Trinidad and Tobago doctor partners with Barbados clinic for HRT for menopausal women

For many women, their fabulous 40s and 50s come with a certain amount of stability – financially, professionally and family-wise. But it also comes with a turbulence that can rock their physical, emotional and mental balance to the core. From hot flashes to mood swings, sleep disturbances to vaginal dryness and decreased libido, perimenopause and menopause can turn the most sane of women into someone their families and friends do not recognise.

Perimenopause is the period of transition leading up to menopause and is characterised by hormonal fluctuations and regular to irregular menstrual cycles. Menopause is the point at which a woman hasn't had a menstrual period for 12 consecutive months.

There are numerous symptoms associated with menopause – ranging from mild to severe – and while diet and exercise can help ease some of the symptoms, general practitioner Dr Nadya Watson says because the symptoms are caused by a decrease in oestrogen and progesterone production by the ovaries, lifestyle changes can only do so much. She believes it is time that treating perimenopausal and menopausal symptoms be seen as a critical part of the country's health strategy.

"We need to consider having a menopause clinic in Trinidad and Tobago," Watson told Newsday.

"Even Barbados and St Lucia have menopause clinics. Yes, they are private, but they are still clinics that women can go to specifically for for hormone replacement therapy (HRT)," which involves replacing oestrogen, and in some cases, progesterone, to restore hormonal balance.

And while there are brochures with information on menopause and dealing with its symptoms on the Ministry of Health website, Watson is adamant that the treatment available in TT is limited and outdated, and that a clinic dedicated to what every woman upward of 40 will eventually experience is necessary.

Modern HRT treatments include bioidentical (plant-based) oral HRT, usually taken once a day, available in both oestrogen-only and combined forms; patches that can be applied to the skin to release hormones gradually into the skin (transdermal); gels and creams that can also be applied to the skin, offering another route for transdermal HRT; vaginal rings, creams, or tablets used specifically for vaginal dryness and related symptoms; and other medications such as antidepressants to manage specific menopause symptoms.

Watson said here in TT there are two oral HRT treatments available, and they are not bioidentical. And while bioidentical treatments have come with risks, the synthesized (lab created) treatments increases the risk of developing clots, especially in patients who are overweight, smoke, or are generally unhealthy.

"So we shy away from it because of the risk factors, and we are petitioning to have what everywhere in the world has, including some Caribbean countries – to have proper bioidentical HRT options.

"The cry is, if I'm having all these symptoms, you need to put me on oestrogen or progesterone that is specific to my needs, not a one-size-fits-all

"With what we have here, I can't even offer you a change in the dosage even if you're still getting hot flushes or irritability after taking it."

As a result, because of the number of women who come to see her pleading for meds to help with the symptoms, Watson has partnered with a clinic in Barbados – BioConnect Medical Centre – a clinic dedicated to treating women who are transitioning through menopause.

"The patients come to me at my south office for an initial consultation and we thoroughly discuss their medical history. If they think they are in perimenopause or menopause, and once we rule out any other possible causes for their symptoms, I write the referral to the BioConnect clinic and they see the doctors (menopause specialists Dr Roberta Corona and Dr Martina Toby in Barbados via telemed), and through prescription only, we access their HRT. BioConnect ships the prescribed HRT dosage directly to their doorsteps."

She said the age bracket usually tends to be from 40 to 59, but some older women have come to her clinic seeking help.

"For women over 60, I tend to put them on natural supplements, with exercise and diet to see how they feel. But if they fall within the 40-59 window, or some people go into menopause before 40 for a number of reasons, they definitely have to go on hormone replacement.

"Before I got involved in the Barbados clinic, I've had many women coming back to me telling me the HRT I prescribed wasn't working because they still feel like they're losing their minds."

Watson referred to a petition that began circulating in early June by Women in Action for HRT in TT begging for the availability of more advanced HRT alternatives in TT. So far over 2,000 women have signed it.

"This is a public show of support for a petition signed by a group of women's health doctors advocating for modern HRT," the petition said.

"Women in TT have no access to the safest forms of modern HRT in the form of oestrogen patches and gel through the skin and natural, micronised progesterone tablets by mouth," it continued.

The group said it is time to prioritise women's hormonal health, as women spend about a third of their lives in the peri and menopause stages, with 85 per cent experiencing symptoms and 25 per cent severe enough to leave their jobs.

Watson said her partnership with BioConnect allows her patients access to bioidentical oestrogen and progesterone, which comes in creams, gels, sprays and patches.

"If you have a womb, you don't use progesterone because it's function is to thicken the lining inside the womb. If you have a womb you have to use both the oestrogen and progesterone.

"Before my patients are referred to BioConnect, I ask for blood work, mammogram, breast ultrasound and pap smear updates. Once they are referred for HRT, we start them off on the lowest dose, depending on their medical history...It takes around three sessions to really get their proper dosage, and from then BioConnect will continue to ship their prescribed dosage directly to them."

"The clinic is growing because many women are coming here to be heard and to get proper treatment."

And while it's still too early to tell if each patient is being administered the correct dose, she said initial reports show they are responding well.

"Good doctors start low and go slow, so they would start at a certain percentage and tweak if necessary – go higher or lower. It takes about three months to get the correct dose, but once they get the perfect dose, they will feel like a new person.

"The correct dose for you is everything; you go out and don't sweat a bucket. When you go to work you don't feel to cuss way everybody, or feel so depressed you can't get out your bed. You see how this affects every aspect of a women's life?

"Then you can have uncommon symptoms like ringing in the ear and severe joint pains. I've sent patients to do X-rays and MRIs and the reports come back normal because the culprit is menopause and the only thing that can fix that is HRT. It is affecting so many women 40-plus, and we can't be angry and irritable all the time. We need a menopause clinic."

For Dr Nadya Watson's Top Tips on menopause, follow The Healthy Living Medical Practice on Facebook, @healthylivingmed on IG, @drnadyawatson on TikTok, and her Top Tips on menopause on all her social media platforms

BOX

Symptoms of perimenopause and menopause

Common

Weight gain especially on the tummy even with diet and exercise

Brain fog, difficulty concentrating, and memory problems.

Loss of Muscle mass

Muscle aches

Joint pain

Hair loss

Headaches

Frequency in urination with a sense of urgency

Increased frequency of urinary tract infections

Increased gum disease and higher risk of tooth decay

Uncommon

Tinnitus (ringing in the ears)

Burning mouth syndrome

Electric shock sensations