Written by Karen Morton, Consultant Gynaecologist and Obstetrician and founder of Dr Morton’s – the medical helpline

See Dr Morton’s enhance women’s health through life

Updated 1 January 2020

At last the importance of addressing Women’s Health is receiving the attention it deserves;in society (see the RCOG’s latest initiative) and in corporations who seem to understand the value of diversity in the workplace and the fact that meeting women’s reproductive needs will attract and retain the very best employees with high productivity. Contraception, periods, fertility and menopause are all in the news.

There have been a number of high profile women talking about their menopause during 2019. Mariella Frostrup, Meg Matthews and Kirsty Wark to name but a few. It has been suggested that it should be taught at school to 13/14 year olds. Personally I think that would be ridiculous just when young teenagers are already starting to find their mothers cringingly embarrassing! HRT has also been in the news because of a somewhat inexplicable difficulty in obtaining well-used and well-loved preparations. I believe this has been for commercial reasons which are to be resolved shortly. I hope I am right! Finally it has been in the news because of another publication on the effect of HRT on the incidence of breast cancer. Everything in life is a balance of risk, and be under no illusion, the overwhelmingly greatest risk factor for breast cancer is being overweight.

So at the start of 2020 Dr Morton’s is delighted to announce our partnership with Maryon Stewart’s company ‘Healthy Wise and Well’. Maryon has been light-years ahead of her time in the area of hormonal mental and physical health with research based treatments for premenstrual syndrome as well as non-medication based treatments for the symptoms and impact of menopause on women. Medication will be needed by some but not all, and at Dr Morton’s we will help you to work out the best strategy for you as an individual, and ask for Maryon’s help when that would be the best route.

The menopause: learn about it and decide on your philosophy

The truth is that we all live too long. The menopause (which is a single date in time; the date of a woman’s last period ever) has got later and later but has not kept pace with improvements in nutrition, heating and antibiotics. Two hundred years ago, we were all dead before the menopause, and the low average life expectancy in certain parts of the world dictates that this is still the case for many women.

One’s attitude towards taking hormones to replace those that the ovaries can no longer produce is a purely personal one.

You can make a good argument for saying that taking oestrogen is no different to taking thyroxine if your thyroid gland stops doing so. We could not survive without thyroxine, nor insulin, nor cortisone, nor a myriad of other hormones that if found to be deficient when a patient goes to the doctor for investigation of tiredness, weight loss or gain, or various aches and pains, would be prescribed. So why not oestrogen……… dare I say, controversially, as a matter of course.

It is unfortunate that the media love to whip up a storm of anxiety concerning ‘risks of breast cancer’ and indeed the literature contained even in the packaging that accompanies a tube of oestrogen cream which has been prescribed as a nutrient to help vaginal tissues to grow pink and juicy as opposed to be ‘dry and painful’, makes women think they are taking significant risk of this most feared of female diseases. My answer to them is that ‘If you were a mouse and you swam around in oestrogen cream (in my clinic I am at this point flailing my arms as if doing front crawl by way of illustration) then perhaps you would absorb sufficient oestrogen to have some whole body effect. The amount used in a human vagina to nourish these tissues and allow an enjoyable sex life and to stop a woman from getting up three times at night to wee because her bladder looks as thin and sad as her vagina, is harmless.

Now, I am certain that responses to hormonal things is a very idiosyncratic thing and every so often I encounter a woman who tells me that after one application of cream, her breasts became uncomfortable so she stopped it. I can only believe her, but this is definitely not the norm. In fact even in the latest publication on the topic from workers in Oxford, oestrogen cream in the vagina was shown to have no risk.

I fully understand women who tragically have a family history of breast cancer or even more poignantly have had it themselves. They will try everything they can to avoid taking oestrogen replacement, but for some, the sweats, flushes and sleeplessness, quite apart from anxiety, loss of concentration and other general symptoms of poor well-being, makes them decide that the quality of life vs risk balance is in favour of taking something.

Please don’t tell women that this is ‘their lot’

How long should woman take oestrogen treatment? There is no right answer. The treatment does not ‘carry you past the menopause’. When you stop it, the symptoms that bothered you are likely to recur, with no test to say how long they will last. Some women never have a hot flush in their lives and others will get them for the rest of their days. I cannot agree with the commonly held view a woman can have oestrogen for five years and no more. Women are entitled to the same quality of life as men, and would you want your lady pilot or surgeon to have had a sleepless night? Yes, OK, the very very small but statistically significant increased incidence of breast cancer in women who have taken oestrogen plus progestogen treatment (you may notice that I have, throughout this piece, steadfastly refused to call it ‘HRT’) for over five years, needs to be discussed, but the final decision surely rests with the woman. I do not believe that there is an economic argument for limiting prescribing, as the benefits of keeping women working and thriving and not getting hip fractures has got to be economically worthwhile.

I have not addressed here the need for the uterus to be protected against the stimulatory effect of oestrogen on the endometrium, by progesterone; but there are lots of ways that this can be done.

Please don’t tell women that this is ‘their lot’. Empower them to be the best they can for as long as they can.