Is it time for HRT? Facing facts at a menopause MOT

Women: are you feeling unusually sweaty, unable to sleep, suffering from brain fog, or under what seems like unreasonable stress? Are you possessed by new sexual desires, or a total lack of interest? One of the most bewildering features of menopause is the many ailments that might figure in one’s own experience. Perimenopausal symptoms can kick in at any point in the years leading up to menopause – the point at which a woman permanently stops having periods (the average age is 51 in the UK). The problem is that the symptoms range from the innocuous and largely anecdotal (itchy ears), to the more dangerous, such as osteoporosis, depression and cardiac disease. 

I have no idea whether I am perimenopausal or simply hot and stressed. Is this headache normal or some harbinger of age-related decline? I’m confused about whether I should be gulping hormone replacement therapy (HRT) or focusing on my holistic health. I’m also pathetically wimpy about taking action and have avoided a smear test for 20 years. In a world of transparency and disclosure, I prefer the ostrich approach. But when invited to take part in a menopause screening at OneWelbeck, a private clinic in London, I take the plunge. 

Should I be gulping HRT or focusing on holistic health?

The screening involves an appointment with Dame Lesley Regan, a consultant obstetrician and gynaecologist, who helms the Women’s Health Centre at OneWelbeck and works at St Mary’s hospital in Paddington. I anticipate a chat about my oestrogen levels, but it turns out that blood tests and small talk are only part of her all-in health-check plan. Within three minutes of arriving, I’m stripped and lying on a counter while someone probes an ultrasonic wand around my lady parts. “You’ve just ovulated through your right ovary,” says the cheerful scanner while pointing out two benign cysts. “They shouldn’t give you any trouble,” she continues, in such a perfunctory manner that any fears I had about cancer are immediately allayed. 

This is followed by an appointment with Regan, who promptly conducts the long-avoided smear test (completely painless) before I’ve had a moment to protest. “You’ve got a lovely pink cervix,” she declares while I cringe on the patient’s couch. Next up, a mammogram (agony). The only advantage of having completed the trifecta of humiliations is that I won’t have to revisit them for a little while: I will relay the results to my NHS doctor so my records are aligned. 

The mammogram and smear test reveal that I am cancer-free. I am further reassured by a follow-up for an ultrasound that is recommended for those people who, like myself, have very “dense” tissue in their breasts (sexy). As for the hormones, Regan is an ardent fan of HRT. Despite wider concerns about its links with cancer, she argues that it’s key in prolonging mobility, longevity and cognitive health. (Others are less enthusiastic: one staff member tells me that she would avoid it for as long as possible.) Regan’s recommendations include “some low-dose oestrogen replacement”, as the blood tests show my hormone levels are quite low. But I am “strictly speaking, not currently menopausal”. And likely have a year or so to go.

I’m surprisingly relieved to have some real information about my hormone health, and to discover that any strangeness I am feeling is more likely life stress. What is useful about the survey is that it offers hard facts instead of old-wifey rumination. And while I’m not ready for HRT yet, I’ve taken at least one of Regan’s other recommendations and upped my iron.   

OneWelbeck Menopause Diagnostics Pathway, £950, and 3D breast screening mammogram with a radiologist’s report, £300