High dose HRT controversy

[Companyofwolves]

Just seen this & a bit shocked.

I know she has encountered a lot of obstacles by a profession reluctant to admit their failings & change.

I feel like she’s such a trailblazer who genuinely wants to improve menopause care for women & is now being discredited for thinking & treating outside the box (of traditional menopause care).

Clearly research & development is much needed in emerging treatments & practise in menopause which has been massively under funded & under acknowledged to date.

So I don’t think she should be thrown under the bus for trying to do that on a case by case basis.

But obviously practise needs to be safe.

Thoughts anyone? It is in the DM & couldn’t see it in any other outlets.

https://www.dailymail.co.uk/health/article-11927783/Is-Britains-foremost-menopause-doctor-risking-womens-lives-alarmingly-high-doses-HRT.html

@norkmonster i can understand that, I've just started my own thread about progesterone intolerance!

I can see why you would be worried also. Fingers crossed you get it addressed properly.

There are two sides to this story.

Louise Newson has done a tremendous amount to raise awareness of menopause, improve treatment and train other practitioners. However she, or clinicians working under her name, are prescribing medicines in doses that are not tested or licensed which may be exposing women to increased risks.
The fact that other excellent menopause specialists, like Dr Jen Gunter and Dr Annice Mukherjee, are openly disagreeing with her I think is highlighting that there are some valid concerns here.

It's very unprofessional for doctors to criticise other doctors, openly, in the media. I'd steer away from any doctor who did that.

I am sceptical of some of the quotes here from other medical professionals and they are really sticking their necks IF they knew their words would be used in this context.

It's interesting that none of the 'top names' in menopause gynaecologists has added their comments to this article. There is a quote from Paula Briggs of the BMS but did she know she was being asked to comment on Newson Health?

Because it's not clear if they have been asked specifically to comment on Dr Newson, or rather asked to comment generally on the use of high doses.

It's very easy for a journalist to have an interview with someone - here, a doctor- ask them questions that appear to be 'innocent' and about general prescribing guidance, but not tell them that their quotes are going to be used in this context- against a named doctor.

You end up with a mish-mash of quotes, aimed at building a case against someone, when those quotes may have been given months or years ago, (innocently) in a different context.

The Mail has an agenda and they have aimed to build a case against someone. It's a bit like making a film where various shots are taken at different times and locations, then all joined together 'seamlessly' to create a version of reality.

I'm not saying there is no concern over high doses, but this isn't the best way to approach it.

Has anyone come across a link of HRT and fibroids? I was recently diagnosed with 1 fibroid and Google says that Oestrogen can feed fibroids? Yet, it's never mentioned as a potential side effect of HRT. I'm wondering if any of the ladies on super high Oestrogen doses have encountered this or even been informed of this by their GPs?

Forgot to add that I started HRT 7 months ago and it's been a godsend. Recently went to 3 pumps from 2 (could be to do with the change of packaging coincidence which has a whole thread on it). Fibroid diagnosed around 6 months since starting HRT.

I am a Newson patient and take over recommended oestrogen. I take 2mg sandrena a day. I was in 1.5mg and I feel so much better in 2mg. 1.5 is the top of the range of recommended range. 1 patch also didn’t feel like enough (I’ve tried them all with shortages and an indifferent GP)I feel great. I sleep well, have good energy and have a BMI in the healthy range for the first time in 10 years. I have a Mirena.

Getting oestrogen from my GP was impossible and was taking almost a full day each month to fill a prescription. I am a normal, very busy woman in my late 40s.

Do I need to worry? I don’t want to lower the does. The dose feels great. My mother had and survived triple negative breast cancer but she is also an obese alcoholic, so it’s confounded. None of her 5 sisters have had breast cancer.

Jen Gunter has been going after UK clinics for a while. She doesn’t like testosterone either. I follow her on twitter and listened to her podcast and don’t find her fully credible.

The BMS have issued a statement to clinicians today

I never took HRT but i did pick up the info last summer (I was diagnosed as having dozens of little fibroids) that HRT can make them worse, much worse even. May I humbly submit, as this thread shows, that sometimes people only hear what they want to hear? If they don't want to hear about drawbacks, they just won't take that info in and truly believe it was never mentioned.

Thanks for statement link, Queen.

I don't think they would mention HRT possibly enlarging fibroids on the leaflet. This is not a side effect in so much as it always causes a problem. Evidently 40-50% of women have a fibroid but many are never discovered, or cause any problems. It is something a doctor should mention if you and they knew you had a fibroid prior to starting HRT. It doesn't apply to just high doses of estrogen - even a small dose could affect some women. It's a conversation to have with your dr and consider regular scans or maybe a Mirena coil if the fibroid causes heavy bleeding while using hrt.

@JinglingSpringbells - thanks for replying. I don't have any trouble due to the fibroid (yet) so I'm unsure whether or not my HRT should continue. Gynae says let's not stop HRT and deal with the fibroid if it causes issues.

Really helpful contributions about this & hope everyone gets any concerns addressed - knowledge is definitely power.

I really wish that the journo at the Mail had gone straight to the BMS for their statement, posted by @QueenOfHiraeth for comment, rather than trawling for responses from other doctors, some of whom may have an axe to grind or bear a subjective grudge. Many medics want to read through a feature before they consent to their quotes being used and simply won't criticise another dr.

The BMS says what needs to be said but without naming anyone in particular.

Very high doses aren't tested and no evidence that huge doses help with psychological symptoms.

If they are used, women have to be advised that they are off-licence and may have risks.

And that enough progesterone has to be used to off-set a high dose.

@lljkk Yes, there is an international consensus on menopause through the IMS (International Menopause Society.) They publish a journal called Climacteric. At one time, the UK gynaecologist & researcher Nick Panay was co-editor. [[https://www.imsociety.org/

Thank you for the IMS link. Just reading their FAQs which are helpful.

Information on fibroids and HRT

www.womens-health-concern.org/wp-content/uploads/2022/11/07-WHC-FACTSHEET-Fibroids-NOV2022-A.pdf

www.ncbi.nlm.nih.gov/pmc/articles/PMC6780684/?fbclid=IwAR3aqg66_VxVpSlWYECa2THRBSgJtD9hRFvfVkGS5VBO9oEh0DbxwHaP3cs

Regarding Dr Newson's approach, the problem is that she uses the fact that the doses of oestrogen in HRT are very low to stimulate fibroids and yet she prescribes doses above the licensed limits.

From the Balance Menopause website:

'Can women with fibroids still have HRT?
The vast majority of women with fibroids can safely take HRT without any problems. The doses of oestrogen in HRT are very low so they are not usually high enough to stimulate the fibroids. Occasionally having HRT can cause fibroids to grow or bleed. Women taking HRT can still have effective treatments for their fibroids.
Women who have had Uterine Artery Embolisation can safely take HRT after their menopause as the fibroids will have shrunk by the procedure and are therefore are unable to grow or be affected by oestrogen.
Many women find taking HRT very beneficial, so having fibroids should not alter your decision regarding taking HRT.
Last Updated: July 2020'