'If I don't have HRT I will die': The real impact of the menopause med crisis
One summer’s day in 2018, a deflated Jen Stanbrook sat in her stationery car and sobbed. She had been experiencing classic symptoms of menopause for months and had requested HRT from her doctor.
She had already been refused it at two different appointments – being told she would need blood tests first – and this time Jen was sent home with an unwanted prescription for antidepressants. She sat behind the wheel and wept.
She remembers: ‘I had been feeling so down and so dark. I called my husband John from the car crying. I don’t know what would have happened if he hadn’t picked up the phone. I felt so low then. I was thinking “What’s the point? I’m annoying to everybody. I’m so angry all the time. I’m no good to anyone. So what’s the point in being here?”
‘It was so scary. I felt so alone.’
Online business coach Jen, 52 – like thousands of women around the country – has faced an exhausting fight to get the treatment she desperately needed.
On online forums up and down the UK, women are telling remarkably similar stories. They begin feeling dreadful; physically ill, mentally impaired and like shadows of their former selves. Then while battling these debilitating symptoms, they struggle to see the same doctor twice, fight to get prescribed HRT, and then battle to ascertain the right balance of hormones for them, before they finally reach some sort of happy ending.
But that happy ending is now being further denied for women up and down the UK due to the latest crisis: a nationwide shortage in hormones. Both Oestrogel and Sandrena – gels that are applied to the skin to replenish depleted hormones – are in short supply, as well as HRT spray Lenzetto.
Approximately 13 million women in the U.K are either peri or post menopausal, with symptoms lasting up to 15 years, according to Menopause Support UK.
Over 60% of women experience symptoms resulting in behaviour changes. 1 in 4 women will experience severe debilitating symptoms, including suicidal ideation. Suicide rates for women aged 45 to 54 – the most common age for perimenopause and menopause – have risen 6% in 20 years, according to the Office of National Statistics.
It took Jen nearly a year to get the right treatment in her hometown of Nottingham. She ended up spending around £2,000 on private appointments, blood tests and treatments – booked when she became fed up of not being able to get the help she needed from the NHS.
Jen’s first symptoms were anxiety, depression and low mood which set in in her 40s. This later turned into brain fog, insomnia and rage.
The menopause also causes her a lot of pain when her hormone levels aren’t right: ‘There are days when I can’t get out of bed and I stumble because my joints hurt and muscles aren’t strong enough. I can’t even walk up the stairs.’
By the time she found herself sitting in her car, paralysed by sadness and frustration, she was ‘very, very low’.
She says: ‘I was in a very dark place. I had awful thoughts.’ It wasn’t until Jen was passed on to the local menopause clinic – after another three month wait – that she was offered HRT in 2019. She cried with gratitude.
Jen was prescribed patches and the coil, and she has spent the last few years refining the balance. It wasn’t until she added testosterone to the mix that she started to feel like her old self again. But then the shortages hit.
‘I now live with this constant stress and worry of – will I be able to get my prescription and if so, will the pharmacy have it? I’m furious, scared and panicked by all of it.
‘It’s the battle. I’m constantly in this state of panic and stress. Am I going to have to fight for people to understand my symptoms and believe my symptoms. And then I’m furious that it has to be such a fight when it’s such a difficult time of life anyway. And I’m just scared, all the time that I’ll run out of money. Will I have to do this for the rest of my life? How am I going to cope?’
Jen has now added her voice to those of women around the country who are saying ‘enough is enough’. TV presenter Davina McCall is spearheading a ‘menopause revolution’, fighting for improved treatment for women, better rights at work and more awareness.
While shortages of HRT have been experienced since 2019, demand surged by 30% after her first documentary ‘Davina McCall: Sex, Myths and the Menopause’ aired last year.
However, according to 51-year-old Christine* from the North West, because men don’t experience the menopause, not enough is being done to fix supply problems.
‘This whole thing just shows that women’s health is not a priority,’ she says angrily. ‘The Government needs to do its part. I’ve worked since I was 16, I’ve paid my taxes and national insurance, and I can’t get the basic treatment I need.’
For Christine, it is a matter of life and death. Christine had a surgical menopause following cervical cancer, from which is she now in remission. But she now has no estradiol left in her body at all; a hormone that is needed for basic functioning of all aspects of physical health, brain health and emotional health.
She says: ‘I cannot live, let alone thrive unless I replace the estradiol on a daily and ongoing long term basis. HRT is not a lifestyle choice. It is vital for me.’
Christine uses Estradot patches, the only preparation that works for her after two years of trial and error. But she is struggling to get hold of it and she is finding that despite ringing around all her local pharmacies, there is none currently in stock.
She says: ‘I never know if my prescription can be fulfilled. I am entitled to free medication, and am instead having to buy my patches, via a private online pharmacist.
‘My three months’ supply has just cost me £140 plus delivery, and this is the second time this year I’ve had to buy them.’
Christine was recently made redundant from her job in higher education, so is worried about money – and her inability to get hold of the patches is causing ‘enormous stress on my health and wellbeing’, she says.
What happens if Christine doesn’t get her replacement hormones? ‘The research points to heart disease, osteoporosis, diabetes long term. I can’t be without it. Short term, I start to get symptoms, which for me are bladder and urinary issues, water infections, vaginal atrophy, no energy, deficient motivation, it affects cognition. It affects everything in the body. Everything aches. You can tell when it is slipping. It’s really difficult.
‘But the hardest part is the stress I get from not knowing if I can get my prescription. I have quite a bit of anger and anxiety. And I’m unable to relax. I don’t need all of this. Stress exacerbates the symptoms – particularly around mental health and brain health.
‘Women’s health is so poor in the UK. If it were blokes, we wouldn’t even be having this conversation. If women were put at the centre of women’s health, this would not happen. It is good to see the Government being put under some pressure about this.’
And, so far, the Government does seem to be taking action. It set up the UK Menopause Taskforce in February to improve support for women, and last month the Health Secretary Sajid Javid announced that a HRT tsar would be appointed to fix shortages.
GP Olivia Hum, a member of the British Menopause Society, and private menopause specialist, recognises the difficulty so many women are facing – but says the medical profession does care.
She says: ‘It is really hard. Because when you’ve been struggling with mental health issues, or sleep, and you’ve suddenly got something that’s working for you, it’s absolutely terrifying thinking about being switched to something else.
‘But actually, a lot of the oestrogen-only patches which replace the Estrogel are still available. If you look on the British Menopause Society website, GPs can go and find equivalent doses. So it is about getting those equivalent doses right.’
Dr Hum advises calling around pharmacies to get the right treatment: ‘We are hearing of people getting the gel very occasionally. Don’t give up. There is Estrogel available – it is just about finding where it is.’
One woman had to call around 30 chemists before she got her prescription recently, according to Diane Danzebrink, founder of Menopause Support UK.
She set up the group after a hysterectomy plunged her into immediate surgical menopause. She didn’t get the treatment she needed, and fell ‘in to a very deep, dark place’ where, she says, she came very close to ending her own life.
‘We have seen an awful lot of distress and anxiety,’ explains Diane. People are really struggling with their daily lives, their work lives, their home lives and their relationships. For many people, not being able to get their HRT has quite a traumatic effect. We have women who have raided their savings to go to private menopause specialists so that they can get the HRT that they need. And the tragic thing about it is that we had shortages back in 2019. This should have been addressed then to ensure that it was never going to happen again.’
Diane warns people not to reduce their doses to try and preserve their supplies. She adds: ‘That can mean their symptoms coming back. We know it’s really, really difficult. It might not be ideal, but there is still HRT in some shape or form in stock. It might not be what you would choose, but it’s better to have something, than nothing.’
The picture of women suffering with broken mental health for the want of HRT is prevalent. So many are given prescriptions for anti-anxiety and antidepressant medication when they first present their symptoms to doctors, which do nothing long term to affect hormone levels.
This is a topic under discussion once a month in East Ayrshire, when a group of women meet in a community hall with tea and biscuits. Many of them were prescribed anti-depressants when they first approached their GP.
Among them is Lynn Roy, who was ‘fobbed off’ with pills for four years before realising that what she really needed was HRT.
‘For myself and these women finding out about other women’s experiences has been a real eye opener,’ says Lynn. ‘One woman reported that she had lost her relationship, job and friends and had only started joining the dots recently and realised that it was all due to her failing hormones. I was heartbroken to hear this, and so angry for her that she had been failed by healthcare professionals who treated her with all sorts of anti-depressants. She says she has lost ten years of her life.’
Credit manager Lynn, 51, has been on HRT for a year. The menopause began with anxiety and has culminated in forgetfulness, exhaustion and a complete decimation of her self esteem.
She says: ‘Everyday life started to get really hard. Family life was really intolerable. I’ve got a teenager and we were clashing all the time. I’ve got quite a high pressure job and I was finding it really to cope.’
She now uses Evarol and Utrogestan and feels a lot better, but she feels she’s only solved part of the problem, as she is dogged by fatigue and brain fog. So she requested testosterone from her GP in February, after doing a lot of research into its effects on mental symptoms. But she has been passed from pillar to post, and is now waiting for an appointment at the menopause clinic.
‘It just makes you feel like you’re bothering [doctors] with something that they don’t see as important,’ adds Lynn. ‘So we all kind of get on with it. There’s a sense that women have to go through menopause. That you should just suck it up and get on with it.
‘It’s been months of me feeling lost and frustrated now. It is a postcode lottery. So many women are having to fight.’
But not if they keep shouting about it. Women – who should be in their prime of life – aren’t going to put up with it anymore. Labour MP Carolyn Harris has taken on the role of menopause warrior, and, along with Davina, Penny Lancaster and Mariella Frostrup and hundreds of others, are standing up and being counted.
As Jen says: ‘Many women in their 50s are at the top of their game. But we’ve had to be silent for so long. This menopause revolution is a moment for us to say “Yes. We are here. This is flipping hard. And somebody needs to sort this out.”’
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