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[Tempest]

https://www.tandfonline.com/doi/full/10.1080/13697137.2016.1221242

Post NICE guidelines, this thought provoking article was published in 'Climacteric'. I know a few of you - MaryG, Darlingbabs, Daisydot, GRL and Annie have been talking recently on thread about professional lack of education in treating women's individual menopausal symptoms and I think you would be particularly interested in this (but we all are, I think)!

I would be interested in hearing your thoughts.

N.B. The article was published in 2016, but I am sure has not been signposted on this forum before. xxxx

[Hurdity]

A very interesting article highlighting where more research is needed (as always!). A lot of us have been talking about lack of professional education on here for many years too, and which the NICE Guidelines and organisations such as the British Menopause Society sought to improve, as well as and gynaecologists  and menopause specialists like Dr Currie and Dr Louise Newson for example. There are two main prongs though - the amount of research that is needed as highlighted by this article (in order to understand better the differences in women's responses to different forms and doses of estradiol, so that future treatment can be individualised) , and the still woeful ignorance of menopause - its symptoms and treatment - and HRT,  by some of the medical profession even of the information that is already available.

Hurdity x

[Tempest]

I thought you might enjoy this article, Hurdity.

I noted too that it's acknowledged in this article  that we have fewer HRT preparations available to us than previously, and that this is in part financially driven.

I was also interested in the idea of using both oral and transdermal routes simultaneously in women who fail to respond to single measures - given that we have few well trained practitioners in menopause within the NHS this thoughtful approach is unlikely to be considered for many women, sadly. xxxx

[Daisydot]

Yes very interesting article Tempest when you break it down into terms people like myself can understand ,it just confirms what we all believe, that anything to do with female hormonal problems is cash driven and looks like the powers that be have decided we are not important enough to invest research cash into and ultimately we should all be prepared to have a whip round because that's the only way it'll ever change,that's just laughable to me.thank you Tempest xx

[Tempest]

Yes! That's the essence of it isn't it, Daisydot?! It's a total travesty. I'm just thinking, because I know it was pulled quite a while back and Prof. Lumsden told me why - because it gave too much of a 'hit' in one go - but the nasal spray idea sounded kinda handy! No chance of anything new like that being developed now, then! 

I'm fearful that all we're going to be left with are giant generic patches manufactured in India and imported gel from Asia (these are our  preferred 'trade partners' now for pharmaceuticals, so I have heard on the grapevine but don't quote me on it. Cheaper end cost to the NHS)! Going slightly off topic, I know a couple of people who have been prescribed the generic 'Dr Reddy's' brand of antidepressants which are sourced from India and they have both had horrible problems (2 different drugs). The pharmacist said it's because although the drug IS the same, the fillers are not and this can very much affect the drug's effectiveness in some people (i.e., the fillers are cheaper and inferior)!😟 xxxx

[Daisydot]

So basically tempest for all the people who knock us for buying otc in Europe maybe it's a good idea to have a look closer to home and see the crap that's being filtered through to us in the U.K.
There's an oesrtrogen spray called lenzetto that was recommended to me by two of our ladies,it's widely available in Europe,I bought it in Spain and it's apparently great,dries quickly and is just sprayed on upper arm.Im going to start on mines when I come back from holiday.why can't we get it here if it's freely available in Europe.

[Tempest]

I know, DD! I've been reading all about it - sounds pretty good! It would be wonderful to 'spray and go' rather waiting for the gel to dry. So wish we could get it here!😟😟 I hope you get on ok with it - please keep us updated when you try it. xxxx

[Annie0710]

Thanks for posting Tempest !

I'd never thought of combining oral and transdermal, that may have been enough for me in the early days, I could have reduced my tablet and topped up with gel x

[Tempest]

I know, Annie! I think quite a few ladies would benefit from a dual approach - maybe even combining gel with a patch to ease any fluctuations. I know a few do this over at Hystersisters. But can you even imagine a GP prescribing us TWO types of HRT?? They have a fit prescribing any most of the time!

 I'll never forget the 'NHS isn't a bottomless pit' convo with my GP when he eventually 'allowed' me that one pump of gel last time and now I see that they've put you on 'short rations' too! Absolutely disgusting! xxxx

[Hurdity]

There have been several members on here who have been prescribed oestrogen by two different methods - usually oral mixed with either gel or patches, and if I remember correctly, some have been on combined HRT as well as women in surigcal menopause. I can't remember their names now....I suppose this approach will benefit the few women who do find the conventional dosing and preparation insufficient - maybe especially those in surgical menopause for whom adequate hormone replacement seems to be understandably challenging.

It is shocking the amount of preparations that have been withdrawn for mainly commercial reasons although recently this has mainly been not systemic oestrogen products but progestogens, vaginal oestrogen and testosterone viz dydrogesterone as separate progestogen, Gynest (estriol) pessaries (cited as "old-fashioned" by the Pharma), Vagifem 25 mcg ( spurious "safety" reasons), testosterone (Intrinsa) patches (for commercial reasons), most of the Prem type horse urine HRT ( although in this case - not shocking as the move towards bio-identical oestrogen ie estradiol is understandable and probably for valid safety reasons). Obviously new products become researched and available all the time but the seemingly arbitrary nature of some of the changes is bewildering, and that gynaes don't seem to be consulted (I presume?).

Hurdity x

[Lanzalover]

Thanks Tempest

Haven't got time to read the article now but will do at some time.

Good to have you back.

Lanzalover x

[Tempest]

It's a good read,  Lanzalover.

Thank you so much! xxxx

[GypsyRoseLee]

Interesting article Tempest, thank you.

I hope that now the tide is (slowly) turning in favour of HRT again, that Big Pharma will start developing more HRT products again. An oral combined HRT incorporating Utrogestan would be an excellent place to start.