Viewpoint

The power of the woman who has conquered menopause can be terrifying, or so found Ernest Hemingway when his old friend, the writer Gertrude Stein, dropped him from her artistic salons in Paris. “Since the menopause she lost all sense of taste. She could no longer tell a good painting from a bad one – it all went pftt,” he said, plaintively. “Gertrude’s ego grew positively monumental in size.”

Stein also had her hair cut short, by her lover Alice B. Toklas, in the style of a Roman emperor. “The haircut marked a turning point in all sorts of things,” said Toklas. Perhaps it was a sign, too, of hormonal change, as Stein’s testosterone grew dominant when her feminine oestrogen ebbed away. It was after menopause that Stein wrote her celebrated modernist work The Autobiography of Alice B. Toklas. One of Stein’s most famous lines is: “A rose is a rose is a rose is a rose.” In his enormous huff Hemingway sent round a copy of his new book, Death in the Afternoon, to her, with the dedication: “A bitch is a bitch is a bitch is a bitch.”

There’s something disturbing about a strong post-menopausal woman, even to a man with big cojones like Hemingway. There’s a whiff of witch or wise woman. After the age of 50, women may no longer need men in the same way, or have to worry about fertility or parenting. Anger, honesty and sometimes creativity are unleashed.

Which brings us to the present-day UK and the headlines, television reports and outrage around the massive shortage of hormone replacement therapy (HRT) around the country.

The protests are loud. A sleeping Amazonian army of Generation X women, who have fought for equality for the last 30 years, has woken. Women have realised the newer body-identical HRT is safer, and that it halts the sudden plunge – as oestrogen and progesterone disappear – into symptoms and decrepitude that previous generations just put up with.

While many people still think HRT is a “lifestyle drug”, that’s quite wrong. For the 14 per cent of us women in midlife who take it in the UK, it is a lifesaver. It keeps us in work, it alleviates the anxiety and depression that hit women in their forties in perimenopause, when suicide and divorce rates peak. It stops our joints creaking. It oils our brains. It lets us sleep. In my case, it prevents a return of the heart palpitations which come when my oestrogen levels are low. Going cold turkey without HRT is dangerous. Women who suddenly come off HRT are more prone to heart failure.

Women are being decimated by the menopause, yet when their hormones are restored, they make a comeback

Now, if other hormones like thyroxine or insulin had run out, the Department of Health would be racing to solve the problem. Recently, Covid-supremo Madelaine McTernan was appointed “HRT Tsar” (why not Tsarina?) to get women their hormones back. But frankly, the NHS and Department of Health could have spotted this coming when the first shortages started over two years ago. If they’d looked at the graph from their own HRT prescriptions, they would see a line rocketing upwards following a television programme, Davina McCall: Sex, Myths and the Menopause, which I produced in May 2021.

HRT prescriptions have doubled in the last five years, but the men (and women) at the top put their heads in the sand and pretended it wasn’t happening. Or just did not care. The person charged with creating the NHS “menopause pathway” and improving the atrociously ill-informed website is a) a man, and b) not a doctor.

The supposed worthlessness of older women plays a part here, as so many are advised by an ill-educated medical profession to “keep calm and carry on”. But the survey we did with the Fawcett Society for our next Channel 4 documentary, Davina McCall: Sex, Mind and the Menopause, revealed that one in ten women quit their jobs during perimenopause and menopause, and 70 per cent suffer memory loss and brain fog, never mind hot flushes.

Women are literally being decimated by the menopause, yet when their hormones are restored, they make a comeback. Particularly when the HRT includes oestrogen, progesterone and testosterone, which is – who knew? – the hormone women make in the largest quantity. For months, menopause specialists and campaigners have been talking to the big HRT manufacturers, most of whom source products from Europe, telling them the sky was about to fall as demand outpaced supply. But no-one in the NHS listened.

There is a fatberg of bureaucracy standing in the way of women getting a cheap and powerfully effective medicine. As Justine Roberts, CEO of Mumsnet, said to me: “It’s staggering that women across the country are being forced to travel miles or turn to the black market to obtain the medication they need, and are entitled to. But we know from our forums this isn’t a one-off problem – it is the inevitable result of a culture in which women’s health is all too often trivialised, belittled and underfunded. This would not be happening were we talking about men’s health issues. No-one talks about Viagra shortage.”

Exactly. What if I told you there was a great new drug for men, which has been proven to lower heart attacks and colon cancer, and helps prevent osteoporosis, dementia and Alzheimer’s? You’ll also live nine years longer if you take it. Better still, it only costs around £10 a month. It will save the NHS billions in the long run. There’d be long lines outside Boots the chemist. Yet this is exactly what HRT does for women’s long-term health.

In lockdown, with nothing better to do, I deep-mined the science papers on hormones and menopause, with the help of academics and doctors from Yale to Australia. I even talked at midnight to one professor who was blocking the ovaries of lady mice in Wisconsin, and found they started getting lost in a maze. When she gave them their oestrogen back, they found their way out. I was so astonished and delighted by the superpowers of hormones, I wrote a book: Everything You Need to Know About the Menopause (but were too afraid to ask).

What was clear was that endocrinologists, neurologists and gynaecologists were all sitting in their separate silos and not putting two and two together. They mostly thought HRT would cause breast cancer, but again that turned out to be sloppy science – the big breast cancer scare came from the 2002 Women’s Health Initiative, which gave mostly overweight patients aged on average 63 (and some were 79) large doses of hormones made from a synthetic progestin and oestrogen extracted from pregnant mares’ urine. Ask any twelve-year-old whether that was a good idea, and they’d say no. The new body-identical HRT has been shown to have no breast cancer risk over five years, and oestrogen-only HRT reduces the risk of breast cancer.

And yet, this old WHI report remains the lodestone for many doctors, particularly the older generation. There is still a huge reluctance to prescribe HRT, and the best body-identical kind is not available in all parts of the country thanks to an NHS postcode lottery. Big Pharma is being slow in pumping out body-identical HRT because profits are low – hormones are not patentable because they are “products of nature”.

Besides, doctors are much happier prescribing anti-depressants to middle-aged women. Surgeries, incidentally, get an extra fee for diagnosing depression, but nothing for diagnosing menopause. Menopause will not be a module in every medical school’s curriculum until 2024. We’re only 52 per cent of the population.

The system is rigged and underpinned with creaking gender bias. Is there a patriarchal unwillingness to have older women healthy and firing on all cylinders, or is it just lethargy and ignorance? Women are happy to embrace maturity, but we are no longer happy to embrace ill-health when it can be prevented. As Stein once said: “We are always the same age inside.”

Kate Muir is the producer of two Davina McCall documentaries on the menopause for Channel 4 and was previously chief film critic of The Times. Her book, “Everything You Need to Know About the Menopause (but were too afraid to ask” (Simon & Schuster) is out now.