A question that is always on my mind about HRT and menopause is that if HRT has so many benefits to our health I.e protects bones and heart disease then why is all menopausal women not on HRT.
This is big, messy knot of an issue that's difficult to unravel.
Though I do take HRT I came to it late, largely out of fear, both of worsening other conditions (hypothyroidism, migraine) & having lost Mum to breast cancer. I think both of these areas of concern are weighed up by many other women, some of whom will be deterred, as I was for a decade before starting.
Beyond individual reasons of family or personal health history, I think more general lack of take up of HRT is probably still partly connected with the persistence of understandable mistrust following the poorly interpreted & reported studies that led to widespread fear of HRT and resulted in many women coming off it 2 decades ago. Women were made afraid of taking it, their doctors were made afraid of prescribing it. With HRT effectively removed from the medical tool kit for so long, GPs were left scratching their heads to know how to help & so the needs of women at our stage of life became further relegated & neglected in the scheme of things. Though more recently advocacy for menopausal women has improved together with awareness that these studies were badly flawed, the misinformation was so damaging to the collective psyche that it's like turning round a cruise ship to set women's healthcare at midlife & beyond on a new path.
Perhaps too, the fact that so many of us lose confidence at menopause on top of feeling physically rotten, wears us down & makes us ill equipped to push for the help we need, especially when faced with resistance from those we have no choice but go to for medical help. Sometimes, unfortunately our symptoms are trivialised & dismissed by those less informed or sensitive medics who simply don't get how devastating menopause can be & this can be hard to fight against when we're physically & emotionally depleted, at our most vulnerable & unsupported.
There's also the fact as others have said, that getting HRT right can be a tricky & drawn out process so that sometimes what we take may make us feel worse rather than better, perhaps leading some women to fall at the first or repeated hurdles & deterring us from persevering. After my first brief trial of an unsuitable combi HRT 13 years ago, my then GP thought a month on one product was enough to know HRT was never going to resolve my symptoms & that was the end of it for more than another decade. As I was still so scared of it at that point, had felt even worse for the HRT & didn't know my GP was poorly informed, I didn't persevere & wasted many subsequent years struggling with very poor QOL before finally trying HRT again several years postmenopause, with other chronic conditions to manage & symptoms still showing no sign of stopping.
Perhaps for those women who feel their symptoms are bearable, even the prospect of systemic health protection for the future (bones, cardiovascular, pelvic floor, GSM etc) is not enough to allay any lingering fears or doubts or make them want to enter into the commitment of repeat monitoring, reviews, tests, endometrial scans for non-standard regimens, etc, especially when there is still contradictory reporting about the long term benefits.
Perennially underfunded, with an always heavy caseload & too few staff, the NHS also hasn't been well placed to deal with any more than fire-fighting of urgent & serious conditions, so that health promotion has become an idyllic concept seen as beyond what can be accommodated.
Maybe for some women who are otherwise healthy at menopause, without other chronic conditions to add to their load, other major life stresses - demanding jobs, ailing parents, children/teens to look after etc, there is simply not enough incentive to embark on a course of action that's still dogged by controversy & that perhaps could be seen as potentially complicating a situation they feel well enough able to live with.
There's also the sad issue of women who've been unable get the menopause support they need from the NHS for whatever reason & can't afford to go private.
In short there may be any number of understandable reasons more women who might benefit from it are not on HRT. By becoming as well informed as we can, we can all play a part in helping GPs help us if they are open to that & if not we can go to another doctor who is.
Wx
