There’s nothing like waking up on the first day of holiday, knowing a stress-free week of R&R lies ahead. But this fantasy comes crashing down when you realise you’ve left the HRT at home.
This, my long-feared nightmare, finally came true last week on the Canarian island of Fuerteventura. Having packed in a hurry, I hastily threw what I thought was my Estradiol bottle into my suitcase. When I went to slather my thighs in oestrogen gel the following morning, I realised I’d brought my teen’s acne cream instead. By some cruel twist of fate, they look remarkably similar.
So there I was, on a much-needed holiday with my partner, without the key ingredient to my sanity. I reckoned I had a three-day window to find a local brand of oestrogen gel before I became a psycho and turned my romantic getaway into a bloodbath.
Having realised my mistake on a Sunday morning, when the local pharmacy was shut, I didn’t panic. I knew I’d be able to go at least a day without. But I made sure I was first in line outside the pharmacy come Monday morning. Alas, what I had assumed was a pharmacy, was in fact a naturopath (the perils of staying in a hippy haven like El Cotillo) with zero stocks of HRT. A whole 24 hours wasted. The race was on.
On phoning the next town’s pharmacy, I was informed they wouldn’t supply the drugs without a prescription. Apparently, proof that I’m entitled to Estradiol back home, courtesy of the NHS app, was not enough. Nor, it seemed, was my sob story. My only option was to get a prescription from a private doctor. This felt like a major hassle and a major expense. So I began thinking, hey, I can do this, I can go without HRT for a week.
The following morning, on day two, I awoke full of brain fog. Exercise has always been my first line of menopausal defence, so I knew it was nothing that couldn’t be cleared with a quick workout. By night three, though, I woke at 1am in a savage sweat. Going cold turkey had turned me into a roasting old bird. Worse still, I was overtaken by irrational anxiety, a notoriously insidious menopause symptom. Suddenly, any amount of hassle and expense seemed worth it.
After some frantic googling, I found an online doctor service called Doctorsa, who, for only £17.30, would give me the prescription I craved. I booked an appointment for the following morning. All done over WhatsApp, it was a seamless experience that swiftly delivered my longed-for prescription to my inbox.
Cycling to the pharmacy in the next town, my anxiety about being on the ‘wrong’ side of a busy and unfamiliar road was off the scale. When I finally got my hands on the goods, after parting with another £13.90 (God bless the NHS and its HRT Prepayment Certificate, which covers a year’s supply for a mere £19.80), I ripped open the packaging with all the desperation of an addict hungry for her next fix. I smeared my thighs in HRT, right there on the pavement.
Getting my mitts on Spanish Estradiol had an instant calming effect. So much so that I started questioning whether my returning menopausal symptoms were real. That brain fog, could it have been a hangover? My nervous partner had been plying me with alcohol in an attempt to stave off any potential hormonal meltdowns. That night sweat? Well, it’s pretty warm in Fuerteventura. And the cycling anxiety? As a non-driver, even cycling in the UK brings me out in hives.
Dr Paula Briggs, a British Menopause Society trustee, says women don’t need to panic if they can’t get access to HRT for a short while. This is especially the case on holiday, where the usual stressors are often absent. She is, of course, right. My moments of anxiety were more likely induced by panic about forgetting my HRT than lower levels of oestrogen. On reflection, I didn’t turn into the grumpy ogre of my nightmares. Yet had I been back at home surrounded by deadlines, domestic duties and troublesome teens, it may have been a different story.
“Women are being made to believe that their world will fall apart without HRT, and this is wrong,” says Dr Briggs. “The reality of temporarily going without HRT is that many women will have no adverse effects, and some women, particularly younger women, might actually feel better. That said, if symptoms are going to recur, they will likely do so in a few days. How difficult this will be for an individual woman will depend on symptom severity prior to using HRT and for how long she’s been using.”
If, like me, you’re so psychologically dependent on HRT that you can’t forgo your daily fix, Dr Briggs says that once HRT is being used again, returning to typical oestrogen levels “will likely take around the same length of time that it took for menopausal symptoms to return. For most women, this means days rather than weeks”. She adds that it’s crucial not to try and play catch-up by upping the dose to compensate for the absent period. “Would anyone consider a week’s antidepressant to catch up if they ran out? Of course not. Some experts can give people the idea that hormones, in whatever dose, are safe. That’s not true and could lead to cardiovascular side effects, including stroke.”
If I’d had access to this wisdom while I was in Fuerteventura, I could have saved myself some logistical stress and quite a few euros by sacrificing HRT for a week.
Dr Briggs tells me this situation can even be a chance for women to wean themselves off entirely. “I had a friend,” she says, “who went on a six-month sabbatical without taking sufficient HRT. She experienced no adverse effects and used it as an opportunity to discontinue HRT. For some women, it’s liberating not to be medicated.”
As someone who’s used HRT for nearly five years, I can see the appeal. If I’m brave enough, perhaps my next holiday will double as an HRT-free holiday.