Rosemary Goring: HRT is not the only solution - being a woman is not a medical condition

With TV presenter Davina McCall raising the issue of the menopause and the severe impact it can have on women’s health with a ground-breaking documentary, suddenly one of the few remaining social taboos was lifted. For that she is to be congratulated. For far too long the m-word has made people squirm, as if it’s too embarrassing or gross to be mentioned. Thanks to McCall, and a handful of notable other champions, such as Penny Lancaster and the Countess of Wessex, those days are finally over.

McCall’s own experience chimed with many. “When somebody asked me if I was OK because I'd messed up on a TV programme, I said yes. And then when she shut the door and went away, I just burst into tears. Because I thought, ‘I’m not OK, I think I've got a brain tumour, or I’ve got Alzheimer’s or something – help me’.”

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Brain fog and memory loss are two of the less well-known symptoms of menopause, although I expect the phrase “early-onset dementia” has been at the front of thousands of women’s minds as they find themselves inexplicably forgetful, flustered or dull-witted.

Everyone has heard about hot flushes, the misery that has launched a thousand stand-up routines. Far fewer, and men in particular, have any awareness – until their partner begins to suffer – of the variety of ways in which this prolonged period of middle age manifests itself. Flying crockery was one of the signs Rod Stewart – no stranger to eccentric behaviour – learned to read as an indicator that his wife was going through this difficult patch. But there are almost as many symptoms as women, and they can be so debilitating that, as recently reported, around 330,000 in the UK have given up work early as a result.

All this is sobering. Yet the tsunami of commentary in the wake of the HRT shortfall gives the misleading impression that for everyone the menopause is an absolute nightmare. Younger women are being taught to dread its approach, and to expect to suffer years of distress and poor health unless they turn to medication. Indeed, such is the heightened mood of alarm – I’d go so far as to call it scaremongering – it has even been recommended that, to avoid its worst effects, it’s best to start treatment long before it begins, while women are still pre- or perimenopausal.

There’s no denying that some women have a rotten time, and need medical help. I don’t doubt that for them, HRT is a godsend. For a few, it seems literally to be a lifesaver, without which they are in danger of feeling suicidal. Nevertheless, it is worrying that increasingly it is accepted that taking drugs is the way to get through this challenging period. McCall’s message to fellow sufferers is “don’t soldier on” but talk to your doctor. Depending on how debilitating it is, however, soldiering on has its place.

Before the m-word came into circulation, people muttered about their mother or aunt going through her “time of life”. It was a fitting description. Just at the point at which women’s oestrogen levels are plummeting, they are likely also to have increased demands on them at home, with teenage children on one side, and aging parents on the other. By this point some will be reaching the pinnacle of their professional careers, all of which makes for an intensely demanding decade or so, in which they could teach circus jugglers or trapeze artists a trick or two.

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On its own this welter of responsibilities would bring stresses enough. Is it not possible that some of the fatigue, migraines, aches and pains, sleepless nights, anxiety, weight-gain and the myriad other discomforts middle-aged women suffer might, in part at least, be a symptom of an overburdened system rather than a grave hormonal imbalance?

Nobody gets through the menopause unscathed, but for millions it is no more than an inconvenience, with occasional flashpoints that make life momentarily grim. Personally, I felt the seven or so years it lasted was a price well worth paying to end the monthly blight of the previous 35 years. Those caused far more havoc.

And even though HRT was never an option, I would still have hesitated before committing myself to a course of treatment for something I felt I could cope with myself. In that respect I’ve been lucky, compared to some whose experience of has been horrible. Even so, as far as I’m concerned drugs are a last resort, to be avoided wherever possible. Despite great pharmaceutical advances, I never fully trust claims about miracle treatments; I fear a payback somewhere down the line.

Because of the intense focus on those for whom the menopause is tough we risk defining ourselves by our reproductive system. The emotive mood this fosters is the opposite of empowering. In terms of women’s image and status, the tone of this conversation feels like a backward step. There’s a real danger that to those who do not properly listen, it simply sounds like a mass admission of failing to cope, needing help, being at the mercy of our bodies.

That noxious idea has underlain women’s perceived inferiority since Adam and Eve. For millennia we were seen as intrinsically the weaker vessel, our wombs representing the root of our irrational behaviour; hence ‘hysterical’. Our physiology was our downfall, making us less stable, less intellectually capable, and ultimately substandard.

On our way through this life, various things will go wrong, whatever our gender. Whether it’s our physical or mental health that’s compromised, I doubt any of us will get by without needing big pharma’s assistance at some point. Yet, despite what you might have concluded listening to the furore over HRT, one thing must be stressed: being a woman is not a medical condition.