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HRT: women’s inequality shapes how the menopause is treated

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Society’s structures—and sexism—mean women going through the menopause face many problems, including the side effects of HRT used to treat its symptoms, writes Sarah Bates
Issue 2670
HRT has real benefits, but also risks
HRT has real benefits, but also risks (Pic:

Around one million women in Britain use Hormone Replacement Therapy (HRT) to relieve the symptoms of their menopause.

But up to one in 50 women taking the most common form of HRT long-term will get breast cancer as a result.

That’s the finding from new research carried out by the Lancet medical journal, published this week.

It suggests risk of developing breast cancers from using HRT is twice what was previously thought.

The research looked at data from 58 studies around the world on more than 108,000 women who had developed breast cancer after taking HRT.

And it shows that the longer women take HRT, the higher the risk will be.

It will come as a shock to the one million women in Britain taking HRT. They had previously been advised that up to five years treatment came risk free.

But the research suggests that the risk-free treatment period could be just one year.


Sir Richard Peto is professor of medical statistics and epidemiology at the University of Oxford. He said doctors could point to the new research to ensure women were fully aware that HRT caused breast cancer.

“These are cause and effect relationships. It’s not just an association that exists, because the HRT is causing the increase in breast cancer.”

Health is a class issue
Health is a class issue
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The British Menopause Society (BMS) said that risks caused by HRT should be considered alongside benefits.

It said the findings “should be taken in the context of the overall benefits obtained from using HRT including symptom control and improving quality of life as well as considering the bone and cardiovascular benefits associated with HRT use.”

The new findings and the robust defence of HRT from the BMS will leave many women worried about what treatment option is right for them.

But the problem is further compounded by supply chain issues that have meant pharmacies are running out of HRT pills, patches, gels and implants. The European Pharmaceutical Review website reports that shortages are “likely to continue until next year.”

“Approximately half of the most commonly prescribed HRT products are currently out of stock in many pharmacies,” it said.

The shortages began last year after some firms in China stopped making HRT patches, causing a surge in demand for other forms of the treatment.

HRT is one of many drugs that are now in short supply. HRT is far from the only medication affected.

Dozens of medication types are now on a “concessions list” where the NHS will pay a higher rate to ensure a steady stream of supply.

HRT works by replacing the hormone oestrogen, or a combination of oestrogen and progesterone.

Doctors are worried that the HRT shortage leaves many women in misery.

Most people have heard of hot flushes, but symptoms can vary from woman to woman, with some suffering hugely.


Symptoms can also include, heart palpitations, anxiety and depression, forgetfulness, vaginal dryness, difficulty sleeping and loss of libido.

About 80 percent of women experience some symptoms, with one in four suffering severely.

Menopause healthcare should be treated as a public healthcare issue.

That means resources need to be available to all who need it—not left to the discretion of individual pharmacists to ensure their shelves are fully stocked.

It’s true that HRT is helpful to many women who suffer daily debilitating menopausal symptoms.

Despite only about 20 percent of menopausal women taking HRT it remains the only treatment available.

The threat to women’s health should be treated as an urgent public issue—not brushed under the carpet and left for each woman to navigate alone.

There needs to be publicly funded research into developing alternatives to HRT that don’t come at the cost of women’s long-term health.

Bosses don’t make provision for menopausal women

Most women experience the menopause between 45 and 55 but some experience it much earlier or later.

There are more than 5 million working women between the ages of 45 and 60—double the number 25 years ago.

So a good number of women will have to negotiate their working lives alongside potentially debilitating menopausal symptoms.

Many have found they haven’t received support at work. One worker wrote to the Guardian newspaper about her experiences during the menopause as a nurse in Scotland.

She said the NHS made no reasonable adjustments during this period.

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“When I asked for shifts to be changed I was treated with contempt—it was almost as if I wasn’t capable of doing the job anymore.

“It was as if I was slacking—there was not sympathy. The message was to get on with it, or you knew what you could do.”

There’s no specific legislation to ensure women get the support they need at work.

The Usdaw union found that over half of women surveyed didn’t feel able to approach their managers if they were suffering.

Adjustments should be made to women can continue to work during the menopause.

This might mean proper guidance for managers, programmes of menopause leave, installing desk fans, uniform adjustments, flexible working or private rest areas.

What is the menopause?

It’s a process of rapid hormonal changes that affects women, usually between the ages of 45 and 55.

  • A woman stops having periods. Symptoms usually start a few months or years before periods stop

The main treatment prescribed by doctors is Hormone Replacement Therapy

47 percent of women have needed to take a day off work due to symptoms but wouldn’t tell their boss why

  • 42 percent think their symptoms were much worse than they expected
  • 3 percent of line managers are given relevant training

Alternative to HRT ‘is unsafe’

Hormone Replacement Therapy isn’t a treatment that appeals to all women, not least because of the increased cancer risks.

But industry bodies warned last week that alternatives could be even worse.

Compounded bioidentical hormone replacement therapy (CBHRT) mimics the exact hormone make-up for each woman.

The treatment is usually put together by pharmacists working in private clinics.

But the British Menopause Society (BMS) say the formulas made for each women aren’t regulated like conventional HRT.

Haitham Hamoda, from the BMS said, “Every expert in the field shares concerns about compounded hormones treatment. It’s unsafe, and unnecessary.”

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