The women who say coming off HRT aged them 10 years – so why don’t doctors let them take it for longer?
- Some 80 years since HRT was developed, there’s still uncertainty about its safety
- Experts suggest that it could raise the risk of heart disease and breast cancer
- This caused many doctors to exercise caution when giving it out on prescription
- Now, less than 10 per cent of women going through the menopause use HRT
Link? Shirley Harries, from West Sussex, was on HRT for 38 years until she was diagnosed with early-stage breast cancer in 2016
Jennifer Griffith was on hormone replacement therapy (HRT) for 16 years.
‘I felt fantastic on it,’ she says. ‘I had tons of energy and my hair was thicker and silkier.
‘Unlike my mother at the same age, I didn’t have arthritis because of the HRT and I led a very full and active life,’ says the 72-year-old retired housing officer.
But, in November 2016, after the mother- of-two moved from London to Sandwich in Kent, she was told to stop taking HRT because she’d been on it ‘for too long’ and it might raise her risk of breast cancer.
‘I remember the day I took my last pill,’ she says.
‘I was panicking and sick with apprehension. But there was nothing I could do. I tried other doctors — NHS and private — but none would prescribe HRT for me.
‘I had no family history of breast cancer, and I would have been prepared to take a small risk because of the benefits I gained, but no one listened to me. It seemed that they were all demonising HRT and listening to the scare stories.’
Jennifer, who is married to Raymond, 77, a retired engineer, recalls: ‘As soon as I came off HRT, I began to get painful symptoms of arthritis. Now I have it everywhere, in my hips, hands and knees. I started to get very bad hot flushes — so bad I would abandon what I was doing and go straight home.
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‘I feel tired all the time and the skin on my face has suddenly become drawn and lined. I’ve lost the volume and silky texture of my hair, even though I look after myself and spend a lot of money to look my best.’
She adds: ‘Coming off HRT really damaged the quality of my life. I feel like an old lady now. When I was on HRT, I never felt my age, but I’ve aged ten years in two.
‘If I could get my HRT prescription back, I would take it in a flash.’
Some 80 years since HRT was developed for the menopause, there is still uncertainty among both doctors and patients about its safety.
This is because major studies such as the Women’s Health Initiative, published in 2002 and 2004, and the Million Women Study, in 2003, suggested that HRT raised the risk of heart disease and breast cancer.
Health : Mrs Harries was asked to discontinue her treatment after developing breast cancer
This created panic and many doctors stopped prescribing it — the number of women taking HRT in the UK fell by two-thirds and, even now, less than 10 per cent of women going through the menopause are using hormone therapy.
This is despite the fact those studies have been reassessed and found to be flawed — partly because the women in them were post-menopausal.
Yet many women who want to take HRT say they’re refused it. Others, after taking it for years, find themselves suddenly being taken off it against their wishes.
Women such as Rosemary Webster, 78, say that their quality of life has suffered as a result. A grandmother of 16 and great-grandmother of 18, Rosemary was forced to come off HRT after 25 years. ‘While I was on it, I felt lovely and everyone said I looked younger than my age,’ she says.
But when she moved from Somerset to Berkshire, her new GP refused to prescribe HRT due to breast cancer concerns. ‘I should have been allowed to take the risk and carry on taking HRT,’ says Rosemary. ‘My skin quickly became flaky and dry and I suffered two bladder prolapses.
‘I still suffer from hot flushes 16 years later — all because I don’t have oestrogen any more.’
The fact is, that ‘for most women under 60, and for many over 60, the benefits of HRT outweigh the risks’, says Dr Heather Currie, an associate specialist gynaecologist at Dumfries and Galloway Royal Infirmary and spokesperson for the Royal College of Obstetricians and Gynaecologists.
‘But many women have to put up with menopausal symptoms that can affect quality of life because of inaccurate advice.’
The evidence is strong that HRT is ‘good for menopausal symptoms and is better than diet, exercise, herbal remedies or antidepressants at controlling symptoms such as hot flushes’, adds Dr Jayanta Chatterjee, a consultant gynaecologist at the Royal Surrey County Hospital.
Concerned: Shirley, pictured with her husband Guy, dreads the end of her HRT prescriptions
Furthermore, he says, HRT has also been shown to reduce the risk of fracture in post-menopausal women.
The NHS guidance says: ‘There’s no limit on how long [a woman] can take HRT’, but advises talking to your GP about the duration of treatment they recommend.
Under NICE (National Institute for Health and Care Excellence) guidelines, all women who are on HRT should have a yearly review to check that they still need it. ‘The prevailing opinion is that women should be offered HRT if they have troubling symptoms and treated as individuals with unique health needs,’ explains Dr Chatterjee, who also practises at the private Surrey Park Clinic in Guildford.
‘This means older women who want to continue HRT should be able to, providing a health assessment has been made and women understand the potential risks. I have patients in their 80s who are happy on HRT after 20 years. As long as they are sensible and have no other risk factors, it is acceptable.
‘Whether they are getting a benefit apart from the placebo effect is difficult to say, however.’
HRT can be taken ‘as long as necessary’ for the correct reasons, which might include warding off osteoporosis, adds Kathy Abernethy, a nurse and chair of the British Menopause Society.
‘I don’t think anyone should be told they have to come off HRT simply because of age, although it isn’t advisable to stay on HRT if you no longer need it.
‘Women might be reluctant to give it up, but it can be sensible to go on a HRT break to see how you react. Whatever happens, women should be able to consider the options for themselves.’
THE CANCER CONNECTIONS
The risk of breast cancer increases the longer that a woman is taking hormone replacement therapy (HRT), but the risk itself is complex.
‘It’s greater for combined HRT — with oestrogen and progesterone — than for oestrogen-only HRT,’ says gynaecologist Dr Jayanta Chatterjee. ‘But the risk appears to be greater when HRT is started around the time of the menopause, rather than later.’
For women on combined HRT, Dr Chatterjee often prescribes a progesterone-only coil (and oestrogen as a pill or patch). This is because it releases progesterone very locally into the womb, so less of the hormone ends up in the breast tissue.
For those who’ve been on HRT a long time, he suggests an oestrogen patch, rather than a daily tablet.
‘This bypasses the gut so it gets to the target organs — such as the brain and the skin — without first having to be metabolised in the liver. Hence a lower dose is more effective.’
Cancer Research UK says there is strong evidence that HRT can cause certain kinds of cancer — breast, womb and ovarian — but the risk with HRT is low compared to risk factors such as smoking or being overweight.
More controversially, certain experts, including Dr Avrum Bluming, an oncologist and a former investigator for the National Cancer Institute in the U.S., suggest that even if a woman has had breast cancer, she can take HRT. Dr Bluming’s own wife and daughter take HRT, despite both having had the disease.
Shirley Harries, 83, who lives in West Sussex, was on HRT for 38 years until she was diagnosed with early-stage breast cancer in 2016 and underwent a lumpectomy.
‘It was a small lump that was removed, but the oncologist said I had to stop HRT because of the breast cancer risk,’ she says.
‘I was relieved they caught the cancer, but sad about having to come off HRT — because I credit it with giving me years of vitality and good health.’
Shirley, who is married to Guy, 83, and is still a keen golfer, says she was advised to take HRT to protect against osteoporosis — the condition that weakens bones — when she was 45.
‘My mother and sister both had osteoporosis and my bones were beginning to thin,’ she says. ‘A year after starting HRT, my bone density was back to normal and to this day, I have sturdy bones.’
Two years after giving up HRT, Shirley says: ‘I know I look young for my age. My hair looks fine and I don’t have many lines.
‘I hope it stays this way, but I’m worried I may start to age now that I don’t have my hormone boost.’
However, some women should not start HRT, says Dr Currie, ‘including those with a personal history of hormone-dependent cancer. For others with certain medical conditions, we need to be cautious in terms of duration, type, dose and route’.
And that, for Rosemary Webster, is the key: ‘Doctors should follow the spirit of the NHS recommendations and look at individual women — not just tick boxes.’
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