Newson Health and the menopause industry

I am a post menopausal GP.
In 30 plus years I have seen the pendulum swing from “It’s great and everyone should take it” to “it’s dangerous and no body should” and back again.
I am always suspicious of any doctor who prescribes a single remedy for anybody who presents.. I think this about stimulants for ADHD too .. I have seen several people have awful reactions to them.
Prescribing guidelines are there for a reason..it is not safe generally to take doses above the recommended upper limit.
I am not surprised by the pushback .. I am out UK though so unfortunately have not been able to view documentary.

That's great that it's helping you.

I think it's helping me too.

But that doesn't mean we should shut down explorations of the risk of using HRT in ways it was never intended, ie high dose for a very long duration.

I haven’t been quoting a few articles I have been referring back to the evidence base of NICE. Women can do whatever they want - isn’t it wonderful. I’ve reviewed all the evidence and transdermal oestrogen with progesterone for me at the minute has zero side effects and I believe has wonderful long term benefits. When I go for my review next month and if the gp presents me with evidence to reevaluate then I will.
At the minute I can see the generation above me suffering from the pain of osteoporosis and chronic utis and I am normal bmi and exercise 6 times a week and eat healthy and my evaluation is it is beneficial.

But this is Newsons own app isn't it?

Of course it's going to endorse her approach.

Interestingly, NICE consulted on new guidelines in 2023 https://www.nice.org.uk/guidance/gid-ng10241/documents/draft-guideline

I can't find updated ones which suggests they still haven't been published, although the bms published their consultation response earlier this year:
https://thebms.org.uk/2024/03/nice-guideline-review-the-bms-response/

They apparently had a lot of issues with the proposals.

I haven't sifted through it all but at a glance it suggests things are rather less than clear cut.

@ArabellaScott I think the NICE guidelines you linked to upthread were actually for a bms summary of the guidelines - I thought they were the actual guidelines too! That document says the previous advice on prescribing for 2-5 years is no longer appropriate as its too restrictive for some individuals (paraphrasing).

However, its worth noting that all the evidence presented in the NICE consultation mentions risks increasing after 5 years duration of treatment - pretty much across all risks.

It seems like duration of treatment is still a point of contention.

Again not true
https://www.balance-menopause.com/menopause-library/does-hrt-really-keep-my-bones-strong/
HRT does prevent osteoporosis

There are conflicting studies. Some suggest that HRT increase the risk of heart disease.

I have nothing against NICE, on the contrary. Don't twist my words. If you had read the whole thread you would know that in my first post I've explained why I'm not on HRT, nothing to do with being anti HRT or NICE. Scroll back and read if you like. Quoting a few articles is not enough I'm afraid, and yes I know how NICE works and I find their work admirable. We are discussing Louise Newson's high oestrogen prescriptions, which are not endorsed by NICE.

Osteoporosis and heart disease also happen in men who don’t go through menopause they are age related and the pathogenisis is much more complicated than reducing hormone levels.
We see an acceleration of bone density loss during the first two years of menopause but then they slow down. Many women are osteopoaetic well before menopause. Menopause just tips them into osteoporotic.
HRT is unlikely to prevent osteoporosis in women predisposed to it. It may put it off for a few years but not indefinitely. It isn’t a magic cure.

The jury isn’t out - see what I have quoted. Drops in oestrogen affect cardiovascular disease.

I’ve quoted articles and if you are a biologist you must know that NICE evaluated all the scientific evidence

I disagree. Aging is pretty much genetically predisposed. Some of us have inherited genes that predispose to a longer life so effectively the aging process is much slower. In my family the women rarely die before 80, none in living memory have suffered with either dementia or osteoporosis. Of those that died prematurely it has benn due to cancer ( only my mum so far). My husbands family are the same. Most have stayed fit and well until a few months before death.

The overwhelming problem that is stacking up is the lack of activities which positively build up and maintain bone density. On the one hand we are better fed but on the other we do a fraction of the weight bearing exercise our parents and grandparents did. An hour in the gym is no substitute for walking everywhere. Women in particular would have a huge workload through the week, which no doubt built up fantastic bone density.
Many women are currently being diagnosed with osteopenia before they hit menopause.
We are no longer active enough to maintain bone density.
HRT is used off licence for osteoporosis because there is not enough long term data to support its use.
Inactivity is a much bigger factor than decreasing hormone levels.
Like most quick fixes we shouldn’t rely on medication as a preventative. We should be encouraging young women to build up bone density in their 20d and 30s so that their starting point is higher. As bone density naturally drops it will take longer to fall to an osteoporotic level.
The jury is still out re cardiovascular disease. I suspect the reasons is may have been connected to HRT are quite complex, possible more to do with the lifestyle of those who have sought out HRT in the past. We know that cardiovascular disease is associated with inflammation which can be related to diet., but there is a strong genetic element too.

But I thought stroke was a potential risk from using HRT - so how can it also protect against stroke (unless this article is talking about a specific cohort eg those with pre existing heart disease)?

...quick Google....https://www.bmj.com/content/340/bmj.c2519

This paper says that there is no increased stroke risk with low dose transdermal, but other types/ dose increase stroke risk.

I think the take away is that the evidence is not clear cut for most of these things (excepting Osteoporosis where it seems to be clearer that HRT is a definite benefit) and that each individual is going to have a different balance of risk and benefit.

I think you've got it from NICE. The "no limit" is probably for low dose vaginal oestrogen for genitourinary symptoms, if I'm not mistaken. Still waiting for the link that says "HRT has no time limit".

I'm not a believer. I need evidence. Robust evidence, if I'm going to trade strong bones for breast/uterine cancer.

Good for you! I'm not anti HRT. We are discussing high levels of oestrogen being prescribed without enough data to back it up. If patients are willing to be guinea pigs it's up to them. But don't blame science for that. I'm a Biologist and I can tell when a scientific article is good or bad science.

That's interesting. I wonder where I got the 5 years from.

Bloody brain fog!

If you are taking HRT and don't have a healthy lifestyle and diet, HRT will not prevent you having high cholesterol or blocked arteries. The website mentions a lot of other aspects that contribute for the overall risk of heart disease.

You do you and don’t do HRT - it doesn’t bother me but the science is in favour at the moment of HRT being effective. I keep up to date and regularly review and the science might change so I keep an open mind. Bit for me at the minute watching the generation of women above me age and seeing how HRT would have helped I’m happy to go ahead for now. But as I say constantly keeping up to date to see what the latest reviews say.

Don't be sorry for me. We're trying to discuss a topic that is controversial for lack of scientific evidence, but you seem to have all the answers already. NICE has recently recommended CBT for menopause. Are you following this guideline as well?

The article clearly states this:
Oestrogen has a protective effect on your heart. It helps to control your cholesterol levels and reduces the risk of fat building up in your arteries. It also helps keep your blood vessels healthy.
If your oestrogen levels fall, then fat can build up in your arteries causing them to become narrower. This increases your risk of developing coronary heart disease, a heart attack or stroke.

The link clearly says this is a support section for women with a heart condition

www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease

I’m sorry if you are not going to follow the NICE guidelines I am not going to waste time arguing. I want to live to a
healthy age with a healthy heart and strong bones
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178928/

Would you care to explain your argument instead of just saying something is or is not just because you think so?

"Menopausal hormone therapy (MHT)
If you take MHT soon after menopause (around the age of 50), it can prevent bone loss"

"It can prevent bone loss"... can doesn't mean it will...

Those are general websites with general advice that includes HRT amongst a lot of other methods for coping with osteoporosis.