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[pepperminty]

My clinic, Newson Health, sees thousands of patients every year, which allows us to collect a huge amount of data about menopause symptoms and the response to various treatments.

In a recent audit of over 300 patients, we looked at oestrogen doses and blood oestradiol levels, and menopause symptoms scores for each woman. A lower score indicated fewer or milder symptoms, a higher score indicated a greater number or more severe symptoms.

Although there was a correlation between oestrogen dose and blood levels of Oestradiol, there was no statistical relationship between Oestradiol levels and Menopause Symptom Questionnaire (MSQ) scores. This was initially surprising, because one might expect that higher levels of circulating oestrogen was related to women experiencing fewer symptoms and feeling better.

These results tally with my clinical impression from having spoken to thousands of women over the course of several decades. Very often, when I see patients for their follow-up appointment, they have had some improvements in certain symptoms, whilst other symptoms remain. In these cases, we often adjust HRT levels to optimise symptom response.

In the study we carried out, the 50 patients prescribed the highest doses of oestrogen had an average oestradiol level of 921 and, on average, their symptom score was 20. However, in the 50 women with the lowest oestradiol serum level (average 113), their average symptom score was 24.

If you’ve followed me for a while, you’ll have heard me say countless times that HRT is not one-size-fits-all and these findings really back that up: some women need higher doses of oestrogen to see an improvement in their symptoms.

Here's the full research: https://newsonhealth.co.uk/wp-content/uploads/2023/05/Newson_Health_Oestradiol_Audit.pdf
2:01 PM · May 4, 2023

[discogirl]

thanks for posting this pepperminty.

i shall have a good read of the research xxx

[pepperminty]

No worries knowledge is power!

PMX

[Dotty]

Looks interesting … thanks for posting x

[Kathleen]

Hello ladies.

Thank you pepperminty.

I wonder if this post from Louise Newson is her way of responding to the criticism she has faced from the BMS about prescribing large amounts of HRT off licence.

I understand her motivation has always been full symptom control and we all want that of course, but the BMS are getting twitchy about the longer term consequences.

As a patient of Newson Health I have filled in the questionnaire several times and my score is about the same every time, possibly because the remaining symptoms I am dealing with have persisted.

I would love to see more studies done on the menopause and the effects of the HRT products that we use these days. If serum Oestradiol isn't an accurate indicator of symptom control then perhaps something else is going on and it would be nice to find out what it is lol.

NH have been keen to measure my blood levels but when I learned that my number was 600 and I still had mood ups and downs I was told by the doctor that I should have been feeling great,  she also said the same about my testosterone levels!

I think this post from NH is a step in the right direction and hopefully there will be some good quality research that actually helps us poor souls who are still struggling.

Take care ladies.

K.

[Claire MM]

Just weighing in I am in the middle of a personal struggle over this.

Having been prescribed higher than licensed dose of estrogen and testosterone gel, estrogen and testosterone while better than they were still show up relatively low in my blood results when last checked one year ago and I still have symptoms.

I have had difficulty with the NHS menopause clinic telling me to reduce estrogen recently and come off cyclogest despite being unable to tolerate utrogestan or a Mirena in the meanwhile continue on testosterone (?) due to BMS guidelines, also refusing to check my bloods.

I had to make a complaint after speaking to PALS.

My gp has recently refused to prescribe any hrt whatsoever and referred me back to the NHS meno clinic who are out of area and don't prescribe despite my complaint.

I tried to speak to the BMS who have contacted my GP on my behalf. However when I asked what had been sent to my GP I was told today that the GP wants to talk to me about that to 'explain' it to me. I phoned the BMS and asked them to please send any information to me directly also if it could influence my care I would like to be privy to it and have read through it before going in to the gp. Which I hope they will do.

In the meantime I have an NHS trusts response to my complaint sitting in my inbox as of today and I really don't want to open it. I feel like I'm a pawn in some kind of political difference of opinion around womens bodies. I just want to experience actual good womens health medical care. We are not one size fits all and the lack of research and support around womens hormonal health both lifelong and at menopause is just really upsetting. It's hard enough to deal with going through menopause and all the responsibilities expected of women in their 30s/40s/50s and beyond without all this hassle to be prescribed and dispensed medication.

I just feel caught up in the middle of a political issue in medicine. And I feel pushed into private healthcare which I cannot afford particularly if it's every part of my HRT prescriptions and blood tests. I would be exempt from NHS prescription charges even on the NHS due to low income.

I don't know how much of this is just to push women out of NHS medical care at this point because that feels like my experience at the moment and like I am doing something wrong or being greedy wanting to have enough estrogen to function. I also have one ovary removed so that makes a difference and probably has affected me at least since my early 30s when it was removed but I was told 'it's all fine' with no blood tests prior to 45 of course because there's no point checking womens hormones according to most gynaecologists and the NHS in general.

Thank you for sharing this pepperminty, it just gives me some reassurance that I'm not doing the wrong thing trying to stay on the estrogen which I am on - even though it still seems too low!

And I'm sorry for the rant. I just can't believe how much of a hot potato menopause is at the moment, I'm sure in years to come we will look back on this time and say 'can you believe it was like that', I hope so xx

[Kathleen]

Hello again ladies.

Clare MM. -  I  completely sympathise with your need to stay on the same  HRT even though your levels feel too low.

The NHS Consultant that I saw recently said that he would write to my GP stating that I should be allowed to remain on my current dose. I was somewhat reassured by that but, like you, the dose is too low anyway so I am getting minimal benefit.

The consultant was alarmed at the prevalence of high amounts of Oestrogen in the private sector and I wondered if he knew about the off licence low dose progesterone that often accompanies it. I assume not but I wasn't going to enlighten him lol. We have enough battles on our hands as it is.

To be fair  the consultant remarked that there was insufficient data about high dose Oestrogen which is why prescribing within the licensed amounts was important.

I think NH and other clinics are in a good position to collect data and outcomes which can influence prescribing in the future.  I hope they make use of their privileged position for the benefit of everyone.

Take care ladies.

K.

[Claire MM]

Thank you for responding Kathleen and sorry for my rant!

I feel like there must be a way of monitoring levels, they say - oh there is no point because it fluctuates too much, but that makes me think managing diabetes means monitoring blood sugar levels which varies a lot, there must be a way.

I'm glad you have a good NHS consultant, the previous one I had for one appointment was good but recently they left and with the BMS statement I was just informed of this BMS statement affecting the meno clinic by a nurse on behalf of a locum consultant. It seems previous consultant had left, as had whoever was reported to be running the NHS meno clinic. I suspect they had possibly decided to switch full time to the private sector.

I can't knock Louise Newson for pushing ahead with meno care for women in the UK, I think she realised how limited things were for women within the NHS, it's just a shame there is this conflict (!) Yes I hope there can be some good research in the field, I imagine you have tweaked levels and tried testosterone etc if you need to in order to try to better manage symptoms,

Wishing you the best xx

[pepperminty]

"My gp has recently refused to prescribe any hrt whatsoever and referred me back to the NHS meno clinic who are out of area and don't prescribe despite my complaint."

Hi Claire MM,

email yur Gp and ask why they re refusing to give you treatment? On what clinical basis and evidence? Look on the newson website , the BMS website and cut and paste as evidence. Then state that you are aware of the risks and benefits of HRT  and you wish to take it, as it is your choice! Then end with that you appreciate their support and that they have taken the time to read your letter etc!
I did when refused and got a call from my GP apolgising and stating that I knew more than him and he asked me what I wanted and I told him! They are human, just ike us - not perfect but sometimes need reminding what they should be doing!

Take charge and take a man with you on even a telephone appointment - amazing what they say or don't say when there is a witness!

PMXX

[Kathleen]

Hello again ladies.

Claire MM -  I have certainly tweaked levels etc over the years and tried testosterone in the past. The consultant I saw was the one who originally suggested that 'less is more' however when I reduced to 25mcg the emotional symptoms were more severe, I literally sobbed several times each day, and the sweats and VA came back. The consultant is happy with the 50mcg I am using at the moment but my moods and tearfulness are still present. The consultant added that he was concerned about the larger doses that the clinics prescribe and he had sent out a note to other medics. I wonder if your GP has received something similar and is now being super cautious.

Pepperminty -  I wonder if the BMS and perhaps the NHS in general are looking at HRT prescribing. If so this may be why Claire's doctor is being difficult.

Take care ladies.

K.

[pepperminty]

Hi Kathleen,

All medicines they prescribe have side effects. Some of the worst are dished out like sweeties, with no reviews. There is more risk in being over weight, drinking and smoking than taking HRT.  Gp's don't get any training in HRT, an the guidelines are clear.
Makes my blood boil.

PMxx