In an article entitled Can you stop the menopause? published in The Guardian, writer Jeanette Winterson describes how she was left physically depleted after experiencing two years of mental breakdown.
Even after her mind had healed, she was still struggling with low energy levels, problems sleeping and her hair was falling out. A visit to her GP confirmed that she was perimenopausal and she was offered HRT. In spite of her high cholesterol levels and other symptoms, Winterson’s GP said she was ‘fine’ and advised her to ‘eat less red meat’.
That sparked the beginning of a journey of healing and discovery for Winterson who did not feel ‘fine’ and was determined to find out why her body felt ‘unpredictable and alien’.
Her experience is similar to so many women’s menopausal journeys; rife with frustration, conflicting advice and the shortcomings of a health system that treats symptoms and illness section by body section, rather than adopting a more holistic approach.
Menopause and Nutrient Deficiencies
One of the first things Winterson discovers is that ‘Nobody tells you that your body needs different kinds and combinations of foods at different life stages’.
After a visit to a ‘fancy nutritionist’ and a trichology clinic to treat her thinning hair, she learns that she is deficient in zinc, magnesium and vitamin D, and her levels of stored iron (ferritin) too low, even though they are still within the range of what is ‘normal’. This is in spite of following a very healthy diet and lifestyle.
All these are common nutritional deficiencies in menopausal women and often supplementation is needed, but unless you ask your GP for a blood test you may not realise you are lacking essential vitamins and minerals.
The hormone imbalance associated with perimenopause can take its toll. Hormones play a vital role in maintaining good mental and physical health from protecting our hearts, preventing osteoporosis, depression and inflammation, helping cognitive function, maintaining healthy skin tissue and so on. It stands to reason that if our hormones are depleted and out of balance, and particularly if we are not replacing them with HRT, we need to step in and supplement hormone function with our diet and, possibly, supplements.
Jeanette Winterson is then referred to Dr Marion Gluck, an expert on bioidentical hormone therapy. At this point Winterson acknowledges the cost and the energy it takes to get the right treatment when she says:
Off I went from Mayfair to Wimpole Street, thankful to have sold enough books to pay for all this private attention, furious that if I wasn’t tenacious, intelligent and solvent, I would gradually be running myself into ill-health…
This is a common experience. Many women, frustrated by the lack support, information or treatment available to them on the NHS have felt compelled to go private and spend a small fortune on doctors’ appointments, tests and bioidentical hormones.
Winterson’s conversation with Dr Gluck reveals two different types of bioidentical hormones, which I refer to as tailor-made and off-the-peg.
What you are paying for when you go for the tailor-made approach is a prescription of bioidentical hormones that is made up to restore your hormonal imbalances exactly. It is an individual prescription and will often be a much lower dose than that prescribed by your GP or Consultant and is usually made up by a compounding pharmacy.
But according to Dr Nick Panay, consultant gynaecologist at Queen Charlotte’s and Chelsea Hospital in London, in an interview with the Daily Mail, ‘It does not make medical sense. It is not possible to work out the level of hormones to give, based on a blood test,’ he says. ‘First, because your levels fluctuate all the time and second because you can’t predict what a person needs from the test result.’
He is also concerned that bioidentical creams made up by compounding pharmacies are ‘unregulated products that haven’t been tested for safety or effectiveness.’
The off-the-peg approach involves bioidentical hormones that have been manufactured by pharmaceutical companies and have a ‘one size fits all’ approach. They contain standard amounts. Although they come in different doses, it can be a bit of a hit and miss affair as you work out which dosage of which hormone suits you best.
The good news is that these bioidentical hormones are available on the NHS but not all doctors are aware of them or are keen to prescribe them. Brand names include Estrogel, Estraderm, Evorel and Hormonin. Progesterone is available in pill form as Utrogestan.
Hypothyroidism and the Menopause
Winterson insists on a thyroid test which makes sense as her cholesterol is ‘bafflingly high’ but the results come back in the ‘normal’ range. Yet according to Dr Marion Gluck, ‘The NHS thyroid test is not sufficient, especially for borderline cases.’
I had a similar experience, which I wrote about in Hypothyroidism and High Cholesterol during Menopause. In my case, I thought I was protected against high cholesterol because I was taking bio-identical HRT, but my low thyroid levels had increased my cholesterol significantly.
I’m ‘lucky’ in that I already take thyroxin so in my case it was just a case of increasing my dosage and within a couple of months my cholesterol levels had reduced. But many women who are suffering from hypothyroidism during menopause are not offered treatment because their levels fall within the so-called ‘normal’ range.
In Winterson’s case her thinning hair could very well have been caused by an underactive thyroid (hypothyroidism), low iron levels or low testosterone levels or a combination of all three, but none of the health professionals she saw made the connection.
The Need for a Holistic Health Model
Another point that becomes clear in Winterson’s article is the need for a different approach to medical treatment. She writes that, ‘I have been looking for medical practitioners able to discuss the mind-body balance as a synergy, not a confusing, frightening war.’
In her case, she is not able to find that with her GP but she finds it in the form of Dr Marion Gluck who says that ‘Doctor and Patient should be in a relationship not a dictatorship’.
I agree with Dr Gluck’s vision of a holistic health model where standard medical practice includes regular blood tests, advice on diet and exercise and psychotherapeutic interventions. But, that is going to cost money and involve changes in the medical school curriculum and GP training.
In the long run, it could save the NHS a fortune as fewer patients develop the degenerative diseases associated with unhealthy diet and lifestyle habits such as diabetes and heart disease.
Better Menopause Treatment for All Women
For some women, simply taking vitamins and minerals and eating well is not enough and it is the use of bioidentical hormone replacement therapy (BHRT) that restores wellbeing and can make a woman feel ‘normal’ again.
What saddens me is that so many women are never offered this chance. It may be because their GP is unknowledgeable about the menopause and BHRT or there isn’t a menopause clinic in their area. All menopausal women should be offered BHRT if that is what they want, not just those who can afford private treatment.
I was lucky enough to be referred to a menopause clinic and was prescribed ‘off-the-peg’ BHRT. For me taking bioidentical hormones is not about being forever young. It’s about correcting an imbalance so that I can feel well and be healthy.
Bioidentical hormones gave me back my sanity, my health and my relationship with my partner. Without them I’d still be stuck in hormone hell. And like Jeanette Winterson, I too feel at home in body.
Read Jeanette Winterson’s article for yourself and let me know your thoughts by leaving a comment in the box below.