How women’s identities are affected by UK shortages of HRT
Nine years ago I wrote a book about how women construct their identities up to and during the menopause. Out of this came a new model of health identity that looked at links between personal, interpersonal and societal health narratives and how these affected individual women.
The findings from the study the book is based on, where I interviewed hundreds of peri-menopausal and menopausal women, were interesting. I took a narrative approach with semi-structured interviews and initially expected women to talk about their health. But it became clear that women’s health — both physiological and psychological — affects every aspect of their everyday lives.
The women who took part in the study talked about health in terms of and interrelated system of relationships where they consulted not only health professionals for information, but also friends, family, the media and event overarching narratives such as politics and religion. This was because information about the menopause and how it affects women is scant and, in places where there is a plethora of information such as the internet, often conflicting in nature and largely unevidenced. But this is how they identify their ‘truth’ about health, and the world and themselves in relation to it.
One area where women were confident and upbeat was about Hormone Replacement Therapy (HRT). They felt that the information about HRT was plentiful and positive. They understood the risks and felt that they could make an informed choice about taking it. Women stated that it was ‘life-changing’ and ‘made them feel human again.’
I can only imagine the horror of menopausal women in the UK who go to their doctor this week for a repeat HRT prescription and find that it is unavailable. Recent statements from various national bodies give vague explanations for shortages and unhelpfully explain that ‘the crisis started late 2018…’. Which begs the question of how they have let this worsen until now, almost one year later?
‘I feel like I am going to die…’
I contacted one of the women who was just starting the menopause when I interviewed her ten years ago. We kept in touch and she told me that her GP had prescribed her HRT for her severe mood swings. So severe that she had taken months off work and had lost almost one quarter of her body weight. Her hair was also falling out and thinning and she had severe vaginal dryness.
The menopause had affected every part of her life, from her ability to support herself to her sexual relationships. Her sleep patterns had deteriorated so much that she was hardly able to function.
The HRT had proved a miracle for her. The mood swings stopped and everything except the hot flushes had ceased. Her hair thickened again and she gained weight. She got a new job and has renewed confidence in her sex life. ‘I can stand a hot sweat or two if it means I get some sleep!’ she joked. But I could see a huge difference in her. She was happy again.
I called her again last week to ask if she was one of the women who had been denied HRT and she confirmed that she had not been able to fulfil her prescription. That she had been given a ‘similar product’ that did not help her. Twice. That her doctor was as worried as she was.
‘I feel like I am going to die. I am getting weaker by the day. What have I done to deserve this?’
Perceptions of Women’s Health
The answer to her question is this: you are a woman past reproductive age.
Women’s health is seriously under-researched (but in the interests of fairness please read this article for some fascinating menopause research). I wanted to study women’s health identity at doctorate level and I was told that the only way I could do this was to fund myself. I did fund myself, because even before I began I knew that women’s health is woefully under-funded and I had saved for almost ten years to be able to officially carry out my study under supervision.
I had previously tried to research Pre-Menstrual Syndrome and I was astonished to find that there is little understanding of it and even less funding. This is a condition that effects millions of women every month, yet no one has found out,either physically or psychologically, what causes it. It was included in DSM in the last edition with a list of symptoms, clustering it into a ‘syndrome’ but little is known about the cyclic changes that bring this about in some, but not all women.
While there has been a little more research into the menopause, much of it is around pharmaceutical money spinners that promote youth. Menopause medicine is transfixed by the values of youth, whereas menopausal women just want to get through the day in a reasonably functional state. For example, recent reports that the menopause can be delayed by 20 years turned out to be a procedure developed to allow women who had undergone chemotherapy to have children, yet the corresponding headlines were a media frenzy of delayed menopause.
My study found that menopausal women were not in search of youth. None of the women I interviewed wished to turn back the biological clock and have more children. Not a single one. Most just wanted a good nights sleep. All of them had heard about the elusive health interview with a senior consultant who then tailors HRT to the woman. None of them had been able to access this service, then or now. But all of them had at least been offered HRT, an offer that is being increasingly withdrawn in the UK today.
This is the bottom line: if you are a menopausal woman today in the UK there is a high probability that you will not be able to access the medication you need. This is despite paying into a National Insurance System that is meant to provide citizens of the UK with healthcare.
There is no solution presented, only a vague hope that HRT supplies will resume sometime in June 2020.
I can only conclude from this that the menopause and its disruptive medical symptoms are now excluded from healthcare.
The effects of HRT shortages on menopausal women
It doesn’t really matter what I conclude, because the scientific evidence speaks for itself. Women build their secure health identity around a medical narrative. This includes confidence that they can access healthcare and that healthcare providers are able to alleviate symptoms of ill health, both physical and psychological.
Denial of this has serious detrimental effects on health identity, causing worry, stress and, as stated above in relation to my findings, effects on every area of women’s lives. Lack of confidence in health leads to low self esteem, feelings of worthlessness.
As another woman who has not been able to access HRT told me this week:
‘People say women become invisible around the menopause. I guess that’s true, then? No one cares enough to find me the medication I need and deserve. How do you think that makes me feel?’
This woman’s health identity has been negatively affected by the HRT shortage. Her personal ‘truth’, supported by a lack of adequate societal explanation as to why HRT supplies have ceased, is now that she is not important and health professionals do not care.
The mismatch of HRT as medicine and the largely media constructed quest for eternal youth in older women has rendered this problem inconsequential. In reality a whole generation of women are suffering in forced silence.