HRT: what every woman needs to know now
As prescription of the hormones comes under scrutiny, Peta Bee talks to the experts
An estimated one million women in the UK take HRT to alleviate hot flushes, night sweats, low mood, anxiety and other debilitating symptoms of the menopause. It can be a lifeline for some of the 4.5 million women in the UK who are menopausal. Yet many women feel confused by their options and surrounded by misinformation, often finding it so hard to access informed GP care that they end up going private.
Dr Annice Mukherjee, an endocrinologist who is honorary professor at Coventry University and sits on the British Menopause Society (BMS) Medical Advisory Council, believes that misinformation about the menopause is rife. “I have never seen so much confusion associated with menopause and its treatments,” Mukherjee says. “There is so much misleading information online, and so many personal anecdotes on social media and elsewhere, that it’s no wonder women are feeling confused and overwhelmed.”
This week HRT made headlines when a BBC Panorama programme investigated some private clinics where doses that were higher than licensed were being prescribed. Many women just don’t know who to trust when it comes to this key aspect of their health so how can they establish what the best way to treat their symptoms is? Here, the experts explain what they need to know.
What’s the best source of information about the menopause?
Your own GP practice should always be the first port of call. “GPs are much better informed than they used to be,” says Dr Nicky Keay, a member of the BMS, honorary clinical lecturer in medicine at University College London and editor of Myths of Menopause, written by a panel of leading medical experts (and due to be published on November 25 by Sequoia Books). “If you have any concerns about your menopause or treatment, you should contact your own GP surgery and certainly not rely on social media for advice,” she adds. “Ask to see a doctor, a specialist in women’s health or anyone with BMS training at your local practice.”
If you feel you are still not getting what you need, you can ask to be referred to a specialist or go private. To find your nearest accredited menopause specialist, simply enter your postcode on the BMS website (thebms.org.uk). All BMS-approved specialists adhere to national guidance, such as that outlined in the National Institute for Health and Care Excellence (Nice) guideline Menopause: Diagnosis and Management.
Why take HRT?
All experts agree that the overriding purpose of HRT is to improve your quality of life. “During the perimenopause and menopause, a woman’s ovaries stop working and levels of oestrogen drop,” says Dr Heather Currie, a gynaecologist at Dumfries and Galloway NHS, founder of the charity Menopause Matters and former chair of the BMS. “The consequences of this decline in oestrogen are linked to the symptoms women experience in the menopause.”
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The point of HRT is to replace these losses with oestrogen in tablet, patch, spray or gel form. “When oestrogen is taken on its own it can cause thickening of the lining of the womb, which is a risk factor for cancer, so progesterone, in the synthetic form of progestogen, is prescribed to offset this and keep the womb healthy.” This does not apply to vaginal oestrogen, prescribed for vaginal dryness, which does not need to be prescribed alongside progestogen and does not cause thickening of the womb lining.
What are considered safe doses of HRT?
Approved licensed doses of HRT are reached after lengthy scientific and safety trials. In the UK up to 100mcg of oestrogen are licensed for general use but that doesn’t mean you will be prescribed that amount of oestrogen immediately, however severe your symptoms. The Medicines and Healthcare products Regulatory Agency recommends starting with the lowest possible dose of oestrogen that will control your menopausal symptoms and the BMS says that “response to treatment with HRT should be based on symptom control”. Incrementally higher doses of oestrogen, within licensed dosages, should be prescribed with a proportionately higher dose of progestogen to ensure adequate protection of the womb lining.
While 100mcg is the highest licensed dose, “above-licence” doses can be prescribed by specialist doctors.Since the Panorama programme, it has emerged that Newson Health specialist menopause clinics run by Dr Louise Newson are being examined by the health watchdog in England, the Care Quality Commission, after “information of concern” was supplied to it regarding high doses of HRT that were being prescribed there (up to three times the licensed dose).
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