HORMONE REPLACEMENT THERAPY: YOU AND YOUR DOCTOR
Whether your doctor is enthusiastic about HRT or not is quite closely linked to how long ago he qualified. Most older doctors hardly studied even the menopause at medical school, and HRT not at all. A survey in Brighton, Sussex, showed that of doctors who qualified in the 1950s, none prescribed HRT in a given year, those who qualified in the prescribed HRT in a given year, those who qualified in the 1960s were slightly more likely to, while those who qualified in the 1970s and 1980s were very likely to. So if your doctor is rather older than average and ‘doesn’t believe m HRT’, you might find a younger doctor more helpful; and, no matter what his age, if you do not feel he is sympathetic to your problems, ask whether you could see another doctor in the practice, or a Menopause Nurse. If you get no luck there, a local Menopause Clinic or Well Woman Clinic will be able to give you the information you want, and do a medical check-up. Help, information, advice and treatment is also available from The Amarant Trust. The aim of the Trust is to promote a greater understanding of the menopause and HRT. They run an HRT helpline for general enquiries, can send you a list of NHS and private Menopause Clinics, run specialist courses for GPs and nurses, and have their own private Menopause Clinics in London and Cheshire, where patients can receive assessment, information and treatment.
Most women nowadays are much better informed on medical matters than their mothers or grandmothers were, and they expect to be given as much information as possible. You do not have to be putty in your doctor’s hands; you don’t have to take (or not take) medicine just because he says so; you have every right to full information and then to make your own mind up. Fortunately, the ‘because-I-say-so, my dear, and-don’t-ask-so-many-questions’ type of doctor is becoming a dying breed, and GPs now expect their patients to want information about their condition and its treatment, including the options available and possible side-effects of different treatments. If you are unsure about anything, go along to your doctor with a list of questions written down on paper and then write his replies down, so you don’t forget anything. You may prefer to take somebody into the consulting and less intimidated, and you have the right to do this, and also to a second opinion.
As a result of the scares abut HRT in the 1970s, many doctors are uncertain how safe it is nowadays, and perhaps do not realise that cancer of the lining of the womb can virtually be ruled out for women starting HRT now as long as they take progestogen as well as oestrogen. They might also link safety concerns about the oral contraceptive with HRT, but as the dose is many times smaller, this is a largely unfounded fear. Although many doctors realise the benefits of long-term HRT for osteoporosis and heart attacks, they are also aware that there is an increased risk of breast cancer in women who take it long-term. It is interesting, though, that doctors involved in research projects with women who are taking HRT do seem to be enthusiastic about it; perhaps they feel it really does work, and, in most cases, has more advantages than disadvantages.
Finally, however well you are getting on with HRT, it is not a panacea for eternal good health, and any of us can develop serious diseases. There are some symptoms you should not ignore, whether or not you think they are connected with either the menopause or HRT:
• very heavy periods
• any bleeding or ‘spotting’ between periods
• any bleeding or ‘spotting’ after sexual intercourse
• any unexplained bleeding once the menopause has passed
• if you still haven’t reached the menopause by about the age of 54
• pain or swelling in the abdomen
• ‘indigestion’-type pain that persists for more than a day or two
• blood in the urine or stools
If you get any of these, see your doctor as soon as possible.
While a few GPs are still reluctant to take menopausal symptoms seriously (‘No one yet died of the menopause, my dear*), many are both enthusiastic and helpful. An increasedear’), many are both enthusiastic and helpful. An increasing number have set up Menopause Clinics within their practices, employing specialist Menopause Nurses, from whom women can receive advice, information and screening. Newly pregnant women see their GPs, and all women approaching the menopause should be encouraged to do so as well, not necessarily to be given HRT, but to discuss the menopause, their symptoms, and any treatment that may be advisable. Women who are well informed about this time of change will feel better able to cope with it, and will not be a burden to themselves or to their doctors.
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