MARIELLA FROSTRUP on why ending HRT crisis really is life or death

Why ending this HRT crisis really is a matter of life or death for women: The shortage of menopause drugs isn’t a niche feminist issue, argues MARIELLA FROSTRUP – it’s another healthcare failing that treats women like second-class citizens

Meeting in a car park to exchange a tub of expensive face cream for a bottle of oestrogen gel might sound like the far-fetched plot of a comedy detective show.

But this is what a good friend of mine was forced to resort to last week.

Unable to get hold of her normal prescription for HRT, she was desperate — and I mean desperate, because when menopause symptoms return, they hit you like a tonne of bricks — and ended up putting out a call for help on Facebook. It turned out that a friend of a friend had some spare and kindly offered to do an exchange.

Really, all the situation needed to have been scripted by Agatha Christie was a code word and a carnation tucked in a button-hole.

For too long, HRT has been viewed as either thoroughly toxic or an indulgent lifestyle drug given to women with little else to do at a difficult time of life.

The continuing shortages, and the fact that women aren’t being correctly informed about it, are symbolic of the harsh reality that women’s health concerns are still not taken seriously by the medical establishment or politicians.

This has been the case for centuries, but I’d like to think that finally things have at least a chance to change, as women put their collective foot down.

We are refusing to shut up and scurry back to our many and varied duties, and have instead launched our own lobbying group, led by MP Carolyn Harris.

For too long, HRT has been viewed as either thoroughly toxic or an indulgent lifestyle drug given to women with little else to do at a difficult time of life (stock image)

Menopause Mandate (menopause mandate.com) is a coalition of menopause campaigners, medical experts, everyday women and celebrities, including Davina McCall, Penny Lancaster, Gabby Logan and Lisa Snowdon, all coming together to fight for a common cause: proper menopause provision for millions of peri- and post-menopausal women in the UK.

We care passionately about the subject, and are furious that women’s health needs are still being sidelined.

This isn’t just about HRT — it’s also about the many ways in which menopause care is under-recognised and underfunded in this country. Menopause provision is not a feminist issue or a niche topic. It’s a human right. But HRT is the most urgent focus right now.

Of course, naysayers will claim we’ve brought the current problems on ourselves.

The ongoing HRT shortages are caused to a large extent, I’m afraid, by the success of menopause campaigners, who have succeeded where the medical profession has too often failed in explaining to women that HRT is a viable and sensible choice for many.

But that’s certainly no excuse for the continuation of the dangerous shortages which have been blamed on increased demand and manufacturing and supply problems.

HRT is a simple enough premise. As ovaries stop producing eggs, the levels of hormones they make, such as oestrogen and progesterone, decrease, and HRT replaces these.

Most of us are likely to have at least one symptom of menopause, such as anxiety, insomnia or depression — often starting in our early to mid-40s with the perimenopause.

(Left to right) Mariella Frostrup, MP Carolyn Harris, Penny Lancaster and Davina McCall with protesters outside the Houses of Parliament in London demonstrating against ongoing prescription charges for HRT (Hormone replacement therapy).

Other symptoms include hot flushes; night sweats; migraines; palpitations; dry mouth, eyes, skin and vagina; brain fog and aching joints. They can last for years.

Recent statistics are clear. Menopause symptoms can affect quality of life to the extent that some women leave their jobs and their relationships fail.

Some even take their own lives — and, as highlighted in the Daily Mail yesterday, experts fear that these HRT shortages could lead to more menopausal women doing so as their symptoms return. Women have reported extreme anxiety and depression at the thought of returning to the ‘black hole’ they experienced before being given treatment.

This is not to say all women suffer horrendously for years. Some sail through. But those who do not need support.

The newest types of HRT are known as ‘body identical’. They have the same molecular structure as our own hormones, so they’re considered to have the fewest risks and side-effects — and it’s these which are currently in short supply, causing widespread panic.

If I forget my oestrogen for just one day, my insomnia and the late-night panic immediately returns.

That’s why women are terrified of going without HRT. The ensuing return of symptoms might mean they won’t be able to sleep or function properly at work. And, for the one in 100 who suffer from premature menopause (before the age of 40), HRT is a medical necessity, and must be taken until they reach 51, the average age of menopause.

Experts now concur that for most, the benefits of HRT outweigh the risks. ‘Body-identical oestrogen and progesterone, with oestrogen given via the skin, is known to be the safest option,’ says menopause specialist Dr Juliet Balfour.

Gabby Logan has also joined the fight for proper menopause provision for millions of peri- and post-menopausal women in the UK

‘Breast cancer risk is slightly raised with the types containing older synthetic progestogens [forms of progesterone], and there’s a small risk of blood clots if you take HRT orally.

‘Many women with other medical conditions have been told they can’t have HRT due to old research which has since been re-evaluated. With the right formulation and a suitable dose, most women can now have HRT if they want it.

‘Heart benefits are greater when it is started within ten years of the last period or under the age of 60, but older women can still start HRT, and there is no time limit on how long it can be taken for. There are benefits to bone health no matter what age it is started.’

It’s clear, then, that we absolutely ought not to be in this position. I’ve seen the graphs showing demand for HRT — climbing steeply upwards — over the past five years. In that time, prescriptions have more than doubled, from 238,000 issued in January 2017 to 538,000 issued in December 2021.

And, according to the website openprescribing.net, which is a summary of NHS GP prescribing data, there was a nationwide increase in demand for that precious Oestrogel between August and December last year. It went from 28,407 units (units is the number of prescriptions, which can last from one to six months) to 34,126 — a difference of 5,719. This could mean a potential shortage of around 35,000 bottles.

As many have pointed out on social media, ‘this wouldn’t happen to statins or Viagra’.

Indeed, to investigate this very point, I did the maths. In the month of August 2021 there were 4,307,272 prescriptions for the popular statin Atorvastatin, and in January 2022 there were 4,500,247. That’s a difference of nearly 200,000. No reports of crippling, widespread shortages, though.

Mariella Frostrup says the shortage of menopause drugs is another healthcare failing that treats women like second-class citizens

Don’t forget that, once we lose our oestrogen, our risk of coronary heart disease increases to the same level as men’s.

I wouldn’t dream of blaming individual health professionals for this. They have plenty to be dealing with. But, as a whole, the medical establishment has historically failed women by focusing entirely on men and their bodies.

When researching my book Cracking The Menopause, it was easy to see how the menopause became toxic and sometimes ‘hilarious’. Centuries of repulsed male medics made sure of that.

Opinions range from the 13th-century scientist Albertus Magnus viewing older women as being so poisonous we could kill children with our eyes, to the 19th-century doctor Edward Tilt suggesting we should be chloroformed to unconsciousness when suffering the ‘paroxysms’ of perimenopause.

This has transmogrified into the present-day gender bias in medicine, with a lack of research into women’s health and a postcode lottery when it comes to women’s services, not to mention an appalling shortage of resources.

Frankly, it’s a miracle HRT was ever developed — but then male doctors did have to live with women enduring hormonal rollercoasters. Anything to stop the mood swings, I suspect.

And, of course, HRT helped to improve our libido, ensuring we’d still be up for sex. Indeed, in the 1940s, one HRT treatment — Premarin — was marketed in the U.S. as something women needed to take to stay young and pretty, and therefore hold onto their husbands. It’s still available today.

By the 1990s, HRT was seen as an acceptable solution to symptoms, but then disaster struck in 2002, when a report by the Women’s Health Initiative (WHI) in the U.S. stated that researchers had ended the combined HRT part of their study early as those taking it were at higher risk of breast cancer, heart disease, stroke and blood clots (via a scaremongering headline).

Millions of women globally stopped taking HRT. Although the study was flawed — not to mention that the results weren’t even statistically significant — the damage was done and menopausal women were left floundering, or at the mercy of the bogus ‘cures’ available online or via irresponsible providers.

Women died — make no bones about it — from not taking HRT. A 2013 study from Yale University estimated that, in a ten-year stretch from 2002 onwards, nearly 50,000 women may have died prematurely from not taking it.

I like to think I was an early pioneer on the menopause campaign trail. In 2015, NICE guidelines on menopause were written, and HRT was recognised as a first-line treatment.

I wrote about the subject quite deliriously at the time, having just gone through two years of insomnia and anxiety with a terrible side order of brain fog.

A prescription of HRT restored me to my former self within weeks and I was evangelical about its benefits. Then, in 2018, I made a documentary about the subject, which was by now starting to gather moss.

Four years on, however, the lack of interest in prioritising women’s health means we’re still stuck in the dark ages. Medical professionals still aren’t educated enough about the menopause.

Most of us are likely to have at least one symptom of menopause, such as anxiety, insomnia or depression — often starting in our early to mid-40s with the perimenopause (stock image)

Last year, Menopause Support revealed 41 per cent of UK medical schools don’t have mandatory menopause education on their curriculum.

This means women are still far too often dismissed, or find their GPs tell them that they ‘don’t believe in HRT’. Many then suffer for years, or turn to an overbooked private sector, forced to spend hundreds of pounds to get the answers and the treatment they are entitled to.

How ironic that we are now keen to take HRT, but can’t get our hands on it.

On Sunday, after an outcry from brilliant campaigners such as Carolyn Harris, the Health Secretary Sajid Javid finally announced an HRT tsar would be appointed to tackle shortages.

If she or he is anything like as successful as Kate Bingham, the much-lauded chair of the Government’s Vaccine Taskforce, then perhaps there really is light at the end of the tunnel.

But while it’s fantastic that shouting loudly works, we shouldn’t have to raise awareness for something that affects 51 per cent of the population. While I am so pleased that HRT has been reborn, it’s clear that our fight is by no means over. In fact, it’s only just beginning. 

  • Cracking The Menopause, by Mariella Frostrup and Alice Smellie, is launching in paperback on May 12 (Bluebird, £9.99).

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