Marion Gluck has been on the frontline of HRT medicine for more than 15 years — a self-described ‘pioneer and firebrand’ whose fierce advocacy of ‘bio-identical’ hormones has drawn critical flak and admiration in equal measure.

At 69, she still sees patients every day in the central London clinic she founded in 2007, the first in the UK to offer bio-identical HRT (BHRT).

‘I’m not retiring any time soon. I’m still interested in life and travel, and I still like men,’ she says, laughing. ‘My main mission is the same as it’s always been, which is to give women a fair chance and a choice about how to treat themselves.’

Marion Gluck, 69, (pictured) has penned a new book discussing societal failure to take women’s hormonal health seriously

In some ways, mainstream medicine has embraced her early evangelism. In the often deeply confusing world of hormone therapies, bioidentical HRT consists of hormones sourced from plants (soya or the Mexican yam) processed so that they’re identical in molecular structure to the hormones produced naturally in our bodies. Conventional or synthetic HRT, meanwhile — which Gluck unceremoniously calls ‘fake’ — is derived from other substances with different chemical structures. No longer viewed with the outright suspicion it first attracted, BHRT is increasingly available to women in some forms, although not always on the NHS.

Yet Gluck remains a controversial figure. Her method of compounding the hormones, or making a bespoke medicine for each patient at a cost of £1,000 or more, is still dismissed in some quarters as a form of ‘alternative medicine’. The British Menopause Society, for example, says that compounded HRT isn’t regulated, doesn’t necessarily work and might even carry additional risks.

Gluck dismisses the critics as simply failing to understand her practice. ‘The compounding element is basically old-fashioned pharmacy, the kind of work doctors used to do in the past.

‘Everyone is unique, which is why off-the-shelf medicine has a different effect on everyone. Especially hormones, which all women know are very powerful things. You have to be incredibly gentle when you’re prescribing hormones and it’s where experience really comes in.’

her NEW book, It’s Not My Head, It’s My Hormones, provides not only a guide through the HRT thicket, but describes in typically outspoken fashion what she sees as a systemic, societal failure to take women’s hormonal health seriously.

Marion (pictured) who founded the first UK clinic to offer bio-identical HRT in 2007, said she often meets midlife women who are sad and exhausted but their doctor doesn't understand what's happening to them

Alongside Caroline Criado Perez’s Invisible Women and Gabrielle Jackson’s Pain And Prejudice, it’s a powerful contribution to the growing body of literature describing a gender bias in medicine.

‘Women’s hormones have always been regarded as a joke,’ she says. ‘Oh, she’s in a bad mood because it’s her time of the month, or look at her, she’s menopausal and impossible! We’ve been treated in such a derogatory way.’

The reality is anything but funny. ‘Over and over again I’ve seen women in midlife who feel sad and exhausted and with a low libido and they don’t understand what’s happening to them, and their doctors don’t understand it either, and they’re just not speaking the same language.

My message to women is: you are NOt going crazy. You can’t help it - nor can you help it if those around you don’t understand

‘Women get told they’re just getting older and to accept it, or they’re handed antidepressants. But hormones affect your brain function. When they’re balanced, they have a calming, normalising effect on you and when they’re not, you can feel like you’re out of control.

‘My message to women is that they’re not going crazy. You can’t help it. Nor can you help it if people around you don’t understand.’

Here, in an exclusive extract from her new book, she focuses her considerable firepower on doctors who dismiss the symptoms of anxious and overwhelmed midlife women . . .

WOMEN MISDIAGNOSED WITH DEPRESSION

A woman’s risk of being diagnosed with depression is 14 times higher during perimenopause than at any other time of her life.

Let’s just pause to consider that statistic, published in The American Journal Of Psychiatry. Is it a coincidence? Clearly not.

In my experience, the perimenopause, that stage of a woman’s life at which her body begins to end its reproductive capacity, lasting anything from two to eight years, is the most challenging time for both patient and doctor. In their 40s and 50s, women’s lives are often exhausting and stressful. They are mothers, wives, daughters, professionals and workers. Many fulfil all these roles and have the responsibility of satisfying multiple demands at once.

Yet can it really be true that depressive illness and menopause go hand-in-hand so often?

A woman is 14 times more likely to be diagnosed with depression during perimenopause than at any other time of her life (file image)

It’s what the data appears to say. Study after study claims to show that women are twice as likely to suffer from depression, anxiety and other mood disorders as men.

Women who complain of feeling low or irritable or tired in midlife are routinely prescribed anti-depressants by their doctors.

Indeed, a similar message comes from no less a body than the World Health Organisation, which concludes that the ‘female gender is a significant predictor of being prescribed mood-altering psychotropic drugs’ and ‘depression is not only the most common women’s mental health problem, but is more persistent in women than men’.

This is quite an indictment, and certainly a handicap for women to carry with them on their journey to a healthy, fulfilled life. Why should being female mean that many of us may need to take mind-altering drugs, specifically antidepressants?

Being female is not a medical condition; perimenopause and menopause itself are not generally medical conditions, so why does being a midlife woman carry with it such an apparent blight on our mental wellbeing?

Could it be that we are missing something here? That what is being diagnosed as depression — and treated with anti-depressants — is not in fact a depressive illness but a hormonal imbalance that we are still all too often ignoring?

I was a child of the Sixties, when women’s liberation was bursting onto the scene. Women and their wellbeing became my raison d’être. I wanted to empower women, through knowledge, to take responsibility for their own health.

Marion (pictured) said hormonal imbalance often causes the same symptoms as depression, some women come to her as a last resort as they know that they are not depressed

And what seemed strange to me, and to young female doctors like me even then, was the number of midlife women who were being prescribed tranquillisers like Valium or other benzodiazepines.

Back then, we were just starting to talk about women’s lives and bodies in new, more open ways and when we looked around we couldn’t help but wonder why on earth so many women in their 40s and 50s were apparently having ‘nervous breakdowns’ that required such heavy-duty drugs.

What has changed? In some ways, everything; in others, not much at all. Women in perimenopause still pitch up at GPs’ surgeries with symptoms of anxiety, fatigue, insomnia or just not feeling like themselves and the response is often a diagnosis of depression, especially after the patient has ticked all the right boxes on the depression questionnaire every GP has handy on his or her desk.

They may need only as few as eight questions, all of which are very broad, such as: How much pleasure do you take in life? Do you feel depressed? Do you have trouble falling asleep or have little energy?

Women’s hormones have always been regarded as a joke. We’ve been treated in such a derogatory way

The apparent remedy is anti-depressants, anti-anxiety medication or sleeping tablets — or all three!

Yet hormonal imbalance often causes exactly the same symptoms. Hopelessness, apathy, anxiety, lack of enthusiasm, fatigue or low energy, poor appetite or overeating, lack of confidence, lack of concentration, low libido, insomnia, even suicidal thoughts — all of these can be the result of the maelstrom of fluctuating hormones that often accompanies perimenopause.

Sometimes, those women then come to me as a last resort. They know they are not depressed and do not want to take the drugs they’ve been given, some of which are physically and psychologically addictive and have side-effects they do not want to endure.

Marion argues the rise in the number of antidepressants prescribed is evident of how women’s symptoms in midlife are routinely misdiagnosed (file image)

Faced with a perimenopausal woman, an open-minded doctor should consider the strong possibility of hormonal imbalance rather than depression, yet too many do not.

There is another important statistic here, one I believe proves how women’s symptoms in midlife are routinely under-investigated and misdiagnosed.

In the decade between 2005 and 2015, the number of antidepressants prescribed in the UK more than doubled. Today, more than 67 million prescriptions are being issued every year, at an annual cost of £280 million to the NHS.

TRUTH BEHIND THAT BREAST CANCER STUDY

It is no coincidence that this shocking rise occurred in the wake of a 2002 U.S. study that seemed to link HRT — the medical replacement of naturally occurring hormones — with breast cancer.

We all remember this study. It began in 1993 and was funded by the American government after much lobbying from the women’s movement. Called the Women’s Health Initiative (WHI), it involved 161,808 women between the ages of 50 and 79 and was supposed to provide definitive answers on the subject of HRT’s safety.

It was meant to last decades, but was halted in 2002 because of ethical concerns. The results were alarming: a dramatic increase in breast cancer, as well as strokes and heart attacks among the women taking the HRT combination of Premarin and Provera.

Marion said the panic caused by the WHI study that began in 1993 caused a sharp decline in HRT prescriptions, as medics turned to antidepressants to combat symptoms (file image)

Premarin, which is made using horses’ urine — PREgnant MARes’ urINe — was the standard synthetic form of oestrogen at the time and the bestselling drug in the U.S., and Provera is a synthetic progesterone substitute still prescribed today.

What had long been anticipated and feared was finally proven: synthetic hormones were deleterious to a woman’s health.

Hundreds of thousands simply stopped taking HRT the next day.

The results of the WHI study have been contentious ever since, causing disarray among doctors over hormone treatment protocols, and disillusionment among women. The study created a climate of fear surrounding hormones and HRT, which spread to all other forms of hormone balancing or replacement therapy.

Panic caused a sharp decline in HRT prescriptions during the first decade of this century, with women again suffering the consequences of hormonal imbalance. And what happened alongside that? A dramatic increase in prescriptions of antidepressants. Sadly, in the wake of the WHI study, the medical profession turned to antidepressants to combat the symptoms of menopausal hormonal withdrawal, such as mood swings and anxiety, instead of searching for healthier, safer alternatives to treat hormonal imbalances.

WHY BIO-IDENTICAL HORMONES WORK

Those alternatives, I fervently believe, can be found in bio-identical hormones, sometimes called body-identical hormones, which have a chemical make-up that exactly matches the natural hormones your body produces.

BHRT was at the heart of my approach two decades ago, and today there is increasing scientific evidence to show bio-identicals have fewer side-effects than their synthetic equivalents.

Marion claims doctors are unlikely to share that the oestrogen and progesterone you get in regular HRT are different from those you make naturally (file image)

It may come as a surprise to learn that the oestrogen and progesterone you get in regular HRT are different from those you make naturally. Your doctor is unlikely to tell you this because they don’t fully appreciate or understand the difference.

I believe that if you are replacing something in a system as complex and sophisticated as the human body, it makes sense to use a like-for-like formula that has evolved over millions of years, rather than a synthetic version of the same.

Take Provera as an example. Used in regular HRT, Provera is another name for progestin, the widely-used substitute for the female sex hormone progesterone. But progestin differs in several small but crucial ways from the natural version of progesterone.

Indeed, progesterone and progestin can have very different effects and sometimes even the opposite effect.

For instance, progesterone is the hormone produced in large amounts in pregnancy and is given to women having IVF treatment because it improves their chances of becoming pregnant.

In contrast, doctors are warned against giving progestin to pregnant women because it can cause miscarriage.

Regular HRT is taken in a number of different ways. The HRT that shows the effect of progestin most clearly contains just oestrogen for the first two weeks of a cycle, followed by oestrogen and progestin for the second two.

Marion (pictured) said in her experience the best treatment is hormone replacement therapy derived from plant hormones

Those second two weeks, which would normally be a time of calmness hormonally, are often described as being deeply unpleasant, with symptoms including headaches, nausea, breast tenderness and mood swings.

In fact, there is evidence that progestin can cause a range of very serious problems, including heart disease and cancer.

Yet in my experience of more than 10,000 patients, the best treatment option is a hormone replacement therapy derived from plant hormones found in the Mexican yam and soya — a safer treatment with considerably fewer side-effects.

Progesterone is the best example of this. What’s remarkable about this natural version is that it’s licensed in the UK for fertility treatment — progesterone is a pro-pregnancy hormone, and the safest, most female hormone that exists — but is rarely prescribed on the NHS for the symptoms of menopause.

The sharp decline in HRT prescriptions coincided with a dramatic rise in antidepressant use

If you ask for HRT on the NHS, you are most likely to be prescribed progestin as a progesterone substitute, with all those nasty side-effects! This is due to the remarkable refusal of the UK obstetrics and gynaecological community to recognise the difference between the two and its implications.

In fact, because there has been no distinction made between natural bio-identical hormones and synthetic HRT, women have been deprived of confidence in hormone therapy in general.

In America, bio-identical hormones are more mainstream. Indeed, almost half the prescriptions for menopausal hormone therapy in the U.S. are ‘custom compounded bio-identical hormones’, which means dosages are tailored to each individual.

We can only look forward to similar developments in Britain, and to a time when women in midlife aren’t routinely handed antidepressants as a treatment for symptoms that are actually due to a hormone deficiency or imbalance. Anything less than a full investigation — and proper diagnosis — of those symptoms does women a great disservice.

I’m proud to have brought the customisation of hormone treatments to the UK in the past ten years. With more awareness and education, I hope to empower women to be able to choose the right treatment available to them, and get the best care they deserve.

Adapted from It’s Not My Head, It’s My Hormones by Dr Marion Gluck (Orion Spring, £14.99). © Dr Marion Gluck 2019. To order a copy for £12 (offer valid to December 22, 2019; P&P free), visit mailshop.co.uk or call 01603 648 155.