HRT — What I Wish Someone Had Told Me Before I Started
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I always knew HRT existed. Filed it away under "probably not for me" and got on with things.
Well that was until my body and mind had other ideas.
The sleepless nights I could almost explain away. The joint pain I put down to getting older. But then came the weight gain, the hair loss, the blood pressure that arrived from nowhere, and a fog so thick some days I genuinely wondered if something was seriously wrong with me. Nobody connected it to hormones. And for a while, I didn't either, and then something clicked and I thought maybe just maybe I might be at that stage of life, where I needed to consider hormone replacement.
When I started researching HRT I walked straight into a wall of conflicting information, outdated science, and decades of fear. And once you understand where that fear came from, the anger is hard to shake.
In 2002 a study called the Women's Health Initiative published findings linking HRT to breast cancer, heart disease and stroke. Overnight, women abandoned treatment. Doctors stopped prescribing it. The headlines were everywhere and the fear stuck.
What didn't make the headlines was that the study was deeply flawed. The participants were mostly women over 60, many of them more than a decade past menopause. They all took the same synthetic hormone combination. The results were never meant to apply to newly menopausal women, and yet that's exactly how they were reported. The media ran with the scary numbers. Nobody corrected it and a generation of women paid the price.
Follow-up research has since picked the original study apart. Women who took oestrogen alone showed a reduced risk of breast cancer. The reanalysis found that for most women, the benefits of HRT outweigh the risks when started at the right time. The science moved on. The fear didn't.
That's why so many women are still walking into GP surgeries being told to just get on with it. A woman entering perimenopause, a hormone shift that can last up to 10 years and shapes the next 40, is offered a 7 minute appointment, antidepressants and a self referral for talk therapy. No wonder women are angry and still suffering.
Two books that changed everything for me. Menopausing by Davina McCall and Dr Naomi Potter, I know she’s not everyones cup of tea but the book is well researched and a must and The Definitive Guide to the Perimenopause and Menopause by Dr Louise Newson. Read them both. Take notes. Go to your GP armed.
Something else worth knowing before you go — HRT isn't one thing. There are options, and understanding them helps you have a better conversation with your doctor.
Oestrogen is the main hormone being replaced. You can take it as a patch, a gel, a spray or a tablet. Patches and gels are absorbed directly through the skin into the bloodstream, which means they bypass the liver and carry a lower risk of blood clots than tablets. Most doctors in the UK now recommend starting with a patch or gel for this reason.
If you still have your womb, you'll need progesterone alongside the oestrogen to protect the womb lining. You can take it as a separate tablet (micronised progesterone, which is body identical, meaning it's the same structure as what your ovaries used to produce), or via a Mirena coil, which releases progesterone locally. Micronised progesterone has a better side effect profile than older synthetic versions and carries no increased breast cancer risk for the first five years.
Testosterone is the one nobody talks about, but it should be part of the conversation. Your ovaries produced it in significant quantities before menopause. Losing it affects mood, energy, motivation and libido. It's prescribed as a gel at very low doses and is increasingly being offered alongside oestrogen and progesterone, though you may need to ask specifically.
Every woman's cocktail will look different. Doses will get adjusted, what works at the start may need tweaking later. That's normal, not a failure.
When it was my time, I went to my GP ready for a fight, armed with all my symptoms and knowing I wasn’t leaving until I was heard, however I was lucky, really bloody lucky. She referred me straight to a gynaecologist, no argument, no fobbing off. There was a wait, but when I finally saw the consultant I was put on HRT immediately again, no argument and no fobbing off. I know this is not the experience of many women out there, and why I’m so passionate about it.
About eight weeks after I started the HRT things started to improve. However,it hasn't been straightforward. You won’t slap on a patch or rub in some gel and it all goes away. I still have symptoms. My HRT needs monitoring, sometimes adjusting, and it can stop working as my body changes. That's not a reason for me to avoid it, just the truth nobody told me upfront.
Advocate for yourself. Do your research. And hear this, you are not going mad.
The racing heart, the itching, OMG the bloody itching, the hair loss, the anxiety that arrived from nowhere, the brain fog, hip pain that wakes you up at 3am, forgetting what you were saying while you are saying it, the rage, just the red mist rage, and the need to just want to factory reset yourself and feel human again. All of it can be perimenopause. All of it.
Your body deserves proper support. Not to be dismissed.
Go to your GP. Read the books. Push back if you're not being heard.
You know your body. Trust it.
Loretta x
P.S. If this resonates, you might also find comfort in my free 5-day Thrive Reset, covering sleep, overwhelm and understanding your changing body after 50. One honest email a day from someone who's lived it.
