• One in seven women will develop breast cancer during their lifetime
• Some treatments for breast cancer can lead to menopause
• Advice on menopause treatment options if you have a history of breast cancer

If you’ve had breast cancer and are wondering what your treatment options are for menopausal symptoms and future health, this guide is for you. It has been written by healthcare professionals and includes contributions from women affected by breast cancer.

Breast cancer and hormones

Breast cancer is the second most common type of cancer in the UK: about one in seven women will develop the disease over their lifetime [1].

Breast cancer is a complex disease, and there are many different types, and the role of oestrogen in the disease is still poorly understood.

When cancerous cells are examined after a biopsy or surgery, it’s established whether or not they have receptors for oestrogen. If they do, it’s known as oestrogen-receptor-positive (ER-positive) breast cancer; if they don’t, it’s ER-negative. This is important when it comes to deciding on treatments for menopause symptoms: knowing whether your cancer was ER positive or negative may influence your decision about taking HRT or not.

All cells in your body have oestrogen receptors on them, so having an ER-positive breast cancer does not mean that oestrogen has caused breast cancer.

RELATED: Dr Corinne Menn: I’m a doctor who’s had breast cancer: here’s what I want you to know

Menopause explained

The usual definition of menopause is a year after a woman’s last menstrual period.

Menopause is related to a decline of the hormones oestrogen, progesterone and testosterone, which are produced in the ovaries and also other organs and tissues, including your brain.

Hormones work as chemical messengers throughout your entire body – reaching and having an effect on every single cell. The hormones oestradiol (the beneficial type of oestrogen), progesterone and testosterone have been shown to improve thousands of cellular actions which then improves function of your body systems and organs. In particular, they have many beneficial actions on bone, brain, circulation, urinary, genital and nervous systems.

When might menopause happen for me?

The average age a woman in the UK experiences menopause is 51 [2]. However, it can occur earlier or later than this – health conditions, genetics, ethnicity and your social economic background can influence the age you experience it, as well as treatment for cancer.

Your menopause may occur at a younger age as some treatments for cancer, such as chemotherapy or radiotherapy, affect ovarian function resulting in hormones levels reducing. This might be a permanent or temporary menopause depending on the type of treatment you have.

RELATED: Surgical and chemical menopause

What kind of symptoms can menopause bring?

Common symptoms of menopause include:

• Night sweats
• Hot flushes
• Mood changes
• Memory problems
• Fatigue and poor sleep
• Brain fog
• Loss of interest in sex or relationships
• Joint pains and muscle aches
• Hair and skin changes
• Worsening migraines and headaches
• Vaginal and urinary symptoms.

It can be difficult to know which symptoms are due to side effects of treatment for cancer, and which are menopausal symptoms.

RELATED: Surprising menopause symptoms

Spotlight on aromatase inhibitors, tamoxifen and menopause symptoms

Tamoxifen is a type of hormone therapy used for the prevention and treatment of breast cancer. It is a selective oestrogen receptor modulator (SERM), which means it blocks oestrogen on some cells, including in the breast, but not on others.

Aromatase inhibitors are a type of hormone therapy used to treat breast cancer in post-menopausal women whose ovaries are no longer producing oestrogen. Sometimes they are used in those who are pre-menopausal, but usually only if their ovaries are ‘switched off’, which is usually done with a hormone injection. The purpose of taking aromatase inhibitors is to prevent the production of oestrogen anywhere in your body.

If you are taking an aromatase inhibitor and experiencing severe menopause symptoms or side effects, you could talk to your breast specialist about the possibility of either stopping your medication for a few weeks to see if this improves your symptoms or taking tamoxifen or another alternative treatment.

RELATED: Podcast: breast cancer treatment and HRT

How can I mange my menopause?

Every woman’s experience of menopause is different and your decisions regarding menopause treatment may change over time.

Your menopause may be temporary due to one of your treatments, for example if you are taking an aromatase inhibitor, or it may be permanent, for example if you have had your ovaries removed or you are at the age of menopause.

Optimal menopause care involves both improving symptoms and safeguarding your future health. Lifestyle changes such as optimising your nutrition, exercise and wellbeing are key, though this can of course be challenging if you are struggling with menopause symptoms or side effects of your cancer treatment.

Here are some lifestyle strategies that can be beneficial:

Keep active

Movement and exercise are important for your general health and also help to keep your bones and heart strong. Ideally you should aim for a combination of activity that raises your heart rate but also impacts through your joints. If fatigue is still a factor, start with a gentle, lower impact activity such as walking, and gradually build up the duration and frequency you are active for. This can improve your emotional wellbeing too.

Make time for you

Spending time doing things you enjoy is beneficial for your mental health. Whether that is going for a walk, catching up with a friend, or spending some much-needed time by yourself enjoying a hobby. Learn to value time just for you.

Eat well – and cut out unhealthy habits

Foods that are beneficial include are those rich in calcium for your bones, friendly to the gut containing prebiotics and probiotics, carbohydrates that have a low glycaemic index (GI) and are broken down more slowly, and foods rich in omega 3 oils. Prioritise fresh fruit and vegetables and adequate protein, as well as trying to limit the amount of processed food you eat.

Some women find that alcohol, particularly red wine, triggers hot flushes and night sweats, though the evidence is mixed in this regard [3,4].

Smoking can worsen hot flushes [5] and increases your risk of developing more than 50 serious health conditions including many types of cancer, heart and blood vessel diseases, and conditions affecting your breathing and lungs [6].

How might the menopause affect my future?

After menopause, your levels of the hormones oestradiol, progesterone and testosterone will remain low forever, unless you take hormone replacement therapy (HRT). Menopausal women have an increased risk of developing heart disease, osteoporosis, type 2 diabetes, clinical depression and dementia.

An earlier than expected menopause may also impact any plans you had to start or add to your family: if you’re struggling with an early menopause and prospect of infertility, The Daisy Network is a charity you may find useful. They have lots of helpful information on their website at www.daisynetwork.org about all these issues, including forums to chat with other young women facing similar issues.

Menopause treatments

Talking therapies

There is some evidence that cognitive behavioural therapy (CBT) can improve some symptoms and improve your quality of life. However, CBT will not improve future health and has not been shown to improve all menopausal symptoms.

Non-hormonal prescription medications

There are numerous preparations marketed for menopausal women either to buy or available on prescription. There is little evidence to support their use for many of them and many of these preparations have not been tested in studies on women who have had breast cancer.

Some types of medication, including gabapentin, pregabalin and antidepressants, such as venlaflaxine have been shown in some studies to improve hot flushes, night sweats and for some women, mood. However, they will not improve all symptoms nor improve future health and many women experience side effects with them. Fezolinetant is a new drug that has been approved to treat moderate to severe vasomotor symptoms in menopausal women. Fezolinetant does not treat other menopausal symptoms, and there is no long-term data regarding the impact of fezolinetant on cardiovascular and bone health, or breast cancer incidence. There are no studies involving women with breast cancer taking fezolinetant. The have been concerns about risks of liver disease and also cancer in some women taking this medication [7, 8].

RELATED: Fezolinetant explained

Hormone treatments

Hormone replacement therapy (HRT) is usually the first line treatment for the management of perimenopausal and menopausal symptoms [9]. There are systemic and local (vaginal) hormones – these have different effects, benefits and risks.

It is important to see a doctor who has clinical experience and knowledge both in managing women who have had breast cancer and menopause – often more than one clinician will be involved in your treatment decisions. It is essential that you are involved in all treatment decisions.

The type of hormones you need and the doses you’re given vary between each woman – it is not a ‘one type fits all’ prescription. HRT will usually contain oestradiol, progesterone and sometimes testosterone. These hormones are usually prescribed separately and it is important that you are given the right type and dose.

RELATED: Getting to the truth around HRT and breast cancer with Dr Avrum Bluming

Women are prescribed hormones to both improve their symptoms as well as their future health. HRT can include the following three hormones:

Oestradiol: this hormone is produced predominantly by your ovaries, but it is also made in your brain and other tissues. Levels fluctuate during perimenopause before declining in menopause and staying low for the rest of your life. Oestradiol helps to regulate your menstrual cycle, plays an important role in bone health, memory and cognition and cardiovascular health and is essential for many bodily functions.

Progesterone: if you still have your uterus (womb), taking oestrogen can cause the lining (endometrium) to thicken. To prevent this, you will usually need to take progesterone to keep the lining of your womb thin and regulate or stop bleeding. Progesterone can also relieve perimenopausal and menopausal symptoms such as sleeping problems, low mood and anxiety, and can be taken by women who have had a hysterectomy or use a Mirena coil as part of an individualised consultation for their symptom control.

Testosterone: this hormone is perhaps best known for improving libido, but you have testosterone receptors all over your body so the decline in levels can also lead to a loss of energy and brain fog, muscle and joint pains, low energy, poor sleep as well as other symptoms.

Can I take HRT if I have a history of breast cancer?

NICE guidance on early and locally advanced breast cancer states HRT should not be routinely offered women with menopausal symptoms and a history of breast cancer [10]. In exceptional circumstances, it adds, that HRT can be offered to women with severe menopausal symptoms and with whom the associated risks have been discussed.

Some women may choose to accept an increased risk of relapse in exchange for relief from menopausal symptoms and an improved quality of life, and that preferences may vary according to individual circumstances and the absolute risk of relapse, which is uncertain due to lack of solid evidence and research in this area.

The lack of evidence from prospective studies and randomised controlled trials highlights the importance of shared decision making in this highly complex area.

What does the research show about HRT in women who have had breast cancer?

The research that has been undertaken regarding taking HRT after breast cancer shows conflicting results: many studies are of poor quality and so the results are difficult to interpret properly. In addition, the studies have often involved older formulations of HRT to the types often prescribed now.

Since 1980, there have been 26 studies published on this area (25 studies have shown no increased risk and 5 showed benefit; 4 reported decreased mortality) [11,12]. Only one, the Hormone Replacement After Breast Cancer – Is It Safe? (HABITS) trial, reported an increased risk of local recurrence, but not metastatic disease or breast cancer death [13]. This study also used older and synthetic types of HRT.

There is a lack of robust evidence on giving HRT and testosterone to women who have had a past history of breast cancer and their risk of recurrence. There is some evidence that testosterone may be beneficial for women who have had breast cancer [14]. However, some women chose to take HRT and/or testosterone as their quality of life is suffering without it. They are also keen to obtain the future health benefits of taking natural, body identical HRT, as women who take HRT have a lower future risk of osteoporosis, diabetes, coronary heart disease, clinical depression, dementia and also some cancers [15].

What is key is that all treatment decisions are based on your individual circumstances, and if you decide you may want to take hormonal treatment, this should be a shared decision-making process with you and your healthcare team.

There are different types and doses of hormones. Testosterone has been shown in some studies to be beneficial to women who have had breast cancer, including those women who are also taking an aromatase inhibitor [16,17].  

Hormones used in HRT are much lower that the doses of hormones in contraceptives and they are also natural (they are synthetic in all contraceptives) – so the same chemical structure as the hormones you produce when you are younger. They are also short acting in your body, so do not build up with time.

Some women decide to take HRT for a few months and then assess how they are feeling and how many of their symptoms improve. They feel reassured knowing that they can stop taking HRT at any time and the hormones will all be out of their body within a day of stopping them.

What are the risks of systemic HRT if I’ve had breast cancer?

It is not possible to quantify risks as they vary between different people and are likely to be different for different types of breast cancer in the past too. If you have had breast cancer, your healthcare team should explain any potential individual risks when it comes to taking HRT, so you can weigh up the pros and cons of any decisions around possible treatment.

It’s important you are informed about benefits and any potential risks and how treatment might impact your quality of life and future health, so you have enough information make an informed decision.

Ductal Carcinoma in Situ (DCIS) and Lobular Carcinoma in Situ (LCIS)

It is unlikely that women taking HRT after DCIS and LCIS have increased risks, however studies have not been undertaken in this area.

ER-negative breast cancer

If you have had an ER-negative breast cancer in the past, then some women consider taking HRT as this cancer does not have receptors for oestrogen in it and so taking HRT is unlikely to be detrimental to future health or risk. 

ER-positive breast cancer

If you have ER-positive breast cancer, you should talk to healthcare professionals who are experts in treating people for the menopause after breast cancer – it’s usually advisable to talk to a menopause specialist, as well as a breast specialist oncologist to talk about your individual circumstances.

HRT and aromatase inhibitors and tamoxifen

Tamoxifen works differently in different women and does not block oestrogen throughout your body. Research has shown that some women who take tamoxifen actually have more oestradiol in their bodies than women who do not take tamoxifen [18]. Some women take HRT with tamoxifen with benefit to both their symptoms and their future health.

Taking HRT containing oestrogen will not usually have any benefit to your symptoms if you are taking an aromatase inhibitor. However, some women take testosterone with their aromatase inhibitor with beneficial effects to their symptoms and possibly their future health [19].

Spotlight on vaginal hormones

Vaginal hormones, also known as local hormones, are different to HRT as they are very low dose and do not get absorbed into your body. They can usually safely be prescribed for women who have had any type of breast cancer [20,21,22,23].

Vaginal hormones can improve symptoms of vaginal dryness, soreness, irritation, pain as well as improve urinary symptoms such as cystitis, recurrent urinary tract infections, increased frequency of passing urine, incontinence and urgency.

They can be given as an oestrogen pessary, vaginal tablet, gel, cream or ring, or as a daily pessary called prasterone. The prasterone pessary contains a hormone called dehydroepiandrosterone (DHEA), which converts to both oestrogen and testosterone in the vagina and surrounding tissues. Vaginal hormones can often be beneficial in women who take aromatase inhibitors or tamoxifen [24].

Managing vaginal and urinary symptoms

Whether you use vaginal hormones or not, if you are experiencing localised symptoms then you may find the following measures help:

• Avoid using soap, shower gels, deodorants, or ‘intimate’ products, and try a gentle emollient wash instead
• Panty liners, spermicides and many brands of lubricants can contain irritants which can make symptoms worse
• Tight-fitting clothing and long-term use of sanitary pads or synthetic materials can also worsen symptoms
• Vaginal moisturisers such as YES VM, Sylk Intimate, or Regelle can help hydrate your tissues and reduce soreness and discomfort throughout the day
• Specialist lubricants for when having sex, such as Sylk, YES OB or YES WB can ease discomfort and make the experience more enjoyable. If you’re using a barrier method of contraception, water-based lubricants are usually best.

Speaking to your healthcare team about managing your menopause

You should be able to make decisions about treatment with your doctor or other healthcare professional. Guidelines from the General Medical Council and recommendations from NICE show how decisions should be made between a patient and doctor and specify that a shared decision-making process should be used.

This involves:

• Encouraging you, the patient, to take an active role in making decisions about their treatment

• Taking into account what is most important to the patient, their expressed needs and priorities and treatment options are explained in light of these

• Open discussion of the risks, benefits, and consequences of each treatment option, including doing nothing, with the acceptance that the patient’s views can differ to the professional’s

• Allow time to answer questions and time to make decisions, making it clear that the patient can change their mind down the line

• Come to a joint decision that is satisfactory to you, the patient.

Here are some other strategies that can help menopause conversations with your healthcare team.

Be your own advocate: being informed means about symptoms and treatment options allows you to be more involved in treatment choices that are right for you – just ensure you uses reputable sources

Keep a record of your symptoms: recording the range, frequency and severity of menopause symptoms helps to build a picture for your healthcare team – the balance menopause support app has a free symptom diary.  You can also use these tools to measure any improvement in your symptoms once you start a treatment.

Plan ahead for your appointment: you might want to ask for a double appointment. Write comments or questions down beforehand and inform your healthcare professional what you want to discuss in advance: this ensures you get the most out of your consultation and gives them an opportunity to do their own research.

Also remember that if you do not get the desired outcome at the first appointment, you do have a right to ask for a second opinion. You can ask to see another clinician within your practice or for a referral to an NHS menopause specialist clinic in your area. Another option is having an appointment with a private menopause specialist.

RELATED: How to talk to your doctor about HRT – and get results

Real life stories from women who have had breast cancer

Caroline went through breast cancer, surgery and chemotherapy and became menopausal when she was 39. She says of her experience:

‘In hindsight, much of my anxiety around taking HRT was due to the symptomatic effects of the menopause. I couldn’t think straight and needed time, the right information and guidance. In the end, small steps worked. Since going on HRT, my anxiety has dramatically reduced, and I can make clearer decisions that are driven by logic rather than fear’

Mel decided to try vaginal oestrogen several years after her breast cancer treatment finished. She says:

‘I recently made the decision to start using vaginal oestrogen. Enough was enough. My symptoms were so severe and worsening, and it was really impacting on my quality of life. For me, it has been a great decision and it has made a huge difference.

However, I don’t regret not making the decision earlier, as I believe you have to make each decision in life based on the information available and how you feel at the time – you can’t look back with regret.

My point is, things can change, the balance can be tipped and that’s ok. The most important thing is being comfortable that it is the right decision for you. I can truly understand why women who have had breast cancer may choose to either have or not have hormones, either vaginally or systemically. But they should have the opportunity to make an informed choice, and most importantly, be at peace with that choice.’

Further resources and recommended reading

 National Institute for Health and Care Excellence (NICE) (2024)  ‘Menopause: Identification and management’

NICE (2024) ‘Early and locally advanced breast cancer: diagnosis and management’

Avrum Bluming ‘Oestrogen Matters’. Published by Piaktus, London.

British Society of Sexual Medicine, ‘Position Statement for Management of Genitourinary Syndrome of the Menopause (GSM)’

References

1. Cancer Research UK, ‘Breast cancer statistics’

2. National institute for Health and Care Excellence (NICE) (2024), ‘Menopause: what is it?’

3. Sievert, L. L., Obermeyer, C. M., Price, K. (2006). ‘Determinants of hot flashes and night sweats’, Annals of Human Biology, 33(1), pp.4–16. doi.org/10.1080/03014460500421338

4. Schilling C., Gallicchio L., Miller S.R., Langenberg P., Zacur H., Flaws J.A. (2007), ‘Current alcohol use, hormone levels, and hot flashes in midlife women’, Fertility and Sterility, 87 (6), pp.1483-6. doi: 10.1016/j.fertnstert.2006.11.033

5. Butts S.F, et al (2012), ‘Joint effects of smoking and gene variants involved in sex steroid metabolism on hot flashes in late reproductive-age women’, The Journal of Clinical Endocrinology and Metabolism, 97 (6), E1032–E42, doi.org/10.1210/jc.2011-2216

6. NHS.uk (2018), ‘What are the health risks of smoking?’, www.nhs.uk/common-health-questions/lifestyle/what-are-the-health-risks-of-smoking

7. Douxfils J., Beaudart C., Dogne J.M. (2023), ‘Risk of neoplasm with the neurokinin 3 receptor antagonist fezolinetant’, Lancet, 402(10413):1623-5. doi.org/10.1016/S0140-6736(23)01634-3

8. Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012–. Fezolinetant. 2024 Oct 10. PMID: 39441946

9. National Institute for Health and Care Excellence (NICE) (2024) ‘Menopause: identification and management’

10. NICE (2018), ‘Early and locally advanced breast cancer: diagnosis and management’

11. Cold, S, Cold, F, Jensen, M, Cronin-Fenton,D, Christiansen, P, Ejlertsen, (2022), ‘Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study’, JNCI: Journal of the National Cancer Institute, doi.org/10.1093/jnci/djac112

12. Bluming, A, (2022) ‘Hormone replacement therapy after breast cancer: it is time’, The Cancer Journal, 28 (3), pp. 183-90, doi: 10.1097/PPO.0000000000000595

13. Holmberg L, Anderson H, (2004), ‘HABITS steering and data monitoring committees. HABITS (hormonal replacement therapy after breast cancer–is it safe?), a randomised comparison: trial stopped’, Lancet, 7;363(9407) pp.453-5. doi: 10.1016/S0140-6736(04)15493-7. PMID: 14962527.

14. Glaser R.L., York A.E., Dimitrakakis C. (2019), ‘Incidence of invasive breast cancer in women treated with testosterone implants: a prospective 10-year cohort study’, BMC Cancer, 19(1):1271. doi: 10.1186/s12885-019-6457-8

15. Gambacciani, M., Cagnacci, A., Lello, S. (2019), ‘Hormone replacement therapy and prevention of chronic conditions’, Climacteric, 22(3), 303–306. doi.org/10.1080/13697137.2018.1551347

16. Glaser R.L., Dimitrakakis C. (2013), ‘Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole: a prospective, observational study’, Maturitas, 76(4):342-9. doi: 10.1016/j.maturitas.2013.08.002

17. Glaser R., Dimitrakakis C. (2015), ‘Testosterone and breast cancer prevention’, Maturitas, 82(3):291-5. doi: 10.1016/j.maturitas.2015.06.002

18. Berliere M. et al. (2013), ‘Tamoxifen and ovarian function’, PLoS One. doi: 10.1371/journal.pone.0066616

19. Glaser R., Dimitrakakis C. (2015), ‘Testosterone and breast cancer prevention’, Maturitas, 82(3):291-5. doi: 10.1016/j.maturitas.2015.06.002. Epub 2015 Jun 24. PMID: 26160683.

20. Agrawal P. et al. (2023), ‘Safety of vaginal estrogen therapy for genitourinary syndrome of menopause in women with a history of breast cancer’, Obstet Gynecol,142(3):660-668. doi: 10.1097/AOG.0000000000005294

21. McVicker L. et al (2024), ‘Vaginal estrogen therapy use and survival in females with breast cancer’, JAMA Oncol, 10(1):103-108. doi: 10.1001/jamaoncol.2023.4508

22. The 2022 hormone therapy position statement of the North American Menopause Society advisory panel (2022), ‘the 2022 hormone therapy position statement of The North American Menopause Society’, Menopause, 29(7):767-794. doi: 10.1097/GME.0000000000002028

23. Hussain I., Talaulikar V.S. (2023), ‘A systematic review of randomised clinical trials – the safety of vaginal hormones and selective estrogen receptor modulators for the treatment of genitourinary menopausal symptoms in breast cancer survivors’, Post Reprod Health, 29(4):222-231. doi: 10.1177/20533691231208473

24. Mension E. et al (2022), ‘Safety of prasterone in breast cancer survivors treated with aromatase inhibitors: the VIBRA pilot study’, Climacteric, 25(5):476-482. doi: 10.1080/13697137.2022.2050208

The post A guide to menopause if you’ve had breast cancer appeared first on Balance Menopause & Hormones.

Joining Dr Louise Newson on this week’s podcast is Suzie Aries, who shares her story of menopause following treatment for a rare and aggressive ovarian cancer in her 20s.

Suzie talks about her cancer diagnosis and treatment, including raising £250,000 to fund treatment not available on the NHS. She also shares the realities of menopause at a young age, how HRT has helped her menopause symptoms, and why she takes HRT for her future health.

Finally, Suzie offers advice for women on how to advocate for themselves during healthcare consultations, and why being knowledgeable, confident and curious is key.

You can follow Suzie on Instagram @suzieclair11 and find out more about her story via her Facebook page Suzie Aries: kicking cancer’s butt.

Click here to find out more about Newson Health.

Transcript

Dr Louise Newson: [00:00:11] Hello. I’m Dr. Louise Newson. I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So on my podcast today, I’ve got someone called Suzie who doesn’t look like the average menopausal woman that you Google who’s got grey hair with a fan, who’s middle aged or even in her late 50s. So Suzie is young and she’s going to share her story, which I hope will help to educate and reassure many people. So thanks for joining me today, Suzie. [00:01:23][72.9]

Suzie Aries: [00:01:24] No problem. Yeah, happy to be here. [00:01:26][1.3]

Dr Louise Newson: [00:01:27] So just tell me a bit about you and the age that you were when you became perimenopausal, menopausal, when your hormone levels changed. [00:01:35][8.8]

Suzie Aries: [00:01:37] It was probably about, so I’m 32 now, and it was probably three or four years ago that I noticed a big change in my hormone levels, in my energy levels, getting their hot flushes and all of those kinds of symptoms. That, well I suppose show that you might be menopausal. But for me, it was something that I probably expected because I’d gone through a lot of cancer treatment. I was diagnosed with ovarian cancer when I was 25, so I’d gone through a lot of cancer treatments, chemotherapy, surgeries, various different things. And finally, I was told that the last kind of option was to have full abdominal radiotherapy. And so that was kind of the point where I thought, okay, that’s my, I suppose my fertility journey is ended here. And I suppose I knew I’d go menopausal, but I didn’t expect it to happen in the way that it did, really. [00:02:37][60.5]

Dr Louise Newson: [00:02:37] So yeah, so 25 diagnosed with cancer of the ovaries is not very common, is it? [00:02:43][5.6]

Suzie Aries: [00:02:45] No, no. It’s incredibly rare. I, hindsight is that I had all of the symptoms for it, but I had no idea of them at the time. And I it wasn’t something that was on my radar. I don’t think it’s something that’s on anybody’s radar when they’re 25, I was trying to make ends meet as an actor at the time and, you know, working my day job and then trying to do my dance rehearsals and things in the evening, it’s just, it was a lot. And and then I was feeling really fatigued. I was feeling bloated. I needed to go to the toilet all the time. I felt like an old woman going back and forth to the toilet when I was trying to sleep. And you know, all of the symptoms were there. And then I got the diagnosis and it was a massive life changing experience from there really. [00:03:32][47.0]

Dr Louise Newson: [00:03:34] So was that picked up on a scan? [00:03:35][1.1]

Suzie Aries: [00:03:36] Well, actually, I have to admit, there are a lot of other people that would have a different story. But I cannot thank the NHS enough for my diagnosis because, well, I suppose my, not even my GP. It was a nurse practitioner at my doctor’s who I ended up going to see when I was feeling really poorly and I was explaining to her the symptoms I was having and, you know, tenderness in my tummy and all these kinds of things. And she immediately noted those symptoms as what they potentially were. Even for someone at my age, I’ve heard so many other stories of young people that have been diagnosed with cancer very late because they’ve been turned away and said, well, no it couldn’t possibly be this. I mean, she said, worst case scenario, it could be cancer. And that’s exactly what it was in the end. So I absolutely have her to thank for getting me on that journey very, very quickly, because by the time I was diagnosed, I was probably stage 3 or 4, which for most people is not good at all in terms of prognosis. But somehow I manage to still be here. So thank goodness for that. [00:04:44][68.3]

Dr Louise Newson: [00:04:45] Which is wonderful. But obviously the treatment that you’ve had has stopped your ovaries working and our hormones, a lot of our hormones are produced in our ovary, but as many listeners know, also produced elsewhere. But without your ovaries, whether they’re removed or they’ve had chemotherapy or radiotherapy or damaged in some way, then people do become menopausal. But in a lot of women I speak to who’ve had cancer treatments for different types of cancer that have had treatments that have affected the way their ovaries work, especially when they’re young, the concentration has been on fertility. Menopause might have been mentioned, but there are two things that concern me, and I don’t know whether it was mentioned to you. One is the symptoms, because symptoms can really affect people in so many different ways. But also as a physician, the future health risks of not having hormones is something that I don’t hear spoken about enough. And I understand in the crisis time, the most important thing is to focus on the cancer. Absolutely right. But and the big but is we need to think about after the cancer, beyond the cancer, because hopefully, as you’ve proven, prognosis outlook can be very good. And you’re young, you’re only in your early 30s. So it’s that future health benefits of having hormones that I worry that isn’t discussed enough. So I don’t know was it discussed much with you at all, Suzie? [00:06:09][84.4]

Suzie Aries: [00:06:10] Well, I mean, the only people that spoke to me about my future health was you guys. When I spoke to one of your lovely doctors. I at the time of when I, you know, started speaking to gynaecologists and kind of menopause doctors within the NHS, they just looked to me like I was anybody else going through this, which I really am not. I am a lot, lot younger than most people that do go through this, which means that my hormone levels need to be higher and not just to kind of sort out the symptoms like hot flushes and things like that, but also for the future. As you say, I don’t want there to be a problem in the future where I, I don’t know, as you say, you can get heart disease if your hormones aren’t right, you’re at higher risk of getting dementia if your hormones aren’t right. And I don’t want that to happen. Obviously, I want to try and live as long and as healthier a life as I possibly can. [00:07:10][59.6]

Dr Louise Newson: [00:07:11] Yeah. And it’s really, it can be very confusing for lots of people because actually even if you look at the insert for HRT, I don’t know if you’ve ever done it for your hormones and it will say risk of ovarian cancer. And that’s actually come from a study, an observational study that was done quite a few years ago, but it was using older types of synthetic hormones. And even then, the risk is probably not there. It’s so small. But when it’s observational, it’s not really good data. But we don’t use those types of hormones. We’re just using natural. We’re just replacing like for like. And so we know the hormones are very anti-inflammatory. They’re likely to reduce any inflammation, any cancers going forwards as well. But if, when we don’t have really robust evidence, certainly in my clinical practice is we share uncertainty with patients and we say there may or may not be risks, but we know that there are benefits and it’s up to that individual. But if you haven’t had that conversation with anyone and haven’t been allowed to have a choice, then you’re very much left on your own, aren’t you? [00:08:10][59.6]

Suzie Aries: [00:08:11] Well, yeah, absolutely. And it was only I think it was when I spoke to you guys or I questioned about the risk of cancer returning based on having HRT, because that’s one of the things that the doctors say to you is that if you take too much of this HRT, your risk of getting cancer. And one of the biggest kind of takeaways that I’ve had from you guys is that actually I think it was someone said there was no, the risk of getting cancer was no higher than that of getting cancer when you are older anyway. [00:08:44][32.8]

Dr Louise Newson: [00:08:45] Yes. So people are still going to have a risk, but that doesn’t mean it’s related to the hormones. And I think that’s really important because there will be people that will get recurrances, that will have a new cancer on HRT, but there will also be people that will trip down the stairs or, you know, fall over and that’s not related to their HRT. So but because I think everyone is so scared, if something negative happens, it’s easier to blame the HRT. But the problem is all hormones have been grouped together as evil, whereas our own natural hormones, you know, you’re designed in your 30s to have hormones and they’re very beneficial for your future health. So to have them taken away and not replaced without good reason could affect your future health and day to day functioning if you were getting symptoms as well, which it sounds like you were. [00:09:35][49.3]

Suzie Aries: [00:09:36] Yeah, absolutely. And interestingly, I work as a sign language interpreter, which means that you need to have your processing there. You need to be able to process information from one language to another. And if you’re suffering with brain fog, like I know a lot of women do when they’re menopausal, that processing becomes that much harder and it’s already hard anyway. I was working with a lady who was struggling to do her job and she said, yes, I’m in the menopause, I’ve got brain fog. And in my head I was going so Why are you not doing anything about it? This is your job and it’s starting to affect your job. And she’s probably freelance like most interpreters are. And so there’s no way that, you can’t, like, take a day or there’s no policy, there’s no menopause policy to protect her if she’s free;ance. So, that really hit me bad because I went, gosh, okay, well, if that was happened to me, I’m a new interpreter. I can’t, I don’t want to blame anything on the menopause, especially when there’s something you can do about it. [00:10:38][62.8]

Dr Louise Newson: [00:10:39] Yeah, and that’s so important, Suzie, because we know the conmmonist symptoms are those affecting our brains. Because our hormones work in our brain, as you know, but especially memory processing and cognition, but even, you know, our mood as well. So a lot of people feel quite flat. They feel quite joyless, they have less motivation and they’re more tired. But we know that actually the way our brain works is really crucial for the way we function, especially in our work. And if you have a job where you need your brain to work very quickly and process things very quickly, and you’ve been used to having that, when it’s taken away from you, it can be very difficult. And for so long we’ve forgotten that our hormones have a role in our brain because it’s been about flushes, it’s been about fertility, it’s been about periods. But actually, you’re absolutely right, because so many people are giving up their jobs or reducing their hours or taking different jobs, often at lower pay, because they can’t function at the level that they’re used to. And we see it time and time again. And it’s very sad when they think, well, that’s just my lot. That’s just because I’m menopausal, without having those hormones back, because we know they improve the connectivity of the neurones in the brain, they help the brain to function. We’ve known this for many years. It nearly a hundred years we’ve known the effect on the brain, but it’s been ignored. And I can’t quite understand why. [00:12:06][86.7]

Suzie Aries: [00:12:06] So one of the jobs that I did as an interpreter, of course, I adhere to a code of ethics and you have to remain impartial is one of them and interpret as accurately as you can and this, that and the other. And it was a GP appointment and I go to GP appointment and this woman is reeling off what I know to be menopausal symptoms. Of course she doesn’t know that. And the GP kind of says, okay, how old are you? Let’s have a look at how old you are. Okay. You’re this old, right? That’s probably a box ticked. It could be menopausal symptoms and. Okay, well, I think we could try some HRT, But, you know, I do have to warn you that, you know, there’s this, that and the other, and that’s the risk of cancer in there’s. And I was there interpreting this information to this person through gritted teeth going I, I just I can’t say anything, you know, because this is a medical professional, but I know this to not be the case. So it was a bit of a tough ethical moment for me I think, having knowing what I know about HRT and the menopause and then having to give what I thought was incorrect information to this person with very you know, you must be cautious. And after a month they said, I think they said after a month, if your symptoms don’t go away, I think we should probably stop. And again, I was going, no, that’s not long enough. [00:13:26][80.1]

Dr Louise Newson: [00:13:27] So did you say anything at the end to that doctor? [00:13:30][2.7]

Suzie Aries: [00:13:32] I didn’t feel I had the place to. But I think if it were to happen again, I probably would. Actually, I take that back. I actually said it’s worth looking on Newson Health if you want to get up to date, accurate information. They have a lot of information on there. I think I signposted to you guys because I know that you are the best, you’re kind of a specialist at it. But yeah, that was a bizarre, a bizarre situation to be in. [00:13:56][24.2]

Dr Louise Newson: [00:13:57] Absolutely. And it is very difficult for people because they’re told different things. And every day in the clinic we see and speak to women who have been told different information. And there is confusion because of this, lumping all the hormones together, thinking they’re all the same and metabolically biologically, they’re very, very different in our bodies. And our own natural hormones, of course, are not made to be detrimental because of course they’re not. We’ve got hundreds of hormones in our body and they work very well and especially when people are younger. I did some work with NHS England a while ago. It was a big national programme for menopause and they said that they were going to focus on women over the age of 51. And I actually put my hand up and said, Actually, if you’ve got limited budget, I would focus on the one in 30 women who are under the age of 40 who have an earlier menopause. And they said, well, it’s not common enough, Louise, to worry about. And actually, I sort of thought, but I kept my mouth shut because I often get, you know, misinterpreted sometimes. But actually it is common enough. One in 30. So in your average class at school, that’s one child or, you know, it depends if they’re mixed classes of course, there might be one in every two classes, but that’s a lot of people that will grow up and become menopausal at an early age. Far more common than other conditions. But the health risks associated with it are huge and we know from some studies that women who have an early menopause don’t have typical symptoms so a lot don’t have flushes or sweats, but they still have these low hormones. And so we should be more proactive as health care professionals. We should be going in to companies and organisations and talking about hormonal health, because a lot of people, if it happens without having something like cancer treatment, it can be more gradual. But there are signs there. They might have had worsening PMS or worsening PMDD. They might have skipped a few periods, they might know that they’ve got a condition that might increase their risk of having an earlier menopause or they might have lots of family members that have had early menopause as well. So we need to be really proactive in picking these people up to reduce suffering, but to improve future health. Because if you don’t have your hormones at a young age, you’re more likely to drain the NHS at an older age because you’re more likely to have more conditions. So it is cost effective, but it doesn’t sound very exciting. And I know when I was a junior doctor, someone said to me, If someone comes in, Louise, who hasn’t had their period and young, just make sure she’s not pregnant. That’s all you need to do. So I hate to admit, but for many years that’s all I did, because I didn’t even think about women who are young menopausal because no one had taught me. So I’m making up for it now. But there will be other doctors who will have been taught by the same people and my age who won’t be thinking. So how do you think we can get more information out? And how do we empower clinicians when we’re the patients? Because as you say, even just interpreting, you can feel quite threatened when you’re, not threatened, but quite, it’s difficult when you’re, I’m talking now as a patient, but when I go and see a doctor, I know their time’s precious. I feel a bit nervous. I take every word they say very literally, and it’s very difficult to have a discussion depending on the doctor, especially if they’re very closed and quick in their consultation process. Some doctors are very open and reflect and say, What do you think? Are you happy with that? Is there anything you want to ask? And then it makes it easier for you. But I do feel as patients, we have to be our own advocates. Many people know I can’t get the dose and type of hormone I’m on on the NHS and I’ve given up trying, but it’s still very difficult. But how do you think that we should be better advocates as patients? [00:17:48][230.5]

Suzie Aries: [00:17:50] I think from my own experience, and that’s including my cancer journey, I have been a huge advocate for myself. I don’t think I would have been had I not had my mum there with me. She advocated for me and we advocated for me together and throughout the whole thing. But I think it’s just it’s having the knowledge yourself rather than going in there with no idea. I think it’s that thing of empowering yourself with knowledge and getting the knowledge and kind of knowing the symptoms, knowing, you know, what’s wrong with you and getting the information about what potentially you need before you go in. Because otherwise you’re going to be sat there nodding your head at whatever this professional is telling you. And of course, they’re a professional. They’ve been through years and years of training, but they don’t have the, especially the GPs, the specific knowledge base to know what you need in this situation. And then it might take a year to be referred to someone who may well be a specialist, but is following these very specific guidelines which aren’t going to match you. And so I think is having that knowledge, but also being able to be quite assertive. In the deaf community, it would be this sign [signs]. It’s one of my favourite signs, I think. It’s that being confident and being assertive to back yourself when you’re speaking to someone and say, Well, for me, for a young person, I am not your usual. I’m not the most common person that has the menopause, but it’s just backing myself to know there’s something not right. And I don’t want this to bother me forever. I think it’s a mixture of those two things. Going in with knowledge and having the confidence to back yourself. [00:19:35][104.9]

Dr Louise Newson: [00:19:35] I think that’s so important because I know certainly with some of the treatments that you had for cancer, you had to really be your own advocate, didn’t you, and seek the right treatment for you? [00:19:46][10.7]

Suzie Aries: [00:19:47] Yeah, absolutely. There was one particular treatment wasn’t on the NHS for me, which was immunotherapy. I think it’s becoming more widely used now, but still not for my cancer. I mean, my cancer was incredibly rare anyway. It was a small cell ovarian cancer of the hypocalcaemic type. Bit of a mouthful, but that treatment wasn’t available on the NHS. There was a very small study of four women that had gone through radiotherapy plus immunotherapy as a combination, and three out of four of them had come out cancer free long term afterwards. And we just went, Well, that’s good enough for me, let’s give it a go. But the NHS were incredibly reluctant to do it. They did send off funding applications and things, but everything was turned down, so we had to fundraise £250,000 for it. But I mean, that’s where I start to believe in humanity again because I got, you know, video went viral. I had people from all over the world donating to me. And so it was incredible. It was, that was a case where the NHS were very reluctant or very sceptical about this treatment because there wasn’t 4,000 trials of it. There was four. But I think it was where both me and my mum went, This is the right thing to do, this is what we want to do. There’s what, what are the other options? We’d say to them. They didn’t have any other options and so we just pushed and pushed and pushed until they said yes. And I think that’s something that you also have to do for HRT and for menopause treatment. I’m actually now, having pushed a lot and having, as I said, used the knowledge that I’ve got from speaking to you guys and from my own body and my own experience, I’ve now managed to convince the NHS to fully prescribe my HRT for me now. The testosterone was only recently added and I’m absolutely thrilled about that, and that’s a large sum per year that I’m now not going to have to pay for. Well, hopefully not. [00:21:51][124.6]

Dr Louise Newson: [00:21:52] Which is wonderful. And a lot of people come to our clinic and increasingly GPs take over their care for their HRT, not always testosterone, but increasingly it is, which is so important because it’s very easy to get other drugs such as antidepressants or blood pressure drugs or statins or whatever. And they’re not even drugs, they’re just natural hormones really. We need to think very differently, change our language and think about the benefits. And actually, if you’re feeling well, which thankfully you are, if you’re healthy, which you also are, you’re less likely to go back to your GP, you’re less likely to be referred to the NHS. You’re saving money even though they’re spending money on HRT, which is actually quite cheap. So it is a cost effective thing. And when you’re young you know you’re going to be on HRT hopefully for decades, you know, for many years. So it should be available for you. It shouldn’t be something you have to come to a private clinic for. It doesn’t make sense, does it? [00:22:51][58.9]

Suzie Aries: [00:22:51] No. No, absolutely not. And I think most specifically, testosterone. I think that was the turning point where I started on a bit of progesterone and a bit of oestrogen. And then it was… It like got to the point where I was having enough oestrogen and I was feeling fine. But I’m a very sporty person and I was still feeling a bit unmotivated and a bit, just a bit lazy and not full of enough energy for myself to want to actually go out and do the exercises. And I think at the time, I think one of the big ones was that I just didn’t really want to have sex with my partner, which, you know, it’s not something you want as a 30 year old. You don’t want to just be there feeling like a cabbage. So and it was the testosterone that immediately well, not immediately. It took a little bit of time to work, obviously, but it just, that was the change. But then when I did initially ask the NHS, they were saying, no, no, it doesn’t fit in with our guidelines of anything. And I just went, I want to throw your guidelines out the window. Your guidelines are just this one size fits all thing, and that’s not the case here. But now they don’t. [00:24:01][69.8]

Dr Louise Newson: [00:24:02] Yeah. And I think that’s very important when we do mention guidelines, because there’s guidelines in everything that we do as healthcare professionals. But they are a guide. They help assist in a general population. But the thing is, is that we are all individuals. We have individual lives. We have individual choices. We have individual decisions about what risk or benefit we’re prepared to take. And we all have our own lives. But also we can make our minds up if we’re consenting adults. And we also have the ability to change our mind. So if you wanted or read something, you can stop your treatment, you can restart it. It is up to you as a individual. And what really saddens me with so much in hormone health is that that decision isn’t even there. It’s not allowed almost. It’s sort of felt like you really have to plead and justify to have something that could make a real difference to you. And if it doesn’t make a difference, then don’t continue. And but people often aren’t even able to start or like you say, optimise that dose because it can take a while to be on the right dose and type. And then that’s why it’s important like you say to see someone who’s really knowledgeable, but works together with the patient. You know, it’s not very rewarding as a doctor to be in a uni-directional relationship where you’re the person in control, you’re the person as a doctor who is basically telling the patient what to do. I do not like those consultations. Very different for my husband, who’s a surgeon. He has to be in control in the operating theatre. Very different. But actually, when it’s a consultation it’s a two way process and even for him, it’s a two way process when he’s deciding the operation. And often a patient might want one operation and he’ll advise something else and they talk it through. But somehow we’ve lost the ability to talk and share, especially when there’s uncertainty. And that’s a great shame. So it’s amazing that you’ve been such an advocate in so many ways. You know, hormone health is just one part, but you have been a huge advocate for your health and you’re living proof, how healthy you are now, aren’t you? [00:26:15][133.6]

Suzie Aries: [00:26:16] Yeah, yeah, absolutely. And I think there’s also well, I suppose on a slightly different note is that obviously women, I’m a woman in my 30s and I am on HRT and in the menopause, which is obviously, as we’ve already said, a unique situation. And I recently met my, who will now be my lifelong partner, the love of my life. And I knew the moment, it was probably it was like our second date or something. And I’ve been dating for, you know, a few months and hadn’t said anything to. I think I’d said something about it to one person who I thought, they seemed quite nice. And as soon as I mentioned it to them, they couldn’t run fast enough. Whereas as soon as I told my current partner, this is the situation. I can’t have children in a biological way. I’d like to have children in a different way. I do have to take HRT every day, you know, rub this gel on my legs, you know, and things like that. And he came back with the most amazing response to it. And he’s been nothing but supportive and kind and where a previous relationship where I’d started it, would always say, have you washed your hands, make sure, you’ve got to wash your hands afterwards. And of course I’d wash my hands afterwards. But it was that. It was almost like a punishment, which wasn’t particularly nice, whereas I’m just, I’m accepted for who I am. And I have to be honest, I get the odd, not brain fog, but the odd kind of like thing where my brain is a bit meh and I don’t know whether that’s just something that comes up every so often. Whether it’s the menopausal symptoms, I don’t know. But I’m given nothing but love for that and appreciation. And I think that’s one massive thing that’s helped me accept where I am, is that I am now with a person who accepts me for who I am, for the gel that I rub on my legs, for the tablets I take at night, and for the fact that we’re going to either adopt children or go surrogacy route and and we’re going to have a lovely family at some point in the future anyway. And so I think that has that has been a huge help to me, kind of on my journey is just being accepted for who I am now. [00:28:24][128.5]

Dr Louise Newson: [00:28:26] What a brilliant way to end being accepted for who you are. I think we all should think more about that. There’s so much I realise as I get older we can’t change about ourselves, so we just have to embrace and make the most of it. So I’m very grateful. But before we end, three take home tips and I think it should be three tips about how to be the best advocate for yourself for whatever treatment you want or you don’t want, you might be refusing treatment. So what are the three things that you’ve learned that you can share about being an advocate for health? [00:28:56][30.6]

Suzie Aries: [00:28:58] So firstly, as I said before, the gaining knowledge yourself, because you know, you’re an example of where there’s incredible knowledge there and resources that people can use to gain that knowledge before they go to an appointment. I think being confident and backing yourself with that knowledge. So I suppose those two come hand in hand. And I’ll add just off the top of my head probably being curious as well, rather than just kind of like taking your lot and just going, oh okay, well that’s going to happen. It’s that thing of, but what if, what if it could be better? What if life could be better? And what if I could feel better rather than just, oh I’m just going to have to feel like this now. I think it’s curiosity is another big one as well to just be curious as to whether things could be better, because they probably can be. Testosterone, you know, being that example for me. So those are my three. What wa it? Knowledge, confidence, curiosity. [00:29:55][57.2]

Dr Louise Newson: [00:29:57] Love it. Very good. Thank you ever so much, and keep going. [00:29:59][2.5]

Suzie Aries: [00:29:59] Thanks you much. Yeah, will do. Thank you. [00:30:02][2.4]

Dr Louise Newson: [00:30:07] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:30:07][0.0]

ENDS

The post Navigating menopause in my 30s after ovarian cancer: Suzie’s story appeared first on Balance Menopause & Hormones.

• Certain medications, such as those used to treat endometriosis and some types of cancer, can stop hormone production in your body
• Symptoms of a chemical menopause can be similar to those in menopause but usually start more suddenly and can be more severe
• Add-back HRT and testosterone can often be taken, which reduces menopausal symptoms and improves long-term health

What is a chemical menopause?

You may be familiar with the term surgical menopause – where an operation such as a hysterectomy or bilateral oophorectomy (removal of ovaries) induces menopause. A chemical menopause is another type of induced menopause caused by certain medications, including hormone blockers (it can also be known as a medical menopause).

These medications “switch off” your hormones, meaning that the production of hormones oestrogen, progesterone and testosterone is stopped or reduced. This is usually temporary while you are given the medication and is usually reversible after you stop having the medication.

RELATED: Surgical Menopause

Who experiences chemical menopause?

Chemical menopause can be induced by Gonadotropin-releasing hormone (GnRH) analogues. These are synthetic hormones that suppress the production of the hormones oestradiol, progesterone and testosterone. They’re usually given as injections or a nasal spray and brand names include Decapeptyl, Zoladex and Prostap.

GnRH analogues are sometimes prescribed to women with endometriosis, adenomyosis and fibroids. Oestrogen can worsen endometriosis in some women – GnRH analogues can suppress or reduce symptoms of endometriosis or adenomyosis, including pain.

GnRH analogues can also be prescribed to shrink fibroids, and can be used to treat PMDD if no other treatment has been effective, and also be part of some fertility treatment regimes.

Some women with oestrogen receptor positive breast cancer are given GnRH analogues as part of their treatment.

Other medications can also cause a chemical menopause, including some types of chemotherapy and some drugs for psychiatric disorders, such as quetiapine.

Women who undergo a chemical menopause are usually younger than those who experience a natural menopause. They may not be as aware of menopause and its implications, or have concerns around ageing and losing their sense of self. The impact of dealing with a health condition and its treatment, and then experiencing menopause, can be overwhelming so it’s important to know that advice and support is available.

RELATED: Endometriosis: I went through a medical menopause at 24

Postmenopausal women who experienced a natural menopause may still experience a chemical menopause due to medications. This is because your body will have been producing hormones (from your brain and other organs and tissues) after your menopause, but chemical medication blocks any hormone production, which can lead to symptoms.

What are the symptoms of chemical menopause?

The most common side effects of GnRH are due to the lowering of hormone levels (oestradiol, progesterone and testosterone) so resulting symptoms are similar to those experienced during menopause. This can include, but is not limited to, hot flushes and night sweats, joint and muscle aches and pains, low or changed mood such as anxiety, loss of libido, memory loss, genitourinary symptoms such as vaginal dryness and urinary tract infections.

Other side effects of GnRH therapies can include headaches, blood pressure changes, weight change and decreased bone density.

When women are without their natural hormones for a longer time, and at any earlier age, they have a higher risk of long-term health conditions, including osteoporosis and coronary heart disease.

RELATED: menopause symptom questionnaire

How can I treat my chemical menopause?

HRT (oestrogen, progesterone, testosterone) is the first-line treatment for menopausal symptoms for the majority of women. If you are prescribed GnRH analogues, hormone treatments are often prescribed at the same time to reduce side effects and menopausal symptoms. This is known as add-back hormone replacement therapy.

Add-back HRT is replacing the hormones that your body would have been producing naturally if they had not been suppressed by the GnRH analogues. If you are on GnRH analogues to treat endometriosis, it might seem strange to take oestrogen as part of add-back HRT but it’s a lower dose than what your body would create if ovulating – the dose is usually enough to alleviate symptoms but not stimulate endometriosis tissue growth. For some women, progesterone and testosterone are prescribed without oestrogen. It is important that add-back HRT is individualised to the right dose and type of hormones.

RELATED: endometriosis and HRT

Taking add-back HRT is also important to help protect your health – one side effect of GnRH analogues is loss of bone mineral content. Add-back therapy has been shown to reduce this loss [1] so is important in helping to prevent osteoporosis. Add-back HRT can also offer heart and brain protection.

Your healthcare professional will work with you to help determine other treatment and lifestyle options that can help alleviate symptoms. This might include reviewing your diet and exercise levels, offering vaginal hormones, advising on sleep and relaxation techniques, exploring cognitive behavioural therapy (CBT) to help improve emotions, etc. Help is available while you undergo a chemical menopause so be sure to seek it out.

RELATED: managing menopause beyond HRT

References

1. Wu, D., Hu, M., Hong, L. et al. (2014), ‘Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis’ Arch Gynecol Obstet. 290(3), pp513–523. Doi: 10.1007/s00404-014-3230-8

The post Chemical menopause: what is it and what can I expect? appeared first on Balance Menopause & Hormones.

Joining Dr Louise on this week’s podcast is Melanie Verwoerd, political analyst, former member of parliament for the South African ANC party under Nelson Mandela, and former South African ambassador to Ireland.

In this episode, Melanie shares her experience of radical hysterectomy, and her shock at just how little information is available to women before their operation. She tells Dr Louise how she is on a mission to close the information gap by chronicling her experiences in a book, Never Waste a Good Hysterectomy, followed by a podcast series of the same name.

Dr Louise also shares her own experience of a having a hysterectomy, and together with Melanie offers advice to women who are preparing for surgery on what to expect.

Click here to find out more about Newson Health.

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast, I’ve got someone called Melanie Verwoerd who actually is from South Africa. And I don’t think I’ve interviewed someone who’s been in South Africa before. So this is a first, Melanie. [00:01:11][60.7]

Melanie Verwoerd: [00:01:12] Oh, lovely. And hello from Cape Town. [00:01:14][1.9]

Melanie Verwoerd: [00:01:15] So you’ve reached out to me and you’ve written a book which we’ll talk about, but it’s about knowledge sharing. A lot of the work that I do, many people realise is about sharing information, sharing knowledge. So as individuals, we can decide what’s right for us. So tell us a bit about you and we’ll talk a bit more in, well, in a lot of detail about hysterectomy, the operation to remove a woman’s womb. So if you don’t mind just saying a bit more about you if that’s okay? [00:01:42][26.2]

Melanie Verwoerd: [00:01:42] Yeah. Thank you so much for having me. It’s lovely to speak to you and to all your listeners, and thank you for what you do for all us women all around the world. So I don’t come from a medical background, actually, I have a political background. I was a member of parliament in South Africa with Nelson Mandela, and between our transition, 1994 to 2001, I then became South Africa’s ambassador to Ireland. I did that for four and a half years, then became executive director of Unicef in Ireland and then came back. So my day job, I’m a political analyst and I also write for newspapers. But in the middle of 2021. So during the COVID time still, I went for a regular gynaecological check-up and during, you know, I was lying there on my back and the gynaecologist was doing an ultrasound and we were chatting away… You know how it is, you always talk as much as you can when you’re having a gynaecological examination just do not concentrate on what’s happening down there. And she suddenly went very quiet and just said, oh, what’s going on here? And then the whole atmosphere in the room changed. You know, it’s like, I think anybody who’s ever had bad news from a medical doctor knows what I’m talking about and said, look, can you quickly run up and go and have some blood tests done? And I said, sure, but what are you looking for? And she said, well, cancer, I can see a huge ovarian growth. And I mean, it really shocked me because I had zero symptoms and also had been perfectly well. And I have gone through gynaecological check-ups every year, and there was nothing the previous year. And then, yeah, then I got on this very fast moving train of medical tests and CT scans and seeing more specialists, and a week later, a radicalised hysterectomy, we can talk about the terminology of course, was performed. And that then put me on this whole journey which resulted in the book and eventually also in a podcast, because I realised just how many women go through this procedure. And yet there’s such a lack of information and support. [00:03:38][115.7]

Dr Louise Newson: [00:03:39] And how old were you when you had the operation, if you don’t mind me asking? [00:03:41][2.6]

Melanie Verwoerd: [00:03:42] Not at all. I was 54, so I was lucky in the sense that I had largely gone through menopause. In fact, the day that I went to the gynaecologist was a year after my last period. So I was officially you know in menopause. So in that sense, for me, having the ovaries removed, of course, there’s always still some latent hormones present, you know, and, and I did have, again, menopausal symptoms, you know, again flushed a bit and felt very down, which could have also just been the operation. But so I was lucky in the sense that I wasn’t put into surgical menopause. I think that is an additional nightmare on top of everything else when you get such a big operation. [00:04:21][39.0]

Dr Louise Newson: [00:04:22] Yeah. So so I mean, a hysterectomy is just removal of the womb. Which is what it is. But like you say, there are different types of hysterectomy actually. So a simple hysterectomy is literally just removing the womb. It can be done, there’s also a subtotal hysterectomy which means that the womb is removed but the cervix still remains. And 20 or so years ago it used to be very common operation because they thought that there was more stimulation, and certainly for penetrative sex, it was more pleasurable for the woman to keep the cervix. But actually there’s not really been good studies about that. And some people think that they’re more likely to have a prolapse if they don’t or do remove the cervix. But again, it’s not really so…so a few people, for various reasons, might still have their cervix remaining and have a subtotal hysterectomy. And that’s important to know obviously, because you want to know have you still got your cervix if you need to have cervical screening or whatever. So but essentially a simple hysterectomy is just removing the womb. And then we also often talk about TAH and BSO because in medicine we love having abbreviations, lots of letters in people’s notes. But that means total abdominal hysterectomy which means the operation’s through the tummy, there’s a cut in the tummy and removal of both ovaries. But that can also be done in a vaginal way as well. So quite a few people only have their womb removed. Some people have the womb and their ovaries moved. And then you had more removed didn’t you? [00:05:54][92.1]

Melanie Verwoerd: [00:05:55] Yeah, I had everything removed. So as I understand it and it might differ from country to country. But from what I understand is that if they sit with a big ovarian growth, mine ended up being the long end of a credit card. So the circumference was like that. They are worried, first of all, of doing a vaginally or laparoscopically because they do not want any part of the tumour to chip off, you know, if there is a possibility of cancer. So they usually then do an abdominal hysterectomy. And because in my case wasn’t 100% sure that they could do the lab test in the theatre. They then did a pre-emptive radical hysterectomy. So they removed, as you said, the womb, of course, the ovaries, the cervix, some of the ligaments, and then also that sort of fatty tissue, the omentum, they call it the fatty tissue or curtain that hangs over your organs because I was told, and you can correct me, but that’s often way especially ovarian cancer tumours like to go and hide. So it was a fairly radical operation and thankfully not all women go through such a radical hysterectomy. And of course, particularly because it has an abdominal wound that took very, very long to recover from. And I think that was partly why it was so important for me to do the knowledge sharing was because just before the operation, I tried to get books, you know, to read. I’m a brainy person. I like reading stuff to be prepared and be in control, you know? And I couldn’t really find anything around hysterectomies and I could find medical journals, but that wasn’t helping me at all to prepare and then post the operation, I started looking also for, you know, information online and so on. And then I discovered all these huge Facebook groups of women who had gone through hysterectomies. Often it’s linked very closely, of course, to menopause, because it’s often women who are sort of in that period of their lives and who were so frustrated, so anxious, many of them also in the NHS, because they felt that they got no support and no information and they were asking each other, which is nice, but of course not the most reliable when you want to get medical information. So, you know, there was one example I remember where somebody said, went onto the group and said, I am eight days post hysterectomy. I just had a big bleed, big blood clots all over my kitchen floor. What do you guys think? Should I go to hospital? Is this normal or not? And of course you want to shout don’t come on to a group, you know. Please, please, please just get yourself to emergency. But that’s sort of was the illustration for me. And these groups are everywhere in the world, not just South Africa. In fact, South Africa is a very small group, but Australia, the UK, America and Europe, everywhere. Because, you know, you said it was a fairly common op procedure, but it still remains a very common procedure. You know, in America alone, 600,000 hysterectomies every year. And I think still many doctors, very unwisely, I want to almost venture inside, particularly male doctors. When women go into menopause and they experience sometimes menopausal symptoms or any other legitimate gynaecological, this becomes the operation that they turn to. And yes, in some cases it is needed and it’s life improving. And it is life saving in many cases. But I don’t think it’s an operation that should be done easily, and as the sort of easy option to deal with menopausal symptoms. And that’s been sort of part of my little activism now is to say, just make it a last resort, not the first resort if women start struggling in middle age. [00:09:29][214.1]

Dr Louise Newson: [00:09:29] Yeah, it’s really interesting. So I did, when I trained to be a GP, I’d done a lot of hospital medicine, so I didn’t have to do lots of jobs to become a GP. The only job I had to do was an obs and gynae job, and that was a long time ago. That was in 1999. And there were lots of women who, in retrospect, were middle aged women, menopausal or perimenopausal, who were having heavy, heavy periods. Mirena coil wasn’t really, it was only just sort of coming out then. And so a lot of people had a hysterectomy for that. And I just thought, gosh, you’re having an operation, but in a couple of years time your periods will be stopped. So anyway, but also as a doctor, we see people when they’re operated on, you know, in the hospital. And when we do a six week check quite often, and I, you know, and I’ve done this a lot as a GP, you know, you see babies six weeks old, the mothers for a six week check. So you don’t realise the enormity of what’s happened in that six weeks. And then my mother had a hip, well she’s had both hip replacements now, and I looked after her and I’ve seen women three to six months after a hip replacement and they’ve been okay. They’ve a bit of pain, bu they come into the surgery. We review everything. But day one after a hip replacement, oh my goodness. And then seeing the bruising down my mother’s leg and the pain she was in and I was thinking, gosh, I had no idea how awful it was because the body heals quite well. And then I had a hysterectomy a few years ago, and it was a simple hysterectomy and it was done vaginally, but oh my goodness, those first few weeks I wasn’t expecting because I think as doctors we’re not trained because we don’t see day by day. And people get discharged day two now, often after an operation, don’t they so we’re not seeing and learning, but I learn all the time from two things: my experiences if I have them, but also from what patients tell me. So what you’ve done is, is allowed people to discuss because we are different, aren’t we? But it is still a big operation. [00:11:22][112.9]

Melanie Verwoerd: [00:11:23] I know that some women, especially when they’ve had vaginal or laparoscopic and it’s a simple hysterectomy they seem to bounce back. Many women do quite quickly, but the vast majority of women that I have spoken to and made, and I speak in many places now on these issues and women and medicine and so on. And the vast majority of them sit there in tears, you know, and write to me just for once, that somebody gave validation to their experiences. And, you know, they I mean, I understand that doctors are busy and especially surgeons and specialists or I don’t know if you call them consultants in Britain, they are very busy. So they once they’ve saved your life or stitched you back up, that’s it. They’re done. You know, that’s job done. But of course for you the process only starts then, right? And I I’ll never forget my surgeon said to me beforehand, week one you’ll be in bed, week two you’ll be on the couch, in week three, you might be in the kitchen again. I objected as a feminist to the last observation, but the point was, in his mind, I should have been back doing what I do by week three. There was nothing like that. I mean, and I’m I’m tough and I’ve gone through lots of medical things, so this was nothing like anything I’ve previous experienced. And it took, I would say, about three months before I felt closer to myself. And the point was I wasn’t healed completely. There was still pain and discomfort and energy issues for at least six months, and maybe even a few months after that. And I think even if we just get permission to know that it’s really hard. And then, of course, you don’t even talk about the psychological stuff, because I think there’s a lot of psychological stuff that goes with it. I was not prepared for how long it was going to take. I was also not prepared that it was quite important to speak to pelvic floor experts, you know? That it might impact, you know, on your sexual activity. None of that I was prepared for. And I think then it comes as a big shock and it’s on top of… And of course, then women who go through surgical menopause and are not prepared for that are not helped with medication, or you know, therapy through that. I think that’s just cruel. I think that’s in a way I would almost describe it as evil, because what they go through is hell. [00:13:34][130.9]

Dr Louise Newson: [00:13:34] Yeah. I spoke to one of my patients today who’s had breast cancer many years ago. She’s young, though, she’s still in her mid-40s, but she had breast cancer when she was in her 20s. Oestrogen receptor negative. She’s had a bilateral mastectomy, but she’s found to have the BRCA gene. So she’s having her ovaries removed to, you know, obviously negate her risk of ovarian cancer, but she’s still having periods and she really wants to have hormones to replace the ones that she’s missing because she gets PMS already and she knows she’s going to feel worse without her…and I spoke to her today because she’s now got a date for her operation. And the consultant has said, let’s just see how you get on without your ovaries. And I said, you know, and they’re they’re sort of worried because she’s had this history of breast cancer, well she’s had her own periods for 20 years. So actually, that makes it a lot easier to think about hormone replacement therapy. And she wants it as well. You know, she knows that her mental health before her periods is terrible. So she’s quite rightly worrying about that after the surgery and the health risks of not having hormones for her bones, heart and brain and so forth. But to say, see how you get on, I think is, yeah, it just makes me a bit upset. [00:14:44][69.4]

Melanie Verwoerd: [00:14:44] I can’t tell you how many stories like that I’ve heard. And I was recently contacted by the mother of somebody in her late 30s who had had a radical hysterectomy, and she said to me that she was deeply worried. I didn’t know her. She just reached out to me via my website and said that she was deeply worried about her daughter’s state of health, but it was her mental health, and I asked if I would talk to her. And of course I said I would, but we need to refer her to a medical expert. And then when I spoke to her, she said exactly the same thing. The doctor said, you know, when she was released from hospital, you might start feeling a little bit off in the next day or two because, you know, you’ve gone into surgical menopause, but come see me in six weeks time and we’ll see how you get on. You know. And she said during those six weeks, because she didn’t know what was happening to her, she thought it was, you know, she didn’t understand why she was feeling so awful. And then she said to me before the operation, because hers was done because of cervical cancer, she was scared that she was going to die. Then after the operation, she got scared that she wasn’t going to die because of the impact of. And I think for me, the thing is, your patient seems to have done the right thing and that’s coming to you. But it is also to sort of as women to start taking control of our health, you know, to also insist and not take, you know, the word of one doctor. I think it’s really important then to reach out, go find the help if you have time to do it before the operation already and then after the operation if you’re not doing well to reach out for help. And it’s not because you’re weak. I think we often think we’re weak. It’s because you need legitimately need help. [00:16:12][87.9]

Dr Louise Newson: [00:16:12] You’re absolutely right. My consultant was brilliant because he said to me, each day you do a minute and then you double it. So you do one minute walking, then two minutes, then four minutes and eight minutes. And I thought, you know what? I’m really fit. That’s ridiculous. But I took it literally because I really wanted to feel better. But actually some days I found it really easy and some days I found it really, really, really difficult. And I think there’s two things really for me that I was not expecting so much because I didn’t have a scar because it was done vaginally. So you look down and you think, have I really had an operation? And so I think women forget that internally you have had an operation. But the two things really was my pelvic floor. I do a lot of yoga. I do a lot of pelvic floor exercises. I couldn’t even feel the muscles like I tried to tighten them, you know, as you do, you need to your pelvic floor, I was like, I don’t even know where they are, have I got them? And I knew I do, of course. So looking at that, but also like not being worried that you can’t do it straight away. A lot of women, even if they’re on HRT before the operation or they’re having their own hormones, often need vaginal hormones when things have settled down, which is very different to HRT. And that’s really important because if you’re, and we talk a lot about sarcopenia, this loss of muscle mass that occurs in the menopause, well you have sarcopenia of your pelvic floor muscles as well. So we can all do our pelvic floor muscles as many times as we can, but there’s no point doing them if you haven’t got the muscles there and the muscle strength. So that’s something that’s really important. But it can take a long time. It really can take three, six months for your pelvic floor muscles to come back. And I wasn’t prepared for that. I don’t know whether that’s the same for you or people you’ve spoken to? [00:17:55][102.7]

Melanie Verwoerd: [00:17:56] Definitely. And, you know, there’s all kinds of problems. I mean, as you will know, I mean, the dreaded which is most probably apart from sex, the thing most spoken on the groups, the dreaded constipation, you know, after the operation, especially when it’s abdominal cuts and so on. So there’s a lot of pain, but also of course general anaesthetic and slow down everything. And then women are scared and all these things I have on the podcast series that I then did on this, there’s a physiotherapist who’s a pelvic floor expert that we speak to, and she talks about if women just come to her beforehand, she can teach them how to actually go to the bathroom after the operation, which can be a major point of anxiety and fear and, and things. So it’s even little things. [00:18:36][40.3]

Dr Louise Newson: [00:18:36] Absolutely. [00:18:36][0.0]

Melanie Verwoerd: [00:18:37] Well, little. It’s not little when you’re into it, you know, but something like that. [00:18:40][3.3]

Dr Louise Newson: [00:18:41] No, but it seems little when you’ve got normal bodily functions. And the other thing that happened to me, which is not uncommon, is that my bladder didn’t work properly. So yes, I was catheterised, it was taken out, I couldn’t empty my bladder. And the first nurse that put my catheter in inflated the balloon on my urethra. It was really painful. She didn’t believe me and I said, just give me a syringe. I’m going to take the water out. Take it out myself. It was awfully painfuL. I knew…and so then the consultant came in and catheterised me. That was fine. I had a catheter in for a few days at hospital. Then I had it taken out just before I went home, and then at three in the morning I was in so much pain and discomfort. I’m very fortunate that my husband’s a urologist, so he went to the local hospital and got a catheter and everything else, and very unromantically catheterised me because I didn’t want to go back to the hospital. I hate hospitals, I really didn’t want to. I knew they would admit me and I didn’t want to. So I had a catheter. But then I had an indwelling catheter for six weeks. So I had a leg bag. I was, you know, wearing my husband’s pyjamas, you know, having the bag next to the bed in the daytime. I have a leg bag initially and then I would just have a clamp. And it was it was really interesting because my husband’s a reconstructive surgeon, does a lot of work for people who have permanent catheters to enable them to urinate through properly through their urethra, but I hadn’t realised how awful it feels having a catheter in. You feel like people know that you’ve got it in, and of course they don’t. There’s something really horrible about losing control of a normal bodily function, and I then took my catheter out too early, so he had to re-catheterize me. So and then I had awful urinary tract infections. And many people listening I’m sure would have had urinary tract infections and… it was awful. I can’t even begin. There was one I had, I had a few and I had one that hadn’t responded to two antibiotics, and it was just excruciating. I can see why people even become suicidal with the pain of having a urinary tract infection, because my bladder was all inflamed, it had this catheter in it, and then I had this infection and oh, I can’t tell you it was awful. And like, I’m married to a urologist, I’m a doctor. I was really scared and I didn’t know who to ask for help. I knew I couldn’t get an appointment with my GP. And it’s accessing help and care. And you know when you’re in a lot of pain, it’s really scary. [00:21:10][149.2]

Melanie Verwoerd: [00:21:12] It really is. And the thing is post-operative, you’re so vulnerable. And then I think there is an additional issue for women and that is asking for help. I think men, you know, they might struggle as well. But I think in particularly also when it’s got to do with gynaecological health, which we are, still no matter how open societies have become still hiding, you know, still not talking about as often, you get the message you should get on with it, you know like and and especially after hysterectomies where, you know, they are children and they are pets to be fed and they are food to be made and washing to be done and jobs to get back to. And women just persevered through it, you know, and that’s often very unwise from a physical and mental perspective. And I think that’s one of the things, a doctor recently wrote to me and said, a gynaecologist, that she had listened to my podcast. And one thing that had changed after the podcast was that she decided she will never do a hysterectomy again, unless she’s also made the partner of the woman involved. [00:22:10][57.8]

Dr Louise Newson: [00:22:10] How interesting. [00:22:10][0.0]

Melanie Verwoerd: [00:22:11] Because she realised just if the the partner, be they male female, whatever the partner’s relationship is, if they are not prepared for what happens and are being able to be in a supportive capacity there, then she realises how much the patient is going to suffer. And I think, you know, how often do we just go to gynaecologist or for exams on our own? And yeah, so important. [00:22:34][23.0]

Dr Louise Newson: [00:22:35] It’s really interesting. So I also, one of my friends had a hysterectomy when she was young. She’s a doctor as well. She was 38 and had a hysterectomy for another reason. And she said to me, Louise, I made the mistake of doing too much, emptying the dishwasher too quickly, and I had to be readmitted because my scar broke down internally. She said, you don’t want that. So then I made this rule. I loved it, for three months, well not quite, I didn’t quite do it for three months, but I said to the children and my husband, look, I’m really not, you know, I’ve cooked for the freezer, food’s all done. I’m really not going to. And I loved the time because I worked a lot. I had my laptop and I caught up with loads of articles and all sorts of things that I wanted to do, and I actually, that’s when I created the Confidence in the Menopause course. I found a company to help me with it. I had lots of time, but it is making sure that people understand that. And I had three caesarean sections. So you do naively think. [00:23:28][53.8]

Melanie Verwoerd: [00:23:29] It’s the same, exactly. I had two. [00:23:29][0.0]

Dr Louise Newson: [00:23:31] Yeah. And it’s not the same. And I think the other thing is and I’m quite happy to talk about it, but the intimacy, if you do have a partner and you want to have sexual experience, it can be, I think, harder than after a baby because especially when you’ve had a total hysterectomy, you can’t visualise is your vagina the same length, does it feel the same your pelvic floor is not the same, you know? And in fact, Sam Evans, who’s a great nurse-trained sexual health person, and she actually contacted me before my hysterectomy and said, Louise, you need to think about your clitoris. You need to think about sort of stimulation, and in a different way. And I thought, gosh, why don’t we talk about this? Why do we just have to think about penetrative sex? And that’s all we can think about. But our clitoris isn’t damaged or affected, usually in a hysterectomy. And we need to talk very closely to our partner what is comfortable, what isn’t, how things change. Because you say that first three, six months, our vagina, our pelvic floor, these tissues change quite a lot don’t they? [00:24:35][64.0]

Melanie Verwoerd: [00:24:36] And the thing about it is that of course in many cases when they remove the cervix they also do shorten the vagina sometimes. So there is a difference in how it feels. Of course if the hormones are, if you have affected hormonally of course, also the vagina as I know you speak about a lot, can get dry and you know, so it’s very important that that can dealt with if there’s an actual wound of course that’s sore. And then psychologically women are worried, you know if there’s now because of course now if the cervix is removed there’s stitches up there, you know. And of course women get anxious. What if that gets undone? Of course they tell you not to have sex for the first six weeks. But it’s quite important that partners also understand that sometimes it takes a lot longer for women to get back into the sexual game. You know, they don’t feel well, they don’t feel themselves. It’s going to take a lot of time and patience, and that’s okay. For women also must feel that it’s okay and not feel obliged. Some women on the groups are day three and they’re like ready to rock, you know, not wise maybe, but I mean and I think it’s actually most probably something that’s not only to do with hysterectomy, but is also for women in menopause generally, you know, is to rediscover our bodies, to make peace with a body that changes dramatically, you know, not only hormonally but also in the ageing process and so on. And for me, I write about that in the book that’s not in the podcast is a medical more of a medical podcast, but the book itself I talk a lot about how I had to go through my personal journey of re-looking at my body, looking at sexuality, you know, sort of really interrogating that and what it meant and, you know, femininity. And. Yeah. So I think it’s not something that’s unique to hysterectomies, but of course, there is a sort of physical and psychological aspect to that. But I think it’s also a general issue around menopause. [00:26:21][104.7]

Dr Louise Newson: [00:26:22] Yeah, absolutely. I think totally. And like I’ve always said, we’re all individuals. So one person might have the operation, be bouncing back, like you say. Others might not either physically or psychologically or both. And that’s fine. Nothing’s right, nothing’s wrong. But the most important thing is that we are listened to and understood and know that, you know, time really helps, but we can be different in our experiences of the same operation. So I’m really grateful for your time. Before we finish, I just you’ve got your book there, haven’t you, just to hold up so you can share it, just three reasons really why people might want to read the book, whether they’ve had a hysterectomy or not. Many people will know someone that’s having one or had one or going to have one. So three reasons, sort of why we should look at the book or listen to your podcast series that you mentioned. [00:27:12][49.9]

Melanie Verwoerd: [00:27:13] So the book, which is called Never Waste a Good Hysterectomy. The first half of the book is about my experience with hysterectomy and women who have read it have very kindly said to me that they felt like it was them speaking, you know, they really associated with what was happening with them and the fear and anxiety and of bewilderment and so on. And then there’s a little bit of activism in there as well, you know, about, why not more research money is spent on specifically ovarian cancer, you know, so little money and the survival rate hasn’t improved. And I should say, mine in the end turned out to be benign. I should have said that at some point, thankfully. So I think for me it is about if you’re feeling lonely, if you need a voice, you know, if you need to read something that might, might be similar to your experience, that’s definitely there. The second part of the book is more for anybody who’s going through menopause. There I deal with, you know, so many of the issues I think women go through during menopause money issues, fears of relationships, the good girls scenario, the superwoman things, all of that. And then the third sort of thing about the podcast itself, the podcast under the same title, Never Waste A Good Hysterectomy, is a 12-episode series that is different from the book. It consists of interviews with doctors and medical experts. So it takes you through and that’s specifically for women with either have gone or going through a hysterectomy. It takes you from the terminology because, you know, I have to say, I was lying on the operating theatre and I had to, you know, they ask you for permission for everything they going to do. And they say they hysterectomy and I said yes. And then they said oophorectomy. And I sat up and I went, hold on, what’s that? You know, like, here’s me not knowing what they’re going to do to me. So the terminology, what to pack for the hospital, what to expect on the day, the pain relief, it takes you through the recovery period afterwards, the sexual issues after a hysterectomy, the pelvic floor issues, there’s an episode for men or partners specifically, and a psychological interview as well with the psychologists about the impact and that, so if you are going through a hysterectomy, or you have a mum or a friend who’s going through it, the podcast I think would be very, very helpful. And women from all over the world is, in the weirdest places in the world is downloading it. And clearly because they feel that they’re not empowered enough by the information. [00:29:32][139.5]

Dr Louise Newson: [00:29:34] Wonderful. So lots of good tips that somebody mentioned. Yeah lots of reasons, but I’m really grateful for you opening up this conversation. You learn so much from what people really experience, but I hopefully, people will just think a bit more about it. And also to be able to ask the right questions if they’re going for surgery themselves. So we will share the links in the notes. But thank you so much for your time. I’ve really enjoyed it. Thank you. [00:29:58][23.8]

Melanie Verwoerd: [00:29:58] Thank you very much. [00:29:59][0.6]

Dr Louise Newson: [00:30:03] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:30:03][0.0]

ENDS

The post My hysterectomy story: here’s what I wish I’d known appeared first on Balance Menopause & Hormones.

In this week’s episode Dr Louise is joined by one of her patients, Lesley Henry, a nurse who lives in Northern Ireland. Lesley shares her experience of menopause, which started before she received a diagnosis of endometrial cancer.

Her treatment for cancer led to a surgical menopause, which she found debilitating. Lesley explains she feared her brain fog and fatigue would prevent her from returning to work and from caring for her mother.

A firm believer in the importance of quality of life, Lesley decided to resume taking HRT. She hopes to help other women who are going through similar experiences and shares the things that have given her the strength to make decision about her treatment and her life:

1. I have a faith. Not everybody will have the same faith as I have, and that’s fine, but I think having a faith helps.
2. Be proactive and find support groups. Through Action Cancer I learnt about scar therapy, which has helped, plus I completed a positive living programme to learn how to re-energise and rebuild my life.
3. Be prepared to say goodbye to the old you. She’s not coming back and in a way, she needs to go.
4. Trust in yourself and listen to your heart. You are worthwhile and your life matters.

Click here to find out more about Newson Health

Transcript

Dr Louise: [00:00:11] Hello, I’m Doctor Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So on my podcast today, I’ve actually got one of my patients who very kindly has agreed to share her story so other people can have a think and a listen about well shared decision making, making choices as an individual. So welcome, Lesley, to my podcast today. [00:01:19][68.7]

Lesley: [00:01:21] Hi Louise, thank you. [00:01:21][0.3]

Dr Louise: [00:01:22] So I met you a few months ago now, and you’ve come from a sort of medical background, haven’t you? Do you mind talking about your job and what you have been doing in the past? [00:01:31][9.3]

Lesley: [00:01:33] So I’m a nurse, I trained as a nurse a long time ago, in July 87 I started, which is years ago. And I was traditionally trained and I’m now a district sister and I have a caseload with another sister. That’s sort of quite high pressured. Lots of decisions to make about patients and their care. And so I have a background and I worked on oncology before, years ago, at Belvoir Park, Northern Ireland, and that’s where I’m from. And I look after my mum. She’s elderly. She’s 92. [00:02:10][37.2]

Dr Louise: [00:02:11] Wow. OK. And nursing has changed over the years. And I started my medical training in 1988, so a long time ago as well. And having nurses who have huge amounts of experience is so important for any healthcare system. It really is. But and I say but because when I first met you, you weren’t working were you? You weren’t able to work the way that you have done and are now. And you were having lots of symptoms that obviously led you to come to speak to me. But do you mind talking about what had happened for your symptoms to occur in you, not to be able to work in the same way? [00:02:48][37.1]

Lesley: [00:02:48] Yeah. So I suppose I have had a long history of having to heavy periods for years and years, and my mum had the same. So I went, in 2021, I went on HRT at the recommendation of my friend because I was having dry eyes, but mostly it was, I wasn’t having a hot flushes and I wasn’t have a night sweats. I was having just other symptoms. But long term I was looking into the future, and I thought I would have osteoporosis because I would have bone pain etc. And also just to prevent… My mum had colon cancer. So I just wanted to sort of, so my cousin actually told me that the benefits far outweigh the risk. So I took HRT patch before I ever met you, before I knew you existed. And then because I had to go the progesterone oestrogen patch. So when I was on oestrogen it was great and when I went on the progesterone patch, I had huge blood loss. I had clots the size of my palm of my hand and my haemoglobin dropped from 12 to 8. So I came off the HRT because I just couldn’t sort of continue with it. And I went then and saw my GP and she referred me for tests. I had a hysteroscopy in the December of that year and in January the biopsy came back clear. Then they wanted to put a coil in. But I have never been sexually active, OK. Because I have a faith and I don’t believe I should live in sin, etc etc and I’ve never met anybody that I’d want to spend the rest of my life with. A bit fussy and choosy, but that’s fair. Yeah. So I went to see a herbalist because I didn’t want gynae surgery. And, it’s quite embarrassing. So I went to see a herbalist. So he put me on medication, and then I went to the gynecologist and she wanted to bring me in on the June of 22 to have a coil put in. So I said I’d like to try the herbal medicine first. So I tried the herbal medicine, but by August, it worked partially, it did help and I didn’t have as much blood loss, but I was still bleeding basically every day for three or four months. So then I rang the consultant up in August and I said, look, I can’t deal with this anymore and I’d like to be put on the list again for a coil, but I was, you know, it was mentioned before and I’m due for review in September. So they put me on a cancellation waiting list and I went for my coil insertion on the 30th of September 22. And so whenever they did the coil insertion, my womb looked fine. They weren’t concerned at all. So whenever, they rang me then in December out of the blue, said, have you been for gynae surgery? And I said yes, I had a coil put in. And then they said, well, could you come in to talk to us about the results? I said, okay, when? Today. So then the alarm bells start going. And bring somebody with you. So then you know… [00:06:22][214.1]

Dr Louise: [00:06:23] So you knew there was something? [00:06:24][1.4]

Lesley: [00:06:25] Yeah I knew. So then I went into Derry that day, that was where my biopsy had been done. And that’s the region I work in or live in. So, I went and my cousin went with me. I was told that I have stage 1A endometriol cancer. And so because I’d worked in Belvoir Park with radiotherapy I said so will I need internal radiotherapy. And I was told, no, I wasn’t at that stage because they thought they’d caught it early enough. But because it hadn’t been red-flagged, because they’d waited for 12 weeks, by the time I had my MRI done it had spread from my endometrium to my myometrium, just on to it slightly, so I was stage 1b, and I needed then internal radiotherapy and a full hysterectomy. So I had a surgical menopause, even though I was 54 and I had sort of started the menopause and I had some symptoms, but I was a bit like my mum. She sailed through or seemingly sailed through. And when I was on the last terms, the surgeon there said, don’t touch oestrogen, you know, you can’t take it. So then because I had endometrial cancer, they sent me to the Belfast Trust. I worked in the Belfast Trust before. And I spoke to one of the oncologists and I said I was having a lot of brain fog and wondered whether I could get back to work, etc. so she said, we’ll refer you to the charity clinic in Belfast. And no matter what, but you’ll have to wait a year before you can take oestrogen. So I was happy enough I suppose to go with that. And then the reason I contacted you was I thought maybe I could go on testosterone if I wasn’t on oestrogen, you know, and get my brain function back. So that was really, you know why I contacted you. [00:08:30][124.6]

Dr Louise: [00:08:30] Yes. And I do remember actually the first time I met you because I was really struck that you, who’s been a very dedicated healthcare professional working as a nurse, was really struggling even to I don’t want to be rude, but even to get a sentence together, it was quite difficult to sort of, would that be fair to say, I’m sorry, Lesley, I don’t want to undermine you, but… [00:08:51][20.9]

Lesley: [00:08:53] No, it completely floored me. [00:08:54][1.1]

Dr Louise: [00:08:55] And I remember you trying to explain how you were feeling and everything, but your words weren’t quite coming out, you were quite hard to actually understand what was going on. But you were also were very frightened and scared because you didn’t want to end your career. You knew you still had more to give to your job and to your life as well. And even, you know, enjoy reading and everything else. You felt like things had been taken away from you and you had no control, which I hear a lot in the clinic. [00:09:29][34.0]

Lesley: [00:09:30] Yeah. I just felt like, you know, the ad on the TV, Macmillan and the man in the desert with the wind howling round him. And I remember my cousin saying, and I find this a lot with people who have cancer. They treat you, they cut out whatever they need to cut out, the surgeons, and the oncologists do whatever they need to do, and you’re dropped. You’re dropped. And you down. Like I drowned emotionally, physically, spiritually, mentally, I drowned. My cousin said, Lesley I watched you drown. And unless you have faith or a purpose or a way through… But my reason for contacting you as well was I’m not married. I don’t have a huge income. I had savings but you know those were running out. Yes I’m well doing because I’m in the NHS and I get six months’ full pay, six months’ half pay but that runs out. And there are no benefits. There are no, you know, there’s a Macmillan grants of up to £300, which doesn’t, you know, cover very much. And you’re sort of left to flounder. So I’d gone to, there’s an organisation in Cookstown which is a volunteer organisation. And I got counselling, but you only get six sessions and then, you know, you’re sort of expelled or, you know, you have to sort of then figure out the next stage of the journey yourself. And because my brain wasn’t working, I couldn’t get my thoughts out at all. And I thought, how will I ever manage to go back and be a nurse? And do the job I do, and be articulate with health professionals and patients and be compassionate. I was exhausted. I wasn’t really sleeping, and I was doing all that I’d been asked to do by the health professionals. I’d gone to see a genito-urinary physio and I had done their exercises and the things that I was advised to do. And the one thing that really helped as well as the HRT was there’s an organisation in Northern Ireland called Action Cancer, and I went to a positive living programme through them. And they also did a menopause, HRT when you’ve had cancer. And that really helped, you know. My cousin, who is a nurse as well, she came alongside and she said, Lesley, the benefits far outweigh the risk. My cancer is oestrogen receptive and they just bandy that about like, no man. But they don’t actually think of the consequences for your life. And I knew I needed to get back to work, and I got back to work within the year because I was on HRT. But if I hadn’t been on HRT, I may not have been able to get back to work. [00:12:46][196.7]

Dr Louise: [00:12:48] And that’s really significant and important. And as many people know who are listening and I know you know as well Lesley is a lot of my work is just about choice. And in medicine, when I started doing medicine, I did a lot of hospital medicine. And it wasn’t about choice. It was about prescribing, making a diagnosis, giving people medication, reviewing them in a clinic, in an outpatient setting, in the hospital. Never once did I really think about the continuity of care, because in hospital, often, especially as a junior doctor, you’ve moved on in six months, you don’t see the people, you don’t have this as, you know, this sort of long-term relationship. And then in general practice, my trainer said to me, Louise, you’re going to have to be careful here because these these are people. They’re not diseases. You have to get to know them and you have to share any uncertainty with them, but you have to enable them to be part of their treatment journey. And I wasn’t sure what he was talking about at the start, but it’s so important I do not live other people’s lives. I do not know what it’s like to have endometrial cancer, and I do not know what it’s like to live after endometrial cancer. I’ve had a hysterectomy for another reason that was benign. So I sort of know that. And I’ve been menopausal. But my menopause is different to yours and ours is different to other people’s. And so in medicine, I find it really hard to just say no. And it’s because often people say, well, we haven’t got good evidence. We’re never going to have good evidence to certain things. But then even if we do have good evidence in 20 or 50 or 100 years’ time, it’s not going to help you, in that immediate situation. And then when we look at endometrial cancer, so that’s cancer of the lining of the womb, there’s about 9,700 cases in the UK. So it’s common. But it’s not the commonist cancer as you know. But actually the life expectancy from it is really good. Like I would never want to choose a cancer, but if I was choosing one, I would choose an early stage, low grade endometrial cancer because it’s a curable disease. And actually outlook from it is better than if I’d been diagnosed with an osteoporotic hip fracture, for example. You know that’s as well as I do, and which is good. So yours was caught early. That’s great. You know, really hopefully, we can never say 100% in anything we do but hopefully it’s a curative operation that you’ve had and treatments. So you’ve got your next journey to look at and embrace and enjoy hopefully. When we look at these receptor statuses, as many people listening know, we’ve got oestrogen receptors on every single cell in our body. So it’s no surprise that you’ve got oestrogen receptors on your cancer. But that’s a good thing. Because if you didn’t have oestrogen receptors, it often shows that the cancer’s mutated. And sometimes that means it’s become a bit more aggressive. So actually oestrogen receptor positive is good. But if you find it, people then think, oh, it’s been caused by oestrogen, you can never have oestrogen. And that’s where some of the confusion lies. But if you’ve had all the cancer removed, it doesn’t matter so much because you’re not fuelling it anyway. And then often we do give progesterone as well to some women who’ve had endometrial cancer and testosterone like you quite rightly say is another hormone that some people will benefit from for their mood, energy, concentration, stamina. And I’ve heard from a lot of women who say, well, I don’t have a sexual partner, therefore I’m not allowed to have testosterone because I don’t need a sexual libido. And I find that’s really quite harrowing because it’s not just about improving libido is why how testosterone can help. So often the combination of the right hormones and you mentioned about pelvic floor and vaginal hormones are very safe for women who’ve had cancer as well, including breast cancer, because they only work locally. And certainly there’s a lot of women who have vaginal symptoms and urinary symptoms. And that’s really important to consider as well. So I know when we first met, we had a conversation. I put everything out and said, you can try and see, because God forbid, if your cancer came back in the first three months after being on HRT, it wouldn’t be the HRT, it would have come back anyway. So in three months you can try and then you can decide. And it’s easier to decide once you’ve started something, because otherwise you don’t know how you’re going to feel. And I’m pretty sure that was a conversation we had, because that’s what I usually have with patients. So you decided to try and you started feel better, didn’t you? [00:17:20][272.4]

Lesley: [00:17:20] Yeah, yeah. I mean basically, sort of a week, maybe less, you know and I used to have dry eyes and all that has gone. And I was sort of maybe starting to have night sweats and that’s gone. And I have to use a dilater, once a week just to keep for examinations and that. And, that has helped with all of that and you know the pessaries. And I’ve gone to my GP, and she has agreed to give me oestrogen. So then I only really get the pessaries and the testosterone from Newson Health, and it’s great just that I have my life back. I have quality of life. Cancer surgeons and oncologists think about quantity. I think about quality. And quality of life is… If you don’t have quality of life, you know, life’s very, very difficult. And I’ve seen so many people who’ve had breast cancer or other cancers and they’re not on HRT and they struggle daily. And it’s like a, I don’t want cancer or endometrial cancer or my menopause, surgical or non surgical, to be a defining moment of my life. I want to move on from this. And sometimes it just seems like a surreal nightmare. It’s gone. I’m starting to, you know, I’m working again, I’m looking into doing lay ministery within my church because I have my head back and I don’t have fatigue. I’m able to sleep well, and I’m able to think cognitively well. And also for long term, I don’t want, my mum had spinal fractures, she had colon cancer, there is a history of, you know, dementia. I don’t really want to go down those roads, you know, and I think probably the long-term effects of HRT haven’t been written yet, because I just think if there are receptors in your brain and there’s so many neurological diseases and I have to probably work till I’m 67 because of the government and the mismanagement of the pension schemes, etc. So because I’d have to work till I am 67, if I wasn’t on HRT, I wouldn’t be able to do that. And it’s life changing. [00:19:54][153.1]

Dr Louise: [00:19:55] Yeah. And, you know, I hear it a lot, and there’s a lot of people who are really skeptical about HRT and think that women take it for lifestyle or for nice skin and hair, and I find that really both upsetting, but also very disparaging towards women, actually, because we are more than our skin and hair, we are about our brains more than anything else. And this morning I was lecturing the divisional meeting for the Royal College of Psychiatrists. So there were lots of psychiatrists in the meeting, and I lectured to them for an hour, and then we had a half an hour of loads of questions. It was wonderful. But it is a cognitive disorder. The commonest symptom actually, is more brain fog, memory problems, but also low self-esteem, reduced self-worth, are very common. So women do become invisible. And in my updated book, the paperback book of The Definitive Guide, I’ve written well, we write a lot about the symptoms but, Joanne Harris, who is an author, wrote about women being invisible and how convenient it is in society for women to be unseen, unheard. And it’s almost like this you put up and shut up. You know, you should be thankful that you’ve had treatment for cancer and you know you’re still alive. But actually, that isn’t enough for a lot of people. You know, and I think it’s it is about choice. I think a lot and I know this sounds a bit weird, but see what you think of it. But I think a lot about when I buy a car. My daughter the other day was asking about the first car I ever bought as a medical student, and I was very lucky. I saved a lot of money. And then my grandfather said, I’m going to give you a bit of money so you have it now before I die, because I don’t want you to get as bad a car as you’re going to get. So I had a very small Vauxhall Nova. It was quite a few years old, and I cycled down to Stockport from Manchester to the garage, and I met my mum there who got the train up so I could show her this car at the garage. So cycling down was quite a long way. I didn’t have a helmet, I had a really old clapped out bike, but that’s what I used then. And then I got in the car, I liked it. It sounds really vacuous. I liked the interior, I liked the color. The salesman was telling me how brilliant and reliable and this, that and the other it was. So I bought it and I was the best thing that I’d done for a long time. I really enjoyed it. It took me off to the Lake District and did all sorts of adventures in it. I didn’t read a randomised controlled study seeing if it was the best car. I didn’t think about my safety. I didn’t think about my safety getting on my bike. But that, for me was what I wanted. And I was very fortunate to be able to have this car. But I think about when we drive our car, there is a risk of crash. Of course,there is and the roads have got busier, so over the last 30 years it’s more of a risk. But I still drive. I drive to pick my children up, I drive to meet people, but that’s my choice. I’m an independent adult. No one’s telling me that the car I’ve got now drives a lot faster than the car I first got when I was 20. But actually, that’s okay. I’m allowed to choose. But I think you’ve made, well I know you’ve made choices that are right for you. And also no-one’s forcing you to take HRT or not take HRT. But you had that decision, that ability to decide, taken away from you when you had your operation. And that’s what I feel really sad with this, because you are allowed to decide which is the biggest benefit you’re getting and which is the biggest risk, but actually, it’s not just the risk for you of not taking it. If you weren’t on HRT, I don’t think you would have been able to continue looking after your mother. You wouldn’t have been able to continue working as a nurse so other people would have been impacted by that decision. [00:23:41][226.4]

Lesley: [00:23:42] Yeah, I think that’s a major factor, you know? And if I hadn’t, I wouldn’t have been able to pay my mortgage. I wouldn’t have been able to keep my mum in the home that she’s lived in for most of her life. And those things carry a lot of emotional weight. And a lot of profound weight. You know, that I can keep my mum in her own home and that I can go out to work and earn enough, and that I can reduce my hours to what suits me. And that I have a quality of life. And it’s not about all the research, studies and all that. I know all of, you know, you hear all of that. And it’s about the quality of life today. And yes, I may develop cancer again. I hope I don’t, but if I do, they can treat cancer, but they can’t treat osteoporosis in your spine. They have no treatment for dementia. They’re working at it. They may develop it. But you know, right now I don’t have dementia. I’m back at work. I have a life that I’m happy with and content with. And I have a dog that I can take out walking every day, you know. And if I wasn’t on HRT, I don’t know that I would have been able to look after my mum and keep the whole thing going. And one of the reasons I did reduce my hours was just to give me a better quality of life as well. You know, just time to be able to… and also, I think radiotherapy causes fatigue. [00:25:29][106.8]

Dr Louise: [00:25:32] Yes it does. [00:25:32][0.3]

Lesley: [00:25:33] Yeah. And sometimes I get really tired and I’m building up my resilience again. And, I can see a way forward. Whereas when you first met me, I didn’t know how I was going to get through the next day. I didn’t want to go on, like, heavy doses of antidepressants. I have a friend who’s on antidepressants because she’s not on HRT because she you know. And it’s just not a way to live your life, you know? And I think as well, a lot of them, you know, consultants, oncologists, they don’t really think about your life. They don’t think about the ramifications. And it’s not patients centred. It’s just surgeon centred or oncology centred. They treat the cancer. They forget about your life. They forget about that you’re a person, that you have needs. You have maybe a husband or a family. I don’t know how people who have husbands and family do, you know, I’ve just seen them struggle deeply with symptoms because they’re not allowed’on HRT. [00:26:45][72.8]

Dr Louise: [00:26:48] Absolutely. And the suffering not just in the UK but globally is sort of palpable really. And a lot of it is avoidable and life is hard enough anyway. So I’m so grateful for you sharing so, well it’s beautiful but awful at the same time what you’ve experienced, but the strength of character that you have is just been shining through. And I knew that when I first met you that this is somebody who’s got some fire in her belly, she knows what she wants. You’re a really determined lady, and you have been over your years, but it’s come back, and I just feel such a privilege to be part of it Lesley and for you to share your story. I’m really, really grateful. So before we finish, I you probably know I always ask for three take-home tips, but I’m really keen to ask you three things that have helped you have the strength to make the decision and choices that you have, not just about your treatment, but in life in general. Because I think listening to you, there’s a lot we can all learn from you. [00:27:50][61.7]

Lesley: [00:27:50] OK. Thank you. Well, I have a faith. I think if you have a faith that helps. Not everybody will have the same faith as I have. And that’s fine. And I think if you go out and try, there’s a lot of stuff out there for cancer that isn’t really research based. That’s not good at all. And you have to sort of filter through. And I’m quite proactive. And so I found Action Cancer. I’d heard of them before all of this, I didn’t really take them onboard because it wasn’t relevant for me. But through that, I’ve learned about scar therapy. Scar therapy has really helped along my scar because it was just quite sore and would have caused me a bit of pain. And that has really helped with lymphoedema around my scar. And also just that whenever you’ve gone through this, you have to say goodbye to the old you. The old you has gone. The old Lesley Henry has gone. She’s not coming back and in a way, she needed to go. She needed to, you know, because she was mad. She was, you know. Somebody said, you know, I used to feel like a Ferrari. You’re like a Ferrari Louise. I was like a Ferrari, I’m now… And then I became like, a pony and trap, you know, because I just couldn’t. So now, I just… You have to learn to pace yourself. You know, and also watch, watch films, watch things that encourage you, like The Darkest Hour, what Winston Churchill went through. You know how he had to persevere, listen to all the crap, you know that you’re told. And discern through all the crap. I have loads of friends. Some really good friends. Some friends I’ve let go of through this, you know, and it’s just, I think, trust in yourself. So I just sort to think, listen to your heart. You know, and think that you are worthwhile, and that your life matters. You know, it may be that you’re a mum at home or whatever, but you matter to the people who love you. And even if you’re in a difficult relationship, your life matters and you’re worth more. And also through doing different programmes, there’s a positive living programme that’s done in Northern Ireland. And it’s two days. You can go to coaching and it’s just about how to re-energise your life. And refocus and rebuild. But HRT has been my saviour in all of this and has got me out of… There’s a psalm in the Bible, it says, you know, I was put in the miry clay and God lifted me out. Well HRT, with God’s help, lifted me out of the miry clay. [00:31:24][213.6]

Dr Louise: [00:31:26] Amazing. Amazing way to end. Listen to your heart, I think is just wonderful. So thank you so much, Lesley, for your time and sharing so many wonderful words with everyone. So I really appreciate it. Thank you. [00:31:38][12.2]

Lesley: [00:31:38] Yeah. And I hope it helps. [00:31:40][1.8]

Dr Louise: [00:31:40] Course it does. [00:31:41][0.3]

Lesley: [00:31:41] That’s all it’s about, helping others. I’m passing it along. Yeah. And thank you, thank you for all your help. You’re brilliant. [00:31:49][7.7]

Dr Louise: [00:31:49] Oh. Thank you. You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:31:49][0.0]

ENDS

The post Endometrial cancer, the menopause and HRT appeared first on Balance Menopause & Hormones.

• Bowel cancer is the third most common cancer in females in the UK
• Women may miss signs of bowel cancer while going through the menopause
• Cancer treatment can cause a surgical menopause. Discover how to treat symptoms

If you’ve had bowel cancer you may be wondering how menopause affects you. Or you may have been through menopause before your cancer diagnosis, so it can come as a shock to experience further menopausal symptoms after your cancer treatment. Here, we take a deeper look at bowel cancer and menopause, and the treatment options open to you.

Who does bowel cancer affect?

Women are less likely to get bowel cancer than men, but it is still the third most common cancer in females in the UK [1]. Approximately one in 19 women (5%) will be diagnosed with bowel cancer in their lifetime and although it can affect people of any age, 94% of bowel cancer is diagnosed in those aged over 50 [2].

Symptoms may include: changes to your bowel habits that last more than three weeks, blood in your poo, which may look red or black, rectal bleeding, abdominal cramps, bloating, unexplained weight loss, fatigue and anaemia.

In the early stages of bowel cancer you may have few symptoms or none at all, and equally, some of these symptoms can be present in other conditions, such as IBS.

REALTED: IBS and the menopause: what’s the link?

It’s also possible for women to mistake signs of bowel cancer when they are going through the menopause – fatigue and bloating can occur during the menopause, for example. If you have endometriosis, you may attribute abdominal cramping to that condition. However, one review paper found that women are more likely to experience an aggressive form of colon cancer [3].

How will bowel cancer treatment affect me?

Bowel cancer treatment will depend on the size of the cancer, its location, if it has spread, and your[PW1]  age and general health, and will be personalised to you. You may require surgery to remove cancer from the bowel, part of your bowel may need to be removed and/or you may need chemotherapy, immunotherapy or radiotherapy.

Treatment for bowel cancer can lead to earlier menopause, known as a surgical menopause.

RELATED: surgical menopause

I’ve been treated for bowel cancer, now what?

For some women, a surgical menopause can be hard-hitting owing to the sudden, dramatic loss of oestrogen, as well as progesterone and testosterone. You have oestrogen receptors all over your body, which is why the loss of oestrogen can cause a myriad of symptoms. Hot flushes and night sweats are common, but you may also notice joint and muscle aches, vaginal dryness, mood changes, fatigue and poor sleep, brain fog and urinary symptoms such as recurrent UTIs.

Some women may not experience symptoms of menopause, or not be too troubled by them, but you may still want to consider the long-term effect on your health of having low hormones. HRT lowers your future risk of developing heart disease, osteoporosis, type 2 diabetes and dementia.

REALTED: menopause and cancer booklet

Can I take HRT?

HRT is the first-line treatment for menopausal symptoms and for most women, the benefits outweigh the risks. Your healthcare provider will help you to make a personalised choice.

Interestingly, a significant (20 per cent) lower future risk of developing bowel cancer has been shown in women who take some types of HRT [4]. It’s not known exactly how HRT affects the bowel cancer risk, but it’s thought that hormones may play a role in decreasing levels of insulin-like growth factors that are associated with some cancers.

If you have your ovaries removed but still have a womb and would like to take HRT, you’ll need to take both oestrogen and progesterone. For those aged under 45 who have a surgical menopause, you may need a higher dose of oestrogen than someone who has gone through menopause naturally, at an older age. If you have your womb removed, you don’t usually need progesterone – you can have oestrogen alone. In most instances, you will be offered transdermal oestrogen, which has no risk of clot.

If you can’t or don’t want to take HRT, you may still be able to take vaginal oestrogen. Many women who go through the menopause will experience genitourinary symptoms such as vaginal dryness (which can affect 60 per cent of postmenopausal women), pain from sexual intercourse or recurrent UTIs [5]. Vaginal oestrogen, which works locally only, can provide relief[PW2]  and prevent discomfort.

RELATED: hormone replacement therapy (HRT): the basics

How else can I manage my menopause symptoms?

If you are experiencing vasomotor symptoms (flushes and night sweats) you may be offered antidepressants or other prescription drugs such as gabapentin, pregabalin, clonidine or oxybutynin to relieve them. Cognitive behavioural therapy (CBT) and hypnotherapy can help anxiety-related symptoms.

It is worth remembering that herbal medicines, such as black cohosh, red clover, ginkgo biloba and St John’s wort, and bio-identical hormones are not regulated.

Lifestyle interventions, such as optimising your diet, exercise, sleep and relaxation, can also help you manage your symptoms.

RELATED: Living well through your perimenopause and menopause

While it can feel overwhelming at first to face both bowel cancer and menopause, it’s important to realise that you do have choices. Take time for yourself to check in and recognise your symptoms, and to read up on as much as you can so that you can have ongoing conversations with your healthcare professional about how best to access support. Be active in your recovery by learning about your options, including lifestyle management and complementary therapy, so that you feel in charge of your life.

References

1. Cancer Research UK
2. Bowel Research UK
3. Rawla P, Sunkara T, Barsouk A. (2019), ‘Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors’, Prz Gastroenterol. 14(2):89-103. doi: 10.5114/pg.2018.81072
4. Grodstein, F., Newcomb, P. A., Stampfer, M. J. (1999), ‘Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta – analysis’, American Journal of Medicine, 106(5) pp. 574–82. Doi: 10.1016/s0002-9343(99)00063-7
5. Sarmento ACA, Costa APF, Vieira-Baptista P, Giraldo PC, Eleutério J Jr, Gonçalves AK. (2021), ‘Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic’, Front Reprod Health. 15;3: 779398. doi: 10.3389/frph.2021.779398

The post Bowel cancer and menopause appeared first on Balance Menopause & Hormones.

• Early symptoms of cervical cancer can be confused with other conditions, including the perimenopause
• Treatment for cervical cancer can trigger menopausal symptoms
• Women treated for cervical cancer are able to take HRT to ease symptoms

Cervical cancer is when abnormal cells in the lining of the cervix (the opening between the vagina and the uterus) grow in an uncontrolled way. Nearly all cervical cancers are caused by an infection from certain types of human papillomavirus (HPV).

Most people who are sexually active will become infected with HPV at some point of their lives but most HPV infections go away on their own within a year or two as the immune system controls the infection. However, when a high-risk HPV infection lasts for years, it can lead to changes in the cells, resulting in a precancerous lesion that can then develop into cervical cancer.

Other known risk factors for cervical cancer include smoking, early age at first sexual intercourse, multiple sexual partners, the presence of other sexually transmitted diseases and a compromised immune status [1]. Taking the contraceptive pill for more than five years is associated with a slight increased risk of cervical cancer, but the risk begins to drop as soon as you stop taking it [2].

According to Cancer Research, cervical cancer is more common in younger females and most cervical cancer cases diagnosed in the UK each year are in females aged 30 to 34 [3].

What are the symptoms of cervical cancer?

In its early stages, cervical cancer often has no symptoms. When symptoms are present, they usually include: vaginal bleeding that’s unusual for you, changes to vaginal discharge, pain during sex, pain in your lower back, between your pelvis or in your lower tummy.

These symptoms are very common and can have other causes – for example, if you have fibroids or endometriosis. And during the perimenopause your periods can change and become unpredictable. It’s important to get any of these symptoms checked out by a doctor to help determine the cause.

How can cervical cancer affect menopause?

If you have not had menopausal symptoms before your cancer treatment, you may find that the treatment – for example, radiotherapy, surgery to remove your ovaries and some chemotherapy drugs – brings on an early menopause.

Menopausal symptoms after treatment for cervical cancer can be more sudden and intense than if you went into a natural menopause. For example, surgery, such as a hysterectomy, will immediately trigger the menopause, while pelvic radiotherapy can damage your ovaries, which can trigger the menopause – usually about three months after cancer starts.

Ideally you should be supported by your healthcare team regarding the menopause before your cancer treatment starts, but sadly this doesn’t always happen. Ask to speak to a menopause specialist at the hospital where you are receiving treatment.

How can I treat my menopause after cervical cancer?

HRT is the first-line treatment for symptoms of the menopause. When people experience an early menopause, including through cancer treatment, it’s advised to take HRT to replace the hormones your ovaries would naturally be producing, until around the age of 51 (when the menopause would usually start). You can then review it, depending on your symptoms and risks.

If you’ve had a hysterectomy, you’ll be offered oestrogen-only HRT (women who still have a womb need combined HRT). A review of studies found there is no evidence of a harmful effect of HRT on cervical cancer oncological outcome, and several benefits – such as reduced metabolic risk and increased quality of life – were reported [4].

HRT is an effective way of helping menopause symptoms but if you’ve had radiotherapy, you may have side effects such as vaginal shortening and narrowing, and sensitivity of the lining of the vagina. Vaginal oestrogen can be effective in treating symptoms.

References

1. Shiraz A, Schiemer R, Staley H, Matsushita T, Hasegawa T, Bryant A, Inoue E, Egawa N, Gajjar KB. (2023), ‘Human papillomavirus (HPV) self‐sampling to encourage the uptake of cervical screening’, Cochrane Database of Systematic Reviews, Issue 11. DOI: 10.1002/14651858.CD014502.
2. Cancer Research: cervical cancer risks and causes
3. Cancer Research: cervical cancer risks and causes
4. Vargiu V, Amar ID, Rosati A, Dinoi G, Turco LC, Capozzi VA, Scambia G, Villa P. (2021), ‘Hormone replacement therapy and cervical cancer: a systematic review of the literature’, Climacteric. 24(2):120-127. doi: 10.1080/13697137.2020.1826426

The post Cervical cancer and the menopause appeared first on Balance Menopause & Hormones.

On this week’s podcast, Dr Louise is joined by Dr Peter Greenhouse, a menopause specialist with 40 years’ experience in women’s sexual healthcare who is actively involved in postgraduate lecturing.

He has recently spoken out about NICE’s draft menopause guideline update, and tells Dr Louise it contains inappropriate and inaccurate statements, particularly concerning HRT and breast cancer safety, and ignores the cardioprotective effect of HRT when it’s started within 10 years of the menopausal transition.

Dr Peter challenges NICE’s stance on HRT for primary prevention and proposes a pre-emptive approach that could help reduce the amount of other medications GPs are prescribing menopausal women.

Finally, he shares his belief that women should be able to take as much HRT for as long as they need to.

You can read about Newson Health’s response to the NICE draft guideline consultation here.

Follow Dr Peter Greenhouse on X @GreenhousePeter

Click here for more on Newson Health

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast. I’m very excited to introduce to you Peter Greenhouse, who I’ve known for a few years, actually, first met him at a Menopause Society meeting, and we’re very inspired by his enthusiasm and determination to educate people in similar ways. To me, really, we have very similar ways of thinking. So welcome, Peter. Thanks for coming today. [00:01:23][72.1]

Dr Peter Greenhouse: [00:01:23] Hi, it’s a delight to be here. I hope we can get the relevant amount of information across in plain English and see what feedback we get. [00:01:31][7.5]

Dr Louise Newson: [00:01:32] So you’re similar but different to me. You’re similar in that you’re interested in hormones. But we’ve got different backgrounds actually and different training haven’t we? [00:01:39][7.7]

Dr Peter Greenhouse: [00:01:41] Yeah very different. Well I trained in both what one might call venereology and gynaecology. I did the gap between the two, and I was the first person to do integrated sexual healthcare in the UK, and I saw the need for it as a medical student nearly 50 years ago. But I finally got round to doing it when I got my consultant post because I’d trained between the two subjects. But at that time, it’s interesting at that time, certainly as a gynae registrar… the first thing about menopause and I’d always struggled a bit understanding contraception and how to do it, because as a bloke you don’t feel any of the, you don’t get any of the hormonal changes. I mean, a man has stable testosterone all his life, has no excuse for being moody. Whereas, you know, women are totally different. And, you know, the main reason that I learned about menopause was because I married one of the world’s top teachers on it, Annie Evans, and we had a great time. And I taught her everything she knows about PowerPoint and STI and she taught me everything I know about menopause. I’ve also learned, of course, subsequently from going to loads of lectures, but most importantly, listening to very large numbers of women telling me their stories. And that’s, I think, is probably where the most learning goes on, where you just listen and you use the accumulated knowledge and the accumulated anecdotes that you’ve got from all the different women that you speak to. And it all adds up to your clinical approach, and it’s got to be a humane and humorous approach that is tailored to the woman’s needs. And that’s basically where I’m coming from. I’m a clinician, I’m not an academic researcher. I don’t think I could do that. I haven’t got OCD, I’ve actually got ADHD, so it’s a very different way of approaching it. But anyway, there we go. So that’s my background. [00:03:15][93.7]

Dr Louise Newson: [00:03:16] And it’s very interesting isn’t it, when you think about clinical experience, because I think recently things have swung the other way where we’re always wanting evidence, scientific evidence, and sometimes we don’t have it. And actually when you have a patient in front of you, it’s about what’s relevant for that individual. I visited a friend this morning who needs to have some chemotherapy for breast cancer, but no one told her the risks of having this chemotherapy and the absolute numbers for benefit. She just presumed everyone who had chemotherapy would benefit. But actually only about 2% of women who take the chemotherapy will benefit. So it’s a very individualised choice. Just for complete clarification here, when I’m talking about the 2% benefit with chemotherapy, this is for this individual person. Any treatment, especially after breast cancer, is very individualised, looking at the overall benefits and risks for each individual treatment, and we often use the PREDICT tool when looking at overall outcomes for individual treatments. So I hope that’s cleared any confusion from my sentence, thank you. [00:04:20][64.1]

Dr Peter Greenhouse: [00:04:20] It’s almost as if we’re doing practice based evidence, which is also based on evidence-based practice. But there’s the practice that you get from talking to the individuals. Of course, another big problem about most of the research is that there are no two women who respond to hormones in exactly the same way, because each individual woman’s response is genetically predetermined. So you have pharmacogenetics going on in the background. And so although you can have a broad brush approach, quite a lot of the randomized trials, it’s difficult, sometimes difficult, to show an effect or you get a counter-intuitive effect. And of course, even worse, if you design a trial with the wrong women like WHI, you know too old, too ill, too fat, wrong drug. And then, of course, you get the administrative team to publish the results in the New York Times rather than any of the primary investigators. So all that misinformation was probably the most damaging thing that’s happened to women’s health ever. [00:05:13][52.5]

Dr Louise Newson: [00:05:13] Absolutely. [00:05:13][0.0]

Dr Peter Greenhouse: [00:05:14] Possibly. I mean, you know, if you think of the number of women who’ve probably died from not getting HRT, or at least that actually, let’s leave the mortality alone, because there’s a calculation that’s been done in the States of about… in the first ten years for women who’ve had hysterectomy of around the 50,000 mark of women who died from the fact that they didn’t get HRT, didn’t get oestrogen-only therapy, which is cardioprotective. And that’s one of the things we come straight into NICE about, is that NICE seems to deny the fact that if you take HRT, you start HRT under the age of 60, then your risk of heart disease is very dramatically reduced and your overall mortality is reduced by a third. And you know, if you think of quite apart from the quality of life issues, which I’m sure we can talk about, and in fact, you have talked about at length in all of your podcasts, we don’t even really need to go into those because most people take that as read. But if you consider the difference between the huge improvement in quality of life, if you took a thousand women, you know 900 of them will be far better off on HRT. A few of them won’t be able to take it. Some of them will get difficulties with it. Some of them are progesterone hypersensitive. Some of them don’t respond to oestrogen, interesting, very small amount. Don’t do that. But about 900 will be very, very much better off in terms of these vasomotor symptoms, in terms of although vulvovaginal atrophy, in terms of mood, you know, lack of depression, better cognition, all these sort of things are going on in the vast majority of women. And the actual risk, the relative risk, an absolute risk to cardiac disease and breast cancer are actually minuscule in comparison. If you take that and, you know, the academics are fighting over tiny numbers, whereas if you stand back from it and take the broad brush approach, the vast majority of women will be far better off. And once again, if you start HRT under the age of 60, you have a one third reduced all cause mortality. Now hang on a minute. In what other branch of medicine would you ignore a one third improvement in overall mortality. I mean, I don’t know. [00:07:17][123.3]

Dr Louise Newson: [00:07:18] I don’t think you would, but I don’t think there is anything else in medicine that is cheap, that is safe. [00:07:22][4.8]

Dr Peter Greenhouse: [00:07:24] Now, we need to be clear about the safety issues is if you use the right stuff and if you use it in the right women. And realistically, the problem with NICE is that it actually has some misleading comments. It also has some incorrect comments, and it also has some rather disingenuous comments that are technically correct, but don’t give you the right idea. So I don’t know which ones we want to start with, but I was just thinking of, I tell you what, let’s just take a quote here from NICE. “Combined HRT does not increase the risk of coronary heart disease”. Okay, now that is technically correct. Interesting. That’s the most recent update from the 17th of November. But in the previous one it said it did increase the risk of heart disease, and that’s because it was so completely wedded to the Women’s Health Initiative results that it wasn’t looking at the actual people that you use HRT in and or you start HRT in. And so although it’s technically true to say that combined HRT doesn’t increase the risk of coronary heart disease, and also the next statement, combined HRT does not increase mortality from cardiac disease. It very substantially reduces it. So although their statement is technically correct, it’s utterly disingenuous, utterly misleading. And it then goes on to say, do not offer combined or oestrogen-only HRT for primary or secondary prevention of cardiovascular disease? Well, once again, you have something like a 30% reduction in cardiac mortality. And it’s interesting as well, if you think of some of the data that’s come out of Finland, one of the best studies is almost halves your mortality if you start under the age of 60. Interestingly, they did, because they got really good data for Finland that, you know, everybody is completely stamped, signed, sealed and delivered and studied in great detail. They know all the drugs that they’ve taken and everything. It’s very difficult to be off the grid in Finland, apparently. But anyway, there we go. They actually showed that even women who start HRT between 60 and 70 have a significant reduction in cardiac mortality. Now, remember, of course, they’re mostly they’re taking oestrogen, oestradiol rather than the American stuff, the conjugated equine oestrogen. And almost nobody in Europe and I don’t know many people in Europe who use the American treatments, but that taken orally that has a slight benefit for younger women, but, you know, manifestly doesn’t for older women. And when they produce their statements, it’s almost as if they’re cherry picking some of the material in the background. I mean, some of the Cochrane reports, for instance, if you drill down into the Cochrane reports, they’ll show reduction in cardiac mortality, reduction in cardiac disease. There’s no doubt about that. All the studies show that for younger women, starting at the right sort of time, starting indeed in perimenopause as well if you need to. But then their final statement in Cochrane is often that overall there’s no benefit. And that’s because they’ve got this awful WHI trial in there, which is, much of it is irrelevant to UK, European, non-American practice. [00:10:21][176.3]

Dr Louise Newson: [00:10:21] Absolutely. [00:10:21][0.0]

Dr Peter Greenhouse: [00:10:22] Hang on. The people in the study, the women in the study got free Medicare didn’t they? That’s a really good incentive. You know in the States I mean so there’s a huge bias in that. Anyway I’m going to shut up now, you could ask me another question. I don’t know if I’m going the right direction. [00:10:37][15.1]

Dr Louise Newson: [00:10:38] You absolutely are. And just to be clear these are the draft menopause guidance that have come out. So they’re still under consultation. But it’s very disappointing because we’ve moved on over the last eight years since the last ones came out, the only NICE menopause guidance. But when when you look at a study or a group of studies that show a benefit, I don’t know about you, but I always then think about basic science. You think, well, how can I explain what’s happened now with reduction risk of cardiovascular disease, there is a very clear explanation because we know oestradiol is very anti-inflammatory, especially in the endothelium, which is the lining of the blood vessels, so it makes sense as well, doesn’t it? It’s not just a sort of spurious result. [00:11:20][41.4]

Dr Peter Greenhouse: [00:11:20] Well, it’s important, its biologically plausible. So you’re much less likely to get clots building up in the cardiac vessels. But it’s not just that it also improves neurovascular transmission in the heart muscle itself. So it beefs up the heart muscle. It stops the heart blood vessels clotting off. And also the nerve conduction within the heart is improved. So it works on three different things. Ah, that’s really interesting. One of quite common symptom is palpitations, which is not just down to anxiety and waking up in the middle of the night, having a panic attack and all that sort of thing, but actual palpitations that women feel. And that’s often, often one of the very first things to get better when you start taking HRT, even a low dose, because quite a lot of people, I’m not one of those, but quite a lot of people will start HRT at the lowest possible dose and then increase it until you finally get on top of the mood, side effects, or the cognition issues or the insomnia or whatever it happens to be. I tend to go in with a mid dose and then go up and down from there, but that’s by the by. But when you start at the lowest dose, the first thing to get better is palpitations. And that’s nothing to do with not having clots there or whatever or preventing the clots. It’s down to direct effect on the heart muscle, but that that also is the same thing that affects the brain as well. So they’ve got another statement almost beneath that. I’m just going to have a look and see if I can find it. It says: “When talking about hormone replacement therapy as a treatment or option for troublesome menopausal symptoms with somebody, explain that overall, taking oestrogen-only or combined HRT is unlikely to increase or decrease life expectancy.” Now that is complete rubbish. I mean, where on earth they got the evidence for that I do not know, but if the evidence is a conglomerate of much older women in the WHI, rather than just the women for whom HRT is most useful, in other words, the under 60s… Ah actually, I have to, I’m going to be a bit ADHD and go off piste a little bit here. And just to say, of course, that in the over 60s it doesn’t actually increase risk. And if you give it in the appropriate dose in the appropriate route and start low and slow, you can make a huge difference to women in 60, even 70 or so. And actually in the cardiac data, even in women starting in their 70s, there seems to be a benefit from the Finnish national study. I can’t explain that, and it seems counterintuitive, but it seems to work. [00:13:45][144.8]

Dr Louise Newson: [00:13:45] Well it’s no surprise, really, because it’s the same hormone, and especially when given to people who are healthier, so who don’t have established cardiovascular disease. The other thing though, we know and we’ve known and even NICE actually do say top level, that HRT has more benefits than risks. Now, if you count up the number of times the word benefit is mentioned compared to the number of time risks is mentioned, risks is actually mentioned 256 times, and benefits is only mentioned about 43 times. [00:14:14][29.0]

Dr Peter Greenhouse: [00:14:15] That’s a ridiculous bias because actually if you use the appropriate HRT and I’ll define that in a moment, in appropriate women, there aren’t any risks, there really aren’t any risks. In fact, no, actually it’s much more important to look at the risks of not taking HRT. Because quite apart from the probably excess risk of dementia, cardiac disease, etc., etc. if you don’t take HRT, then interestingly, of course you are more likely if you’re unlucky enough to get breast cancer, you’re more likely to die of it. Now, this is something that I find absolutely unforgivable about NICE and everything, and nearly all the recommendations that come out of people who support NICE, is that it was known from before WHI that if you happened to be on HRT when you were unlucky enough to get a breast cancer, your survival was much better. Ten year survival was 80% versus 64%. That was back in 1999 or thereabouts. I think that was a Danish study, but the fact is it’s not very different from in other centres. And although people said that’s a healthy user effect because they’re healthy enough to go to the doctor, they’re on HRT and maybe the HRT reveals a breast cancer that was there and wouldn’t have been seen, etc., etc. on mammography beforehand. But whatever, taking HRT is associated with better breast cancer survival. But in the Finnish data, once again we come back to Finland because they probably have the best figures for their entire country. We’re talking about, you know, half a million women being studied over many years. It actually shows that women between 50 and 60 have two thirds reduction in breast cancer deaths. And overall it’s 50% reduction. So you’re half as likely to die of breast cancer if you take HRT at whatever age. And nowhere does that appear in any of the information. And, you know, that’s the opposite of what your GP might tell you or what your GP might think. And it’s also the opposite what members of the general public would think. So it’s inappropriate that these negative messages should get out when you could actually give a positive message. The other thing I wanted to say, I was trying to get to was that the biggest risk of not taking HRT is ending up in the hands of your GP with random polypharmacy, because if you’ve got a pot pourri of perimenopausal or menopausal transition symptoms, and you go there with your, if you don’t happen to have hot flushes because a lot of GPs will say, “oh, you got all these other symptoms, your insomnia and your low mood and depression, your brain fog and all that sort of stuff but you haven’t got hot flushes. You can’t have perimenopause or menopause.” Absolute rubbish, of course. So if you’ve got the classic symptom, the worst symptom. I know you’ve done studies, but I personally think it’s insomnia and brain fog. The two big ones, and certainly those are the things that affect me. And you know, blokes get the same sort of symptoms if they’re on call for a long weekend. You know, anybody who’s sleep deprived will get brain fog. Although actually there’s a direct effect on neurotransmission, as you know, and you’re much better at explaining it than I am. There are so many different effects that the oestrogen works together. And of course, the hot flushes are a neurological phenomenon, actually neurovascular phenomenon. So if you put all that lot together, it’s so much better to be taking HRT than taking hypnotics or sedatives to make you sleep. You get addicted to them. What next? Oh, antidepressants. The worst possible thing you could take. You need a hormonal solution for a hormonal problem. Why would you want to take an antidepressant? And are you, actually you came up with this lovely description that some of your women describe, your Birmingham women describe. And I don’t know whether we can use an expletive. So, you know what I’m going to say now, but they call it the f-ing pills because, you know, crash the car, oh, sod it, you know in other words it blunts your emotions. And it inures you to some of your problems, which sometimes can help you get through if you’re not going to take the HRT. But the way I try to describe it is that SSRIs are a bit like pouring oil on troubled waters. It can smooth some of the ripples, may very slightly reduce the amplitude, but has absolutely no effect whatsoever on the wave motion underneath. So it doesn’t affect the hormones. [00:18:20][245.4]

Dr Louise Newson: [00:18:21] And it might be detrimental. We know there are some long term risks of the SSRIs, including osteoporosis actually, so that nothing with it is without risk. [00:18:30][9.0]

Dr Peter Greenhouse: [00:18:30] I would have said there’s a multifactorial thing in there. I would have said that one of the main, if SSRIs are associated with osteoporosis, that’s because the women aren’t taking HRT. [00:18:39][8.9]

Dr Louise Newson: [00:18:40] It’s a combination. So men have an increased risk of osteoporosis too, so. [00:18:43][3.2]

Dr Peter Greenhouse: [00:18:44] Okay, well, I’m not going to go down there because I don’t know enough about men. But it’s a fascinating thing because we’re almost going down my mental list of all the things that go wrong, your risks of not taking HRT. So we’ve done SSRI. Oh yes. What we haven’t done with SSRIs is that women should be told that they got approximately a 70% risk of anorgasmia if they take SSRIs. Now, that’s been brilliantly hidden in the small print by the drug companies. But it’s actually true. And of course, virtually all women will get some diminution in their libido when they take SSRIs. We know this, of course, because we do know in effect in men, because we use these drugs for premature ejaculators in men, stops them getting to orgasm. So of course it has the same effect in women. Why would you want to take a drug that stops you getting to orgasm? I mean, I’m sorry I haven’t got an answer to that one at all. And where did informed consent and side effects go in the advice that people are supposed to give? I’m sorry, I’m a bit lost on that one. Anyway, you see where we’re going with this? Another thing, of course, is that if we’re going to get cardiovascular protection with HRT and you don’t take the HRT, then you’re going to be doing the statins, the ACE inhibitors and all the other drugs, all the other stuff that people get. Of course, that stuff needs monitoring. It needs dose adjustment. It needs loads of it, I mean, the bottom line with the whole thing is you got loads of visits to the GP for a poorer overall result and poorer quality of life and a lack of joy. That was it, I came up with this little phrase in my lecture about lack of JDV, joie de vivre, which actually is enormously important because, you know, we’ve talked about this before, that quite a lot of women will describe this lack of joy, not just on taking SSRIs or just from perimenopausal or menopausal symptoms. And you can get quite a bit of that back with oestrogen. Of course, quite a few people would need testosterone as well, but we can talk about that separately if necessary. I don’t know whether we wanted to get on to any of the other things that NICE said, because I’ve got a few other odds and sods here. [00:20:45][120.6]

Dr Louise Newson: [00:20:45] Well, I was going to say, there are two areas that I think are also disappointing in NICE. One is when they talk about dementia risk because they don’t actually talk about benefit with HRT, and they seem to have forgotten. They just talk about risk in women who start HRT over the age of 60. So it’s very skewed the results that they’ve looked at. [00:21:03][17.3]

Dr Peter Greenhouse: [00:21:03] But dementia is very important because if you actually start early enough, there are loads of different studies on dementia, but most of the recent randomized trials going forward are never going to be long enough to show an effect in a large enough population. And the only really good study that we’ve got is actually a retrospective study from Roberta Diaz Brinton’s group, where they used the Humana insurance database. We’ve got 400,000 women. And of course, the great thing about the insurers is they know exactly who’s been taking the drugs because they’ve damn well had to pay for them. They also know who got Alzheimer’s and who got this, that and the rest, because they had to pay for them to go to hospital. So it’s actually pretty robust, albeit retrospective data. And what it shows is that if you take transdermal HRT, it reduces your risk of neurodegenerative disease by 80%, eight zero %. And even if you take oral and conjugated equine oestrogen, it reduces it by 60, six zero %. And also the confidence limits are very, very tight. It’s an enormously significant reduction. And actually even, even WHI came up with a in the women on conjugated equine oestrogen-only HRT, they had approximately a 15% reduction in mortality from Alzheimer’s disease. Now, even WHI using stuff that we would never use still gives you a benefit. And of course, remember that when they actually looked into it, when Roberta Brinton’s group looked into their study, they showed that it needed to be, remember it need to be MHT, menopausal hormone treatment, in other words HRT started at the right time, started early enough either before menopause or just after or within a few years of. So if provided it was started early enough, the effects were manifest by about the age of 65. So you’ve got to continue it at least till 65. And the longer you stay on it, the greater the magnitude of the effect. And then finally, you know, the idea is basically, for God’s sake, don’t stop it. Now, why does it work? Why are we coming up with this when NICE is telling you not to do it? Well, it’s biologically plausible. We’ve already said in the long term that oestrogen protects against microvascular atheroma, which is one of the causes of dementia and contributory to all the neurovascular, the neurodegenerative diseases. But not only that, it improves initial cognition anyway, which helps a lot. But it’s not just from dementia. We know that, for instance, if you control hypertension, then you also reduce dementia. If you control diabetes, you also reduce dementia. And once again, it’s the same mechanism. It’s this oestrogen giving protection against micro clotting atheroma in the not just the arteries, in the tiny little arterials that supply all the tissues of your brain and all, you know, all the muscle in the rest of the body. So there’s a huge biological plausibility for HRT reducing your risk of dementia, improving your joy, your quality of life, your sex life, the whole bloody lot, and also protecting your bones as the best thing. So what the hell are they going on about not to give it for primary protection? I suppose, I mean, actually, that’s one of the things that none of the menopause organisations have actually put a marker down for, although some of the top people in the world, Roger Lobo, John Stevenson, Howard Hodis and company wrote about seven years ago about back to the future, HRT as primary prevention. [00:24:23][199.7]

Dr Louise Newson: [00:24:23] Yeah, which is a great paper. [00:24:24][1.3]

Dr Peter Greenhouse: [00:24:25] Brilliant. Absolutely brilliant paper. Yeah. I think in fact, instead of reading the current NICE guidelines, I would advise anybody go and read Roger Lobo’s paper. I’m sure you can add a reference to the bottom of it. It’s beautiful. [00:24:37][11.6]

Dr Louise Newson: [00:24:37] We absoluely can because it’s really lovely paper and it talks about science and it talks about evidence. One of the reasons that HRT, certainly in America, isn’t recommended for primary prevention is because of insurance. Because if they said it was, it would have to be covered by insurance. And no one wants to pay for insurance that affects 51% of the population. So it’s more of a politcial thing. [00:24:58][20.6]

Dr Peter Greenhouse: [00:24:59] But why would the insurers want to pay for all the early… you know, the cardiac disease and all the other stuff? [00:25:04][4.7]

Dr Louise Newson: [00:25:04] Who knows. That’s just madness isn’t it? [00:25:07][2.6]

Dr Peter Greenhouse: [00:25:07] How many times do you need to go to see your GP for your sedatives and for all the other things, and also the long term nursing care of people with cognitive difficulties? I mean, NICE is supposed to take an overview of the whole economic model, and I don’t think that economic model is very good if it’s going to cause more GP visits for poorer mortality. [00:25:28][21.2]

Dr Louise Newson: [00:25:29] Yes, it’s very much looked in the short term. And yet again, it’s been focusing on symptoms, especially those vasomotor symptoms, which we’ve already said are not the most common and hasn’t paid regard to the longer term health risks, which is really important. So hopefully this consultation document will not get through without significant red pen going through it and alteration. [00:25:49][19.9]

Dr Peter Greenhouse: [00:25:50] If we can shout loud, not shout loud enough, argue calmly enough with the right evidence base. Bearing in mind, of course, our own practice base evidence as well. From what we see from the individual women in front of us, because most of the epidemiologists will have never seen, you know, would never actually have practice politically. And I think it makes a big difference. I mean, actually, that’s one of the lovely things about doing menopause work is that, I mean, I’m now retired from the NHS, but I keep going because of course, luckily everybody can Zoom or whatever it is nowadays. And it’s the fact that you can make such a huge difference to the quality of a woman’s life in a one hour or half hour consultation. And, you know, one of the reasons one does medicine is to help people. And you get so much, by and large, excellent feedback. And there are very few women that you can’t make a huge difference to their quality of life. And then, of course, you’re not going to see it X years later. You will have probably made a contribution to their quantity of life. And that’s not a bad thing at all. [00:26:50][60.4]

Dr Louise Newson: [00:26:51] Absolutely. No. It’s very powerful and very transformational medicine. So before we finish Peter there’s lots more we could talk about, but we do have time constraints. When I spoke to you probably about three or four years ago now, we were talking about instead of HRT, just calling it natural hormones because that’s what it is. We have this debate about this medicine, but it is just natural hormones. So what I’d like you to do is just, I always ask for three take home tips. So three reasons why people should consider their natural hormones. [00:27:21][29.9]

Dr Peter Greenhouse: [00:27:22] Well, because if you take away the natural hormones, then you’re going to get difficulties and issues. And if you lost any other natural hormone in your body, such as insulin, you get insulin replacement up for diabetes. If you’re hypothyroid, you’d get a thyroid hormone. And so why not get oestrogen and testosterone plus or minus progesterone if you need it. So I think it’s really just a question of replacing what you’ve lost to keep you going in much better shape. That’s the first point I would say. Other things to think of is also, of course, if you do stick it out and stay on it for life, you know, why on earth would you want to stop treatments that are going to keep you in better shape? So there’s really no very good reason to stop. And in fact, if you use transdermal oestrogen and a natural human progesterone, if you use human oestrogen and human progesterone, natural hormones, basically, then there is never going to be a point at which any very, very small theoretical risks might in any way outweigh the enormous benefits that you’re going to take it. So, so I suppose the final punchline then is in terms of how much what you need is as much as you need for as long as you live, because why would you want to stop? [00:28:32][69.6]

Dr Louise Newson: [00:28:32] Yes, very good advice. As much as you need for as long as you live is just sums it up really. So thank you ever so much for your time. And keep flying the flag for us menopausal women. So thanks very much. [00:28:44][11.7]

Dr Peter Greenhouse: [00:28:44] Thank you Louise. It’s great. Cheers. Bye. [00:28:46][1.6]

Dr Louise Newson: [00:28:50] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk and you can download the free balance app on the App Store or Google Play. [00:28:50][0.0]

[1691.5]

The post Challenging NICE’s draft menopause guidance appeared first on Balance Menopause & Hormones.

Content advisory: this podcast contains themes of mental health and suicide.

Dr Louise is joined by her patient Trudie Jennings in this episode to talk about the complexities around HRT during and after treatment for breast cancer.

Trudie describes how she started HRT to successfully manage crippling anxiety and other menopause symptoms and a few months later she was diagnosed with an aggressive breast cancer.

NICE guidance states women should stop taking systemic HRT if they are diagnosed with breast cancer. However, after careful discussion with her cancer doctor and nurse, Trudie decided to continue with HRT during her treatment as, for her, the menopause symptoms were more challenging than her cancer treatment.

Trudie and Dr Louise discuss shared decision making and informed consent, and how important it is for women with and after breast cancer to be fully informed about potential risks, benefits and uncertainties about HRT following a breast cancer diagnosis so they can make the best decision that is right for them.

Trudie’s three tips for women who have had breast cancer and are struggling with their menopause: 

1. Know that as a patient you do have choices about whether to start or continue HRT after breast cancer treatment.
2. Speak to your doctors and nurses and be informed so that you can make the right, personalised, decision for yourself. Trudie has found her healthcare professionals in cancer care open and helpful when discussing her need for HRT.
3. You know your own body best, so listen to your body to get the treatment that will be best support you.

Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org

Click here to find out more about Newson Health

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause, symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast I’ve got someone with me called Trudie who’s very kindly agreed to share her story. So I first met Trudie about five years ago, and she came to the clinic as a patient and travelled many miles, actually, to come and see me. So welcome, Trudie. Thanks for joining me today. [00:01:20][69.5]

Trudie Jennings: [00:01:21] Thank you. [00:01:21][0.3]

Dr Louise Newson: [00:01:22] So when you first came, it was a few years ago now, about five years ago. And people weren’t really talking about the menopause as they do now. And I don’t know quite how, hopefully you’ll explain, how you found me. But then you came all the way many miles from the north to the clinic. So do you mind explaining what happened and when you discovered that you might be experiencing some symptoms? [00:01:42][20.0]

Trudie Jennings: [00:01:43] It was around 2017. I was 49, and that year I started to feel anxiety for no apparent reason. I was happy, I was healthy, I was enjoying life, married, no children, but a great life, really. And it was more irritating than anything else, this anxiety, because it didn’t seem to be thoughts associated with it, it just felt like a bodily sensation. Anyway. So I was kind of just trying to cope with that and ignore it. But then in December I came down with a tummy bug and I didn’t get better and I couldn’t get out of bed. And after about three weeks of consistent nausea, I was really starting to get worried and was going to the GP, certainly calling them two or three times a week and going at least twice a week. And my GP was saying that there was just nothing that they could find that was wrong with me. My bloods weren’t showing anything and then eventually they suggested I go for a brain scan and at that point I just knew that wasn’t the way forward personally. I knew there was something else going on. And then I had a friend, my friend Sarah, saying that my symptoms were so like morning sickness that she’d had with her youngest daughter that the parallels were just, she said that you’re describing exactly the same thing. And she said she remembered her doctor telling her to get out of bed and put herself together. But she said she was absolutely floored by it, which led us to start thinking about hormones, which sounds a bit daft now, but it just hadn’t been on our radar at all. I’d arranged privately to go for an endoscopy and colonoscopy just to make sure was that there was nothing going on. And after that I got the all clear. The consultant said that off the record he wondered whether it was menopause because he said his wife’s friends were coming down with so many strange symptoms with the menopause. And he said, it just seems like it’s a lot more than people realise. So that was really helpful. I went back to my GP who said that night sweats and hot flushes were the only symptoms that she felt were appropriate. And because I didn’t have them that she didn’t think it was the menopause, I started to worry about my coil that I just had fitted a few months previously thinking, oh gosh, is it to do with that and hormones? And I had that removed and immediately I plunged into anxiety that was beyond belief. I was internal shaking, agitated, just absolutely dreadful. We started scouting around and I found a doctor in a town not very close by, but close enough to go on a day trip to. And he took my bloods and found that I had no progesterone, oestrogen or testosterone. And he had sort of a, I don’t know, some sort of private pharmacist prepare hormones for people. And he sent me a sample through the post. And unfortunately, it did nothing at all. I had to put a little bit on the top of my arm, but it didn’t do anything at all. But at least I knew the hormones looked like it was a possibility. I actually came to you after that. I saw your name was starting to appear on things like the websites where women with symptoms similar to me were talking about how are we going to get some help for this? And I arranged an appointment with you and we drove down to, it was Birmingham then, and had an appointment and you said straight away, this is not anything other than what I would see as the menopause and I think I can help you. By that time I was taking antidepressants because of my anxiety. I say, anxiety, there’s almost a different book of symptoms for the menopause, if you ask me, because the anxiety was so physical. It was this internal agitation that wasn’t related to anything. It wasn’t related to thoughts. It was just this constant, almost biological, awful feeling. Anyway, you prescribed patches and testosterone and progesterone. And by June, saw you in the April of 2018, by June 2018, my husband and I went on holiday to Croatia and had a smashing time. In fact, we just you know, it was just unbelievable, the transition, the transformation. My appetite was back. I was happy. It was just great and we came back for review with you in the August of 2018. And yes, I don’t know if you want me to continue then what happened? The second chapter, part two, then was that I told you that I had an inverted nipple and you asked to have a look at it. And I think we both realised that it probably was quite serious. And you then wrote to my GP and asked for an immediate referral and I think it was the Thursday, the following week I was in hospital, diagnosed with breast cancer and I was on a fast track then. [00:06:27][283.8]

Dr Louise Newson: [00:06:27] Yeah, because I very distinctly remember that consultation, because I obviously asked if you wanted me to examine you because you said you had found a lump. And lots of people have lumps and most lumps are not cancer. And I examined you and I thought clinically, this is a cancer, but you don’t know until you have a proper histological diagnosis. And we both looked at each other, didn’t we? I remember very clearly saying, I can’t tell you for sure, but we need to get it checked out. And then the next question was you said to me was, do I need to stop taking my HRT? And you had only just started to feel so much better. And I remember we looked at each other and I said, well, we don’t know it’s cancer yet, shall we wait until you’ve got a diagnosis. And you said, yes, I think I’m happy to do that. And it’s an individual choice, some women will stop straight away and some women… but you decided, didn’t you, that you’re going to and I remember you contacted me because your appointment came through quickly and then you got the actual proper diagnosis, didn’t you? [00:07:31][64.4]

Trudie Jennings: [00:07:32] I did. It was an aggressive cancer. It was seven centimetres long actually, by then. And yeah, they were clearly expecting me. The oncology team was expecting me to come straight off the HRT, but were really understanding when I said that actually when I told them my story and said I don’t think I can get through this if I am not on HRT. And I gave them lots of articles and some of the articles that you’d advised me to have a look at, and they were absolutely fine with it. Totally supportive. Yeah. [00:08:02][29.6]

Dr Louise Newson: [00:08:03] Which is amazing because I actually remember, I’ve got quite a good memory and I often remember locations of when I’m doing something or speaking to someone. And I think it was at a weekend when I got through to you because my daughter was playing in a concert at Birmingham Conservatoire. She’s a trombonist and I really wanted to speak. I think you might have emailed me to say that I’ve been diagnosed and so I’m remember phoning you up. And I was trying to find a quiet place that was discreet in this concert hall before I did, because I dropped her off early so she could have a rehearsal beforehand. And I remember talking to you about your HRT and they’ve given you, didn’t you have chemotherapy first before surgery? [00:08:40][37.8]

Trudie Jennings: [00:08:42] I did, I did. I had quite a big bout of chemotherapy which shrunk the tumour, thank goodness. [00:08:45][3.4]

Dr Louise Newson: [00:08:47] What it’s usually called is neoadjuvant chemotherapy. So it just neo means ‘new’, before. So some people have the breast surgery and then they have chemotherapy. But because yours was, and please correct me if I’m wrong, but my recollection was because it was quite aggressive and a big cancer, what they want to do is shrink it before the surgery. Is that right? So you have heavy duty drugs, basically, chemotherapy. And your oncologist had decided that it was such strong chemotherapy that actually, whether you take HRT or not, is not really going to make a difference to your overall prognosis. And you know that the outcome from your cancer and I actually I mean, obviously it’s a few years ago now, more and more people who’ve having treatment for breast cancer or have had breast cancer are asking a question about hormonal treatment. But I thought actually how wonderful that you’ve had what felt like a very open conversation with some very wonderful doctors who could think in a reasonable way because it’s a very kneejerk, easy reaction to just say, stop your HRT. And obviously that happens a lot for a lot of women. And obviously without HRT there would be no risk for your breast cancer, but actually for your mental and physical health, which you needed to be really strong to cope with the treatment. That’s where you were coming from, wasn’t it? [00:10:12][85.2]

Trudie Jennings: [00:10:14] It was. There was just no, my husband said, you can’t, you can’t not have it. You know, it’s just a no brainer, really. So yeah, and I do think I got through it because of the HRT. I was still on the antidepressant. And I have to say, although it was pretty horrendous, the whole thing, and had a mastectomy, then I had radiotherapy. It was a walk in the park compared to the menopause stuff, genuinely, genuinely, genuinely. I remember saying that at the end I would, you know, no comparison. I was so poorly with the menopause and the cancer, I was, you know, I was but my head was okay. [00:10:48][34.1]

Dr Louise Newson: [00:10:48] That’s quite something, isn’t it? Because and I’m not here to belittle breast cancer at all and for everybody it’s different experiences and the treatment is different but it’s quite simplistic medicine to suggest that the menopause is something that doesn’t affect women as much as breast cancer treatment does and especially to have chemotherapy as well, which can cause, and it did cause side effects, didn’t it? [00:11:13][24.7]

Trudie Jennings: [00:11:16] Yes. I had sepsis at one point and, you know, I lost all my hair and all of that sort of thing, but really I felt okay. I knew it was something I had to get through. I had lots of support. I didn’t have internal tremors, I didn’t have blackness, and I didn’t have any of that. I was just back to kind of my normal self coping with something that was awful. [00:11:34][18.8]

Dr Louise Newson: [00:11:36] And then after your chemotherapy you had a mastectomy and then did you have other treatment after that? [00:11:43][6.5]

Trudie Jennings: [00:11:43] Yes, I had radiotherapy after that, yes. [00:11:45][1.7]

Dr Louise Newson: [00:11:45] And then after that. Did you have any other drug treatment or do they offer anything else or what was the plan after that? [00:11:51][6.0]

Trudie Jennings: [00:11:52] Yes. I’m on tamoxifen for ten years. [00:11:53][1.6]

Dr Louise Newson: [00:11:54] Right. Okay. And have you stayed on your HRT with tamoxifen? [00:11:57][3.4]

Trudie Jennings: [00:11:59] I have, I decided to stay on it. I had my bloods done pretty shortly after my radiotherapy and they were very low, two 200 milligrams of patches and I was only getting 84 on my reading and I’ve recently, probably shouldn’t have, but I went up to three just out of interest to see what whether I would feel dramatically different. I had my bloods done with my GP and they’ve only gone up to 97 with three patches. So I’m not a great absorber, that has to be said. [00:12:26][26.6]

Dr Louise Newson: [00:12:28] It’s very interesting, isn’t it? Because there’s a big debate, as you probably know over the last few months about the maximum dose, what we should be prescribing and it’s more about the amount that we absorb rather than the amount being prescribed. And we’ve been looking at all our data and we show like you, there are some people that have higher doses prescribed, but they have less in their blood compared to others and some have lower doses and they have higher absorption. And it’s so interesting because our skin is really different as well. So. So your blood level of oestrogen is actually still quite low, isn’t it? [00:13:00][32.4]

Trudie Jennings: [00:13:01] It is. It is. And when I use the testosterone, all it happens is that I grow hairs. That’s all that happens. So if I put it on my leg, I just get a big hairy leg. So it suggests it’s not absorbing terribly well there. [00:13:15][14.2]

Dr Louise Newson: [00:13:15] No, but you’re still using the testosterone. [00:13:17][1.5]

Trudie Jennings: [00:13:18] No, I don’t, because it was just creating hairs. And when I had that tested, it was just insignificant the amount that I had. [00:13:24][5.4]

Dr Louise Newson: [00:13:25] So obviously you weren’t absorbing this either, which is very interesting. Some people don’t. And this is where HRT is very individualised. You know, the guidelines are very clear that it should be individualised and we are all different. And also what works at one stage doesn’t always work at another stage as well. So, you know, constantly we look at choices of preparation. Sometimes we’ll change from a patch to a gel or a different type of patch or a different type of gel, or with the testosterone, we might try a different type of testosterone. And we are also different and there’s no right or wrong. And tamoxifen, for those listening, is interesting because it’s something called a SERM, which is a selective oestrogen receptor modulator. So it can be anti-oestrogen on the breast tissue, but it can actually be pro-oestrogen in other areas, including the lining of the womb, actually. And so we know also that some women who take Tamoxifen actually have a higher level of oestrogen in the bloodstream as well, even if they’re not on HRT. So we don’t really understand and it’s not as simplistic as oestrogen is the devil when it comes to breast cancer. And also I spoke to someone the other day actually who had been on HRT for six weeks, developed breast cancer, and she said the HRT must have caused it. I should never have taken it. And we still don’t know whether HRT is associated. It might be if there was a cancer there already when someone was taking HRT, it might grow a bit quicker. But we also know from evidence that women who were on HRT at the time of diagnosis of their breast cancer have a better outcome. And is it because those women it presents quicker and earlier because it’s growing quicker, so you’re more likely to feel it? Or is it that the oestrogen is anti-inflammatory and helps, you know, reduce some of the inflammation in the cancer and improves outcome? And we don’t know the answer. So it’s very interesting. But I think also it’s about you know, I know because I’ve spoken to you before, you don’t regret taking HRT even though you’ve had breast cancer, do you? [00:15:39][134.0]

Trudie Jennings: [00:15:39] Not at all. I don’t associate them. I mean, I used to drink socially an awful lot. And I would say if I want to try and pin it on anything, I would put it onto my overconsumption of alcohol. You know, when I read statistics, why would I think it was the HRT that I’d taken for a few weeks as opposed to the drinking I’ve done for the past 20 years, you know? So, yeah. [00:15:59][20.2]

Dr Louise Newson: [00:16:01] And for a lot of women, it’s bad luck actually, about one in seven women, as you know, develop breast cancer. And it’s the same as other types of cancer. Sometimes we just don’t know. And often it can be numerous things. It might be partly related to drinking, it might be partly related to your genetics, it might be partly related to something else that we don’t even know. And I think that’s really important because you can always blame yourself sometimes when you’ve had a diagnosis of something. And that’s just the worst thing to do because you are a really positive person, that’s for sure. And looking also at your future health, because you are a really healthy person, aren’t you? And you want to keep healthy. [00:16:41][40.0]

Trudie Jennings: [00:16:44] I am yes, and that’s that’s the idea now. [00:16:45][1.1]

Dr Louise Newson: [00:16:46] And we do speak to a lot of women who come to the clinic who’ve had breast cancer, and they actually say, I’m more worried about osteoporosis or heart disease or, or actually my day to day wellbeing than I am about having breast cancer. And I’ve heard and you’re not the first person who said I would prefer to go through all that treatment again if it meant I would feel better from taking HRT. And then this there’s a whole moral question for me as a doctor. How can I refuse a treatment where there is a woman who knows what it’s like first hand? To have had treatment for breast cancer says to me, I would prefer to do that again than continue as I am now. [00:17:30][43.8]

Trudie Jennings: [00:17:31] Absolutely. And I talked to my cancer nurse, the Macmillan nurse specialist who is absolutely amazing. And I said, what’s happening? So to continue the story then I felt so well after my recovery from cancer, I came off the antidepressants and my husband, honestly, he just went through the roof when I told him that, I decided to take my patches off and I just thought I feel great. And I literally fell through the floor. And I was fine after I came off the antidepressants. That was in the August, I think. And then in the December, I decided to take my patches off and within three weeks I was desperate. It was awful. Appetite lost, anxiety. And there’s something about it’s so hard to believe that it can be all about hormones. And I jumped straight back on to the antidepressant and again with my husband saying, please don’t, please don’t. This has been hormonal from the start, please. Me saying, I can’t. I can’t. I’m just so frightened. I can’t go back there. I can’t go back to feeling like that. And I had a terrible reaction to the antidepressants, the same one as I’ve been on previously. But I just had an absolutely terrible reaction. So then the GP prescribed me another one equally bad, I was going down and down and then another one. I’d gone back on the patches by this time, but I was suicidal by then. I felt so unwell and I wasn’t okay. It’s kind of a different feeling of suicide, I imagine to, I don’t know, but it felt like I feel so unwell. There’s just no point. I’ve had a great life. There’s just no point in feeling like this. And I could have just said, thank you very much, everyone. I’ve had a lovely time, but that’s it. You know, I can’t live like this. And another friend who is a psychologist said to me, Trudie, we can’t help you at all if you’re dead, but you know, we can help you if you stay alive. And I just thought that was just a really, really helpful way of putting it. And we ended up finding a private psychiatrist again, which took so much honestly. There was just no availability sort of locally within the health service. And she was amazing and she wasn’t interested in the menopause. She said, I’m just going to sort your brain out because you’ve overdosed yourself on so many different things here. And she did. And yeah, I’m still on the antidepressant. My husband is still adamant that all of this could have been avoided if I just stayed on my HRT. But I’m in a really good place and I would say the past two years are probably been the best two years of my life. [00:20:03][152.1]

Dr Louise Newson: [00:20:03] Amazing. So you’re going to stay on your HRT? [00:20:07][4.1]

Trudie Jennings: [00:20:09] I am, yes. Yeah, definitely I would. You know, there is part me that thinks could we just get it up a little bit, but I think nothing’s broken at the moment so and that would be one of the takeaways I would say to anybody, take, you know, get what you need, take what you need to get yourself back, because yeah, it’s just so dreadful not being yourself. [00:20:28][19.4]

Dr Louise Newson: [00:20:29] Yeah, and it’s a really important point as well, because HRT is not necessarily something that people have to take forever. They don’t have to make the decision when they start how long they’re going to take it for. We know the guidelines are clear. You can take it as long as the benefits outweigh the risk, review every year. And for most women, that is forever. But when women have, they’re taking it and they’re unsure of the risks/benefits as in for women who’ve had breast cancer, then it becomes a very individualised choice. But also, I always say to women, it is reversible. You don’t have to keep taking it. If you then have a wobble or decide you want to see what you’re like without it, of course you stop it. And as you found first hand, that it doesn’t build up in the system. It doesn’t last very long. So it really only lasts the day that you use it. And it means then that women are in total control, which I feel very strongly as a woman myself. I want to be in control of my destiny. I want to be in control of my health. I want to be in control of my future as well as much as I can. Of course, there are so many things that just you can’t be in control of. And with hormones, as long as women are taking hormones following breast cancer, knowing that there is uncertainty, knowing that there might be an increased risk, knowing that there are still benefits to your bones and heart and brain and everything else, then that’s why I feel very, very strongly and I’m very happy to be challenged, that women can make the decision themselves. If I was just sticking it on patches onto everybody that had breast cancer, that would be completely wrong. It’s a very individualised choice. And also, I don’t live your life, Trudie, I would love to live your life seeing that, you showed me before we started, where you live. A beautiful view of the sea. But I don’t live your life. And I don’t live with your husband. And for him as well, it has a massive impact for him when you’re not on hormones. And he’s incredibly supportive. But it has to be a choice that you’re comfortable with more than anyone else, but also the people that are with you as well. And I think your story just highlights that so clearly that there is no right or wrong in what we do. And we have guidelines as healthcare professionals and we in some of the NICE guidelines, it says in extreme cases we can prescribe HRT for women who’ve had breast cancer. I would argue that you were quite extreme because you were unwell. [00:23:19][170.0]

Trudie Jennings: [00:23:19] I was. [00:23:20][0.7]

Dr Louise Newson: [00:23:21] But also we’ve got the shared decision making guidance that we are allowed to share the decision. And even if we as healthcare professionals don’t feel comfortable, but the patient does and understands there might be risks of that treatment, then that’s fine as well. And informed consent, really important that you are allowed to accept or refuse treatment even if there are risks with that treatment or not having that treatment. And I think this is really important. You know, we’re in 2023. We’re not in the 1900s when women are locked away without any discussion because they’re hysterical. We have to move forward and allow women to have their life. Because you’ve relocated, you’re having a sort of new life almost but I’m not sure you would be doing that if you weren’t taking HRT would you? [00:24:10][49.0]

Trudie Jennings: [00:24:10] I don’t think I would. Absolutely not. And that’s why I’m taking it. Yes, it’s about very much about living in the moment. And I think that’s one thing all of this has taught us, my husband and me. Just take each day and just enjoy it because none of us know what’s around the corner. But if I can do anything to maintain my sanity and my physical wellbeing, I’ll take it now. I will. [00:24:35][25.0]

Dr Louise Newson: [00:24:36] Mmm. That’s so important. So I am so grateful Trudie because I know it’s not easy and I know it’s taken me a while to persuade you to come onto the podcast to talk about very personal things, but I know that your words will really help people and maybe make people think in a slightly different way rather than a very binary black and white yes and no way, because medicine is an art form as well as a science. And the art is getting it right for that individual patient. And I strongly feel that. So I’m very grateful. So just before we end, I always ask for three take home tips. So three tips for women who have had breast cancer, who are struggling with their symptoms and maybe are quite scared of HRT or have been told they can’t have it. What three things do you think would be good just to empower them to maybe think or get what is right for them? [00:25:32][55.9]

Trudie Jennings: [00:25:33] The cancer nurse specialist that I saw, so I asked her, how are the women that you’re dealing with that have come off HRT immediately they’ve been diagnosed with breast cancer, and she said pretty dreadful. And she said a lot of them come through it, but a lot of them are housebound and very unwell for a couple of years and that’s a couple of years of life. So she was actually, I can’t say delighted. She was very happy that I had taken the decision to stay on the HRT. And it’s just back to what you were saying, Louise. I think it’s about quality of life. You decide for yourself if you can maybe, you know, battle it out, just give up a few more years and get through the whole blinking thing. That’s a choice, of course. Mine was I just couldn’t. I just couldn’t face it. No chance. So that would be the first thing is, you know, that there is a choice there, as we’ve said. And to talk to you health professionals and, you know, I’ve generally found them really, really good. I went for my fifth and final mammogram just a couple of weeks ago down here. And because I had moved to a new area, they wanted to see me, the surgeon wanted to see me, actually. And he was just so brilliant. He didn’t bat an eye when I said about the HRT. And yeah, we had a really interesting conversation about it. And he said, if you have any symptoms because your cancer was so aggressive, you could come in here five times a week and say, you want to be seen and you will be seen. He said, so we don’t need to say we’re discharging you. And I just thought, that’s so reassuring as well. So yeah, yeah, really sensible. And of course I won’t because, you know, hopefully if, you know, I might have to go once or twice, but who knows. But I won’t be hammering on his door. But just to know that I could and I would be taken seriously was really, really good. It is very different, the menopause situation now. And I just devour every piece of literature, everything on the TV, all your stuff Louise on menopause. And I honestly just think, oh, it’s just it’s so good to hear because at least mostly women will think know that they’re not going mad. And that’s what I would say is you’re absolutely not going mad. You know your own body, you know what you’ve been through, even if you’ve had issues before, you know if it’s different, if it’s worse. And you get out there and get the treatment. And don’t let anyone tell you that, you know, you’ve been a bit of a hypochondriac or whatever. You get it, you know your own body. And can I just say then my relationship with my mum has got so much better actually. And what came out was and I asked her if I could say this, that when I was away at university she was 51 and she tried to take her own life and she was hospitalised. And my family kept this from me. And she said it was the menopause, wasn’t it? And I said, well, I don’t know, but it sounds awfully like it was. And we’ve talked about it and talked about how unwell she felt and how no-one would, exactly the same symptoms as me. When we were talking about it, she knew what I was talking about. And it makes, you know, and she said that’s why she always say you will get through it, though. You will get through it. You come out the other side and you feel great and all of this. That was really special, too. And I’m sorry that she had to go through that. And I think now hopefully she wouldn’t have to go through that. [00:28:53][200.0]

Dr Louise Newson: [00:28:56] Really important, so important and really empowering. And I think that’s the message that’s weaved through this whole podcast actually is about choice. It’s about being in control, being empowered, but also really being supported as well. And I think that’s really important. So it’s been wonderful. I’ve really enjoyed this podcast and I’m very grateful to you Trudie so thank you again. [00:29:18][21.9]

Trudie Jennings: [00:29:18] Thank you, Louise. It was great. Thank you. [00:29:20][1.7]

Dr Louise Newson: [00:29:25] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:29:25][0.0]

END

The post Breast cancer treatment and HRT appeared first on Balance Menopause & Hormones.

Leading US oncologist Dr Avrum Bluming joins Dr Louise Newson to talk about the crucial role of oestrogen in women’s health.

Despite HRT’s proven benefits in protecting against heart disease, bone fracture and cognitive decline, many women still avoid it over breast cancer fears.

It’s been more than 20 years since media headlines about a study called the Women’s Health Initiative linked HRT to an increased risk of breast cancer. In this podcast, Dr Bluming says that in fact we now know oestrogen alone decreases the risk of breast cancer development by 23% and risk of death from breast cancer by 40%. 

He also disputes the findings of the WHI study that combined progesterone and oestrogen HRT leads to a small increase in breast cancer cases.

‘It is very upsetting when such an influential study continues to misquote their own data,’ says Dr Bluming, who has spent 25 years studying the benefits and risks of HRT in breast cancer survivors.

Dr Bluming points out that oestrogen used to be a treatment for breast cancer before chemotherapy was developed, and that rates of breast cancer increase as we age, despite the fact our oestrogen levels fall as we get older.

You can read about Dr Bluming’s latest paper here, and listen to an earlier podcast Dr Newson and Dr Bluming recorded here.

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr. Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free Balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving, and always inspirational, personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast, I have someone who is in the US, so not near me, but I’ve had him on my podcast before and I’ll hopefully have him again. Someone called Avrum Bluming, who some of you might have known, who is a very inspirational and academic doctor who has got the most amazing knowledge and also clarity about things. And I first heard him talk at the Royal Society probably about seven years ago and thought, wow, this is so interesting because he’s saying some really common sense things and common sense often gets lost in medicine. We’re always trying to find the biggest, the best, the most impressive cure for something. And then we forget basic science and Avrum’s talk at the Royal Society just made me sit and reflect and think, Louise, what are you doing? Go back to basics in medicine, which is what we often do. So he’s helped me more than he knows over the last few years, really trying to unpick evidence in a very simple way. So I’m very delighted, Avrum to introduce you again to the studio. So thanks for joining me. [00:02:09][118.5]

Dr Avrum Bluming: [00:02:10] It’s a pleasure, Louise, as always. [00:02:11][1.5]

Dr Louise Newson: [00:02:12] So yours and my background are similar, but different in that you’ve been an oncologist for many years and I wanted to be an oncologist, and the only reason I changed was really for family reasons, just because, I just, with my husband being a surgeon, I thought, actually I want to work part time. And in the nineties, when I had to make career choices, after I’d done all my medicine exams, it was too difficult to go part time as a doctor then. So I’m always jealous of people that are oncologists. But actually I think I don’t regret what I do in the slightest. But you’ve written the most amazing book that many of my listeners would have heard of, and if they haven’t, they should look it up called Oestrogen Matters. And this is something that even the title actually, Avrum. Oestrogen is something everyone seems to be really scared of and actually oestrogen, can you just explain, it’s just a hormone in our bodies, isn’t it? [00:03:07][54.6]

Dr Avrum Bluming: [00:03:07] Yes, it is. Both male and female. Yes. And I gave a talk last week that you and I were just discussing in front of several hundred perimenopausal women. And I was aware that they were afraid of hormone replacement therapy and oestrogen specifically. And I asked them, what is it about hormones that you’re afraid of? And I put several options in front of them. I said, are you afraid of heart disease? And very few of those several hundred hands went up. Are you afraid of hip fracture? And very few went up. Are you afraid of cognitive decline? And a few more went up, but not many. And then I said, are you afraid of breast cancer? And almost all of the hands went up. Well, I am a medical oncologist. I have spent the last 50 plus years working with patients who have cancer, and 60% of my practice has been women with breast cancer. So I’m very familiar with that entity. In addition, my wife had breast cancer. My daughter had breast cancer. My wife’s sister was just diagnosed with breast cancer. I’m very grateful that all three of them thus far are in excellent health. But I’m very aware of the fear surrounding breast cancer, both as a patient and as a physician. And you mentioned the Women’s Health Initiative. The Women’s Health Initiative, as you well know, and many of your listeners know, is a 1 billion plus dollar study that was initially published in July of 2002. And that really put a target on hormones, a target that has been fired at many, many times. The prevalence of hormones in the United States fell from about 44% of the eligible population to less than 5% where it remains today. And the major fear was breast cancer. And so at your discretion, you let me know when you want us to get into that, and I will gladly get into that. [00:05:44][156.2]

Dr Louise Newson: [00:05:44] Well, let’s get into WHI in a minute. But before we do, let’s just talk about what a hormone is, because actually, some people think hormones are only oestrogen and the sex hormones, but we’ve got lots of different hormones in our body. And they’re just chemical messengers, aren’t they? Can you just elaborate what a hormone actually is? [00:06:02][18.4]

Dr Avrum Bluming: [00:06:03] Sure. I wouldn’t say just because I think they are miraculous chemicals. They are the chemicals that circulate in our bloodstream and go from the organs, secreting them to the organ receiving them, and tell the receiver organ what to do, when to grow, when to multiply, when to stop growing, whether you should secrete a certain product, whether your heart should increase its rate of beating per minute in response to exercise. Hormones are wonderful. The hormones that we talk about most specifically in women are oestrogen, which is a hormone that has now been shown to be responsible for many attributes of women that make us recognise them as women, but they also help decrease the risk of heart disease among women as they get older, decrease the risk of hip fracture among women as they get older, preserve the ability to think clearly and also prolong life if they’re started within ten years of a woman’s final menstrual period. We use one additional hormone, and I’m sure most of your listeners are aware of this, oestrogen alone can increase the risk of uterine cancer. And so women who still have a uterus when they are given oestrogen are also given progesterone, which is a hormone that prevents that increased risk of uterine cancer among women taking oestrogen. So when we talk about hormone replacement therapy, we’re talking largely about oestrogen and oestrogen plus progestin, progesterone, when a woman still has a uterus. [00:08:11][127.7]

Dr Louise Newson: [00:08:12] And progesterone has its own metabolic effects in the body as well. It’s an important hormone for many women, but we’re just sticking to oestrogen. We know that every cell responds to oestrogen and actually our ovaries produce oestrogen, but our brain produces oestrogen. And I’m sure other areas of our bodies produce oestrogen as well, don’t they? [00:08:32][19.9]

Dr Avrum Bluming: [00:08:32] Yes, they do. And oestrogen has a 640 million year history. It is present in octopuses, which go back that far. And for those of you who think I mispronounce the plural of octopus, I didn’t. It is octopuses. [00:08:53][21.0]

Dr Louise Newson: [00:08:55] They’re very interesting because as you know, and some listeners know, I’ve got a pathology degree as well, and we learned a lot about the role of our immune cells to fight infection, but also to fight disease. And as soon as I started to read more about oestrogen, knowing how we’ve got receptors for oestrogen on all our immune cells, and actually when we have low oestrogen in our body, it increases inflammation and also the way our cells work. As you say, our cells are so important, but we have mitochondria in the middle of our cells, which is actually like the powerhouse of the cells, isn’t it? It sort of works out the whole energy and determines how so many processes occur. And we know that oestrogen is very important for mitochondrial function as well as the immune cells, as well as lots of other processes in our body and as you say, in our brains. It works as a neurotransmitter, a really important chemical to allow our brains to work. So there are lots and lots of benefits. And we know actually for many years, haven’t we, in studies that women who have regular periods, women who are naturally producing oestrogen, are healthier than women who don’t have their periods. So, I mean, we’ve got some good studies from women who’ve had their ovaries removed. Their risk of disease actually increases quite quickly after and even my really non-existent menopause training as an undergraduate in the eighties, I was still taught that women are protected from various diseases, including heart disease, usually up until the age of 50, and then something happens. And that’s something obviously is the menopause. But they failed to tell us that. Then women catch up with men afterwards and their risk of heart disease and so forth increases. So this is why I’m talking at the start about this common sense medicine, really, isn’t it? Because oestrogen is really important when we have it naturally in our bodies, isn’t it? [00:10:52][116.8]

Dr Avrum Bluming: [00:10:52] And it’s not just theoretical, but women who have their ovaries taken out early or women who reach an unusually early menopause have increased risks of heart disease and bone fracture and cognitive decline. And giving them oestrogen eliminates that increased risk and helps prolong life. Yes. [00:11:15][22.6]

Dr Louise Newson: [00:11:16] Which makes sense, isn’t it? You know, in medicine, we try and replace what’s missing. And so if we know something is missing, we replace it and it improves. And also, lack of oestrogen can cause so many symptoms that we’ve talked about quite a lot before that are associated with the perimenopause when hormones start to decline and also the menopause. So I sometimes think which, just bear with me here, Avrum, if I was an alien from outer space and I knew nothing about the WHI, had read no adverse media about HRT, hormones or oestrogen. And I was listening to this conversation, I would then be probably asking you with my inquisitive mind. So. Right. So why aren’t we just replacing everyone with oestrogen? Because it’s a really important hormone. Women live a lot longer than they used to 100 plus years ago. We used to die earlier, so now we’re living into our seventies, eightes, nineties if we’re lucky. But a lot of time without hormones. We’ve just been talking how good it is as a biologically active hormone. So Avrum why are we not all taking oestrogen then? [00:12:23][66.6]

Dr Avrum Bluming: [00:12:23] Well, first at least half of us are males and we have problems taking oestrogen. So let’s focus just on the females among us. And if you were an alien, you might have seen the headline on The New York Times. If you were smart enough to get to Earth, you probably got The New York Times or the London Times, and you would have seen that there was this very expensive study that was looking to determine whether giving oestrogen to women as they pass the menopause line would help them. And the study first came out as a press conference, which is unusual. Usually a study is published in a medical journal. Healthcare providers have a chance to read the study and form an opinion. This time before it came out in the Journal of the American Medical Association, it was widely published in news media around the world. And what they said in the results of the study is that it increased the risk of heart disease, increased the risk of cognitive decline and increased the risk of death. They have walked back all of those and said, well, in fact, if it started around the time of perimenopause or within ten years of a woman’s final menstrual period, it actually improves all of those things. At the same conference in 2002, they said it also increases the risk of breast cancer. And that was the leading headline. Interestingly, at that time, it had no increased risk of breast cancer found to be statistically significant. But that didn’t prevent the press conference and the news media to widely publicise that. At that same time, the Food and Drug Administration in the United States issued what is called a black box warning that says if you take this, any product containing oestrogen, it will increase the risk of cancers and specifically breast cancer. We now know because the Women’s Health Initiative has published updates many, many times since then, and here we are 21 years later, and now we know that oestrogen they found and this goes along with other researchers as well. Oestrogen alone decreases the risk of breast cancer development by a statistically significant 23%. And even more importantly, it decreases the risk of death from breast cancer by 40%. That FDA black box warning is still in place. There is a movement among several scientists here in the states to change that, but it is still very much in place. The Women’s Health Initiative now says that, well, it’s the combination of oestrogen and progesterone that increase the risk of breast cancer. And in fact, what their data say is for women who start oestrogen and progesterone around the time of menopause or within ten years of the last menstrual period, the combination does not increase the risk of breast cancer. The population they studied was a population with a median age of 63. Many of them were considerably, half, were considerably older than that, and that hasn’t been widely circulated. Even if they were right that the combination of oestrogen and progesterone increases the risk of breast cancer, the increased risk would be one per 1,000 women taking it per year. And it doesn’t increase the risk of death from breast cancer, although they still claim that it increases the risk of breast cancer development. And in fact, even that claim is challengeable. What the paper I just published within the past few weeks says is there was no increased risk among the population that took the combination of oestrogen and progesterone, regardless of when they started taking it. That, in fact, I told you there was a decreased risk among women who took oestrogen alone. And if you graph the risk of oestrogen alone on the same graph as the combination, it is the identical curve. And yet oestrogen reportedly is associated with the decreased risk. And the combination increases the risk. There is no increased risk. It’s just that the placebo group against which the WHI investigators compared the women taking the combination had a lower than expected risk. Why should the placebo group have a lower than expected risk? Well, a significant number of them had been taking oestrogen before joining the study and being randomised to placebo. And if that population were removed from the data before graphing it, the increased risk completely disappeared. [00:18:16][352.7]

Dr Louise Newson: [00:18:18] Which is quite something, isn’t it? [00:18:20][1.5]

Dr Avrum Bluming: [00:18:20] I mean, more than something it’s actually very upsetting. It is not intellectually straightforward. And we rely on reports that help determine how we practice. And it is very upsetting when such an influential study continues to misquote their own data. [00:18:43][23.0]

Dr Louise Newson: [00:18:45] Now, there’s so many things that are wrong because it’s the same with us in the MHRA. Again, have this similar black box where it’s warning about oestrogen and in fact, cancer research over here, Cancer Research UK, say that significant number of breast cancers could be avoided if women did not take HRT. And when I’ve challenged them and I have on several emails, they’ve said yes, for oestrogen causes cancer. And again, I think about this alien thing. So if oestrogen caused cancer and I didn’t know any science and I didn’t know about the WHI, surely we would then be seeing a lot more cancer in younger women who produce naturally oestrogen, but also women who had more pregnancies. Because when we’re pregnant, we have very high levels of oestradiol in our bloodstream and there isn’t any evidence. In fact it’s to the opposite, isn’t it Avrum, for people who are pregnant? [00:19:40][54.8]

Dr Avrum Bluming: [00:19:40] That’s correct. The biggest risk factor for breast cancer, aside from gender, is age and the risk of breast cancer increases as age increases. And as you correctly state, we would think it should fall as oestrogen levels fall, and it doesn’t. In addition, we used to use oestrogen to treat breast cancer when we didn’t have chemotherapy or other agents. And there was a reported 44% response rates to giving oestrogen to women who have measurable breast cancer. And finally, a woman who is pregnant and gives birth before age 20 has a 70% reduced risk of lifetime development of breast cancer. There is a very interesting study that was just published by Ann Partridge this year from Harvard, saying that women who were taking a medication that is meant to interfere with oestrogen’s actions who were premenopausal and wanted to get pregnant, were allowed to take two years off from their treatment, get pregnant, which bathes the body in oestrogen and progesterone, and then come back to treatment. And they’ve been followed so far for seven years with no increased risk of recurrence. So clearly saying that oestrogen increases the risk of breast cancer is both wrong and not provable and harmful. One other thing. Progesterone deficiency is associated with a five times increased risk of breast cancer development. So blaming it on progesterone doesn’t make sense, especially since progesterone was also used to treat measurable breast cancer and was at least as successful as Tamoxifen. [00:21:47][127.0]

Dr Louise Newson: [00:21:48] Indeed. And so the other alien bit of me is thinking when the WHI came out, breast cancer incidence was probably about one in 11, one in 12 people, depending on what study you read. But people who, and we get a lot of letters of complaint in our clinic saying, how dare you put these women at risk of breast cancer by giving them HRT? And obviously we aren’t because we know the evidence. But if you were saying, as you did quite rightly, the prescribing rates for HRT in the U.S. were a lot higher, about 44% dropped to 5%. In the U.K., they were about 30% and they dropped to less than 10%. So you’ve got far less women taking HRT. So if you are saying, well, maybe it’s because it’s not the pure oestrogen, it’s HRT, because those three letters scare so many people. Surely with the reduction in prescribing of HRT, we will have had a reduction in incidence of breast cancer over the 20 years. So have we, Avrum? [00:22:55][66.4]

Dr Avrum Bluming: [00:22:56] Well, it depends on whom you ask. The Women’s Health Initiative investigators who still claim that oestrogen increases the risk of breast cancer do claim that there is a reduction in incidence as a result of the reduction in the frequency of hormone replacement therapy. There was a reduction in incidence of breast cancer in the US, which was noted starting in 1999, but which the investigators claim was really due to their 2002 publication. That doesn’t make sense. The reduction, they say, is still ongoing, but it’s not. The incidence of breast cancer around the world is increasing. And by the way, even that small reduction and it was small, was not seen in most countries around the world where hormone replacement therapy prescriptions dropped. And what’s most important to remember is the overwhelming majority of patients who take HRT do not develop breast cancer, and the overwhelming majority of breast cancer patients never took HRT. So to look at any population statistic and try to derive from that evidence of oestrogen’s carcinogenicity is misleading at best and dishonest at worst. [00:24:34][98.0]

Dr Louise Newson: [00:24:35] Absolutely. And certainly in the UK it’s around one in seven women who now develop breast cancer. And as you know, obesity has overtaken smoking as the commonest cause for all types of cancer, including breast cancer. So it’s not as easy as oestrogen causes breast cancer. And a lot of people are still told when they have an oestrogen receptor positive breast cancer, it’s an oestrogen driven or oestrogen caused. And actually, when I explain to women that not having a receptor is the abnormal bit, so when it’s oestrogen receptor negative, that means that the cancer’s mutated and is not actually as good prognosis often. We have oestrogen receptors, we’ve already said, everywhere. And so it’s not as easy and straightforward as just saying oestrogen causes breast cancer because there’s the alien bit of me that I keep talking about, which is a common sense bit, but there’s also the science bit and now we’ve got evidence as well. And what’s so sad for me is to know that an evidence-based approach has not been taken when it comes to oestrogen in HRT for women who’ve had breast cancer. And this study that has been really looked at by so many people and the majority people are in complete agreement with you, Avrum, it’s still the biggest barrier for women to be able to get HRT. And the other thing that I think is really sad is that choice is not being allowed. Now, you’ve already said women we know are scared about breast cancer, but actually when they know the facts, they are then more educated to think about how scary other conditions are. And so if I told you I had breast cancer or if I told you I’d just had an osteoporotic hip fracture, I think with all your knowledge and experience, you would be more concerned about my osteoporotic hip fracture because my outlook from that actually is more severe than most types of breast cancer. But it’s something about this word cancer. So we need to be thinking not also just about supposed risks of HRT that we’ve already said aren’t really there. We need to focus on the benefits because there are so many benefits from taking HRT for many, many women, aren’t there? [00:26:51][136.9]

Dr Avrum Bluming: [00:26:52] Yes, there are. And we have to be careful that we don’t dance around the question that most women ask, which is if oestrogen doesn’t cause breast cancer, why is breast cancer 100 times more frequent among women than it is among men? If oestrogen doesn’t cause breast cancer, why do treatments that we say impede oestrogen function seem to work on breast cancer? And the short answer is I can’t put it all together in a unified theory. I wish I could, but I can’t. I can avoid simplistic answers, however, and you had mentioned that an oestrogen receptor positive breast cancer often responds to some treatment that seems to interfere with oestrogen function. That’s true. Tamoxifen is the first drug that came on the scene for that. Tamoxifen has at least ten different functions besides oestrogen blockade. When Tamoxifen is given to a premenopausal woman, her level of circulating oestrogen goes up tenfold, and that doesn’t impair the therapeutic benefit of Tamoxifen. And by the way, the multiplying cells in a breast cancer that is responsible for the tumour growing is not an oestrogen receptor positive cell. Even among oestrogen receptor positive tumour patients, the oestrogen receptor is present on many cells in the body. You started the program off by saying that, and in oestrogen receptor positive breast cancer is a relatively slow growing breast cancer compared to an oestrogen receptor negative breast cancer. [00:28:55][123.1]

Dr Louise Newson: [00:28:57] It’s very interesting, isn’t it, yet women across the world, but actually also healthcare professionals across the world are still scared away from oestrogen. And it is really sad and I don’t quite know how that’s going to change. In fact, I’ve posted today, the day that I’m recording the podcast, not the day it’s going out, a little excerpt from your wonderful paper on my Instagram, and I only did it a few hours ago and already there’s lots and lots of interest. And actually the women are understanding and I think that’s what we work for, isn’t it? As doctors, we’re there, I remember you saying to me years ago, Louise, I’m an advocate for my patients. I’m here to listen and guide them. And I think that’s so important. But what we are realising with the work that we’re both doing in different ways in different countries is allowing women to have the knowledge and share, you know, what this sort of truth behind oestrogen as well, because it is quite easy when you know the facts. But there is so much good news about oestrogen. And so for you to write this article, I think is a real turning point. But it’s a shame it’s taking so long, isn’t it, for people to really understand? [00:30:19][81.8]

Dr Avrum Bluming: [00:30:20] It’s very important for women to understand. I was a practicing oncologist when the standard treatment for breast cancer was mastectomy, even a radical mastectomy, and it was thought for close to 100 years that breast cancer spread contiguously from one part of the body to tissue right next to it. And so you took off as much as you could, and that’s what doctors did. The reason it changed, even though we knew that a lumpectomy with radiotherapy was as good as a mastectomy as early as 1929, the reason it changed in the 1960s and early 1970s is because women got educated and said to their physicians, enough. They said, I’m not going to sign a consent form that allows you to remove my breast before I even know if I have breast cancer. You wake me up and we will talk about it. And women have to do the same thing here. A physician who dismisses you, if you ask about hormones, saying, I don’t want to kill you or I don’t want to give you poison, is not an informed physician, and your responsibility is either to help that physician find the appropriate information or you find a different physician. [00:31:52][92.7]

Dr Louise Newson: [00:31:53] Indeed, that’s such an amazing way to end. And I all for being the biggest supporter of my own future health, as well as a menopausal women myself who has been a patient to many different people before I received the treatment that I wanted. It’s really important that we have choice and that is so key. So I’m very grateful for your time, Avrum. And I hope people will listen to this podcast more than once because there’s a lot of information in there, there is a lot to unpick. So please take your time listening and hopefully share it with people, listen again in a calm way and you probably won’t be calm at the end because it’s very frustrating what’s been happening to women. But we can change it and we are changing things. So before I end Avrum, I always ask for three take home tips. So I’m very keen to ask you three things that you think will make the biggest difference over the next 20 years for women to get back onto hormones. What are the three things that you think are already helping or which will help more? [00:33:00][66.2]

Dr Avrum Bluming: [00:33:01] I think the single most important thing is for women to take an active role in their care. Now, we’re not pushing medicine, and this isn’t candy, like any medicine. Benefits versus risks. And we haven’t gone over the risks which are small, but they’re there, have to be calculated. But Eric Winer, who is the recent past president of the American Society of Clinical Oncology, in his presidential address, titled Partnering with Patients, saying that advancement of research and clinical care will be maximised if we partner with patients. Let them understand what we are suggesting and let them be active partners. I think that dwarfs anything else that would happen. I think the second step, and one that I would love to see but may not happen soon enough, is I’d love to understand what cancer is. Our current understanding of cancer as something that has to be cut out or burned out or poisoned out is a very simplistic understanding that doesn’t fit the experimental data that we already have. And once we understand it, we will be so much better off in being able to approach it intelligently. [00:34:36][95.6]

Dr Louise Newson: [00:34:38] Hmm. [00:34:38][0.0]

Dr Avrum Bluming: [00:34:39] That’s two. Offhand, I didn’t come prepared to discuss three, but of those two would be enough. [00:34:47][7.8]

Dr Louise Newson: [00:34:47] Oh I’m pleased you’re not greedy. Very good. I think. I think number three is keeping education for all healthcare professionals, actually, to allowing them a bit of time to really look at the evidence unpicked rather than just taking this top line that they’ve done for many years. And it is happening. Things are changing, definitely. So keeping professional curiosity not just for oestrogen, but for all aspects of medicine, I think is really important. [00:35:15][28.2]

Dr Avrum Bluming: [00:35:16] Being able to practice medicine, as you well know, is a wonderful privilege and very exciting. But in order to feel both privileged and excited, you must stay curious, recognise how little we know, and how much more we have to learn. [00:35:35][18.1]

Dr Louise Newson: [00:35:35] Absolutely. So thank you so much for your time today, Avrum. I really enjoyed it. [00:35:39][3.8]

Dr Louise Newson: [00:35:44] You can find out more about Newson Health Group by visiting www.newsonhealth.co.uk. And you can download the free Balance app on the App Store or Google Play. [00:35:44][0.0]

ENDS

The post Getting to the truth around HRT and breast cancer with Dr Avrum Bluming appeared first on Balance Menopause & Hormones.