I want my HRT: Why I take hormone replacement therapy — and it’s not to keep me looking young

‘Our obsession with youth brings too many HRT risks’ rings the ridiculous clickbait headline of a recent opinion piece in The Sunday Times. ‘Now we know: HRT is not the cure-all for ageing that women hoped.’

Deliberately juxtaposing ‘HRT’ with ‘risks’, that first sentence makes little to no sense. What exactly does ‘too many risks’ mean? How many is too many? And get a load of those first person pronouns, the great ‘our’, and the ‘we’ in the standfirst, all-inclusive and absolute. ‘Our obsession’, apparently, is with ‘youth’, as if ‘we’ all go hanging around school gates at every opportunity. But who does this ‘our’ refer to? Wouldn’t it be more accurate to say that some people may be obsessed with looking younger than they actually are? While some people may merely be mildly interested. Others may not be interested at all. It can’t be all of us, in any case, because I for one am certainly not obsessed, as the witches’ bristles on my chin and grey roots in my hair testify (quite apart from not having the energy, if I’m obsessed with anything, it’s with feeling better). Certain celebrities and people in the metropolitan media who write this sort of opinion piece may be obsessed with appearing younger, I wouldn’t like to presume. That’s not my real point here, though, which is that the media — written and broadcast (especially television) — is rarely interested in nuance. Nuance doesn’t make for sexy headlines, and words like ‘some’ or ‘may’ are hardly ever used.

*can also include a tiny minority of women under 40
Photo by Priscilla Du Preez on Unsplash

To be fair, headlines are not generally written by the columnists themselves, but copyeditors, and manipulated deliberately in order to gain our attention. Reading this particular piece, it’s easy to see that that first person pronoun ‘our’ that is used in the headline never was intended to mean ‘everybody’ in the first place. What ‘our’ really means here is ‘women’, the middle-aged among us*, who may already be, or who may be contemplating, taking hormone replacement therapy for symptoms of the perimenopause . That HRT is also an apparent ‘cure-all for ageing’ came as news to those of us in certain online HRT communities who, at the time, were preoccupied with recent sensationalised reports about a paper published in the Lancet that suggested that women who take HRT have a higher risk of breast cancer than previously thought.

Referred to in the Sunday Times column, 'This study was a review of both published and unpublished trials done in the past, and not the result of an official randomised controlled study — meaning that the results were not conclusive and that the current menopause guidelines regarding HRT do not need to be changed' (Dr Louise Newson). Professor Emeritus of Surgery and visiting Professor of Medical Humanities in University College London, Michael Baum, who is also a surgical oncologist who specialises in breast cancer treatment, expressed his disgust with the British press and their sensationalist coverage of the Lancet report, while much time was spent by menopause specialist Dr Louise Newson and other medical experts, GPs and women’s health campaigners in the online communities reassuring people about the irresponsible coverage of a topic already loaded with misinformation and fear. Not that any of this stopped the Sunday Times writer from using it as an excuse for a column. If Louise Newson hadn’t flagged this column up on Twitter I — and I suspect many others — would never have been aware of it. I wish I still wasn’t but once seen you can’t un-see, and I was reminded of those popular tweet formats that people use in response to unexpected and irrelevant announcements:

No one:

Sunday Times columnist: You silly middle-aged women with your anti-ageing elixirs, risking cancer to stay youthful! You’re obsessed!

A few of us took the bait on Twitter, myself included:

The writer’s response to me was the same that she had repeated to a number of people. It consisted of an in-built disclaimer that she had also used in her article as a defence for its questionable content:

This was one of the tactics used by the writer of another dreadful article about menopausal matters that I’ve blogged about. Cover your arse by first stating something obvious and uncontroversial that no one can disagree with (the grass is green, or the Pope is a Catholic). And because you can’t sustain a whole column on this point, proceed to say something ridiculous. ‘Look, I’m not saying that the grass isn’t green; I make that very clear in the column. But there’s some stuff out there that suggests it’s actually magenta.’ Or, ‘Look, I’m not saying that the Pope isn’t a Catholic; I make that clear in the column. But rumour has it on the Vatican grapevine that he’s also an enthusiastic Jedi.’ It’s a kind of writing that is common in broadsheet opinion pieces and it’s one I find really irritating because it’s dishonest. This kind of writing — professional contrariness with inbuilt disclaimers — enables one to absolve oneself of accountability; you don’t have to own what you say. It’s cake-and-eat-it writing, you can have it both ways and, what’s more, it enables you to get away with anything. It’s comparable, it seems to me, with saying something like (because come on, this is fun!), ‘Of course I’m not saying that Hitler wasn’t responsible for the atrocities against Jewish people in the Second World War. I make that clear in the article. But if you Google these obscure sources you’ll find that some people say that he was actually a rather nice chap.’ And if ever anyone challenges you (and they probably will because what you’re saying is so ridiculous), just keep copying and pasting your disclaimer.

The patronising tone of the writer’s tweets was indicative of the overall tone of her article. ‘I do worry,’ the piece says, ‘about the way in which HRT is often discussed not as a possible medical necessity, but instead as a sneaky draught from the fountain of youth.’ Again, this came as a surprise to the women in the online HRT gatherings, the supportive and encouraging communities sharing meaningful information based on evidence and facts. HRT is ‘often discussed’ as a way to stay young? It’s sweet that the writer is worried about that but literally none of us had heard or read about HRT being discussed as a beauty aid, either online or in real life. In conversations about HRT and the menopause with women — and since being diagnosed with PMDD I’ve had a few — I’ve never encountered anyone who’s ever said that their main reason for using HRT is to keep them looking visibly youthful. It neither reflects my own experience, nor that of the women I know, either among my family and friends, or acquaintances further afield.

Yet in the article, the generalisations kept coming. ‘Women over 50 today are… adopting rigorous exercise and dieting. Wrinkles are frozen with Botox and cheeks are plumped out with fillers. In many cases women of 55 now look younger than their mothers or grandmothers did at 40.’ Again, this may apply to a few women — and if they are out there, I’d love to meet these goddesses: bloody good luck to them and their #tenyearchallenge — but they are bound to be in a minority (probably in the wealthier parts of London). That all women over fifty today are adopting extreme anti-aging beauty regimes simply isn’t true, and is a picture that bears no relation to reality on the ground in most of this country. Here in my small fishing town in the south west I don’t know any women who use Botox or fillers, and many of the women I do know would laugh at the suggestion (some of them before ordering their next pint and nipping out for a ciggie). They would be as revolted by Botox as other friends of mine, some of whom have actively started to avoid the toxins and poisons present in cosmetics, detergents and clothing, preferring alternatives that contain ingredients that are safe and which one can understand. Like the women online, many women I know talk about hot flushes, insomnia, mood swings, lack of energy and motivation, and feelings of despair. Simple tasks, such as getting out of bed, getting dressed and doing the laundry can sometimes feel epic, if not impossible and this, in the circles I mix in, is the context in which HRT is always discussed — as a medical necessity. I’ve never seen or heard it discussed as anything else.

In a frustrating exchange on Twitter, the columnist explained to me that genesis for her piece came from the illustrious source that is the Daily Mail, in which an article had been published in response to the headlines about the Lancet report. ‘Yes, there are cancer risks,’ states consultant breast surgeon Professor Kefah Mokbel. ‘But I'd still prescribe HRT.’ It’s an article that mainly reassured, yet at the end there comes an intriguing quote. ‘At the moment I have a set of twins as patients,’ says Prof Mokbel. ‘One of them took HRT and one didn’t. Both have ended up with breast cancer and the only difference between their individual situations now is that the one who was taking HRT looks years younger and has had a much better quality of life thus far.’

Ah. ‘Looks years younger’. Questions that occur to me — how old the patient was when she started taking HRT, how long this was before she developed breast cancer, and exactly how many years younger she looked after her treatment — evaporate in the face of those three little words. Who cares, as long as you look younger? Take HRT and you too will look younger than a cancer patient.

My Twitter dialogue with the Sunday Times columnist continued.

She was particularly keen to pull me up on my original tweet, in which I used the word ‘bashing’ (see above). This puzzled me, given that she referred to HRT use as often being ‘a sneaky draught from the fountain of youth’, which makes women who take it sound like children and most definitely feels like bashing to me. Then there was her link to a piece written by Hilary Mantel, in which Mantel referred to Joanna Lumley, among others, as an archetype of graceful ageing. So swept up in this superior piece of writing was I that I accidentally attributed the Lumley reference to the Sunday Times columnist (I know! How stupid of me), who took issue with this mistake that I’d made. In the midst of our dialogue, this too confused me, like: ‘That’s what you took from that? That’s the hill you want to die on?’ The columnist wasn’t particularly interested in engaging with me in a discussion other than to keep repeating what she'd already said — and to be fair, why should she be? — but as well as taking exception to the Lumley mistake, she urged me not to take her piece at face value, telling me and others on Twitter to Google ‘HRT youthful’. She also told me to look carefully at the detail of her piece, rather than at what I thought she said.

The thing is, I’ve tried looking for the substance of what she too thinks she’s said, and there’s not a lot there. Perhaps that’s to be expected of a 1000 words squeezed from a quote in a Daily Mail article, a few obscure Google results, one of which is 23 years old, and Feminine Forever, a text from the sixties by Robert A Wilson who, in her book The Change, Germaine Greer gives short shrift, describing him as suffering from acute 'anophobia' (fear of old women). 'Robert A Wilson based a whole career on amateur diagnoses misheard in his youth' and 'the sight of a woman's bloated body being torn open by a grappling hook as it was fished from a reservoir'.

Reading the Sunday Times column, anyone would think that the writer had unearthed a phenomenon that was about to sweep the nation. Yet, as I said in one of my tweets, it seems more of a niche preoccupation and hardly mainstream (as is often the case of features in broadsheet supplements, which often focus upon writers' immediate social circles and who bear no resemblance to people living ordinary lives all over the country). If you have to keep saying to readers ‘I make that clear’, perhaps it wasn’t? And doesn’t telling readers to comb the corners of the internet for microscopic samples of people as evidence invalidate your premise? Why not just be honest in the first place and say, ‘I was reading a piece in the Daily Mail in which a professor briefly mentioned that one of his cancer patients was on HRT and looked younger than her twin and I thought it was interesting. I decided to Google it to see if it was more of a thing and found a few obscure sources that don’t really prove much, but which may suggest that something is going on with HRT at the moment that’s a bit underground.’

But within columnist culture, this sort of thing doesn't do because it doesn't make good ‘copy’. Whereas exaggeration, generalisation and sensationalism does. And it’s much easier to simplify complex and problematic issues such as women’s health. 'Women who take HRT actually can lower their risk of breast cancer by modifying their lifestyle even if the HRT might increase their risk slightly,' says Dr Louise Newson on Instagram. 'In addition, studies have shown that women who take HRT have a lower risk of heart disease, osteoporosis, osteoarthritis, type 2 diabetes, depression, bowel cancer and dementia.' Women who take HRT — and I am among them — know the risks as well as the benefits. We weigh it all up with the rest of our lives and some women, a tiny amount, may find that using HRT has a side-effect of making them appear more visibly youthful than they otherwise would. But I would put money on that not being why they take it, and no doctor would prescribe it on that basis. If Joanna Lumley is an aspiration for some (and personally, she makes me want to barf), I prefer to focus on how I feel before how I look, and the energy — physical and spiritual — that I radiate. In fact, I would trade a few more lines — even a few more pounds — just to feel better. Kathy Burke, Anne Hegerty and Eileen Atkins (who was once propositioned by Colin Farrell and who alone makes Doc Martin reruns worthwhile) seem to me to be examples of women who have come out the other side of the menopause remaining every bit as attractive as they were before. And don't get me started on Patti Smith, who is responsible for evolving me out of dresses and into t-shirts, jeans, jackets and boots - and hopefully grey hair some time soon.

HRT deserves to be celebrated, and the women who take it do not deserve to be maligned or infantilised. However, the real story here isn’t about HRT, the women who take it, the menopause, or a perceived obsession with ageing. It’s about the media — or most of it — and the quality of its content, in print and online. It’s about how poorly we are all served especially by our print media, which is as toxic as any poisons in our food and physical environments, and is, thankfully, in its death throws. Soon the traditional print media will become extinct and I for one will not be sorry to see it go. I feel no sentimental attachment to any of those rags, tabloid or broadsheet, with their bad, bad writing — when quibbling about Joanna Lumley is all you've got —  and its trolling and gaslighting of large sections of the nation, stoking fear and division with fake news in preference to evidence and facts.

We — and I use that second person pronoun (plural) deliberately and accurately — all deserve better.