England is the only country in the UK where some people are still asked to pay for their medicines, and I have never really understood the rationale behind who is exempt and who isn’t. Why, for instance, do people with an underactive thyroid get all their medication free, while those with asthma or heart disease have to pay £9.35 per item? Indeed, why does anyone in England have to pay while the rest of the UK doesn’t? Most doctors and pharmacists I know would like prescription charges abolished. And the sooner the better.
Rant over — for now — because there is now a ray of sunshine on the horizon. Campaigners lobbying for hormone replacement therapy (HRT) to be exempt from prescription charges have been offered a “commitment” by the government to make it cheaper for women who have to pay. It may not be the full exemption they were seeking, and details are being finalised, but expect a one-off annual charge of £9.35 for 12 months’ supply, saving most users about £80 a year, and some more than £200 (costs vary depending on the type of HRT and quantity prescribed).
It’s only a small step in the right direction, but a timely one as the menopause, and the problems associated with it, climb political and medical agendas. There are 13 million women in the UK living with the effects of approaching or having been through the menopause (a woman’s last period), and many are far from happy with the help they are offered. Or, more often, not offered, thanks to research muddying the waters.
The science around HRT has been conflicting over the past 20 years, leaving many doctors and women confused about the relative benefits and risks. The problems started with the Million Women Study (MWS), which linked HRT to breast cancer, heart disease, stroke and blood clots in 2003. The findings alarmed women (and their doctors) and the number taking HRT in the UK halved within 18 months.
However, just a few years after the MWS made headlines around the world, newer data (including from the MWS itself) started to contradict the findings. Fast-forward to the latest review of the risks and benefits of HRT by the National Institute for Health and Care Excellence (Nice) and the picture looks very different. Here are some of the main conclusions.
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While pill versions of HRT may increase the risk of blood clots, the now more favoured transdermal preparations (gels and patches) do not. Nice also concludes that HRT “does not affect a woman’s risk of dying of cardiovascular disease” (heart attack and stroke) — indeed, some types (oestrogen-only) may reduce the risk.
Lots of women — and their doctors — worry about breast cancer, and taking HRT does slightly increase the risk of being diagnosed with the condition. According to the latest data from the Medicines and Healthcare products Regulatory Agency, if 1,000 women under 69 take combined HRT (typically oestrogen and progestogen) for five years there will be 17 extra cases of breast cancer (80 out of the 1,000, versus 63 per 1,000 in non-HRT users). The risks are lower for oestrogen-only HRT, with five extra breast cancer cases detected.
However, there is still some debate about what happens to women with breast cancer who have been on HRT, compared with their peers who haven’t taken it. One large Finnish study, following nearly half a million women over 15 years, found that HRT actually reduced the risk of dying from the disease. So more cases in the HRT group, but fewer deaths.
Bottom line? The link with breast cancer is still going to put off women and their doctors, but it needs to be balanced against the day-to-day benefits of potential relief from commonly reported symptoms such as hot flushes, night sweats, reduced libido, vaginal dryness and low mood and anxiety, as well as some protection against osteoporosis and resulting fractures.
Many women sail through the menopause, but most struggle to some degree, often for many years, and one in four has debilitating symptoms that have a big impact on quality of life. If you are one of them, please don’t dismiss HRT until you have discussed the pros and cons in your particular circumstances with a GP who has a special interest in the menopause. If your practice doesn’t have one, and your own doctor isn’t keen to prescribe, ask to be referred to a menopause clinic (typically run by a GP or gynaecologist).
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Like all medicines, HRT isn’t for everyone, but if you are considering it, make sure your decision is an informed one based on up-to-date evidence. You can access the full Nice guidance (revised in 2019) on the diagnosis and management of the menopause online at gov.uk/drug-safety-update.
A guide to the symptoms
● The most common symptoms of an impending menopause are irregular periods (occasionally abrupt cessation), hot flushes and night sweats
● The average age for periods to stop for women in the UK is 51, but it is very common to be a few years either side of this (if it occurs before the age of 45 it is deemed premature and should always be discussed with a doctor)
● The diagnosis can be made on symptoms alone in most women and there is no need to check hormone levels
● While symptoms such as hot flushes can settle on their own within two to three years, they often last a lot longer, with one in ten women suffering for a decade or more
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● Other symptoms, such as discomfort with intercourse, do not generally settle on their own but tend to get worse with time
For further information, including changes to prescription charges relating to HRT, visit womens-health-concern.org
