Hormone Replacement Therapy Prescribing
Hormone Replacement Therapy Prescribing
Prescribing of higher than licensed doses of oestrogen in HRT is being provided routinely to women in some clinics. Hormone Replacement Therapy Prescribing in high doses results in excessive bleeding, endometrial hyperplasia or endometrial cancer.
The MHRA recommends using the lowest dose of oestrogen that controls menopausal symptoms. Length of use depends on an individual’s circumstances and dosage recommendations are to ensure patient safety. There are no guidelines which recommend that the dose of oestrogen provided should be increased out of license or that different forms of oestrogen should be added together to control symptoms.
In the event of a significant event occurring (such as endometrial hyperplasia or cancer) in women using different formulations of oestrogen, outside of license, the prescribing clinicians are responsible for having put patient safety at risk.
Endometrial Hyperplasia
Endometrial hyperplasia is a precancerous condition in which there is an irregular thickening of the uterine lining. This may cause uncomfortable symptoms for women, including heavy menstrual periods, postmenopausal bleeding, and anemia due to the excess bleeding.
Breast Cancer
HRT can slightly increase the risk of breast cancer. If you’ve had breast cancer you’ll usually be advised not to take HRT. The increased risk is low: there are around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years. The risk increases the longer you take it, and the older you are.
This can lead to a syndrome, known as tachyphylaxis, in which women with high estradiol levels continue to experience menopausal symptoms, leading them to believe that they need more estrogen. However, higher levels of estrogen can also cause adverse mood related symptoms.
Endometrial Cancer
Oestrogen-only HRT increases the risk of womb cancer. The risk is increased the longer HRT is used. This may stay for some years after HRT is stopped. This is why it is usually only prescribed to people who have had a hysterectomy.
Routine testing of oestrogen levels is unnecessary and is associated with an unnecessary cost both to the NHS and patients in private clinics.
The recent rise in the use and popularity of menopause services and products has highlighted the need for more regulation and clear guidance to protect women. We welcome such guidance. Sadly our clients suffer fear, anxiety and pain when cancer is diagnosed.
Call us today
If you’re ready to discuss your situation or have any questions please contact Dr Victoria Handley today. Don’t suffer in silence. Call FREE on 0800 470 2009 or email vhandley@handleylaw.co.uk