Yes, contrary to rumours, you can get HRT for perimenopause in France. But you do need to know what you are doing, as doctors offering a full regime when you are not yet fully menopausal are going against official French recommendations.
What do the French define 'perimenopause' as?
In France menopause is seen as having gone an entire year without a period. The years leading up to this, where hormone levels drop and symptoms begin, is seen as perimenopause.
In 2021 the Collège National des Gynécologues et Obstétriciens Français (CNOG) put out updated recommendations for prescribing HRT that are on par with those of other Western countries. Except, unfortunately, that they kept in the suggestion that HRT is only prescribed after this one year post-periods mark. In other words not in perimenopause. But this idea is often, thankfully, ignored.
Why does France prescribe less in perimenopause than other countries?
They actually don't. For a long time now many French gynaecologists DO prescribe HRT to perimenopausal women.... it's just that they prescribe 'progesterone-only' HRT.
I first learned this many years ago when a doctor told me I didn't need HRT but as I was leaving slid me a prescription and said 'just take this'. I got home and googled what it was, and it was dydrogesterone, a progestin. AKA, it was hormone replacement therapy.
Note that some doctors also put perimenopausal women on the mini-pill, a progesterone-only birth control, to regulate perimenopausal symptoms.
Is progesterone-only HRT dangerous?
No medication is risk-free. But when it comes to HRT for menopause in non-hysterectomised women, it's the oestrogen that comes with higher risk. Left unopposed, oestrogen can thicken the lining of your womb, thereby raising your risk of several cancers. Progesterone is taken to balance this out and keep your womb lining at a healthy thickness. (Note however that progesterone is the risk if you had a hysterectomy, so it isn't prescribed to women without a womb.)
In summary, there is nothing inherently dangerous when it comes to progesterone-only HRT in perimenopause. The real risk is that it won't solve all your symptoms.
Why do they prescribe only progesterone in perimenopause?
It's due to a concern around 'oestrogen dominance' in perimenopause. This is something that has long been recognised as an outdated and oversimplified concept in other countries. But it's something France, along with many alternative practitioners and Instagram quacks, still promote.
Of course some women can suffer from oestrogen dominance, but suffer is the correct word, as a true oestrogen imbalance leads to endometriosis.
Hormones work together, not separately. In women with an average health profile, there are times when oestrogen might be too high not as its dominant, but because it’s more unopposed. But that can change depending on the time of the month.
Levels fluctuate constantly. If one blood test shows high oestrogen it doesn’t mean that a woman doesn’t need a full HRT regime to find a healthy ratio of progesterone and oestrogen.
How can I get a full HRT regime in perimenopause?
Go to the right gynaecologist.
First, you need to find the right gynaecologist who is forward-thinking. You don't just talk to your family doctor (HRT is not their responsibility in France). And you don't go to any random gynae, unless you are prepared to be frustrated. Do your research.
Know how to describe your symptoms in a way that makes French doctors listen.
Assuming that will be what women talk about in other countries is incorrect. Going in and complaining about fatigue and anxiety, for example will get you a blank look. And perhaps a comment along the lines of, "Who doesn't suffer from that?"
The officially recognised symptom is heat-related (hot flashes or night sweats). But there are a few other symptoms to mention that are described in detail in the book.
Be the exception to the rule.
There is one officially recognised exception, by the way, for getting HRT in perimenopause.
Which is proof of very low bone density. If you had a bone fracture and/or have a bone density scan with proof of an issue, then HRT is recommended. But note claiming you have osteoporosis won't get you anywhere. It has to be a serious situation and you need evidence.
Actually need HRT.
Thanks to the media onslaught around menopause right now, I meet many young women who want HRT because they have have what I call 'menopause hysteria'.
They are terrified of what is ahead, and think they need to jump onto HRT based on what they saw on Tiktok over any real research! When I talk with these women, they don't have actual symptoms other than their anxiety. Which, with further discussion, they have always had. Ladies, remember HRT is neither magic nor candy, it is a serious medication. Lying to a doctor to get it is not advised, nor is taking it before you actually need it.
What do I do if I get given progesterone-only HRT?
You have two options. Take it and see how it goes. If your symptoms don't clear up in three months, go back and push for oestrogen gel to be added to your regime. Second option, try another gynaecologist.
Still have questions? Please post them below! Want more info on how to describe your symptoms in the right way to a French doctor, and about what HRT regime you actually need? It's all covered in detail in my book. Or book a consultation for bespoke advice for your HRT journey.