THE DAILY MAIL
2 MAY 2016
CHRISTA D'SOUZA ON HRT
Christa D'Souza feared taking HRT because of breast cancer risks. She shouldn't have.
Going through some old photos, I found some of me in a swimsuit five or six years before I'd had babies. God, I thought, whoever said you should wear a bikini throughout your entire 20s, had been spot on: I should have been doing exactly that.
Back then, I looked great. But a few decades later, as I approached the menopause . . . well, it was like wearing a 12 tog duvet - or, as one friend put it, like those padded cooler jackets you put on a bottle of wine.
It wasn't just about feeling bigger, it was not having any say over it. My body, after years of toeing the line when I told it to, obediently shrinking when I put myself on the Paleo diet or the 5:2, suddenly had a mind of its own. It just didn't seem fair.
A blood test confirmed the obvious: my levels of reproductive hormones had been steadily descending. But it's remarkable how dim you can be if you choose.
I persuaded myself that my new, duvet shape was just the result of my body pushing the 'so what?' button after years of dieting.
Besides which, I was still, at 53, having periods. Oh boy, was I having them. Nature's way, apparently, of alerting you that everything is gearing up for that one last chance to have a baby before it is too late.
And then, in the summer of 2014, whooooomph!, they stopped. Just like that. And though I should have been grateful, all I could do was mourn their passing.
And then came all those symptoms, as I described in Saturday's Mail, that I had ludicrously assumed I'd be spared: hardcore insomnia, absence of sexual desire, increased appetite, thickening waist.
You'd think, wouldn't you, that by way of compensation for all this, the PMT symptoms - the sore boobs and irritability - would go, too? But oh no. They hung around like stragglers at the end of a party.
The biggest surprise for me was probably the severity of the hot flushes, though thankfully they mostly happened in bed. There was, however, one memorable exception.
It was a party at a swanky place in Mayfair, central London. Italian waiters in white coats shaving truffles onto risotto, young women in head-to-toe Chanel, that kind of thing.
And suddenly this heat, out of nowhere, rising, rising from my solar plexus to the roots of my hair; my face pulsating like a sore thumb in a Tom And Jerry cartoon.
In a funny, perverse sort of way, it was fascinating that my body was able to do this, without me being able to intervene in any way. But the mortification of having to keep dabbing at my upper lip and then having to get up, dripping, in my sleeveless dress and go outside, cancelled the wonder of it big time.
But the idea of taking hormones? To be honest, I didn't consider it at first, for one main reason: in September 2007, I was diagnosed with breast cancer after finding a lump the size of a grape pip in my right breast.
It was grade 1, treated with radiotherapy, and a mere verruca compared with the experiences of so many of my poor friends who have had the disease. But it was cancer nonetheless, meaning I wasn't eligible for HRT. And so began what one of my friends has described as a treasure hunt through the clinics and hospitals of Britain and abroad in search of help for my menopausal symptoms.
"But the idea of taking hormones? To be honest, I didn't consider it at first, for one main reason: in September 2007, I was diagnosed with breast cancer."
First stop was the Clinique La Prairie medical spa in Montreux, Switzerland, founded in 1931 and made famous by clients including Marlene Dietrich, Winston Churchill and David Bowie. It is also the first in Europe to have a section dedicated to the menopause.
'I find that most of my female patients do not qualify for hormones,' Dr Mikael Rabaeus, head of cardiology and internal medicine, tells me.
'They qualify for taking care of themselves. Lifestyle accounts for 80 per cent of your risk of early death. Ceasing smoking and doing physical exercise has an excellent effect on menopausal symptoms and life expectancy in general.'
His colleague, Dr Thierry Pache, who founded the clinic, takes a different approach.
He thinks hormones can be 'fantastic, if you are delivering the appropriate dose to the appropriate patient'. He has patients in their mid-70s who are still using HRT.
An endocrinologist by training, he has a robust attitude towards the scare stories, quoting research that says two glasses of wine a day are more of a breast cancer risk than full-dosage conventional HRT.
But at the same time, he believes women in the West are overloaded with hormones and he would never treat me, a breast cancer survivor (how melodramatic that sounds) with them.
He recommends Climavita Forte (also known as Cimicifuga racemosa), which contains black cohosh and, as I later read, is fantastic for treating bed bug bites. Combined with acupuncture, it can help with menopause symptoms, he says.
But no, it will not do a thing for my expanding middle. Only four hours of exercise a day and a change in diet will do that.
'I think even Audrey Hepburn had trouble in this area,' he says. 'But then the way a woman's body changes around menopause, a lot of men find that beautiful.' And so I fly back to London with my prohibitively expensive Climavita pills - feeling, it has to be said, rather dejected. The hot flushes are still coming thick and fast, I'm in leggings because my jeans don't fit and the resentment I feel is becoming harder to deal with.
Why did I have to go and get cancer? Why couldn't I be one of those women who feel fabulous after taking HRT?
But maybe I could. Certainly, the next expert I meet isn't impressed by my prescription from Montreux. 'Whatdoyoucallit? Cimicifuga? Honestly, sometimes I do despair!'
This is Professor John Studd, consultant gynaecologist at Chelsea and Westminster Hospital and former chairman of the British Menopause Society. With his quiff of silver hair and booming, patriarchal tones, he is a world expert on the links between menopause and loss of libido.
He is also an unashamed proponent of HRT - yes, even for women like me, who have had breast cancer. While I tell him about my medical history, he pads over to a chaise longue with his shoes off, peering at me from over his glasses.
I've got to the bit about being prescribed Prozac for depression back in 1988 and still being on it a quarter of a century later, at double the dose. And my history of low bone mineral density, thought to be a precursor of osteoporosis.
'Of course you must take HRT,' he says, padding back to his desk. He briskly whips off a prescription for oestrogen gel, testosterone gel and progesterone in pill form - the latter being the only one that he anticipates I might, even at this low dose, have trouble with.
My wonderful oncologist, Carmel, meanwhile, rolls her eyes when I go for a check-up and tell her I am considering the hormone route. Yes, I can do what I want with my body, but she suggests I don't.
"Why would I want to put more oestrogen into my body when I have oestrogen-positive cancer? Especially when I am already at risk by being a drinker? Back and forth, back and forth…"
Why would I want to put more oestrogen into my body when I have oestrogen-positive cancer? Especially when I am already at risk by being a drinker? Back and forth, back and forth. Part of me feels morally weak for wanting to take the edge off the menopause. After all, my symptoms are not as bad as those suffered by other women. Perhaps it's a problem of culture and perception?
'If your status was raised by menopause, if you were treated as a wise woman and older men still found you attractive, what would be the problem?' says Susan Bewley, professor of complex obstetrics at King's College London. 'Nonsense,' says Dr Erika Schwartz, who specialises in bio-identical hormone therapy (more of which in a moment).
I've come to her glamorous Fifth Avenue practice in New York to get a second (or third, or fourth) opinion. 'Once you lose your hormones, you are nothing more than roadkill. You have two options.
'You can make a conscious decision that, from now on, it is all about you; that you are going to do something you have never done before, which is to put yourself first.
'Or you continue as you are until you drop dead.
Dr Schwartz doesn't pull her punches. Dressed in a tight black dress, she is a hybrid of Joan Rivers and Charlize Theron and looks shockingly young for her age, which is 65.
I reiterate my concerns about having had oestrogen-positive breast cancer. 'Listen, lemme tell you something. If you don't take hormones, you are going to wind up in trouble from every point of view. Brain. Bone. Heart. Your cancer.
'Another thing, you didn't get breast cancer because you had too many hormones in your body. There are a million other reasons you got cancer. One of them is that as you get older, your cancer risk goes up, independent of everything else.'
When I get back to London, I have made my decision. OK, Dr Schwartz is on record as saying she thinks swine flu is nothing more than a common cold.
But on the other hand, she has an immensely encouraging, reassuring vibe about her. Plus, she looks bloody marvellous for 65.
I go to my local chemist to get my bio-identicals. There isn't a huge amount of difference between bio-identicals and HRT: the former are made of plant sources such as wild yams or soybeans and have an identical structure to the hormones our bodies produce.
Conventional HRT consists of the hormones they've been using since the Sixties, which can be harvested from pregnant mares' urine, though this isn't always the case.
Most meaningfully, conventional HRT and bio-identicals are chemically synthesised in a lab. The idea that bio-identicals are all natural is simply not true.
However, they are often tailor-made for you, unlike the one-size-fits-all HRT. They're expensive, too. I pay £40 for three months' worth.
There are three potions: Oestrogel, which mimics the oestradiol produced by the human ovary; Testim, a gel containing testosterone; and Utrogestan, a capsule that contains the progesterone.
For the first 24 hours, I feel like Alice in Wonderland, wondering which potion is going to affect me and in what way.
Oestrogen and progesterone, fair enough. But testosterone? Is it going to make me look manly?
For a couple of days I can't stop thinking about what it is going to do to me. Then, inevitably, I forget all about it - until about three weeks later, when I realise the sleeplessness and hot flushes have disappeared.
Within a month, my periods return (Oh, did I not tell you? Progesterone can give you a chemical bleed - which is why it is entirely possible to 'menstruate' well into your 70s).
Within three months, the extra duvet of flesh round my stomach that seemingly had nothing to do with diet has gone. If I overeat, it comes back - but that's simply my fault for eating too much.
On the other hand, what to do with all the saucy dreams the testosterone gives me? The return of desire is all very well, but every day, all day?
As my friend Rosa puts it: 'I suppose it is quite a fun thing to try, to put that particular sexy hat on for two or three weeks.
'But do I actually need it 24/7? Frankly, I've not got the time.'
Her words strike a chord. So, somewhat regretfully, after a month I take myself off the testosterone. But I keep on with the Oestrogel and progesterone.
So how do I feel now? Like my old self again. Though when I say 'old' self, what do I mean? This hormonal even keel is better than my old self. Much better.
And the idea of feeling the way I do now on the hormones for the next quarter of a century or more, with no fear whatsoever of my cancer returning?
Oh, yes please. I'll take that like a shot.