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[Petra]

Hello Women, There's a link in the latest Menopause Matters newsletter to a Telegraph article "Private menopause clinics prescribing HRT at 'twice the recommended dose'" that I wondered if anyone has an archive link to so I can read it or can cut and paste. Sorry to be cheap, but I'm in NZ and don't want to pay just for the one article. :-/

Also interested if anyone who's read it has any thoughts. (Obvs, I haven't read it yet.)

[Dotty]

https://pharmaceutical-journal.com/article/news/private-menopause-clinics-prescribing-oestrogen-at-twice-the-recommended-dose

This might be the same article

=============
Edit by Emma
Yes, the link above is the same article.
To read the Telegraph site without their popup, disable javascript for the site - in the chrome browser, click on the padlock icon in the address bar and you should see a javascript toggle. Toggle it off, reload the page and popup be gone.

[Flossieteacake]

Oh dear. I feel this article will scare many women. There was a bit that said people were given too much oestrogen and:

"And that was in addition to vaginal oestrogen and topical gel being used too.”

I wish they had not mentioned the vaginal oestrogen as localised oestrogen already gets a bad press with so many GPs uneducated and saying not to take it along with other types of HRT. 

[Zoe]

It strikes me as alarmist. I am with Newson Health and have found them to be very careful and evidence based. My own HRT is within the recommended doses. But they also take an individualised approach and that is where the disagreement seems to lie.

Many GPs will not exceed or depart from the guidelines/recommended doses as they understand them, and sometimes their understanding is wrong (eg no hrt until through the menopause).

Some private practitioners are prepared to think outside the box to benefit patients and so assume full responsibility for this. My experience has been that Newson Health keep a close eye on any issues that arise and are routinely vigilant (eg testosterone levels or regular scans where needed). Nothing maverick in their approach.

We know from this forum that everyone is different and some people just don't absorb gel or patches well. We also know it is never as straightforward as all the celebrities make out.

Personally, I would never have got the help I needed without going private. It is a sad fact. Hopefully this will be less necessary for women in the coming years.

 

[Flossieteacake]

It strikes me as alarmist. I am with Newson Health and have found them to be very careful and evidence based. My own HRT is within the recommended doses. But they also take an individualised approach and that is where the disagreement seems to lie.

Many GPs will not exceed or depart from the guidelines/recommended doses as they understand them, and sometimes their understanding is wrong (eg no hrt until through the menopause).

Some private practitioners are prepared to think outside the box to benefit patients and so assume full responsibility for this. My experience has been that Newson Health keep a close eye on any issues that arise and are routinely vigilant (eg testosterone levels or regular scans where needed). Nothing maverick in their approach.

We know from this forum that everyone is different and some people just don't absorb gel or patches well. We also know it is never as straightforward as all the celebrities make out.

Personally, I would never have got the help I needed without going private. It is a sad fact. Hopefully this will be less necessary for women in the coming years.

You make some very good points there. I agree with what you have written.

[Keep On Swimming]

Zoe thank you so much for sharing all that, it has helped me reading your experience.

Best wishes.
xxx

[Mary G]

Sounds like complete BS to me.

The clinic I used in London were extremely strict and would not prescribe HRT without recent breast scans and transvaginal scans.   

They had very strict guidelines and insisted that women on continuous combined HRT regimes had a womb lining measurement of 5mm or less and they were extremely strict with women on cyclical regimes and would not prescribe unless the womb lining was 4mm or less immediately post bleed.

EDIT:  Sorry, I should have been clearer, it was a private menopause clinic in London that prescribed bespoke, compounded HRT as well as conventional, branded HRT.

[Zoe]

I think we are just the generation that is caught in a shift in thinking around HRT. It is a pain when the professionals can't seem to reach agreement - even agreeing to disagree - and we bear the brunt of it with doctors who are misinformed or who confuse things.

I do a lot of my own reading of research and evidence but I am geeky like that!

Re. endometrial protection, the BMS has a really good paper on this and it outlines all the options available. There is plenty room in that for an individualised approach.

See: British Menopause Progestogens and endometrial protection for the pdf.

Edit by Emma:
Link activated

[Ellie O]

BMS recommends to use 200 mg continuous progesterone for 75 to 100 mcg patches. How much progesterone should women take on 200 mcg patches? 😳

[Zoe]

The BMS paper mentioned above on progestogens and endometrial protection doesn't specify what a 'high' dose of oestrogen is.

It does say that if a person is on a high dose of oestrogen then they should consider taking a higher dose of utrogestan (up to 200mg daily or 300mg over 12 days). I think it is deliberately vague because a) what is high for one person may not be for another due to absorption rates; b) it is acknowledging that some women do need a high dose of oestrogen; c) clinical judgement is needed as to what a patient needs based on how they react to the HRT regime (bleeding etc).

What I take from this paper and also the evidence from Newson Health is that there can be great variation in doses depending on the individual patient. Research shows that as little as 45mg a day of utrogestan, continually, can be enough to protect the uterus and prevent bleeding. Yet some women need up to 200 or 300mg utrogestan to achieve the same.

I think it demonstrates why flexibility along with close monitoring is really important. What we don't need is a 'one size fits all' approach doled out by doctors who are not prepared to monitor our progress, offer scans when needed etc.

This is why I am grateful that there are GPs, NHS and private, who are taking this area of medicine seriously and developing a stronger evidence base.

**45mg per day progesterone taken vaginally - just to be clear. This is why some women use 100mg utrogestan alternate days vaginally. Yet others need much higher doses and it suits them.**

[Pippa52]

The Menopause Consultant I go to certainly has never advised me to be on a high oestrogen dose.  She is letting me find my own ideal level with her guidance and regular blood tests to monitor.  Really helpful and informative  to see the article though and thank you so much for posting

[Ellie O]

Hi Zoe,

According to BMS, high doses are 75 to 100 mcg patches.

https://www.womens-health-concern.org/wp-content/uploads/2022/11/27-WHC-FACTSHEET-HRT-Doses-NOV2022-A.pdf

See page 3

[Ellie O]

BMS published a statement in response to The Daily Telegraph and the Sun articles:

https://www.womens-health-concern.org/2022/12/bms-statement-hrt-prescribing/

[Dotty]

The BMS statement says “higher doses” of oestrogen. This probably means doses off licence. 75 and 100 patches are licensed doses and , therefore are high doses but not “higher doses”…. as Zoe has said above.

[sheila99]

Methinks they talk sh*t too. The nhs edict is to go on symptoms not blood levels whereas a dangerously high dose depends on the amount inside your body not how much you put on skin that hasn't been absorbed.