HRT: who do we trust in a wisdom vacuum?

The recent Panorama highlights how women are confused and exploited

I watched this week’s Panorama on the ‘menopause industry’ with interest.

I watched partly out of professional curiosity - as a writer on women’s health I’m often caught between the two world’s of ‘natural’, versus, ‘medicalised’, and I had heard that this particular episode was going to be a bit of a ‘hit job’ on one of the UK’s biggest advocates for HRT, Dr Louise Newson. I wondered if it was going to lift the lid on HRT itself and ask questions about the current massive uptick in women wanting to be prescribed it. I wondered if it might bring some balance.

I also watched it from a personal perspective. I’m 49. My periods stopped abruptly when I had my first Covid vaccine in May 2021 - I was then 46. I am not anti-vaccine and I went on to have two more covid vaccines during the pandemic. My periods revved their engines a few times following that first vaccine, but mostly stayed away. I’ve now been over a year without them and am officially ‘post menopause’. And so far I’ve not had HRT.

If I went to a doctor and told them about the vaccine thing I feel almost certain they would tell me it was a coincidence. “What do you expect, you are ‘that age’?”, kind of thing. But there have been many women reporting changes to their menstrual cycles following the covid vaccine and some pieces of research into it, with mixed conclusions. Nobody seems to know and in my case, what could they do about it anyway?

As I’ve navigated the past three years, I’ve spoken to a lot of perimenopausal women and there seem to be so many common themes. For some, it’s clear cut. They have horrendous hot flushes, they feel absolutely awful, all of the time, they get HRT, it’s life changing. But for so many others, it’s more complex. For starters, there are often one or more of the following things happening in their life around this time in their forties:

• Relationship difficulties

• Financial worries about both present and future

• Dissatisfaction with career path and realisation it’s too late for some (not all) changes

• Elderly or unwell parents

• Bereavement

• Health issues eg cancer scares

• Parenting struggles eg with teens

• Changing faces and bodies

• Feeling invisible

• Angry at the treatment of women / misogyny / male violence / patriarchy

• Having a huge load of responsibilities each day

Women experiencing some or all of the above will feel stressed, exhausted, depressed, anxious, and perhaps find it hard to sleep. But being knackered and pissed off and sad is not a medical condition. So how do women know what’s menopause and what’s just a perfectly rational response to the situation they find themselves in?

The Panorama investigation had no answers to any of this, but what it did highlight for me is the ‘wisdom vacuum’ we find ourselves in. Isn’t it funny how often you hear people say, ‘Oh it’s SO brilliant that we’re ALL now talking about menopause isn’t it?!’, and yet what are we actually saying about menopause? Because all I see is a lot of confusion. Mainly what women are saying is that they have no idea what to do and don’t know who to turn to.

As Panorama highlighted, in this wisdom vacuum many women decide to shell out for ‘alternative’ supplements, teas, etc. And according to Panorama, most of these are not really evidence based. So there’s another phenomenon of the wisdom vacuum. Exhibit A: nobody is talking about menopause for years or bothering to research it. Exhibit B: we don’t have any evidence about herbs, vitamins, mushrooms and the like. What a surprise: we know nothing about something we’ve not bothered to think about much. So the conclusion seems to be - at least from Panorama - that all the supplements are therefore a waste of time. Hmm.

The programme then focused on Louise Newson and how she is allegedly over-prescribing HRT. Private menopause doctors are big business in the UK. Why do women turn to them instead of their NHS doctor? Because they don’t have any confidence that their NHS doctor will know the first thing about menopause. Lots of women have positive NHS experiences but lots of women also have really awful stories of being fobbed off, belittled, and getting prescriptions that they don’t feel confident in.

In this wisdom vacuum, women look for answers and they turn to alternative gurus, herbal supplements, or private HRT clinics. In my books about childbirth I have written about ‘the broken chain of wisdom’ that impacts birth and breastfeeding. Many of our mothers and grandmothers had highly medicalised pregnancies and births and went on to formula feed. This broke the old way of knowing and passing on knowing, woman to woman, mother to daughter. The same is now true of menopause. Women have had a generation or two of relying on someone outside of themselves to tell them what to do. They have not listened to their bodies, to each other, or to their elders. Elders?! What a quaint thing that sounds. We don’t even have it in our lexicon any more.

So who do we trust? Many of us turn to the internet but this is also a minefield of conflicting information. Recently I was thinking about whether to try HRT and I googled to see what information I could find about the claim that it reduces the risk of dementia.

I found a 2024 Danish study in the BMJ that said HRT increases the risk.

The Alzheimer’s Society website says that the research is mixed, some say it reduces risk, some say it increases it.

NHS says we don’t really know yet.

The Menopause Charity says crack on! Their leading paragraph on this tells me HRT could reduce my risk of dementia by as much as 73%!

But a little look round their website and guess who the founder is?

Not that I agree or disagree with the Panorama attempt to discredit Newson. But this is a person who, rightly or wrongly, is making a tidy packet out of HRT. They are not going to sit on the fence about it, are they?

And once you’ve done a google about HRT, watch out! The cookies will come and find you and your social media will be filled with advertisements promising you will look and feel like a 25 year old by next week if you only just open your wallet.

This week I am finishing the edits on Ultra Processed Women and as usual, having the most extravagant imposter syndrome you can imagine. Who am I to write this book about food and health? I am not an expert. Etc. But one thing I would say, and this has been really brought home to me during the writing process of UPW, is if you decide someone is an ‘expert’, you also need to ‘follow the money’. Every week there is at least one news piece about how ultra processed food isn’t really that bad for you, and look at these tins of spaghetti and how much fibre they contain! Some of them may be genuine, but in many cases, there’s a line you can follow back to a lucrative sponsorship deal from companies that stand to lose a great deal if we all just start eating pasta with grated cheese instead.

The Panorama programme did at least highlight that, as menopausal women, everyone and his uncle is trying to flog us something. But what it didn’t explore is why - and where this leaves us as women, needing holistic support, needing women’s circles, needing our elders, needing research and doctors who’ve read it - but instead lost in a sea of misinformation from people who have their bank balance rather than our best interest at heart. In the wisdom vacuum, exploitation thrives and women suffer.

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Preorder your copy of Ultra Processed Women, it’s out on 27th February 2025!