But it's an unsustainable way to live the third act of one's life. I first spoke to my GP about the perimenopause eight years ago, when I was 45; my periods were so heavy that sometimes I was scared to leave the house. You are too young to be discussing the menopause, he said, laughing.
I had the coil for a few years and then, when I was 50, my periods stopped. But, as the months passed, other symptoms started to appear.
Last September, I spoke to another GP at the practice on the phone. I told her that three years earlier, my hair had started to come out, whole handfuls of it, when I washed it. I talked about the anxiety. The random inability to cope with the tiniest things.
The brain fog. The spikes of irritability. The aching joints. The occasional vaginal dryness (which can make sex and smear tests excruciating). And, more than anything, the flatness.
I could still appreciate the small things – a blazing sunset, a swim in the sea, great food – but nihilism was creeping in. I could put up with most things, but the lack of sleep was crippling.
"I can prescribe antidepressants," said the GP.
"I don't think I'm depressed," I replied. "I think it might be the menopause."
She wasn't convinced. She didn't think HRT was the best option. Had I thought about the Mirena coil? Ugh, no thanks, not again.
In the last five years or so, the conversation around menopause has changed for the better. Celebrities such as Davina McCall and Meg Mathews have started sharing their experiences – last week, presenter Gabby Logan spoke about having perimenopausal symptoms at the age of 47, declaring she didn't want to let it slow her down or affect her career.
The trouble is, doctors haven't caught up, and although the latest guidance from the UK's National Institute for Health and Care Excellence says for most women the benefits of HRT outweigh the risks, it's still a challenge to get hold of it if you want it – as I discovered.
I put up with my symptoms for another month, but by October last year, I couldn't keep going. I didn't want to go back to the GP and beg for HRT in case she said I was not only depressed but also deluded about being depressed.
I decided to seek help privately despite not having the spare cash. A smooth-talking nurse told me that, after my initial outlay of £125 (NZ$239) for a blood test and £240 for an hour-long video call with a GP, bio-identical HRT – which Gabby Logan says she's taking – would cost less than a cup of coffee a day.
I didn't even bother Googling "bio-identical"; I was that desperate. The GP nodded sagely and said that all my symptoms were menopause related. I was buzzing afterwards; she had heard me, seen me.
Then an email arrived saying that the bio-identical HRT would in fact cost more than £2 a day and, in order for my prescription to be activated, I had to have a scan of my womb lining at the cost of just under £100.
I decided, rather late in the day, to do some proper research. Bio-identical hormones, plant-based substances which are said to mimic the hormones that your body produces naturally, are not regulated and therefore not available on the NHS. I bailed. But I didn't get better.
'I see women every week who are suicidal'
Dr Louise Newson runs Newson Health, a private menopause and wellbeing centre. She worked as an NHS GP for 15 years and regularly prescribed HRT. "Not only does it make women better, but it decreases the risk of heart disease, dementia and osteoporosis," she says.
Newson's team sees over 1000 women a month and has a waiting list of nearly 3000. "They just want HRT. They haven't got loads of money and shouldn't need to resort to a private clinic. We do a lot of work trying to persuade NHS GPs to prescribe HRT the way we do."
Why exactly are GPs so reluctant to offer it? Newson says it's mostly down to poor training of GPs and healthcare professionals in the menopause and safe prescribing of HRT.
She talks about the waste of funding within the NHS as women are referred to secondary care for their hearts because of palpitations, or to rheumatology clinics because of joint and muscle pain. "I did a study of 5000 women. For nine per cent of women, it takes at least 10 GP appointments to just get a diagnosis for menopause."
Her research shows that around 70 per cent of women are, like me – and Meg Mathews - offered antidepressants by their GP when in fact they are menopausal. "I see women every week in my clinic who are suicidal and have nowhere else to go."
Breast cancer risk
Dr Radhika Vohra, an NHS GP and member of the British Menopause Society, says that she wasn't taught about the menopause at medical school – and it remains almost a footnote.
"As the population is living so much longer now, knowledge of the menopause has become even more important. Misinformation about breast cancer has carried on for decades."
The increased risk of breast cancer is, according to the Lancet medical journal's definitive 2019 study, this: one in 50 women of average weight taking the most common form of HRT – combined daily oestrogen and progestogen – for five years will get breast cancer as a result.
In Western countries, the risk of developing breast cancer over 20 years after the age of 50 rose from 6.3 per cent among women not taking HRT to 8.3 per cent among those who did. Women taking HRT must ensure they attend breast screenings and remain vigilant.
HRT and me
In January this year, after friends (and my mum) urged me to try HRT via the NHS, I tried the GP again. I asked for HRT. I got it. Estradiol gel in the morning and Utrogestan before bed – a combination of oestrogen and progestogen.
My sleep improved almost straight away and the existential dread receded. HRT is not, of course, some kind of miracle drug. Life is still hard. I do not, in truth, know how long I will take it for.
But what I do know is that my life would have been very different if the first GP hadn't laughed when I suggested I was peri-menopausal and the second GP had taken me seriously instead of immediately suggesting antidepressants.
Quite simply, I wouldn't have thought I was going mad.
I don't think women should automatically take HRT, but I am certain that GPs should undertake menopause training so that when women come to them in a state of desperation, they are presented with all the options.
It's about women being seen and heard. I, for one, felt better the moment I was taken seriously.
- Amy Raphael is a writer and critic. Her latest novel for children, The Forest of Moon and Sword, is out now
