I decided to write this blog about HRT and menopause as we are so obsessed about investing in our skin, (me included!), but it seems, not our hormones and future health!   I also wanted to share my experience as my journey has been a long one and I want to help others.   I also know that everyone will be affected by menopause during their lifetime one way or another, regardless of gender.  Silence is not golden - not when it comes to the menopause! so *gulp* here goes...

(Disclaimer : This is not a pity party!)

*I wanted to explain to you why it is VITAL that you treat the menopause as an oestrogen deficiency. I am breaking the silence.  It's about diseases - heart disease, Alzheimers and osteoporosis - all directly related to the decrease in oestrogen.  They progress without you knowing they are there, until they hit you...

Menopause is not all about hot sweats, it is far more complex.  There can be about 20 odd symptoms -

Palpations, anxiety, insomnia, excitability, panic attacks, difficulty concentrating, tiredness, loss of interest, depression, crying, irritability, dizzy spells, tightness in head, numb body parts, headaches/migraines, joint and muscles pains, loss of feeling in hands and feet, itchiness, (which is called formication), breathing difficulties, hot flushes, night sweats and low libido...lovely!!

We refuse to listen to our body. We listen to celebrities but not the symptoms that our body is alerting us to!!  They are there to wake you up and tell you to get help.  Instead of seeing our GP, (more about that soon too!) and getting the right help we are chosing to put our future health at risk.

*No man would put up with these symptoms, they are a result of a deficiency - just like diabetes or thyroid deficiency - and if you don't treat those you have a big problem...and it's the same with oestrogen.

So let me tell you a little bit about my journey and why I wanted to write this...

I am a very private person but I think sometimes we need to speak up, especially if we can help others, empower and to educate, (especially as women we tend to get the raw deal).

When I was younger I had endometriosis and this led me having numerous operations.  I felt very poorly for years before this, every month my periods were so awful. Battling on, as we do. I also suffered with awful PMS.

To cut a very long story short, luckily I was eventually able to have a daughter, she is now 21, (I am 51).  Looking back I now realise I suffered with post-natal depression, but masked it the best I could. I was ashamed of myself for feeling that way. In those days mental health was not discussed, oh how times change!

I yearned for another baby but having endometriosis it proved nigh on impossible. I had various operations to investigate why I wasn't conceiving, and one op led to me having one of my ovaries removed due to having multiple cysts on it. We then went down the IVF route but did not go ahead with the treatment plus looking then looking into adopting.

Eventually I had to have a total hysterectomy due to having fibroids, endometriosis and damaged fallopian tubes, (it was awful coming round from the anaesthetic being told I had had a total hysterectomy, it was a shock, it was my worst fear). This was about 12 years ago. (This also led me on to having a major bowel operation years later, due to scarring from the operations, which nearly led me to having a colonoscopy bag fitted. Luckily, that did not happen).

Sadly, 12 years ago there was not any support or information regarding what would happen to you after a total hysterectomy , (which actually, is a major operation.  It was one of the most painful things I have ever experienced, especially as the hospital didn't provide me with the correct painkillers! Not to mention the psychological effect this has on a person afterwards).

Prior to the hysterectomy I was basically told by the specialist that I will need to go on the lowest dose of HRT for the shortest amount of time to help with any symptoms.  There was no mention of anything that I may experience after the operation.  I was led to believe that my health would improve and I would be free of painful periods and migraines and I would get my life back, (I suffered with awful pain and the worst migraines).

Hindsight is a wonderful thing, (and also the internet!) If only I had had the support I needed and the right advice and medication over the years...

Looking back on those 12 years after the hysterectomy I can only say that I suffered with terrible anxiety, excruciating migraines that would often last for 3 days, exhaustion, insomnia and  bouts of depression.  I thought it was just me, not an effect of the hormone deficiency due to having a surgical menopause, brought on by the hysterectomy. I was only 38.  (I would later learn this is also called Premature ovarian insufficiency, or P.O.I.)

I kept this to myself. I tried my best everyday to get up and function, and I did but it was a huge effort and a real struggle some days.  38, Mum to a 9 year old, running my own makeup business and a home, also looking after elderly parents, not to mention house renovations!

Some days were good, I savoured those, but when the symptoms were there, I had to plough through the day, putting on a smile and battling on.  I had found the gym by this time and what a godsend that was.  It was such an escape and relief from my symptoms, if only briefly. I now know how important exercise and a healthy diet is.

The days I had to work when I was at my worse,  I mastered plastering on a smile, but behind it I felt so exhausted, lost and hopeless.  No one would have had a clue that I was suffering. I did find that helping other people in my work, helped me take my mind off it, which I am very grateful for.

I have always took pride in being polite and happy around people.  I am naturally a caring person and working on weddings you need to have these qualities to ensure the Bride is having the best day of her life.  I am happy to say that I have never let anyone down on a wedding day nor let them know how bad I was feeling.  It wasn't about me, it was about them and it spurred me on knowing they depended on me to help them.  It always gave me a huge amount of happiness, seeing other people happy and knowing I had helped them to not only look their best, but feel it too.

Those 12 years were, I can only describe a challenge!...

I was backwards and forwards to the specialist.  I had given up on Drs and when I did go, they just wanted to give me anti-depressants.  I was not depressed!! I knew there was something amiss and had been told I was hormone deficient by a Dr but I didn't understand what exactly that meant and I had no offer of an increase to my HRT, let alone other hormones, such as Testosterone...that's for men isn't it?!!

So, fast forward to last year.  I experienced a "panic attack".  Quite honestly it is one of the most frightening things I have ever experienced.  This was the point where I just could not and would not go on like this anymore.  I had also visited my GP again and they prescribed me antidepressants yet again! I have only tried them once and they just are not for me. I don't disagree with anyone taking antidepressants, its a personal choice and of course, helpful for some people, but I knew I was not depressed, I just felt unbalanced and was experiencing lots of other symptoms too.  I was determined to get to the bottom of it...I knew there was more to it than that and I was adamant I was not going to be on anti-depressants for the rest of my life.  Surely there had to be more to this...

I went armed with all of my symptoms, I had even written it all down together with my history but again, 5 minutes later, I was walking out of there with a prescription that I knew was not the answer to my symptoms and that I would not be taking!...antidepressants again!!..I know many women who have gone through similar experiences and been offered anti-depressants.  This has to stop!!

I have since learned that most GP's are not educated or knowledgable about HRT and the menopause sadly, and if we want to get the right treatment or help we HAVE to go private..ridiculous isn't it.

If you have had postnatal depression in the past, or a history of PMS, then it is more likely you will experience these types of symptoms during or after your menopause. This is because your body is more sensitive to changing levels of hormones. Taking the right type of oestrogen can really help improve this low mood and other symptoms related to the menopause. Many women find that they feel calmer, have more energy, are more motivated and generally much happier when they take HRT.

Oestrogen helps to regulate serotonin, a neurotransmitter (a messenger chemical) that carries signals between nerve cells in the brain.  It is known as the "feel good chemical" thanks to its positive effects on mood, emotion, energy and sleep, so falling levels of oestrogen can directly impact on your mood.

Luckily I found the amazing Diane Danzebrink online and also I found Dr Louise Newson's book, "Menopause".  This, I believe, was the lightbulb moment for me.  I owe them both so much.

Here are the links -

www.dianedanzebrink.com

www.newsonhealth.co.uk

www.menopausedoctor.co.uk

Diane is the founder of the Menopause support campaign www.menopausesupport.co.uk She is also the driving force behind the #makemenopausematter campaign, launched with the support of cross-party MPs at Westminster in 2018.  She is seeking major change across society in the way we talk about menopause.  She is also a professional coach, counsellor and trauma therapist and nurse trained in menopause.  She is the media lay person for the Royal college of Obstetricians and Gynaecologists, a member of the British menopause society.  She is regularly interviewed by the media and has appeared on ITV's Lorraine, Good morning Britain, Channel 5 news, ITV news and BBC radio.  She also tirelessly hosts menopause sessions and helps countless women across the U.K also increasing the knowledge of the menopause.  Diane has also experienced first hand the joys of the menopause, and her story is very inspiring.  She is in the process of writing a book about it.

I spoke to Diane a couple of times and I was gobsmacked by what I learned in such short a time! She was amazed at how I had been "existing on fumes" and said it was "nothing short of a miracle that I had survived for all of these years on such a low dose!"  She also was very shocked that I hadn't had a DEXA bone scan to monitor my bones since my hysterectomy, (I have since had this done, and thank goodness, all is well).  She explained to me that we have lots of oestrogen receptors all over our bodies and if we are not getting enough oestrogen then this will affect our serotonin levels, leading to feelings of depression and anxiety.  She told me, "Oestrogen helps support serotonin"....BINGO!

 

 

Dr Louise Newson is a GP and Menopause specialist and holds an Advanced Menopause specialist certificate.  She is passionate about improving education about the menopause and also improving the safe prescribing of HRT to health care professionals.  She has lectured extensively and continues to develop menopause information to her website, (link above).  She has worked with many large organisations to provide advice regarding menopause in the workplace and contributed to many articles in newspapers and magazines, also being on TV and radio.  She is also the founder and director of Newson Health ltd, which is a private clinic, (due to there being far too little provision for menopausal women in the NHS), which offers evidence based care for women.  She has also launched the free Balance app and the Menopause charity with the help of media ambassadors Davina McCall, Lorraine Kelly, Liz Earle and Meg Matthews.  Dr Newson is also running a new Menopause education programme with Dr Mark Coombe, Educational director of Fourteen fish, which is a U.K company specialising in medical appraisals.  They provide education for over 40,000 GP's and healthcare professionals in the U.K.

I picked up the book by Dr Newson in my local Tesco and read it in one day.  I was absolutely gobsmacked as every page I turned I could relate to! Plus I had read about surgical menopause.  No-one had ever discussed this with me.   I had also made a telephone appointment to speak with Diane so I had made a positive start.

There is also a fab group on Facebook - Harley street at Home Menopause. Dr Naomi Potter from Harley street is amazing. Follow her on Instagram too, website - www.drnaomipotter.com

Dr Potter explains about the risks and benefits of HRT -

"I believe management of peri-menopause and menopause should be a choice based on evidence. ​Some women can't or choose to not take HRT. Seeing someone close suffer from breast cancer may be enough for a woman to decide they want NO increased risk at all. That is perfectly justified.​

I have summarised what we currently know in terms of the the benefits and small risks with modern, body identical HRT.

Starting HRT in the peri-menopause (ie when symptoms are starting but a woman still has periods) or soon after the menopause , offers many health advantages.

These include protection from osteoporosis, Alzheimer’s disease, heart disease, stroke and metabolic conditions. It also cures the distressing menopausal symptoms.

HRT has also been shown to reduce overall death.

Breast cancer is what is often the biggest concern for women. At the moment we think there is a very small increased risk of breast cancer when taking combined oestrogen and progesterone. The increased risk is the same as the increased risk from drinking a couple of glasses of wine a night. It is similar to taking the combined oral contraceptive pill. The risk increase is equivalent to the risk decrease if you exercise for two and a half hours a week. Obesity is the biggest risk factor and increases the risk 6 fold. Also, there is no increased risk of dying from breast cancer when taking HRT.

I hope this goes a little way to explain the safety and benefits of HRT as we understand it today."

Dr Newson explains -

"Obviously menopause is a completely normal, natural event that every woman will go through", yet it remains a taboo subject with many incorrect perceptions and GPs just do not have the knowledge, expertise or time for women who are going through this.  "There is a total lack of accurate information, not to mention about HRT too.  This means that in the UK only one in ten women who would benefit from taking HRT actually take it" and like me, are offered antidepressants or anti anxiety medication. "66% of 3,000 women who took part in a survey have been offered antidepressants by their GP, despite there being no evidence that they help to improve the low mood associated with the perimenopause and menopause".

As Dr Newson says in her book, "Too many women think they must simply soldier on through troublesome symptoms.  This "put up with it" mentality not only risks ruining relationships, but careers too, with one in ten women admitting they have considered quitting their job because of their symptoms.  It doesn't have to be like this".  "The mere mention of the word Menopause often causes confusion. Society's reluctance to discuss the menopause openly, misinformation in the media and a lack of credible information online mean that many of us don't know what to expect".  "Arming yourself with this knowledge will help you to recognise the signs and symptoms of your menopause and crucially, will help you to feel empowered to ask for help in coping with the symptoms should you need to".

So basically, "menopause is when you stop having periods and haven't had a period for one year. Women have two ovaries - grape sized glands that lie either side of your uterus.  The ovaries have two main functions. They release an egg each month during the menstrual cycle for possible fertilisation, a process known as ovulation.  The ovaries also produce hormones, which are chemical messengers that travel through our bloodstream to our tissues and organs affecting processes such as growth and development, sexual function, reproduction and mood.  The ovaries produce three key types of hormones:

Estrogen - an umbrella term for three female sex hormones that have a number of functions in every part of our body. Progesterone - this hormone helps to maintain the menstrual cycle and is an important hormone during pregnancy. Testosterone - although it is commonly seen as a 'male' hormone, women also produce testosterone.  Testosterone is also produced in the adrenal glands". "Your menopause occurs when your ovaries stop producing eggs and, as a result, the levels of oestrogen, progesterone and testosterone fall".

"Perimenopause - The period leading up to your menopause, when hormone production decreases and you may start to experience symptoms.

Menopause - When you haven't had a period for a year.

Post menopause - The time in your life after your menopause" (you will be post menopausal until you die).

"The average age for the menopause for UK women is 51 but genetics, underlying medical conditions and treatment for cancer can mean that you go through it at an earlier age".

"If the menopause occurs when you are under 45 years of age then it is called an early menopause.  If you are under 40 it is known as premature menopause, or premature ovarian sufficiency (POI).

"If you undergo a hysterectomy you may also have your ovaries removed at the same time.  If this happens then you will immediately be put into the menopause, and event known as a surgical menopause, regardless of age".  "The 2015 National Institute for Health and Care Excellence (or NICE) menopause guidelines recommend that if you are due to have treatment that is likely to cause the menopause, then your doctor should explain to you what you should expect and how it will affect your fertility. You should also be offered support and information about how to manage your menopause if your treatment is going to lead to the menopause occurring". BINGO.  I had found the answer in this menopause bible! I had a premature menopause and to top it off I had no explanation or support at all plus incorrect and insufficient medication! I had been existing on "fumes" (not enough oestrogen), for all of that time, with no support or guidance from anyone or anywhere.

The way I look at the menopause is that it is a hormone deficiency and if we lack certain hormones we will be more prone to bowel cancer, depression, Type 2 diabetes, cardiovascular diseases...the list goes on.  Oestrogen affects us everywhere - in our eyes, brains, skin, vaginas...absolutely everywhere! so to merely replace it, makes complete sense to prevent these things happening in the future.  HRT protects you.

For the majority of women who start taking it under 60, the benefits outweigh the risks.  There are 2 small risks for women taking HRT - risk of breast cancer and a risk of a blood clot...

Taking combined HRT maybe associated with a small risk of developing breast cancer, however, some studies show this risk is reduced if micronised progesterone is used.  The risk of breast cancer with any type of HRT is low; for comparison the risk of breast cancer is greater in a woman who is obese or who drinks alcohol regularly, or doesn't exercise.  If a woman has a history of blood clots, liver disease or migraines theres a small risk of clotting if taking the tablet form of oestrogen, but taking it through the skin, (transdermally), such as patch, gel or spray, doesn't have these risks.

Too many women are scared about HRT following very negative reports in the media. The biggest worry they have is associated with breast cancer. However, there are some really important facts about this. Firstly, all the studies have shown that women who do not take a progestogen (so those women who have had a hysterectomy in the past) have no increased risk of breast cancer with taking HRT. Secondly, women who start HRT when they are under 51 years of age (the average age of the menopause in the UK) do not have an increased risk of breast cancer. Thirdly, the small increased risk of breast cancer that has been demonstrated in some studies has shown that this risk is lower than the increased risk of breast cancer if you are overweight or drink a couple of glasses of wine a night.

Taking HRT actually reduces your future risk of really important diseases such as osteoporosis, heart disease and diabetes. So, in addition to helping you feel better, you can be reassured that taking HRT is actually a real investment for your future health.

I had made an appointment with a local Dr who specialised in Bio-identical hormones and paid to see her. (HRT is Body identical, so far superior I later found out).  The bio-identical method is where they mix up a special herbal medicine and you drink it.  (Diane explained to me that these kinds of practises should be illegal as they will not help anyone and no amount of herbs will help or protect you like HRT).  After this first consultation I cancelled my follow up.  I also learned that this is not regulated so another reason to boycott these places.

I had decided to invest in going to see a Private Dr who specialised in Menopause, as I was so desperate.  Diane recommended one, (based on who was closest to me) and  I was so pleased she did.  I visited a private Dr in Nottingham, Dr Joanne Hobson at Spire hospital, and straightaway she explained exactly was the problem with my symptoms and results from my blood tests.  I was gobsmacked.

They showed I was extremely low on Oestrogen and Testosterone, (Oestrogen was 270.  (When you think when you ovulate when you are younger it is about 1,000).  To cut a long story short, she recommended I up my dose of HRT and introduce Testosterone.  I was using patches and then tried a gel later on, however, after months of trying them they just didn't work for me, I was not absorbing them. I was so frustrated and still not feeling good. Not sleeping, brain fog, exhaustion, etc....

I decided to contact Dr Louise Newson as I had heard some very impressive stories and still, I was desperate.  (She also helps Davina McCall!)  I knew she was the leading U.K pioneer and advocate for menopausal healthcare.   I was determined that this was going to be the year I got myself sorted,  I looked at it like it was an investment.  Like I was spending my money on my well-being and future health, which to me was priceless, (it would also hopefully stop me spending so much on skincare and makeup!)

Dr Newson is based in Stratford-upon-Avon, however, she does do Zoom consultations.  She also works, (unpaid), long hours to help educate and inform fellow G.P's.  She also regularly appears in the media to spread the important message that HRT can entirely solve so many female health problems and in the vast majority of cases, the benefits of HRT far outweigh the risks.

To quote Liz Earle, (also another pioneer), "I don't believe in medicalising the menopause but I do firmly believe it is our right to be able to enjoy life in our later years free from debilitating and often life-limiting symptoms".  You can download Liz's e-book via her website, "The truth about HRT" and it is a fantastic read).  She says, "It should be our basic human right to enjoy the simple, safe health protection and healthcare as we age.  Body identical HRT from my GP is something I take, something my mother takes and something I shall encourage my daughters to be aware of and take when they reach mid-life.  I would hope that, by then, it will have become standard healthcare practice.  Looking back on my late forties and the many health issues I experience back then - insomnia, memory loss, brain fog, achy joints, severe headaches, pelvic infections and many more - I only wish I had discovered it sooner. I no longer experience any of these and have more energy, better sleep, improved mood and joie de vivre than at almost any other time in my life. I wish the same for you".

(I had also read another book, "Oestrogen matters" by Dr Avrum Blumming, which I also highly recommend).

Liz continues, "HRT is freely available on the NHS from your G.P.  It is safe, highly regulated and body identical, (which means it precisely matches - molecule for molecule - the natural hormones in our own body).  This was not always the case in years gone by, but today's modern and safest form of HRT is both body identical and made from wild yams. Those who say they would ever want to treat their body with natural substances, (such as herbs, etc) can be safely assured that the hormones in the type of body identical HRT comes solely from plants and will precisely match those naturally made in the body".

"HRT stands for Hormone replacement therapy and hormones are used in many areas of medicine from taking the contraceptive pill, to regulating a thyroid condition with levothyroxine.  In some ways, it is a shame that the use of oestrogen to help relieve so many awful symptoms of the menopause has been given this special label.  When you think about it, there are many other kinds of HRT, (replacing insulin in a person with diabetes for example), but this somehow doesn't seem to bother anyone.  Similarly, taking the contraceptive pill for decades in our early years, (a much higher concentration of synthetic hormones working directly against the natural rhythms of the body) doesn't seem to fill us with the same level of fear or arouse such a strong feeling at the much lower levels of the body identical hormones in HRT.  This is bizarre".

"The label HRT seems exclusively reserved for the use of hormones for the menopause and it has become controversial due to its (wrongly reported) links with breast cancer".

I had a Zoom consultation with Dr Louise Newson, (I had sent her all of the relevant information and history, plus blood test results).  She was very professional.  Naively, I did expect to get better as soon as I had tried what she had suggested.  I wasn't prepared for the expense nor the further frustration I felt.  It had been a looooong 12 years and I was desperate to feel more balanced, but she explained that it could take up to a year at least to get sorted...(A private consultation can cost anywhere from £180-£250)

After 3-4 months I wasn't feeling any better on what she had suggested, and she suggested I try a new Lenzetto spray and I was not absorbing the gels nor the patches I had tried.  It was at this point I had to contact my local CCG, (Clinical commissioning group), as I was having problems with my GP practice as they were not very co-operative at all, and just not knowledgable, plus they would not prescribe what Dr Newson was recommending!! (I did not want to pay privately for my HRT when it was readily available on the NHS, and why should I have to?!)

I had bought some Androfeme cream privately, (which is a Testosterone cream aimed specifically for women).  Testosterone is not licensed in the UK for women but in the NICE guidelines it does state that "Consider testosterone  supplementation for menopausal women if HRT alone is not effective".  This hormone is often perceived as the "male hormone".  However, women also produce (and need) this for muscle strength, good mood, mental clarity, libido and memory.  This does decrease with age so we do feel the benefits of replacing this.  Despite its many benefits and lack of health risks, many GPs are reluctant to prescribe this as they simply do not understand it!  GPs frequently prescribe things that are off-license, (but obviously this is for women so we have more of a struggle on our hands!) So you will probably struggle to get it prescribed by an NHS GP unless they are knowledgable on menopause care sadly, however, do keep at it until you get there with it. We should not be denied our own hormones!

The AndroFeme was £80 a tube that lasted about 3 months! so the next best thing was to try and get some Testosterone via the NHS, (this is freely available to men you might know!) Testim or Tostran is available.

Liz continues, "It can take a few months for the effects of taking testosterone to become apparent and its considered especially important for younger women who have gone through an early menopause".  Bingo again!

My own GP would not only not prescribe the new Lenzetto spray, (despite it being available on the NHS) but she also refused to prescribe me the testosterone, which I had been advised by Dr Newson to have.  Dr Newson also said I could supplement with a tablet if needed and to have a high dose of the oestrogen spray.  My GP was not happy! and did not even attend the Zoom meeting organised by the CCG with them and Dr Newson!..very embarrassing on her part!!

The CCG had to write and explain to my GP exactly why I needed the products and also the dosage. This was not without a lot of blood, sweat and tears on my part I can tell you.  It was relentless! but the CCG were so helpful and I urge you to contact them to help you if you are not happy with the care you are receiving from your GP.

After the CCG intervention, (it took 2-3 months), I was granted the HRT spray and Testosterone via the NHS.  This was a triumph!!  I think I cried!!

I am still on my wellness journey, it is going to take a while I know, but I am now on the right path to getting better as I have found a great GP and know I am not going completely bonkers anymore! plus I am now replacing my hormones being supplied by the NHS.  I am due to talk to Dr Newson again for a follow up soon.

I have also taken up Yoga and exercise daily, (which I absolutely love!), and walking my 2 dogs. I find Yoga to help me massively not only for fitness but mentally too. I also love the Joe Wicks way of eating...its all very healthy.  I really believe a lot of ailments and illnesses can be prevented, if we just looked after ourselves!

During lockdown I took part in the Joe Wicks 90 day plan, which has been incredible for me, I have lost 10lb in the 90 days and I am now a complete convert. This is a way of life for me now, there is no going back. So with the right combination of HRT, exercise and the right food I am looking after myself more than I have ever done before. I very rarely drink alcohol these days either, there is no benefit to that for me...

I wanted to share this with you, (my story is not in all its full glory, as you may appreciate), it would just take too long.  I also want to help other women, like me, who have been ignored and received no care or given incorrect advice and medication.  I also want to make sure that my daughters generation does not have to go through this. We as women, need to fight for our own hormones, (that in itself it just so wrong!) and to get that correct information out there to help each other out.

There are so many myths and untruths I wanted to share with you the facts that I have found out, through thorough research and (unfortunately) spending money on, (at a time which is very difficult!)  I hope for the future that HRT will be more readily available on the NHS and also that menopause care and knowledge will improve.  It will no doubt save the NHS a lot of time and money...not to mention us!!!!

Here are a few facts you may find interesting - (as explained by Dr Newson on Instagram).

Once we have low hormone levels or hormone levels are always going to be low, so we need to think of the menopause as a long term hormone deficiency. We will never get these hormones back unless we take them ourselves. Because our bodies are exposed to low levels of hormones this leads to potential problems.

When our hormones levels are low we have an increase risk in conditions such as heart disease, diabetes, osteoarthritis, osteoporosis, Type 2 diabetes and dementia.

If you think back to the Victorian times, the menopause was around the mid-50's (now it is early 50's), so we used to die quite soon after - around 57/59 quite soon after the menopause. Now we live a lot longer, in our 80's now.  Most of us will be post menopausal for about 30 years! and that means we won't have hormones in our bodies for about 30 years and this is why the increase risk in these conditions need to be thought of.

Yes the menopause is natural, it is not a condition or a disease but it can lead to diseases.

After the menopause a woman is 5 times more likely to have a heart attack. The Royal Osteoporosis society say 1 in 3 women will have a hip fracture and 1 in 2 will develop osteoporosis.

We are all different and each person will need a different amount of hormones and different treatment.

Younger women need higher doses of oestrogen according to their symptoms. There is a licensed amount recommended, however specialists often prescribe more than that, it isn't because it is dangerous it is just that some people just need higher levels.

If you think about a diabetic - a patient with diabetes - often they have differing amounts of insulin required or if someone has thyroid problems the doses will change from one person to the next. Very fit athletes tend to metabolise hormones so they need a higher amount too.

Side effects of HRT - these usually settle after 3 months. Breast tenderness/weight gain. Most women actually lose weight when on HRT.  This is partly due to them taking HRT and they eat better, exercise more, sleep better and drink less alcohol. If we sleep better we don't put as much weight on. Oral oestrogen can lead to fluid retention, so having it through the skin is shown to lose weight.

On the mid-line it is common for fat to be around there, fat cells are stored there. We put weight on there because our bodies want oestrogen so replacing this often helps us lose weight.

You don't need to stop taking HRT...ever! The guidelines are clear - we can continue to take it as long as the benefits outweigh the risks. For most of us, the benefits do outweigh the risks because any symptoms improve and there are long term health benefits.

You can stop taking HRT thinking you have "gone through the menopause" and you have no symptoms but then, you will have no protection and you will have an increased risk of osteoporosis and heart disease.

HRT keeps the bones strong and you can take HRT for life!

The study that shows a possible risk of breast cancer followed women over 18 years and showed that women taking HRT have a lower risk of death of all causes including from cancer if you take HRT.

Even if the risk of breast cancer is small, most women taking HRT feel better so they exercise and lose weight and reduce their alcohol intake - so the risk factors for breast cancer are reduced, even if with the risk of taking HRT increases.

A lot of women are worried they can't take HRT - purely because of misinformation.

If a woman has a history of a clot or family history of clots, they can still take HRT but they have to have oestrogen through the skin and if needed, micronise progesterone, as there is no risk of a clot.  The older types have a small risk of a clot and heart disease so they are best avoided by these women.

If a woman has a family history of breast cancer or cancer then she can still have HRT as it doesn't increase the risk further.

The contraceptive pill is not the same as HRT, it is synthetic and not body identical, which is not advised.

If your GP refuses HRT you need to ask them why and look in the NICE guidelines and take the copy in to show them.

Here is a recent letter from one of the GP's at my practice, who is clearly not educated about HRT or the menopause. It was a very patronising letter and highlighted to me how much work we had to do still. I had contacted them as I wanted them to reassure me that they would take on board my findings from the specialists and so in turn, help their other patients. Sadly I think this GP is a lost cause...! (Dr Dinosaur I call him haha...)  And just to point out, he did not refer me to a specialist at any time.

I felt very strongly about my whole experience and felt I had to write to him to ask him to stop needlessly prescribing antidepressants and instead, get up to date with the current advice about the menopause and HRT.

Anti-depressants are not a treatment for menopausal women.  They do not help with the low mood associated with the menopause. A survey of 3,000 women showed that 77% had been offered or been given them, (they will help with clinical depression and can sometimes help with hot flushes), however, if you are offered antidepressants say no.  The NICE guidelines state that they "will not help with the low mood associated with the menopause".

Women produce Testosterone naturally.  More than oestrogen form our ovaries! so when the ovaries are gone, testosterone is reduced.  It is very important for our brains, muscles, joints, skin, hair...everywhere! We have hormone receptors all over for testosterone as well as for oestrogen.

The NICE guidelines are very clear, if a woman is taking HRT and her libido has reduced, she can also be offered testosterone.

For vaginal dryness, you can apply local oestrogen. When we don't have oestrogen in our vaginas the wall of the vagina becomes dry and so replacing it locally makes the blood supply better.

*Heart disease will kill 2 in 1 women. Without oestrogen plaques build up in the blood vessels and then you have a heart attack, and the symptoms in women are very different. Jaw pain, neck pain and discomfort in the back, so sometimes we don't even know we are heading for one and we don't know we are having one - and its the same with our bones.

*Until we get a fracture of the spine or hip, (not all from falls), we can fracture our spine from coughing.  The mortality rate from fracture is 20%. Some people have multiple fractures and if you look at nursing homes, 90% of the women there are there because they have had fractures.

*Alzheimers has a mortality rate of 100%.  This is the greatest silent killer. Extrapolate that brain fog over 20 years - this is a huge warning sign. Without oestrogen our brains shrink and plaques build up. Alzheimers is brain shrinkage. Forgetfulness is your brains attempt to wake you up to act.

* Menopause is giving you symptoms to wake you up and get help and prevent these diseases. So lets break the silence and go speak to your GP, (one who understands the menopause and HRT!)

You can start taking HRT even when you are older!  *If you do remain silent into your golden years, they won't be so golden! (*Taken from a booklet from Barbie Taylor - a Gynaecologist and Menopause evangelist and Fiona Clark, founder of Harley street Emporium).

I hope you will join me in spreading the word and using the hashtag #makemenopausematter which is a campaign that Diane has started.

As I hope you can appreciate, this has been a long journey for me and ongoing, and I know that GP's are just there to treat symptoms not the root cause but with more knowledge and education we can all help to encourage each other in gaining the most optimum health for us and for our daughters, friends, Mum's, Grandmothers, etc, etc! We should not have to pay privately to gain the right support to gain our own hormones back! GP's need to be educated and with the help, support and expertise of people like Diane, Dr Newson, Dr Naomi Potter, etc, I am hopeful for the future.

Please do feel free to contact me if you would like any advice, (anything you tell me will be treat with the strictest confidence).  If I cannot help you, I will give you some pointers. Obviously I am not medically trained but can only speak from my experience.

I hope you have found this information useful, please do let me know.  There should be no embarrassment about subjects such as menopause, lets normalise it! It is to our benefit and the next generation that we do.

This has been a blog very dear to my heart and it has taken me a good year with all of the research and gathering of evidence, and I wanted to pass it on to you. I am a very private person but I feel very strongly about this and passionate about helping others.  I'll be on my HRT until I pop my clogs!! (I bet you any money the Queen is on HRT!)

Thank you for reading.

Love, Tina x

(Oh and P.S another good book is My menopausal vagina by Jane Lewis!!)