Newson Health and the menopause industry

Great that your GP is giving you some autonomy and input to your treatment.

By 'too long' I mean where evidence exists to show that risks of treatment go up over time, there will usually come a time where by staying on the treatment, the risks start to outweigh the benefits.

The difficulty is, as you say, in determining where this point is.

Arabella seems to have linked more recent research to show that the age / duration
increase in risk is v small.

Again, I'm not saying HRT should be restricted unnecessarily but we are doing women a disservice if we refuse to consider the known risks as well as the benefits.

Antidepressants are not addictive (stopping abruptly can cause discontinuation symptoms, but this is not the same as addiction, where you need a higher and higher dose over time) and the risks of taking them do not increase over time.

Great links, thank you.

I’m one of those women who continued bleeding normally (though heavily and inconveniently) well into my sixties, was treated by the NHS (hysteroscopy to see if there was anything untoward, which there wasn’t , prescribed Oestrogel and Mirena). I continue to have cyclical mood swings, cramps and other period-like symptoms, though to a lesser extent, into my seventies. I intend to stay on HRT permanently.
I believe that the original research that concluded that the average age of menopause was flawed, AFAIR the sample age range was narrow, 45 - 55 possibly. The (well-regarded) clinic I attended didn’t seem particularly put out, so I assumed I wasn’t the only older woman they’d treated.
It seems that some people have noticed that the age of menopause can vary significantly, but the narrative is so firmly established that the medical profession is still wedded to “average age 51, anything much after that impossible”.

www.ncbi.nlm.nih.gov/pmc/articles/PMC10557373/

Estrogen combined with progestogen may be associated with a small increased risk of being diagnosed if taken for more than 5 years after the age of 50, (approximately extra 4 cases per 1000 women aged 50-59 over 5 years) but these extra are thought to be due to HRT promoting the growth of cancer cells which are already present, not actually causing the cancer.

This is really key.

As is the fact that obesity has a larger risk factor.

I suppose in an ideal world mammograms would happen before starting hrt if women are going to be starting hrt at earlier ages (NICE says from age 45.)

need to also point out there are some women choosing to continue their hrt after bc diagnosis, sometimes while on SERMS such as tamoxifen. Including another gp who specialises in hrt. (I forget her name. Very good on histamine issues.) An oncologist I saw said I could. I decided to try without, partly as it's the bleeding I struggle with.

I think this is part of the issue with coverage on TV programmes which are limited on time and can't go through all the facts about HRT. They speak about HRT as if it's all one thing, like aspirin. I just have estrogen patches as I have had a hysterectomy, my friend uses gel and a mirena coil, others have tablets, patches and progesterone tablets, gel and tablets plus testosterone - there are endless combinations, multiple doses.

Because I am only having estrogen through a patch, my decision to continue or stop after 5 years/ age of 60 might be different to someone else.

From my experiences with breast cancer consultants....

It's not so much the oestrogen as the progesterone. My consultant said this. (Women without wombs on oestrogen only have a lower risk of bc. But I don't know what happens if there's already an oestrogen positive breast cancer cell there.)

Higher doses of oestrogen require higher doses of progesterone. They have the data up to a 100 patch and equivalent. The synthetic progesterone is a known known with a very slightly raised risk. As with progesterone containing contraceptive pills - but the older you are the higher your risk of bc.

They don't have data for body identical progesterone iirc. Or it may be the same. But in my experience it can be a tricky one to use in hrt - some people find it makes them very groggy, some find it's not strong enough.

Women who have first pregnancies after the age of 30 are at slightly higher risk due to the hormones, as with any woman older than this and there's an increased risk within the first 10 years after a pregnancy. Due to the natural hormones.

Mirena is very effective- I wasn't allowed that even though it's a localised dose. Incase a stray cell is floating around and fancies settling in my bones and gets 'fed.'

Then there is also the issues around endometrial cancers and other hormonal cancers which can be impacted by too much oestrogen without the right progesterone level.

But this seems to have been lost in translation with the programme.

So lower doses can more safely use lower doses of progesterone.

I will be using vaginal estrogen for the rest of my life. Because atrophy isn't going to miraculously reverse itself. As for the patches, will take it as it comes, but I wouldn't be horrified to be on them for a long time.

My GP said I could be on HRT for as long as I wanted.

Not sure how you measure whether someone's been on it for 'too long'?

We don't insist people are only on anti depressants for 5 years, despite anti depressants being addictive

What has this story about the woman in your office got to do with women being prescribed HRT?

I wouldn't necessarily assume that, about men.

Malingerers are a thing. And they are a problem for doctors.

And there are also people who become convinced that their problem has a certain cause, when in fact it's clearly not that at all. There is a woman who comes into my workplace daily who is constantly blaming her health issues on her celiac disease which is apparently caused because her sister feeds her meat. Her doctor apparently does not believe that is her problem, because he is a foreigner.

It's really not always as simple as the patient knows what is best.

In the US there is a huge issue with patients getting ideas from drug advertisements.

I wish I could find the link, but I read about the older study of HRT and bc risk, the one that caused the panic, was apparently over estimating the risk because the participants were older, and on it for longer than is now recommended.

I'm sure I read that 5 years under age 60 is what's now recommended (as risk starts to increase if used for longer/ older women). so if Newson clinics are prescribing wildly differently to that (and it sounds like in some cases they are, and at much higher doses than naturally occurring oestrogen) then that could be cause for concern.

That doesn’t really pan out because if only 15% of women take it, the effect on state pension age would be minimal.

But the cancer risk of all those extra hormones is significant surely?

State pension age is now 67 Women are leaving the workplace before that age due to debilitating menopause symptoms. They are maybe more likely to stay in the workplace if HRT helps. I dont think its a coincidence that this is being advocated for women over 60 at the same time state pension age has gone up.

IMO if women over 60 want or need it they should have it but i dont believe this is a coincidence that these two things have happened at the same time.

My GP says she's happy to give me HRT until I'm 80. I have a prepayment certificate so it costs me about 20 a year.

I have heard LN say that it’s not medication it’s replacing hormones that you’re deficient in. That’s all well and good if you’re below menopause age ( surgical meno or early) but you shouldn’t have those hormones post 60. What long term studies are there of women aged 60+ on long term hrt?

I don't think anyone here is arguing that women who need it should be prevented from accessing HRT.

Rather that it is worth being mindful that some doctors are prescribing it in a way that its not licensed for (very high doses for many years) and which doesn't seem to take account of individual risks, also that its in drug companies interests to encourage women to take it/ play down any risks and that that is worth keeping an eye on.

Also, for some women, the risks are likely to outweigh the benefits. Of course they could stop taking it if they like but they probably shouldn't be in it in the first place , if that is the case.

True though that it's not reasonable nor helpful to tell someone who feels shit that they don't feel that bad really (GP basically said this to me, that I don't feel bad enough to qualify for HRT. Fuck off, I feel terrible! And they wouldn't say that to a man re a male problem, I bet).

Tish tosh, @Blanketyre ! You don't need HRT! You just need to pull yourself together, put your big girl pants on and do some yoga and positive thinking! And if you're really not managing your menopause with self-care (and you really should, because any decent woman sails through it), then be prepared to beg, plead and battle with the GP who will do their very very best to put you off.

FUCKS SAKE.

No, awful is not open for discussion. If a woman feels awful then she feels awful. It's not up to other women to decide whether she should or shouldn't feel shit.