Liz Earle: "We need to separate fact from fiction on HRT"

Like many women, Liz Earle had no real concept of what the menopause would be like until she started to consider her personal journey when she began experiencing symptoms. "I found it baffling that there was so little information available to me and the millions of others who were at a similar stage of life," she says. "Advice was muddled, contradictory and very often failed to explain what was happening," This was what prompted her to write  The Good Menopause Guide  in 2018 and now a new e-guide,  The Truth About HRT .

Liz’s aim is to give all women affected by their symptoms, as well as their medical advisors, the most up-to-date and helpful information to help them make choices that could significantly improve their long-term health and wellbeing. "Given the controversy and confusion surrounding the safe use of HRT, and specifically the natural hormone oestrogen, I decided to write my new guide – and publish it on International Women's’ Day. I believe it is a fundamental human right for all mid-life women to have access to better hormonal healthcare and information."

Liz Earle's myth-busting guide to menopause

The perimenopause is stealthy...

"I think it’s fair to say that the perimenopause  (the years of hormonal fluctuation leading up to the menopause) can sneak up on most of us in our forties and take us by surprise – we may feel fabulous and in the peak of good health, only to become aware of niggling troublesome changes, which when pieced together like a jigsaw puzzle suddenly make sense!

“It’s hard to pinpoint an exact time when I began to experience my own perimenopausal symptoms as I had a late baby at the age of 47, so my own hormones were wildly fluctuating, but for many women they start in their forties, some even earlier in their late thirties, when the menopause  itself is many years away. That’s what makes our decline in oestrogen so hard to read.

"Many of us find ourselves in the sandwich generation, running busy lives, raising teenage children and looking out for elderly parents while also working. We may not realise amidst all this juggling that we are in the midst of the perimenopause.

“Female friends in their forties are amazed and surprised when I say that their sleeplessness, tiredness and low mood are most likely caused by shifting hormones. Particular symptoms to look out for, as well as the physical ones, include loss of confidence, anxiety and feeling tearful at the slightest upset. Strange outbursts of unexpected anger and rage can also be due to declining oestrogen  levels.

MORE GLOSS: Panic attacks in menopause, one doctor's personal story

“The average age of the menopause is 51, with the perimenopause usually starting from around the age of 45 onwards. In some cultures, and communities, such as among Pakistani women, the average age is even earlier. As for the ‘end’ of the menopause, every woman’s experience is as individual as a thumbprint – it may last a few months for some and up to ten years for others, and all of these time spans are considered completely normal in medical terms."

Why I opted for HRT...

"For me, pretty much my only symptom of menopause was sleep disturbance and that was the one that sent me booking the doctor’s appointment. As a busy working mother of five, I can handle most of what life throws at me – but only if I get a good night’s sleep! When that started to go, I sought professional help.

"As far as I’m concerned, HRT is simply topping up what our body naturally lacks as we age, as our oestrogen levels naturally decline. I now have much better sleep and increased energy levels, so I can do more! The long-term health and wellbeing benefits (in terms of reduced risk of coronary heart disease, osteoporosis and even dementia protection) outweigh the risks for the vast majority of us.

"Body-identical HRT from my GP is something I take, something my mother has taken for decades and something I shall encourage my daughters to be aware of and take when they reach mid-life.

"Body-identical hormones are the regulated kind from GPs and menopause specialists; these include all transdermal oestrogen (so all patches and gels are body-identical). Utrogestan is the only body identical form of progesterone available from your GP. Both these forms of oestrogen and progesterone are 100 per cent body identical and are derived from wild yams. They are often confused with bioidentical hormones, which are compounded hormones made in private pharmacies and are unregulated and not universally recommended by medical experts, including both the British and International Menopause Societies.

Why we're confused about HRT...

"Since its arrival on the scene, HRT  has divided doctors and confused menopausal women. I think it’s so important to separate fact from fiction on HRT and make women aware of what they really need to know, which is why I wrote my e-guide.

Here are some key facts:

* There are few (if any) cancer risks associated with taking HRT

"And even some proven cancer-protective benefits, such as lower rate of colon cancer. Specifically, on breast cancer, as I highlight in the downloadable guide, HRT is not a significant risk factor and the main study that caused all the controversy has now been discredited. Other acknowledged health benefits include a much lower risk of coronary heart disease, Type 2 diabetes, osteoporosis, stroke and mental health.

* HRT is a daily treatment with no cumulative effect

"It simply tops up our hormones to previous levels as these decline with age, replacing what was already there. The day we stop taking it, our body reverts to its natural hormone level at that time and there are no ongoing benefits. It’s a bit like taking the contraceptive pill except that HRT works naturally in line with the body unlike the Pill, which uses synthetic hormones to change our hormonal balance so as to prevent pregnancy.

* There is no upper age limit for HRT

"The International Menopause Society stated in its 2016 review: “there are no reasons to place mandatory limitations on the duration of HRT… whether or not to continue therapy should be decided at the discretion of the well-informed woman and her health professional…”.

* You do not need to have a blood test before being prescribed HRT

"From age 45 onwards, all HRT should be prescribed on symptoms alone, having discussed your personal medical history and your lifestyle with your GP. The National Institute for Health and Care Excellence (NICE) guidelines  are very clear on this point.

"That’s not to say all women can take HRT or all are suited to it. It’s important that you discuss your own personal needs with your GP or specialist doctor, which will take into account your personal health history, underlying conditions and lifestyle. It’s an individual prescription as there are several different types and doses, so it’s not a case of one-size fits all."

What are the alternatives to HRT?

"Some simple additions to our everyday routines can help with the many varied symptoms of the perimenopause and menopause (for more on this see  The Good Menopause Guide ). These include helpful nutritional therapy, herbal supplements, acupuncture, Cognitive Behavioural Therapy, yoga, weight-bearing exercise, meditation, skin solutions and more. However, what none of these strategies will do is replace your oestrogen. Only HRT will do this."

The power of a menopause diet plan

"Food has such tremendous power to help and heal our changing bodies and what we choose to eat is one of the most important wellbeing factors we can control in life. My top tips and special ingredients for the perimenopause and menopause, as outlined on the Liz Earle Wellbeing  website and in The Good Menopause Guide, include phyto-oestrogens, which provide oestrogen-like compounds that occur naturally in the plant kingdom.

"Phyto-oestrogens can help ease many menopausal symptoms. Soya  milk and soya flour, linseeds, tofu, Japanese tempeh and miso, pumpkin seeds, sesame seeds, sunflower seeds, celery and green beans all contain useful phytoestrogens and are good ingredients to work into your diet if you’re not taking HRT. It’s also important to ensure adequate iron  levels (for energy), magnesium  (for sleep and stress), calcium  and Vitamin D  for bone density and iodine  for a slowing metabolism.

"Why not start the day with apple and cinnamon chia pots (full of magnesium and calcium), lunch on a warm green bean salad with spring onions and avocado (full of Omega 3s and prebiotics), curb your afternoon sugar cravings with a slice of my famous menopause cake , and end the day with a baked sweet potato burger made with kidney beans and chickpeas."

Other natural remedies for menopause

"There’s increasing evidence from across the world that small simple additions to our everyday routines can really help with the many varied symptoms of the perimenopause and menopause. For example, a recent study of more than 3,500 women living in Latin American cities showed that women who do little or no exercise experience more severe menopause symptoms compared with those who are more active.

"Leading personal trainer Michael Garry , who I spoke to as part of my research on the menopause, says there are three simple stretches we should all do every single day as we get older to protect back, leg and hip mobility. These stretches include a particular focus on hamstrings, quads and calves."

Menopause as a positive life stage

"Nowadays the vast majority of us will live for 30 to 40 years after the menopause. So, my advice is to see this time of life as a good moment to take stock and begin to appreciate who we have become and what we may still achieve and do – or even change! Personally, I feel there is much more for me to achieve and do – and I’m excited that my magazine Liz Earle Wellbeing has recently gone global!"

What we should tell our daughters

"I’ve long highlighted to my two daughters the importance of eating a well-balanced diet and doing weight-bearing exercise, to avoid ending up with crumbling bones later in life, but I’ve reiterated this message to them further to my recent research. From our late twenties onwards, we can’t build any more calcium into our bones, so it’s a matter of bone maintenance – preserving what we have already got through diet and exercise. This is severely tested during the first five years of the menopause when nearly 10 per cent of our bone mass is lost. Weight-bearing exercises (any upright movement so pressure flows through the spine, pelvis and legs) also play a key role in strengthening bones and keeping them strong."

We need greater openness about the menopause at work

"We need to give ourselves as women far more credit for simply keeping it together and when we can’t to put up our hand and ask for help – both at work and with friends and family. If the stigma of mental health issues can be overcome to make top billing across the media, government and the public then so should the menopause - it happens to all women fortunate enough to live long enough!

"A brilliant example of how the workplace might adapt comes from GP and menopause medical expert Dr Louise Newson  who I have interviewed a number of times for my Wellness with Liz Earle podcast . She offers workshops to the older female police workforce across several countries and devises strategies for and raises awareness of how the menopause might affect them."

Liz Earle’s e-Guide,  The Truth about HRT  is downloadable exclusively from  www.lizearlewellbeing.com