Newson Health and the menopause industry

[ArabellaScott]

https://www.bbc.co.uk/news/articles/cp8e5y4e83lo

Keeping an eye on this. Newson makes an awful lot of money out of HRT.

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

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

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.

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.

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

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

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.

But this is Newsons own app isn't it?

Of course it's going to endorse her approach.

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.

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 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.

No it really is very widely accepted
https://theros.org.uk/information-and-support/osteoporosis/treatment/hormone-replacement-therapy/

I hope that you are aware of NICE’s operating remit
The National Institute for Health and Care Excellence (NICE) helps practitioners and commissioners get the best care to people, fast, while ensuring value for the taxpayer. We do this by: producing useful and usable guidance for health and care practitioners.

They are housekeepers not scientists.

Their guidance is often frustrating for prescribing practitioners since many useful medications are not available. However they do keep some of the more maverick prescribers in check.
Unfortunately the use of some really revolutionary cancer drugs , the expensive ones are not available for the small number of patients who would really benefit from them because of cost cutting.
I’ve seen posts by women on mn in their early 40s asking if the mild aches and pains and fatigue are perimenopause. No you are just aging. HRT will not cure aging, it will just make the journey through meno easier to deal with. We will all get old eventually and a low dose of sex hormones will make no difference.

Quoting 5 studies is not strong evidence, but anyway, under 'Similar content" come all the other factors that will determine bone density: eating healthy, daylight and vitamin D and so on. As I said before, if you don't have an overall healthy lifestyle, HRT won't protect you from osteoporosis, heart disease, dementia, diabetes, depression and a lot of other diseases. Bottom line: having a healthy lifestyle is the main factor for ageing well, and this is because we can change our lifestyle. The other main factor, genetics, can't be changed (yet).

Ah, I wasn't questioning the concept of HRT to help Osteoporosis being accepted (I said so above).

I was questioning using Louise Newsons own app as a reference on a thread discussing her approach - it's hardly going to be unbiased (that's not to say that it may not also be true).

That is your case. If every woman comes here to defend her own menopause experience and not acknowledge that others have different experiences and genetic/medical/social background, and that a doctor can quote a few articles and "a wealth of data" (her own data, without peer review) to justify her high dose off-label prescriptions of oestrogen, this thread will be very long and a bit useless.

Yes, women can do whatever they want - so? Nobody is saying they can't take HRT.

HRT doesn’t prevent HRT it merely slows down the process. As per normal LN has oversimplified the message.
She also claimed that it was safe for breast cancer survivors to use HRT. She’s not blessed with a great deal of common sense.

Indeed LN uses her patients as Guinea pigs resulting in somewhat biased data.
Prior to her setting up business she had published nothing related to the menopause and has no specialist training in endocrinology so is a bit of a charlatan.

I think she has found an open niche, or a chasm more likely, in the NHS regarding the lack of menopause knowledge amongst GPs, and has capitalised on it (excuse the pun). Add to that the social media phenomena, and she is THE menopause doctor. Too much marketing and too little substance.

I think it will be available soon on YouTube.

NICE evaluated all the AVAILABLE scientific evidence, which is not relevant to this discussion, because there is no scientific evidence on the benefits/risks of oestrogen doses above the licensed dose for menopausal women.

Ahh, thank you. I did think they were surprisingly scant! I couldn't find the NICE guidelines referenced.

Thanks to Angrymum and Aston and Azaleah for useful posts about NICE.

Fraud I'm glad HRT has helped you. The subject is obviously a complex and nuanced one and using clear and accurate language is important .

It's not just that, it's all the health benefits – helping to reduce heart disease, osteoporosis, diabetes and dementia because it reduces inflammation.

Even I can now see that that is such a simplistic framing of a really complex area.

All those things are very separate conditions. And there is more or as much evidence for lifestyle factors (depending on which condition you're looking at.)

Exercise in particular is extremely anti inflammatory. That's why cancer and heart op patients are encouraged to do so. It is definitely much harder to exercise on the same way as you did when you're younger. And the more deconditioned you are, the more you need to build up very slowly. But that is the same for men and women generally

Women also need to follow very different guidelines for exercise to men, based on their physiology. For example women must eat within 30/40 mins after a proper workout/ heavy lifting, as well as a small amount before. If you're actively exercising, intermittent fasting is not helpful. "Time restriction" is fine - which is just normal eating, have a break over night for 12-13 hrs. Women also need a decent breakfast. I found Stacy sim's advice extremely helpful on all this. And feel I could have done with knowing about it all a decade ago as peri started.

I've had to hide and unfollow some social media people/ groups because the shouting about hrt being "the only thing to work" is really distressing (as I believed that thanks to LN) and I now know is BS. She was right to re start the conversation and campaign for women to access via the nhs. But that's very different to some of the claims she makes.

I know lots of women have a terrible time with the NHS over menopause, but just to counter with a positive: I’m in perimenopause and have been on HRT for 2 years now. In that time I’ve lived in two different cities and been to two different GP practices and seen many different individual GPs for it, and also been referred to an NHS gynaecologist for a related issue. My care has been superb. I have never been refused nor discouraged from taking HRT, the doctors have worked with me to get the right (licensed) dose and type and the risks and benefits clearly explained.

I know other women haven’t been so lucky, but I just wanted to counter the narrative that NHS GPs are uniformly rubbish at this - they aren’t, and if you’re suffering menopausal symptoms it really is worth trying them before paying anyone for help.

NICE updated guidelines due out on 7th of November.

https://www.nice.org.uk/guidance/indevelopment/gid-ng10241