SAMANTHA BRICK: I’m sick of this HRT mania because my menopause was great

TV producer, broadcaster and writer Samantha Brick shot to infamy a decade ago after her article for the Mail titled ‘Why do women hate me for being beautiful?’ caused an internet meltdown. Today, at 51, she is perimenopausal and has lost none of her ability to cause a stir… 

I’ve spent the past decade dreading the menopause. The fear set in when I was 40 and a travel company invited me on a weekend retreat for midlife women that was specifically designed to prepare us for ‘the change’. Activities included seminars to teach us how to cope with aching joints and night sweats.

There were exercise classes for avoiding the bone-thinning disease osteoporosis, and sex therapy to help dwindling libidos and vaginal dryness. It was, needless to say, a deeply depressing experience.

The past few years haven’t helped my fears. Everywhere you look there’s another glamorous, famous woman telling us of the horrors of menopausal life and that it’s only bearable with hormone replacement therapy, or HRT.

I watched Davina McCall’s menopause documentary shortly before my 50th birthday last year, in which she revealed her disabling symptoms, and I was horrified. According to official figures, demand for HRT has soared by a third in the year since the show, which has now been dubbed the ‘Davina effect’.

And so I’ve spent the past 18 months preparing for my inevitable decline. I took up daily yoga, hiking and meditation. I got rid of my microwave to force me to cook healthy meals from scratch. But when, just under a year ago, my periods began to stop, I was pleasantly surprised. I felt – and still feel – great.

Today my body is toned, slim and full of energy. My mind is calmer than it ever has been and it is rare that I don’t manage eight hours of sleep at night. I have never taken HRT.

I’ve learnt that the menopause message – that you’ll hit 45 and morph into a red-faced, sweaty, miserable shell of your former self, all of which can only be remedied with drugs – doesn’t represent the truth for every woman.

I haven’t developed a matronly bosom thanks to the redistribution of body fat. I’m not sprouting facial hair as a result of plummeting oestrogen levels. Things are just fine in the bedroom. And I’ve also learned that this is the case for a significant number of menopausal women.

Studies show that about a quarter of women don’t experience any menopausal symptoms. Just 15 per cent suffer severely, with symptoms lasting roughly four years on average. The truth is, expectations for many are far worse than the reality.

Only one of my large circle of girlfriends – who are all roughly my age – opted for HRT. Most spent a year or so suffering the odd hot flush in warmer months and finding sex a bit uncomfortable without extra lubrication.

I’m not saying it’s not awful for some. I’ve seen comments on social media from women who have been suicidal due to the severity of their hormone-related problems and say that HRT was life-saving. I’m also aware of the Fawcett Society survey that found one in ten women felt they had to quit their jobs due to menopause symptoms. But among women I know, the menopause barely comes up in conversation, let alone warrants the need for daily medication.

I think it was pretty unnecessary that I spent the past ten years dreading this stage of life.

A few years ago, to find out more about what was in store when my hormones dropped, I joined a Facebook group for professional women, and I was struck by the number in their late 30s who were terrified about their future health.

One 33-year-old, a single mother of two, seemed concerned about the crushing anxiety and insomnia that lay in store. How would she cope with two teenagers alone, without sleep or a clear head?

One 55-year-old said she’s been taking hormone pills for a decade, while another told of spending at least £1,000 a year on private prescriptions for testosterone gel.

A fortysomething woman said she spent weekends hunting for her favourite brand of oestrogen gel, which was difficult to get due to shortages (ironically, this is partly due to the increased demand due to celebrity endorsements).

Oddly, when I asked, none of these women seemed to be able to truly explain why they needed to take HRT. Every vague ailment seemed to be blamed on dwindling hormones – from exhaustion, to short-sightedness, to sore throats.

Recently, University of California doctors interviewed sixtysomething women about their experiences with HRT and found the main driver of their treatment was fanatical articles they’d read online promising that the treatment would make them feel and look younger.

According to the British Menopause Society, the hormonal changes in midlife cause hot flushes, night sweats, tiredness, low mood, anxiety and cognitive trouble such as poor memory and concentration. The NHS says palpitations, muscle aches, joint pains, weight gain and itchy skin are also menopausal symptoms.

I do not doubt that some menopausal women experience all of the above, to varying degrees, but experts say it doesn’t mean that the hormonal changes are necessarily to blame.

‘A change in our hormones is just one thing that can make a difference to how women feel as they age,’ says Dr Joyce Harper, Professor of Reproductive Science at the Institute for Women’s Health, University College London.

Prof Harper explains that, as we approach middle age, our healthy cells gradually begin to die. This means our organs and other tissues – including the brain – function less efficiently.

The muscles which we use to breathe become weak, so we take in less oxygen. This can lead to headaches, exhaustion and breathlessness. The cartilage that keeps our joints supple wears thin and tendons and ligaments become less elastic, resulting in aches, pains and injuries. We lose up to ten per cent of our muscle mass per decade, after the age of 30, so exercise becomes more challenging but also much more important.

Fluctuations in hormones are, of course, related to the dreaded middle-aged spread, but other factors are involved, such as changes in our taste and smell and a slowing of the digestive system.

‘It is well known that men are prone to gaining weight in midlife, as well as aches, pains and lack of energy,’ says Dr Harper. ‘It’s not all down to the big, bad menopause.’

As for anxiety, is it surprising that we feel especially fraught in our 40s and 50s? We’re clinging on to our career, dealing with deaths of loved-ones, looking after old or sick parents and financial pressure is looming with retirement just over the horizon. I’m not a mother, but add children into the mix and I can see why some might feel close to the edge.

Research published this year investigating psychiatric data of thousands of individuals across several countries, identified midlife as the most stressful, emotionally charged years. The scientists – from the University of Warwick – found people in midlife were twice as likely to suffer depression than those over 60 and people under 25. Reasons included work stress, dependent children and a sense of unmet aspirations.

Perhaps it is easier, psychologically speaking, to blame a single physical change – for which there is a medicine.

I’ve been guilty of it myself. In September last year, when my periods became lighter and more sparse, the tinnitus that I’d suffered on and off for years got significantly worse. I’d been blighted by the ringing in my ears for over a decade but it is much more noticeable in times of stress.

This time, I’d convinced myself it was related to the menopause. I’d read a post on Instagram, shared by a menopause campaigner, which told me that phantom sounds were a common menopausal symptom that a HRT prescription would sort right out.

I voiced my concerns with my husband, who pointed out that I was drowning in work deadlines while also grieving the death of a close relative.

Of course hormonal disruption may have played a role but age-related hearing loss, which is known to be a major trigger, is a pretty much universal problem.

Oddly, once I began writing down my daily stresses, in the form of a diary, the tinnitus seemed to ease.

I know advocates believe almost everything can be cured, or even prevented, with HRT but the research doesn’t yet support many of the more eye-catching claims. According to a 2020 British Menopause Society report, there is little strong evidence to suggest HRT, in both pill and topical form, is beneficial for anything but hot flushes and vaginal symptoms, such as dryness.

Although there is some data to suggest short-term courses of HRT in the initial stages of the menopause can improve depressive symptoms, researchers say that it has no greater effect than other treatments, such as cognitive behavioural therapy, or talking therapy.

A 2019 review of 12 studies, involving more than 4,000 women, found HRT had no significant effect on muscle mass. Another analysis of 28 trials, published by the medical charity Cochrane, found HRT had no effect on body weight or fat mass.

If HRT was risk-free, perhaps it wouldn’t matter if it did what you hope it will. But there are risks, albeit very small. It can increase the chance of cancer returning in women with a history of certain types of breast cancer. There’s also a risk of blood clots.

Of course, for women with unbearable symptoms, the benefits vastly outweigh the risks. But I do wonder about those women on social media. Are they taking drugs they don’t need?

Prof Harper says that all too often there is a far simpler solution to midlife health complaints.

‘So many women tell me they feel terrible, and when I ask about their lifestyle they say they have no time to exercise and rely on glasses of wine every night to relax.

It is no wonder they are exhausted and aching – inactivity can be detrimental as we get older. If we don’t look after ourselves it stands to reason we will suffer.’

I often wonder if the health kick I embarked on in my early 40s is the reason I’ve got off lightly. But it’s not just diet and exercise: I don’t scroll through brain-rotting social media apps or binge on television shows for hours on end. I have a set bedtime of 10.30pm and I limit my alcohol intake to three days a week.

As a British expat living in the French countryside, I have the benefit of a somewhat more relaxed European lifestyle, with long lunches and late starts.

Interestingly, one 2013 international analysis showed that French women are less likely to suffer moderate and severe hot flushes than English women.

And it is puzzling that menopausal symptoms differ depending on where you are in the world. For instance, studies have shown that Hispanic women are far less likely than others to suffer any menopausal symptoms. Research has also shown a third of Spanish women who experience symptoms take HRT, compared with half of women in the UK.

Meanwhile, in Thailand and Hong Kong, the figure is less than 20 per cent of women. In China, it is as low as two per cent, according to some studies.

Perhaps our unhealthy lifestyles – Britain is the third most obese country in Europe – has something to do with our exceptional level of suffering in midlife.

I’m not saying that my approach is for every woman, and I know that I’ll be incurring the wrath of the menopause lobby, but someone needs to rally against the prevailing idea that HRT is a miracle cure for all the ailments of ageing.

A healthier lifestyle, allowing more time for ourselves, exercising regularly, ditching the takeaways and deleting all social media apps is surely a more sensible place to start.