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Why are health care professionals so reluctant to prescribe HRT?

I recently ran a menopause training course for health care professionals. It was lovely meeting practice nurses and GP's all online from my upstairs office, the joys of the Covid new norm and technology!

A key part of the training course was discussing the importance of HRT, how it can benefit women in the menopause transition and menopause, the different types and options offer women choice and variety. Talk came onto treatment and HRT, I was shocked that some health care professionals were still reluctant to discuss and prescribe HRT to their patients, worried about the risk of prescribing HRT.

I meet many women who say that being prescribed HRT is lifechanging for them, giving them their lives back. Without HRT women have to live with a variety of life changing symptoms. Looking at the research the benefits of HRT are well proven, taking HRT offers systemic relief from many menopause symptoms including hot flushes, night sweats, sleep disturbance, anxiety, low mood, the list is endless, after all there are over 30 known symptoms of menopause! If HRT offers relief for so many different menopause symptoms, we have to ask the question why are so many health care professionals reluctant to discuss the benefits of HRT and prescribe it for their patients?

As an experienced nurse I believe in giving the patients I see evidence based information that allows them to make their own decisions regarding their health care and what medication or treatment options they would like to consider, but it makes me wonder if some health care professionals lack the knowledge or confidence to discuss HRT as a treatment option for women during the menopause.

My little brain cell began to think about this question, the elephant in the room HRT is it really that bad, are the risks really that high? 1 in 8 women develop breast cancer in the UK, often this can be attributed to a variety of different factors rather than a single focus. Lifestyle factors such as alcohol consumption, smoking and BMI play a crucial role in increasing the risk of breast cancer. Other lifestyle choices such as exercise seam to offer a protective factor. Recent research such as the Lancet study published in the media suggested a much higher risk for women taking HRT, the media added fuel to the fire and created a mass panic that spread to health care professionals, HRT was not to be used, it was to risky! However it is important to take into account that these studies were not RCT studies, the gold standard of research and that they were based on following women who were using the older forms of HRT. The increased risk is related to the type of progesterone women use as part of their HRT. Using the newer micronised progesterone or mirena coil offers less risk, and for women using oestrogen only HRT the risk is much lower.

We have to also think about education, have you ever asked your GP how much training they may have had in women's health or the menopause? You might be surprised by the answer, our GP's are after all generalists they see everything from patients of all ages. Women make up 50% of the population and the menopause is something that every women will experience in their lifetime, it's my mission alongside many others to offer education and training for health care professionals on all things menopause.

In conclusion I think a picture speaks a thousand words, and I will leave you with a brilliant image from the British Menopause Society illustrating the risks of HRT and breast cancer. No treatment is without risk, but surely women need to be given all the information to make an informed choice on possible treatments for the menopause. Annual HRT reviews offer professionals the opportunity to monitor and advice women to make sure the treatment is still right for them. Women are living longer, spending around one third of their lives post menopause, HRT can offer symptom relief and protection for your heart and bones, shouldn't all women in the UK be offered the choice?

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