oestrogen (which is applied through the skin, for instance as a gel or patch) and separate progesterone costs around £120.
I struggled for years to find body-identical HRT. My life fell apart. My GP stonewalled me and I relied on friends’ recommendations to find my HRT.
After considerable risk and expense (I was taking unregulated compounded HRT without realising its potential dangers), I finally found Dr Louise Newson in 2019. She is a doctor who has a clinic for menopause specialists. Her quick prescription of oestrogen and micronized progesterone was quickly approved. She explained that these were made under strict regulations for NHS use and could be obtained from me.
This could not have been done. This natural product could have been safely given by my GP three years prior to when I presented with heart palpitations.
Within four days, HRT had brought me back from the brink. It is possible that I will continue to use it forever. It is a shame that it took me so long to get it prescribed.
Everything You Need To Know About The Menopause (But Were Too Afraid To Ask) by Kate Muir is published by Simon & Schuster, £16.99. © Kate Muir 2022.
To order a copy for £15.29 go to mailshop.co.uk/books or call 020 3176 2937. Free UK delivery on orders over £20. The offer price is valid up to February 2, 2022.
Here are 5 top meat replacements
Ultra-processed meats can lead to obesity. Sophie Medlin from City Dietitians London suggests five healthy plant-based alternatives.
Better Nature Organic Tempeh Mince, 170g, £3.29 fodabox.com
Calories per 100g: 172, saturated fat, 11.6g, protein 17g, fibre 6.1g, sugar, 0.06g, salt, 0.1g
There are just four ingredients here — soya beans, fermented with a tempeh culture (a dried fungus), water and cider vinegar. Tempeh can taste bland but is a good source of muscle-building protein — you’ll get 14g in a 85g portion, and 5.2g of gut-friendly fibre.
Niru Banana Blossom, 540g, £2, ocado.com
Calories per 100g: 11; saturated fat; 0g protein; 0.8g fiber, 2g sugar; 0g salt; 0.7g
Banana blossom has a flaky texture that’s perfect for curries and stir-fries. The recommended 110g portion is low in calories and contains 8 percent of your daily fiber.
Clive’s Nut Roast, 280g, £5.25, waitrose.com
Per 100g Calories: 186; saturated Fat, 1.7g Protein, 4g Fiber, 4.3g Sugar, 7g Salt, 0.7g
THE nuts and seeds, including Brazil nuts, walnuts, almonds, pumpkin and flax seeds, supply useful nutrients, such as polyphenols — compounds containing antioxidants and heart-friendly fats. But there’s only 4g of muscle-building protein per 100g so you may not feel full.
Eat Wholesome Pulled Jackfruit Spiced Beef-Style, 300g, £3, ocado.com
Per 100g: Calories: 151; saturated Fat, 6g; Protein, 2g and Fiber, 15.8g. 2.2g. Salt, 0.2g.
The cooked jackfruit contains a lot of fibre, and is rich in antioxidants carotenoids. These are thought to lower the chance of heart disease and other diseases like cancer. This coconut milk contains a lot of saturated fat.
Biona Quinoa Mini Burgers, 195g, £4.30, ocado.com
Calories per 100g: 246 calories; saturated fat; 1.8g, protein; 7.3g, fibre; 4.5g, sugar; 3g salt; 1.3g
Quinoa, which is a high fiber grain rich in essential amino acid and vitamins, is the key ingredient. These hamburgers have a high level of unsaturated fats that are good for the heart.
MANDY FRANCIS