The growing use of hormone replacement therapy (HRT) and risky prescribing of high doses has triggered a rapid rise in the number of women sent for urgent cancer tests, according to a report by Britain’s leading menopause specialists.
The medications, given to relieve some of the worst symptoms of menopause, are safe and effective for most women, but they can cause side effects, including irregular bleeding.
Although common within the first six months of starting hormone replacement therapy, irregular bleeding in postmenopausal women after that may be a symptom of uterine cancer and should be investigated without delay, NHS guidelines state.
Over the past three years, an increasing number of patients on HRT reporting irregular bleeding has resulted in a 43 percent increase in the number of patients being tested for uterine cancer, top U.S. health doctors said. women.
Such is the concern that last week the British Menopause Society (BMS) published new guidelines on prescribing HRT and treating bleeding side effects.
The increasing use of hormone replacement therapy (HRT) and the risky prescribing of high doses has led to a rapid increase in the number of women being sent for urgent cancer tests (file image)
Since 2018 there has been an explosion in demand for HRT driven by celebrity activists, including TV presenter Davina McCall, who have been pushing for greater awareness.
Hormone replacement therapy (HRT) pills used by women to relieve menopause symptoms
Timothy Hillard, consultant gynecologist at University Hospitals Dorset NHS Trust, Poole and one of the authors of the new BMS guideline, said: “These figures will not surprise anyone working in gynaecology.”
Since 2018 there has been an explosion in demand for HRT driven by celebrity activists, including TV presenter Davina McCall, who have been pushing for greater awareness.
The number of patients prescribed HRT in England increased by almost a third in just one year: from 1.8 million in 2021 to 2.3 million in 2022, according to official figures from the NHS Business Services Authority, which caused intermittent drug shortages.
Along with an overall increase in HRT use, Hillard said another reason bleeding is increasing is because women are prescribed HRT at a younger age: during perimenopause, the years before menopause, when Hormones fluctuate.
“During this time, women still have periods, so there may be confusion about who requires an urgent referral to investigate bleeding,” she said.
“In postmenopausal women, there is a one in ten chance that irregular bleeding is a sign of cancer, but for younger women in perimenopause that risk is lower.” Part of the reason for the new guidance, which has been drawn up with input from the Royal College of Obstetricians and Gynecologists and other leading women’s medical bodies, was to address that issue, so that patients are not referred for unnecessary investigations, she added.
The BMS guidance also cites “a growing trend toward unlicensed prescribing of higher-dose estrogens with suboptimal doses of progestogen” as a reason for the problems.
The medications, given to relieve some of the worst symptoms of menopause, are safe and effective for most women, but can cause side effects such as irregular bleeding.
HRT contains female hormones estrogen and progesterone that decline in middle age
HRT contains female hormones estrogen and progesterone that decline in middle age.
Women are usually prescribed estrogen in the form of a patch, gel, or spray, and the medication is absorbed through the skin. Progesterone is usually administered in capsule form.
Both hormones can also be combined in one pill. Estrogen is safe when prescribed in authorized doses, but experts believe that excessive amounts, along with insufficient doses of progesterone, cause the lining of the uterus to thicken abnormally, known as endometrial hyperplasia.
This can lead to heavy bleeding and an increased risk of uterine cancer, so hyperplasia needs to be investigated if discovered.
A Mail on Sunday investigation, published in April last year, revealed concerns about a private clinic, Newson Health, prescribing higher than authorized doses of HRT to one in five of its patients.
The firm, which sees approximately 4,000 women a month seeking menopause treatment, is led by Dr Louise Newson, a GP and advocate of high-dose prescribing.
Dr Newson (right) has campaigned prominently on behalf of women on the issue of menopause.
Dr Louise Newson, pictured alongside Mariella Frostrop, left, along with Carolyn Harris MP, Penny Lancaster and Davina McCall at a campaign march to raise awareness about the menopause. She has faced criticism after allegedly prescribing patients with HRT at higher doses than those recommended by the NHS.
She insists that women may need twice the authorized amount of estrogen if they struggle with the mental health symptoms of menopause, and that her approach is not risky.
However, following our article, the British Menopause Society (BMS), the Royal College of General Practitioners, the Royal College of Obstetricians and Gynecologists and others signed a joint alert, warning that HRT with estrogen should not be prescribed in higher doses to those authorized. limits “to ensure patient safety.”
The experts we spoke to say that until a few years ago they rarely, if ever, saw women taking such high doses of HRT.
“We have all seen a huge increase in the number of patients coming to us for cancer research,” said BMS president Dr Paula Briggs, a sexual and reproductive health consultant at Liverpool Women’s NHS Foundation Trust.
“Most don’t have cancer, but it is really worrying for women and the tests are not pleasant.”