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Good morning. HRT: Hormone Replacement Therapy. The very name suggests a therapy that is designed to treat a deficiency. It is Hormone Replacement Therapy, so that suggests that there must be a hormone deficiency that needs to be replaced. This in turn suggests a disease, and in a situation where problems are going to arise you have a deficiency; you have a disease.

It is given to menopausal women. Therefore, this immediately suggests that the menopause is a disease, or at least a condition resulting from a hormone deficiency, and indeed many doctors when telling their patients as to why they need HRT will say to them: "Look, you know diabetics lack insulin: we give them insulin; you're lacking hormones; we give you hormones – it is just the same! Your ovaries have stopped working, you won't make any more oestrogen, so we must replace it for you, otherwise you are going to grow old, you are going to look old, you are going to wrinkle, you are going to fall apart... all sorts of terrible things are going to happen to you."

And sadly, this is the view of the menopause which is promoted today. It is promoted by the drug companies, who instil all this information to the medical profession via literature, conferences and their sales people – and many of these professionals accept this view and in turn then promote this to their patients. Also, the drug companies promote this view via the media and provide specialists to speak on the media; to write in the media, and this idea then gets promoted to the public at large. And many women who hear this information believe it... and who can blame them? Because we want to be informed about what is happening to us at this time of our lives, and the sources of information (the media, the medical profession) – we consider them to be informed, and indeed they are. We expect them to be reliable and honest, and also, who wants to look to a future where we are going to be old and wrinkled and have bits falling off!

But of course, what the public do not realise is that many of these views put forward are biased and one-sided, and they are only told half the story. They are told all of the advantages... you are not told the disadvantages and the side-effects, and even when these are raised, they are often minimised to such an extent that you don't believe they really exist, they are a bit of scaremongering.

Menopause is Not a Disease
But I think in spite of all this propaganda, most of us instinctively know that the menopause is not a disease; it is a normal process, and it is a process through which women are intended to pass and have passed for many years. That is not to say that some of the changes are not disconcerting to us, unpleasant and can create great problems. And then we also have a lot of the more minor symptoms, and we must be very careful not to subscribe to the view that the discomforts of modern life all need investigating and that they are all signs of diseases that need to be checked and treated.

As I have said, we have been going through this for many years, and it is not a new thing: we have always had the menopause, because it is part of a normal process, and studies into evolution and the way it works have shown that adult females must live beyond the menopause in order to rear their young. The reason that I am saying this is because so often you will hear that "The menopause did not exist years ago; it was not a problem, women never lived beyond the menopause" – as if the only function for a woman in life is to bear children. But in fact, it is important that these children are reared and it has been shown that if the human female did not live a certain number of years beyond the menopause, the human race would have died out by now.

It is also said in respect to us not living long enough in the past to have had menopauses, that the life expectancy of a woman a generation or so ago was only about 45-50, whereas now it is 70, 80, we hope even longer. But that again is not, in fact, true. The life expectancy fact is true, but what they forget is that life expectancy is the average life lived by women born in a certain year. Now, several generations ago, many babies died at birth, so a lot of women died off before they had even reached their first year. Many died in childbirth. But those who survived beyond childbirth, on the whole tended to live as long as we do nowadays, and you only have to go to church records and graveyards and you will find proof of this. But the average was shorter because so many had died off earlier, and we must not be fooled by that statistic, which is often trotted out.

So how did this situation arise, then, when we find ourselves in this situation where the general consensus of the medical profession and, indeed, many menopausal women is such that you need to take HRT – you have reached a certain age; you must have it?

The Start of the HRT Business
They seem to have forgotten that our grandmothers and great-grandmothers did not need it, had problems and were able to deal with them, and we shall be hearing later today of many of the remedies which probably our grandmother and mother used. But we have forgotten about many of those methods, because they did not have at their disposal the facilities that we now have. This HRT business all started way back in the 1960s with – I'm sorry, John – an American, a gynaecologist by the name of Robert Wilson. This man actually single-handedly introduced and cemented for all time the idea that the menopause is a hormone-deficient disease. He referred to it with frightening adjectives such as "this living decay". He claimed that oestrogen was the answer and that every woman should take it and he was helped by the fact that at this time a drug company had just managed to produce the first relatively-inexpensive oestrogen. It was Premarin, which of course is still used a great deal now, extracted from the urine of pregnant mares. Up until that time, the only oestrogen available was extracted from the urine of pregnant females, and was incredibly expensive.

Dr Wilson was a great entrepreneur and he promoted, together with the drug company, oestrogen – he promoted it with what can only be described as evangelistic fervour. You only have to read his book Forever Feminine and some of the articles he wrote, and he was helped a great deal at that time by the fact that the medical profession had already begun to view the menopause as a disease, but they were viewing it at that time as a disease of the brain – you know, women went 'funny' at that age – so they were all given psychotropic drugs to keep them nicely under control. Actually, if you think back to the Victorian times, the very word 'hysterectomy' encompasses this, because 'hysteria' was thought to be what happened to women then – okay, the uterus was the source of their hysteria; therefore, you removed it – 'hysterectomy'. And that operation was done on many women, just because they behaved a little strangely at the menopause! And the thing is, all these claims are accepted by the medical profession, without research. You know, he claimed all these great things that oestrogen did, and the legacy of this exists today. In textbooks and articles you will find comments made by this Dr Wilson which have never been put to the test and everyone just accepts them – they go on from article to article.

Oestrogen and Progestogens
However, a problem arose in the 1970s, when it became clear that using oestrogen like this on its own was suddenly producing an awful lot of endometrial cancer, because oestrogen – as we know – stimulates the lining of the uterus; if you get too much stimulation, then the cells behave abnormally and become cancerous. So, something had to be done, and the drug companies put their heads together, and it was well-recognised that the hormone progesterone protected the uterus – this was known. But the problem for the drug companies was that it was not really feasible to put progesterone into their products because it was a natural product; you cannot patent a natural product, therefore it opened all sorts of financial problems for them. So they took progesterone into the laboratory, tinkered with it, and produced progestogens, and these are what are now – even to this day – in HRT, and they are there for one reason – one reason only – which is to protect the uterus and prevent uterine cancer, which in fact they do very well. But sadly, they have none of the other balancing effects that progesterone has upon oestrogen, and they in fact have many unpleasant side-effects themselves.

Now there are many forms of HRT in use today – the earliest, as I said, was Premarin, which is still very popular; it is a conjugated oestrogen made from the urine from pregnant mares, and quite frankly in my view it is superb if you happen to be a menopausal horse, but why they try telling you ladies that it is a 'natural hormone' is beyond me! All except two of the other forms of traditional HRT which are prescribed nowadays just contain oestradiol. Now, we have in our bodies three oestrogens, I will talk more about them later. Oestradiol is one of them, and this is the most stimulating and therefore cancer-producing of all the oestrogens, and that is the one put into the majority of forms of HRT, be they tablets, patches, creams, implants. There are two others: Trisequens is one of them which has a second oestrogen in it that has some oestriol which is considered to be the safest of all the oestrogens; and then there is Hormonin which, in fact, is a tablet that contains all three oestrogens, and is available on prescription but for some reason is not often used in general practice. I think it is because it has been around a long time and it does not get promoted very much by the company that makes it.

Critique of HRT Research
And this is the main fact about HRT which has always puzzled me: and this is the fact that if one accepts there is a hormone deficiency or an imbalance, and that it is important to restore this balance or to replace these hormones – as indeed they may be missing to a much larger extent in women who have had their ovaries removed – why on Earth do we not replace it with hormones that are the same as our body makes? Why use an artificial hormone? Why use a different hormone or a different combination of hormones from those which our body makes? And I think that if one does accept that you have to use hormones, then for goodness' sake, let us use the ones our bodies make, not ones that we wouldn't dream of making. And the other thing that often puzzles me is that we are being told all the time how wonderfully-researched HRT is. And it should be remembered that this is not as true as you would be led to believe. There has been quite a lot of research done on Premarin which is the conjugated oestrogen from horses, and all that applied to Premarin when they checked it has been assumed to apply to oestrodial, which is a completely different oestrogen and comes from plants!

That is not to say that there has not been some research done on the oestradiol, but that is the main source of the material. Also, a lot of this so-called 'research' is in fact retrospective studies: they have taken groups of people who have been on, or not on, HRT for a certain number of years, and observed the differences in them. They seem to forget there might have been differences before they started; I mean I am quite convinced that if you took people who wore, for example, red underwear or black underwear, you could prove that they have fewer problems in the menopause than those who did not – because retrospectively, if you pick your groups properly, you can prove practically anything.

Now, this is where traditional HRT at the moment is, and I think that the menopausal women of today are going to be looked back on in medical history as the most medicated group of potentially healthy women in medical history.

And it will also be noticed that we were the contraceptive pill guinea pigs as well. And this may be, in fact, one of the reasons why there is a high incidence of menopausal problems today. Many of us here today are already in the menopause, and others of you are fast approaching it, and we are fortunate to be here today to discuss all these things, and we have reached a phase in our lives where we need to have this information; where we need to make a choice. And the choice is really: do we become permanent patients of our GPs and gynaecologists for the rest of our lives, with our lives revolving round HRT, having check-ups, screens, investigations that we would not have needed if we had not started on HRT? And will we be persuaded by the medical profession that if we do not take these drugs we disintegrate? Or do we accept that the menopause is natural and that we can use some hormones if necessary and other methods – many of which were known to our grandmothers and great-grandmothers – and pass through the menopause with joy and dignity?