What you need to know about HRT and cancer

Angela Wright is a GP based in North Yorkshire who has a diverse background in palliative medicine and clinical sexology. That includes two years studying for a psychosexual therapeutic diploma followed by attendance at the European Society for Sexual Medicine doing their advanced exams. She is now a Fellow of the European Committee of Sexual Medicine, meaning her knowledge spans both therapeutic and medical expertise. 

As Angela has used her training with a number of women going through menopause in her clinic, she also did the British Menopause Society's Advanced Menopause Specialist training. She now works in a number of different settings with menopause and sexology but retains her interest in cancer and oncology as well. Her private clinic has B Corp certification and does a lot of voluntary work with cancer patients through the charity, Maggie's.

In this article she talks about HRT and cancer, dispelling the myths and helping you to understand what's right for you.

 

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Can someone who has been diagnosed with cancer have HRT?

It would be lovely to give a short 'yes' or 'no' answer, but there is no ‘always’ and ‘never’. HRT should always be on the menu and get discussed but we don't know enough about the pros and cons yet because there's still a lot of uncertainty in answering this question. However, if nothing else works and if quality of life is effected enough by the menopausal changes that the patient wants to give it a go, then I think practitioners should let them do that if they understand the risks.

NICE class breast cancer as a no go for HRT, so how does a doctor handle that and feel comfortable in the legal position?

I follow the British Menopause Society guidance and they allow a little more nuance - that in exceptional circumstances where nothing else has worked, we may consider HRT as an option. I don't see that as a decision for me to make; I see that as a decision that the woman makes - at what point is life significantly impacted to the point where they're prepared to take risks? 

We talk about shared decision making, which is another NICE guidance - to share decisions with patients. The role I have is to give as much information as I have, including where we don't know enough, and talk to a woman about how that applies to her so that ultimately she can make her choice. If she knows that well enough then I have done my responsibility legally.

How do you coach someone through this decision?

It's individual for each patient because of the impact of cancer and menopause on quality of life. The best we can do is share everything we do and don't know and help her to put that information into the context of her own experience so she can make the most informed decision she can.

Contrast for me the NHS GP experience for someone with menopausal issues vs your private practice experience.

I work in the NHS where I am supposed to consult within 10 minutes. I work in an NHS secondary setting where I am supposed to consult within 30 minutes, and I work in private practice where I have 50 minutes for a consultation. 

I have the same skills in each setting but I consult differently because of the time constraints. I personally have come up with ways to get around those restraints for NHS patients though - I have a pre-recorded 50-minute video that I send with all the information I want to share if I had all the time in the world. 

I overrun as well - I probably spend 20 minutes with patients and the women I see know that about me; they know when they get in with me I will listen to them because it's a big deal. The key point is making this decision is a big one and you can't do that without all the information - it's my job to get that information across however I can.

 

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You're operating on a very different level to most people who have the ear of the celebrities - how do we change that?

The lady I work with, Angela Sharma, is very similar to me. I genuinely want to work ethically and the biggest thing that's important to me is doing a good job by my patients. I value professional respect rather than social media appeal. We barely market and we get a lot of footfall through personal recommendations. I think when people see the way we work they see we're doing our best. 

There's a fine line to ensure you're not exploiting this area, which is why we have a private clinic but try to use that model to do some good and also work with Maggie's. I always want to do the best for my patients and feel pleased by what we're doing.

 

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