SOME medics are prescribing HRT at “twice the recommended dose” putting women at risk of deadly cancers, an investigation has revealed.
Hormone replacement therapy (HRT) is a treatment which uses synthetic oestrogen and progesterone to relieve menopausal symptoms.
These include issues such as anxiety, changes in mood and difficulty sleeping.
However, a recent investigation by The Pharmaceutical Journal (PJ) found women attending private menopause clinics are being subjected to “unorthodox” prescribing.
In some cases, women are receiving HRT with very high levels of oestrogen which can lead to an increased risk of some types of cancer and bleeding.
The NHS states that your risk of developing breast cancer may rise if the body is exposed to too much oestrogen.
Experts at the Cleveland Clinic also state that cancers such as ovarian and endometrial cancer rely on the hormes to develop.
This comes as the number of HRT prescribed in England soared by over a third in just one year, as awareness of the symptoms became more widespread.
Increased demand for the life-changing drugs have meant shortages have been ongoing since 2018.
Several pharmacists and nurses claimed they had encountered patients on very high doses of oestrogen as HRT.
Speaking to the PJ, Brendon Jiang, a clinical pharmacist based in Oxford said his team were increasingly getting letters from private clinics requesting patients to be prescribed doses of oestrogen that are not recommended by NICE – the body which inform the NHS.
“The worst I’ve seen is double — so 200 micrograms — the max 100 microgram Evorel patches,” he added. “And that was in addition to vaginal oestrogen and topical gel being used too.”
Nuttan Tanna, a hospital pharmacist consultant in London said she had received similar feedback in her region: “[We have] referrals for bleeding investigations and then find the patient was on very large doses [of oestrogen] prescribed previously by private providers.”
The British Menopause Society (BMS), told the PJ that it was aware of issues regarding the prescribing of private providers and was addressing the matter “as a priority”.
In a joint statement, Dr Paula Briggs, the chairman of the BMS, and Dr Haitham Hamoda, past chairman, said that the society was “very much aware” of the issues surrounding “unorthodox prescribing” by private providers.
“We have been contacted by significant numbers of members, non-members and women questioning the prescribing that falls out with national guidance and licensing recommendations.
“We are working with other specialist societies and colleges — who share our concerns — to address this matter as a priority,” the letter read.
Debra Holloway, a gynaecology nurse said it is “unusual” that you would need higher doses of oestrogen than licensed recommendations.
She said if you’re putting someone on higher doses of oestrogen and you’re not opposing that properly, you are putting the patient at an increased risk of hyperplasia and cancer.
Responding to the concerns, Magnus Harrison, chief medical officer of Newson Health Group, the largest private menopause clinic in the UK, explained that some women need higher doses of oestradiol because absorption of oestrogen through the skin is “variable”.
Magnus said that for younger women with premature ovarian insufficiency, studies have shown that higher doses of oestradiol are needed to achieve a physiological response.
He said that low oestradiol levels in the menopause are associated with increased risk of diseases such as cardiovascular disease, osteoporosis, type 2 diabetes and dementia.
He added that the data regarding actual dose of progesterone to provide adequate endometrial protection is “not robust”.
Just this year, some HRT pills were made be available without a prescription for the first time.
The move is part of a drive to boost women’s health by improving access to HRT.
The government was forced to act on HRT access after critical medicines ran out of stock in the spring, with patient woes revealed by The Sun’s Fabulous Menopause Matters campaign.
