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Original poster

Higher than licensed dose of oestrogen- GP suddenly refusing to prescribe

31 replies

Mrsbunnychops · 18/11/2025 20:16

I’ve been on HRT for a few years and had a terrible time with awful symptoms for years before with an early menopause, my GP started HRT but due to lockdown and the fact that even on the maximum dose I still felt dreadful, I turned to Newson Health.

I had many tweaks over the years, tried different types and doses and for the last few years and seem to have finally got to a sweet spot, feeling bit better overall, Newson health sent letters to my GP etc and was getting my bloods done there 1-2 x year and at least an annual review then BOOM - today the GP asked me in for a review and without even asking how I was etc she told me she wasn’t prepared to take the risk anymore as higher than licensed dose 😩!! She wasn’t interested at all on anything I had to say and she just told me to pay for it all via Newson Health.
I have been feeling the most ‘well’ I ever have and my BP etc are the best they’ve been for a long while… I am so upset 😭

OP posts:
Foxybyname · 19/11/2025 08:17

I would ask the GP to refer you to an NHS Gynae consultant.
I did this when my practice refused to continue to conduct blood tests so that I could access testosterone via Newson Health.
Ridiculous, as it now costs the NHS more (consultant resources and the actual cost of the drug) but they were happy to refer me and the wait wasn't too long at all.
Definitely worth a try.

JinglingSpringbells · 19/11/2025 08:23

Mrsbunnychops · 19/11/2025 08:10

Honestly, don’t get me started on that Panorama programme! 🤬

From your point of view, what measures are being put in place to prevent endometrial hyperplasia?
Are you taking a higher dose of progesterone?
Are you having regular scans?

The BMS in one report says that women who are on unlicensed doses (including longer cycles like 3 month cycles if they are intolerant to progesterone) should have scans regularly- they even mention every 3 months which is probably impractical in the NHS.

Has the private GP who has prescribed this dose discussed hyperplasia and how they need to a) prevent it and b) monitor it?

JinglingSpringbells · 19/11/2025 08:29

@backinthebox Re. testosterone prescribing, my understanding is that some NHS trusts do prescribe and some don't. Testosterone is not a direct comparison with huge doses of estrogen.

There have been directives about huge doses of estrogen from the BMS and if a GP ignores the risks or doesn't put in place measures to monitor the risks (ie regular endometrial scans) they could be accused of negligence if a patient becomes ill.

It may be as simple as the Practice issuing an up to date guide for GPs and telling them not to prescribe huge doses because of potential litigation.

JinglingSpringbells · 19/11/2025 13:10

backinthebox · 18/11/2025 23:57

@JinglingSpringbells I’ve sat the ABPI exams (ironically with Female Reproductive Health as one of my special subjects, although back then HRT was still a Very Rare Thing) and passed with distinction, so am comfortable with legislation and ethics surrounding prescribing off license. This is one of the topics I would often end up discussing with doctors as my specialist area of knowledge (pain control) would often require creative solutions and a willingness of a doctor to step outside of the normal bounds of drug licensing.

Since you are convinced on this thread, and on the thread I started some months back, that GPs simply cannot prescribe outside the licensed usage and dosage of a drug, how do you explain my GP’s comfort level with prescribing testosterone off license? One of my children is also on a drug which this same GP prescribes off license. Of course GPs can prescribe off license, just as any doctor can, but what normally limits this is that the breadth of knowledge they are required to maintain at superficial level in order to serve a broad spectrum of patients means they are rarely a specialist in one area. Consultants, otoh, as well as private specialists, have a much narrower scope of practice, so are much more knowledgeable and confident in their field.

It’s entirely within the power of a GP to prescribe a drug off license, both at a higher or lower than recommended dose and for purposes for which the drug has not been formally tested. As an example, my DC has taken nifedipine in the past for severe Raynauds Phenomenon. Nifedipine is an old fashioned calcium channel blocker licensed for high blood pressure. It is often used for various other reasons though, despite not being licensed for them. My GP happily prescribed it off license to a child below the minimum age on the drug license, even though the side effects include potential heart failure.

I think that the poster using the example of weight loss drugs is getting confused about the reasons a GP cannot or will not prescribe a drug. Do you know about practice and/or local authority formularies? A formulary is the list of pharmaceuticals that a doctor can choose to prescribe from, as set out by either their practice or their local authority depending on how the local health service operates. With weight loss drugs, the costs mean that prescribing criteria are restricted to only certain groups of patients, even though many more fall within the allowable range of symptoms for the drugs. So a patient could be suitable for a weight loss drug (or a cancer treatment) under the licensing for that drug, but the local formulary prohibits the prescription of it. Where we are at with HRT is that GP practices are still keeping these drugs in their formulary, but refusing to prescribe outside of the maximum licensed dosing.

Wrt the comparison between weight loss drugs and HRT, it could be argued (although many users of WLI will disagree here) that you can lose weight without drugs if you try. I have not yet come across anyone who has managed to reduce the clinical symptoms of the change in hormone composition brought about by their menopause by ‘trying harder.’

There is definitely scope for further research on the safety and efficacy of higher doses of HRT.

ABPI exams

Sorry but no idea what these are🙂

backinthebox · 19/11/2025 17:22

@JinglingSpringbells Association of the British Pharmaceutical Industry, a compulsory postgraduate qualification for any pharmaceutical company employee who works directly with medical staff to promote their company’s products. Full knowledge of drug testing, manufacture, prescription and limitations are examined, along with specialist knowledge of selected medical subject areas- mine being Women’s Health and Pain Control. So I have a reasonable understanding of what is meant by drug licensing and what are hard rules and where any grey areas are.

I find it interesting that you choose the example of prescribing for longer cycles as being an area of concern - ironically one of my products was specifically a long cycle HRT brand, which had plenty of research behind it.

JinglingSpringbells · 19/11/2025 20:38

I find it interesting that you choose the example of prescribing for longer cycles as being an area of concern - ironically one of my products was specifically a long cycle HRT brand, which had plenty of research behind it.
Was it Tridestra? It's not available now - not clear if it's discontinued for good or supply issues. I think it's more the case now to individualise separate products to create longer cycles and monitor when using.

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