I started HRT in August and whoa, it’s good stuff. I said a few weeks in that I was still very angry, but my oestrogen level has now risen to the point where I found a pile of dishes “soaking” in the sink recently and instead of spitting ancestral curses at my husband, I thought: “I know – I will model good kitchen practices by calmly washing these.” Then I did! My anxiety has stabilised to a level where emails and calls excite only the standard mild-to-moderate dread and my brain fog has dissipated so much I even turned a column in early once – an unprecedented event. It was worth going through another coil insertion (I could explain why but I’ll spare you) – the highest endorsement, as anyone who has experienced that particular jabby delight can confirm.
Why am I talking about HRT again? I don’t particularly want “being menopausal” to be my thing – I’m more interested in why Edith, my hen, has decided to live in a tree. But things keep coming up (much like Edith) and here we are. Just this week I read a news report that HRT “should not be prescribed to ease symptoms of anxiety and depression in menopausal women”, according to “landmark new guidelines”, with experts saying “there was little evidence that HRT helped to improve low mood, anxiety and mood swings”.
So not only have the hormonally challenged had to deal with protracted HRT shortages, but surveys suggest many struggle to get GPs to take their symptoms seriously. And now the 2023 Practitioner’s Toolkit for Managing Menopause, “designed to be implemented around the world”, and endorsed by the International Menopause Society among others, says HRT doesn’t work and shouldn’t be prescribed for some non-physical symptoms. What a massive middle-aged woman bummer.
I’m also concerned that this means the new improved me is pure placebo. It’s enough to reboot my eyelid twitch. Plus – and this really riled me – now I know that, will the placebo effect stop working? It’s already taken me two days to write this; perhaps it’s already happening. What does that leave me? “Good nutrition, being physically active, cessation of smoking, limiting alcohol and stress management,” apparently. Cool. Hopefully gnawing on a yam while banging my head against a wall counts.
Hang on, though. After panicking that “they” (no idea) might take my HRT away, I decided that rather than spiralling, I would read the Toolkit and it turns out it doesn’t quite say that. It says the study found no benefit for “depressive symptoms … in postmenopausal women”. It also says: “While benefits for perimenopausal women have been suggested, the data to support this are too scant to draw conclusions.” Also, there is “evidence for improved sleep quality” with HRT (in itself a gamechanger for many).
Because a little medical journal access is a dangerous thing, I emailed Professor Susan Davis, the lead researcher, to check. She confirmed the recommendations relate to depressive symptoms in postmenopausal women and there’s some suggestion of a benefit to mood in perimenopause, but only in far-too-small studies to base recommendations on. “We need more studies in perimenopausal women,” Davis said (which is hard, because defining perimenopause is challenging). Phew.
Ah, the wild, yet simultaneously boring ride of female midlife. This Toolkit – a systematic review of evidence informing best-practice guidelines – is actually good news in navigating it. Knowing where HRT doesn’t seem to help is a vital first step to working out what does, though the problem, as with so much women’s health, is that far more research is needed. The menopause isn’t cancer or Alzheimer’s, sure, but it affects millions of women and just because they haven’t tended to complain about their experiences, it doesn’t mean many aren’t suffering, experiencing discrimination or leaving the workforce.
It’s a relief, in the meantime, that a shadowy cabal of experts isn’t coming for our HRT. I’ve cancelled my dark web Oestrogel and explained the Toolkit findings carefully to my own perimenopausal body and we’ll keep believing, for now. I’ve also called off the march of angry, anxious middle-aged women. Even though waving pitchforks was the ideal weight-bearing activity for our crumbling bones, we were all relieved: we’re tired, busy and don’t like making a fuss. Although actually, isn’t that precisely the problem?
Emma Beddington is a Guardian columnist
