Article in i newspaper from the chair of the British Menopause Society.. did anyone see this

[cyclamenqueen]

https://apple.news/Aa2-fIfSERV6VX7KRMF20yw

apparently HRT is ‘out of control’ I hope the link works

Not clicked yet but is this behind the usual paywall?
If so, can you copy and paste the article.

Odd headline. Does PB say it or is the journalist writing that?

I can’t see it because the amount of vendors on the cookies page is too long to through, turning them all off.

I’m very interested in what said though. Could you tell us the gist?

The article is only available to subscribers of the i, unless you can copy it and paste.

Part 1

“I’ll start by saying, I am not in any way anti-HRT (hormone replacement therapy), as long as it is properly managed and within guidelines to ensure that the safety and wellbeing of the woman being prescribed takes priority. But recently I’ve seen quite a few worrying cases. Some of my patients’ estradiol levels (a form of the hormone oestrogen) are way too high.
Estradiol tests are sometimes used to measure levels in the blood of patients on HRT. I would usually hope for estradiol levels to be between roughly 200 pg/mL and 400 pg/mL among those on HRT. Once you get to anything above 600 pg/mL (different units have different cut-offs, but we use 600 in my unit), patients can experience something called tachyphylaxis, which is a return to the same symptoms they had before treatment, so they think they need more oestrogen.
In the past week alone, I’ve seen three women with levels in their thousands.
It can be a really vicious cycle and is very difficult for clinicians to explain to patients that they need to stop their HRT because their levels are too high.
The way some people are using HRT at the moment feels out of control. In the 30 years that I’ve been treating menopausal women, I’ve never known anything like this. We have guidelines for a reason – to ensure patient safety – but I think because the focus on menopause has been so dramatically exponential, some women’s expectations of how they’re going to feel after taking HRT is unrealistic.
Not all symptoms in midlife are resolved by HRT in ever-increasing doses, as some women are led to believe by misinformation on social media.
My suspicion is that, to get to the estradiol levels I’m seeing among certain patients, some are self-medicating, by increasing the amount of hormone therapy they are taking because they think it will make them feel better. My hairdresser recently told me that they were feeling down one day so decided to double their dose of oestrogen.
I believe this behaviour is being fuelled by social media. If you don’t feel a dramatic change in symptoms with normal doses, you see other women online saying they feel amazing and encouraging others to increase their dose, but it’s more complicated than that.
With implants (little pellets that go into the skin, used for women who can’t absorb hormones through the skin and who have contraindications to oral treatment), when there’s a cumulative build-up of oestrogen, this is easier to control, because we just don’t reinsert until the level comes down. But with things that people control themselves, like gels, it’s easier to increase the dose themselves.
Instead of using four pumps, using eight, for example. I can’t think of another area where people would self-medicate in this way. You wouldn’t double your antihypertensive treatment if you didn’t feel well would you? It’s not safe.
I have women coming to me in tears, who are so depressed they feel suicidal and are asking me to increase their HRT doses to unsustainable levels. But there is not a shred of genuine evidence to support using high-dose oestrogen to manage significant depression. You can’t change everything with HRT – and you can make things worse by overusing.
Having very high estradiol levels can also increase your risk of bleeding – our rapid access services have seen a 400 per cent increase in the number of women with bleeding on HRT – endometrial cancer, and potentially breast cancer [Cancer Research UK says HRT slightly increases the risk of breast cancer, ovarian cancer, and sometimes womb cancer. But the risk is small]. It’s not something that can be ignored.
The truth is we have no trial data to show what happens when women have persistently high levels, but my observation is that when estradiol levels are way outside of the normal range – it seems to have an adverse effect on their mood.
So what’s the solution? There is still so much misinformation out there surrounding HRT. I spend the first five minutes of almost every consultation I have redressing the myths that a patient brings with them. I know people feel not enough women can access HRT, but I think the majority of women who are accessing menopause care are getting quality care. There is now almost a culture of GP-bashing when it comes to menopause, but most GPs that we see in training are really good.”

The article may be the same one that is published in Medscape - google her name and subject.

2/2

“As I said, I’m not in any way anti-HRT, but I think we’re now seeing too many women being started on too high a dose. Where do you go from there if that’s insufficient, or they are still symptomatic?
I also think some women now feel like they have to go on HRT. Menopause is a life stage, and people should be able to choose how they manage that life stage. Nobody should feel they have to take HRT.
It has become a difficult topic to discuss because people now have such polarised opinions on it, there’s just no middle ground. HRT is fine as long as it’s properly managed and the woman’s wellbeing is the priority.
My message to any woman is, again, that not all symptoms in midlife are resolved by HRT in ever-increasing doses. So if licensed doses don’t resolve the symptoms, they may need to look more widely for solutions. Please don’t independently change what you’re doing with your HRT.
Speak to your GP, who probably knows more than you think – if they don’t, there’ll be someone else in the practice they can ask for advice. But resorting to managing your own hormone treatment is potentially damaging to your health.”

It basically says that people are self diagnosing and demanding high levels of hrt than are safe or appropriate.

Seems that the number of media “experts” might be helping with raising awareness of the menopause but that is now causing issues with people’s expectations when visiting GP’s.

I agree with her

There is now almost a culture of GP-bashing when it comes to menopause, but most GPs that we see in training are really good.”

It's obvious though that the GPs she sees who have bought-into BMS provided training are already motivated to help women. (BMS runs training courses all year round.)

It's the GPs who don't bother to sign up that are the issue.

@Witchbitch20 It says that women are self-medicating with higher doses.
This is something that GPs should monitor as they do the repeats. If a bottle of gel lasts 1 month (using 2 pumps daily) and the patient comes back after a week or 2 weeks for more, they should ask why.

I have never seen any 'media posts' advising women to increase beyond 4 pumps which is the maximum licensed.

I agree with her too and an unpopular opinion I’m sure, but certain celebrities have done very well financially out of this push to medicate the menopause.

I totally disagree about GPs knowing about menopause; I have had to fight for anything
Not to mention the 3 months on the wrong hrt, sequi not continuous because I'd had a recent period.....the day before they took my ovaries out

I had to explain it all to the nurse after leaving in tears as the gp was so nasty to me

I mean over taking meds is an issue - but looking into the cause might be better than just saying its celebrity's fault for talking about it

That sounds reasonable. If women are self-medicating by increasing their dose because they believe more must be better, then that's seriously bad news.

We know from other medicines that we take, that more can be harmful - it's tempting to take more painkillers if the stated dose isn't cutting it but we know that doing so is a) risky and b) won't necessarily make a difference.

Do women think estrogen=natural so that it's not possible to take too much?

@JinglingSpringbells Ok

It's interesting that her personal website offers private treatment with the very pricy Mona Lisa 'touch' which is laser treatment for VA. Yet this has been criticised by some experts as being ineffective and opinions on it vary.

If women have been convinced that their symptoms of joint pain, swelling, tiredness, skin itching and feeling like they've been through a cement mixer filled with bricks every morning when they wake up can only be due to their ovaries shutting up shop, rather than being an autoimmune disease that can be easily treated with DMARDs or biologics, no wonder they're still feeling shit and think 'It can't be a high enough dose'.

If they're actually justifiably unhappy, tired and emotional because they're in a crappy relationship, their kids are being horrid, their boss is piling more and more work and rules onto them with constant criticism rather than giving them respect and greater autonomy and it isn't because they are mere hormonal beasts of burden in need of more magic estrogen, no wonder they're still feeling shit and think 'It can't be a high enough dose'.

If they're actually undiagnosed with ADHD and are completely burned out from trying to function despite their missing diagnosis, but have been convinced that it's all your age, dear, no wonder they feel like crap and think it can't be a high enough dose.

If they're actually malnourished because they're trying to keep their weight as low as possible for 30 years or because they are so skint and tired, they've had to rely upon cheap, low nutrition food for years, their bone density is abysmal, their iron levels are low, they're chronically deficient in Vitamin D and experiencing osteomalacia as a precursor to osteoporosis, but it's been blamed on her age and hormones rather than a desperate need to improve nutrition, no wonder they feel like crap and think it can't be a high enough dose.

Whilst Davinia McShouty makes an absolute fucking shedload out of writing everything off as withering ovaries instead of social, economic, interpersonal and genuine physical conditions that can be relieved if they are actually investigated and treated instead of dismissed as being due to getting on a bit, no wonder women still feel like crap and think it can't be a high enough dose.

And sometimes it isn't a high enough dose. But there is more to women's lives and health than the level of hormones their ovaries are secreting. Easy to write them all off, though, isn't it?

You just described me! It's a perfect storm and whilst hormones aren't everything, I'm lucky to have a doctor with a measured approach and have a dose I think is ok but also need life changes to address everything else. This age is so hard for me personally

I don't think this 'outburst' is about Davina. (And if she hadn't made a packet out of menopause programmes, she'd have chosen another health topic. It just happened that she was menopausal and wanted to publicise her own story.)

I think the feature is about other doctors (without naming them) who have come in for the same criticism from the BMS earlier in the year. And they do use social media, which is what she refers to.

It's very unprofessional for doctors to behave like this especially as all drs have different opinions on treatment. Once you get into medicine, you find there can be as many opinions as there are consultants.

Yes, of course it's not sensible to double the dose of any drug without medical advice.
She makes some valid points.

But others are not correct and they come over as a personal attack, without her naming individuals.

Interesting. Why don't they do more blood tests on hrt patients? I take it for arthritis mainly and was told by NHS gynaecologist that I could increase oestrogen if I felt a need. I did once to see if it would help an arthritis flare but stopped cos it didn't.

No wonder she doesn't want women on HRT. Bashes her bottom line.

I've suffered all my life from awful periods (starting when I was 8), to PMDD that despite me being suicidal and self-harming every month, doctors wouldn't help with.

I've pushed and pushed since the start of my menopause for HRT in a form that helps my mental health. I was told the HRT pill (made me suicidal) was my only option by a GP that had her finger hovering over the Oestrogel entry in the BNF and told that older women only want HRT to make themselves more attractive to younger men.

I finally found a gynae who was happy to prescribe Oestrogel for my first two weeks and the combined patch for the second fortnight. This is the only way I can function physically and mentally without wanting to kill myself or my DP or leave him wanting to leave.

No pricey laser needed to make my vagina feel comfortable either.

It's a shame that some women will self-medicate a higher dose but there will always be people like that. They tend to demand antibiotics for conditions that won't respond to them, too. My sister ticks both boxes and spoils it for the rest of us.

Interesting reading.
Almost contradicts what Dr Newson says and does ( in a way).

All medication needs to be used safely and realistically, nevertheless.

HRT just isn't the silver all singing all dancing bullet unfortunately.

I'm struggling on a medium dose of Hrt and without it, struggle more.

It can be hard for women to get pain relief & the correct treatment for long-term conditions; adding hrt to the list I have to fight for is unfair

My brother has similar ai conditions and symptoms to me and gets treatment much earlier and easier than I ever had - I thought with hrt I'd be 'OK' but no 5 years on I'm paying private to get what my body needs

@NeverDropYourMooncup
I couldn’t agree more. Women often hit menopause so depleted in so many different ways. Not saying hormones aren’t a part of the problem but it’s complicated and Davina doesn’t live the way most ordinary women do. I find her annoying and hypocritical due to this.

My take is that if women were able to get the timely and expert advice when they needed it they wouldn’t resort to self medicating. It’s because they feel on their own with their symptoms.

I am not really that keen on the hype to be honest. I hate the narrative that fifty something women are all obsessed with the menopause and a bit mad and unreliable . But equally I do think it’s good that people can be more open .

It's almost like You can’t change everything with HRT which runs counter to the common narrative on this (MN) social media platform, that every mental or physical health problem past the age of 35 is due to menopause, and HRT is the only effective solution. According to MNrs, when HRT "doesn't work" you have to change your brand/blend/patches/pills, because the reality couldn't possibly be You can’t change everything with HRT.

What a novel perspective !! #Sarcasm