Hi – editor Collette here with my own personal, simple, express guide to navigating the often confusing world of the menopause and what HRT to take. I’ve written this as today I was contacted by no less than four confused and exasperated women seeking an idea of what to actually take.
It really hit home to me that despite celebs getting on board and GPs being pushed to be better informed, the menopause is still bamboozling so many women.
Disclaimer: so first of all I’m not a doctor and I do not claim to be the world’s leading light on HRT. I am simply a woman who has been on an ‘HRT journey’ and now feel confident enough in my experience to share it.
I’m also a journalist who has written about women, health and lifestyle for over 20 years for national newspapers and glossy mags. I’ve appeared on award-winning menopause podcast Effin Hormones too. I’ve also specialised in a lot of health campaigns as a media advisor, writer and PR. I also have a healthy level of discernment due to all this and a good head for research (maybe I can save you some time!).
Right, so below is MY PERSONAL EXPERIENCE of HRT so far, coming up to 24 months. I started having peri symptoms in my mid/late 40s. You are NOT obliged to follow the same protocol as my journey but it may give you some insight.
Why am I championing HRT?
I’ve always been ‘Miss Natural Remedy’ – if there is a natural alternative to any medical issue, that’s me. I trained as a holistic therapist 20 years ago and I am a BIG advocate for the ‘natural’, complimentary health route.
However, while exercise, herbs and nutrient dense food will take us so far, no amount will fix lost hormones due to menopause. These key hormones ‘drop off a cliff’ for women at midlife and they do NOT magically return. We are therefore deficient in key hormones that once helped us thrive, feel sexy and yes, helped keep us sane!
A healthy lifestyle, well managed stress, keeping our weight under control and definitely exercise, is really important but will not miraculously produce lost hormones. We need to “replenish” our hormone deficiency. And in my personal opinion, the best way is via BODY identical HRT and that’s also the opinion of the best doctors in this area, like Dr Louise Newson of the Newson Clinic.
How do I feel now I’m on HRT?
I’m almost 24 months into my HRT journey and I am feeling and looking much better for it – I’ve lost weight, got rid of my brain fog and yes, my libido is buzzing away again! It’s taken the ‘Goldilocks’ porridge approach though … as in a few tweaks here and there to get to the ‘sweet spot’ that suits my body and brain best.
Note: I’ve written this express style, so do note the following abbreviations: O (Oestrogen) P (Progesterone) T (testosterone) meno (menopause) peri (peri-meno).
HRT on the NHS?
So, firstly, there are not enough menopause-focused NHS clinics for the demand the out there. For the regional (Manchester/Cheshire/Lancashire) readers who’ve asked, yes, there is an NHS menopause service here in Greater Manchester (St Mary’s) but the waiting list is ridiculous.
Luckily, there is a big push by the government now to get GPs, practice nurses and pharmacists better educated on the menopause (meno) as there is a tidal wave of women who need properly assessed HRT and to feel really confident in their choices. I’ve done a couple of podcasts on this topic. My own story is that I had peri symptoms and as a result I did stacks of research.
What I take:
Most of us just want to know what the heck to ask for and take! So, dear reader, I am sharing my HRT details to give you an idea (not instructions) of what is possible. I ended up going privately – the very good Newson Clinic – seeing a private specially trained GP via them (lovely one based in Cheshire and by video call). She was great – she got me on a high dose of Oestrogen only patches (Evorel) 100mcg initially (the licensed recommendations are often too low but follow your specialist’s advice. While that may seem a lot it was great for my body). I now alternate between 75mcg and 100mcg, as my O levels are in good shape now. Note, I also like the O gel as handy at times – the one I use is Estrogel.
My specialist also put me on standard dose P (progesterone) aka Utrogestan tablets. Then we waited 4 months to see how I got on with those and I had some bloods done (private place in Didsbury) and they showed my T – testosterone – levels were still crazy low and so she could then confidently prescribe me T cream (AndroFemme) but a standard T gel is available from most pharmacists with a GP script.
I am so happy and feel great on this regime now. All the HRT is BODY identical, that means it is NOT synthetic and it is regulated by NICE – the National Institute for Health and Care Excellence – giving it the approval of the NHS.
What is BODY identical as opposed to BIO identical HRT?
I am not here to knock bio-identical HRT as so many women I know who are on it are thriving. So, yes BIO is fine but expensive. I am not judging anyone who pays out for it but it is NOT regulated and there is no guarantee that some of the ingredients are not in part synthetic.
Synthetic (chemical) HRT is what partly got HRT a bad press in past – that and a very misleading study which got everyone in a huge panic about HRT – more here: don’t panic about HRT. Synthetic HRT (chemical based) is just not worth taking in my opinion and yet for years GPs dished it out. Don’t get me started on the contraceptive pill either.
BODY identical is available on the NHS. Yes, GPs now have to prescribe BODY (natural) identical HRT – especially if a patient asks for it. So be sure to ask that your HRT is BODY identical – you are entitled to it.
Paying for your HRT prescription – good news:
From April 2023 in the UK we will pay for a single annual prepayment of £18.70 for hormone replacement therapy (HRT) prescriptions. More here: https://pharmaceutical-journal.com/article/news/prepayment-scheme-for-hrt-to-start-in-april-2023
What to ask for? My personal itemised prescription:
O – Estradot patches (if your GP/pharma has not got these in ask for Evorel oestrogen only patches – not the combo ones as the P is synthetic). Transdermal patches are better as absorbed via skin and not the liver (as with oral meds) – much better for you.
Estrogel – I also get this in my script (yes, I have educated my GP and insisted I get these products). The gel is handy as a ‘top-up’ or as a plan B if I run out of patches.
P – in the UK you will be prescribed BODY identical P (made from yams) the brand is called Utrogestan.
T – if you go private at first, you will likely be prescribed AndroFemme but once you’ve been approved you can get your T script via your GP and they will likely prescribe either Testogel or Testim (I take Testogel as that’s the one my chemist tends to get in). You only need a tiny amount as a woman and in my own case the difference kicked in pretty quick – a few weeks – I felt great like the old me and even better.
Issues with Progesterone – depression, hair loss, mood swings, headaches…
Progesterone: women only need this hormone for a week or so a month (similar to our old fertile cycle) but GPs who rightly have to follow NICE guidelines recommend taking it EVERY day (as it ensures womb lining stays thin and no build-up of tissue – thus avoids uterine cancer).
A lot of women are talked into getting a Mirena coil /IUD. I’m not a fan at all – the P is synthetic and as it’s stuck inside your body, constantly releasing P, you’ve got a slow release of a hormone that just does not agree with many women. On saying that, some women report no problems at all and like the convenience (but not the vile pain of having it fitted). It’s your choice but make sure it is an informed choice. I’ve a friend with terrible depression and hair loss who now waiting to get her Mirena taken out.
The thing is a LOT of women are P sensitive in general – they get weepy, very down or/and migraines/headaches etc… I am personally very P sensitive, so I take Utrogestan just 7-10 days a month and I personally opt to take it vaginally as a pessary (it can be swallowed orally or popped inside the vagina – UK packaging just does not make that option clear). I then have a bleed (I quite like a bleed and feel good for it) and then get on with my life. You just have to work out what works for you but this is just my own personal experience.
If you don’t have any sensitivity to P, an option could be to just take 1 tablet every two days and see how you go. One every day appears to be just too much for a lot of women but listen to your body. Again, your GP will not suggest most of this but look, this is a ‘process’ and not a one-size fits all situation.
Why take testosterone? Isn’t that for blokes?
No – women produce MORE testosterone than oestrogen! We need 3/4 times as much T as O and most women just don’t know that. T is so important! I personally feel like a new woman for getting it back in my endocrine (hormonal) system. I’ve lost weight, brain fog has gone, libido has shot up (incredible) and muscle tone is coming back. More on T here: .https://www.newsonhealth.co.uk/wp-content/uploads/2021/07/Testosterone-FINAL-22.pdf . Here is a good podcast with Liz Earle on the topic too: https://play.acast.com/s/5e43fdd6e40bfc8e713b02ff/http%3A%2F%2Flizearlewellbeing.com%2F%3Fp%3D69329
How do I get Testosterone??
Once you have been on O and P for 4-6 months and you are in good health, in most cases you can be considered to try T (testosterone ). As mentioned, I am on Testogel and I was originally on a private script for AndroFemme cream which is clinically licensed for women in Australia but not yet in the UK (it’s pretty expensive at £80 a tube).
How did I get my T? Basically I had a private initial consult with the Newson Clinic and then a follow-up – my specialist did my T script after I paid for my bloods (£60). My notes were then sent on to my family GP from Newson Health and now my GP does my full HRT script including my testosterone. By the way, I felt better on T within weeks!
My GP is being difficult – what can I do? What do I ask for ??
This is not uncommon but is getting better, especially with big names like Davina McCall, Lisa Snowden, Lorraine Kelly, Dr Louise Newson and many more raising awareness. You are legally entitled to HRT on the NHS. More here: https://www.themenopausecharity.org/wp-content/uploads/2021/05/How-to-ask-your-GP-for-help-rev.pdf
Here is an example letter to send in to your GP if you feel you are not getting the response you need: https://www.balance-menopause.com/menopause-library/example-letter-to-gp-requesting-hrt/
Should I go private?
I feel strongly that HRT should be easily available on the NHS and that GPs are more educated. However, I had to go private initially as I knew I wanted to get sorted effectively and quickly, plus I was in a position to pay. I am in no way affiliated to any clinic or HRT brand for the record but I do think the service at the Newson is excellent and not bad value – they are totally transparent with their fees too (see the website). I paid £295 for my initial consult.
Newson now have so many more menopause specialist GPs (twice as many as when I first enquired) – what a great sign! Go to: https://www.newsonhealth.co.uk/meet-the-team/. Note, you are fine with a nurse or pharmacist too (cheaper) as they all get the same training but it’s up to you – I just liked speaking with a GP.
Other help and getting inspired to live your best meno life!
Podcasts: There are now so many fantastic podcasts (I was on this fun one) – Effin Hormones and so was the ace Dr Louise Newson: https://effinhormones.com/podcast/effin-hormones-returns-with-dr-louise-newson/ – so get into listening about other women’s experiences.
Documentaries: The Truth About Menopause – this is great and really got me motivated to go on HRT. https://www.bbc.co.uk/programmes/b0bt4c3m
More recently the Davina McCall doc https://www.channel4.com/programmes/davina-mccall-sex-myths-and-the-menopause – Sex, Myths and the Meno is great too!
Instagram: tonnes of great accounts – I follow Lisa Snowdon, Louise Newson, Wise & Well and of course Davina.
Wishing you the best of health and hoping that one day ALL GPs and medics are really so knowledgeable about menopause that all the stigma and confusion surrounding it is a thing of the past! In good health, Collette (editor).
Please speak to your GP or specialist if you have any medical questions.
