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[Hurdity]

I agree that much of the article is very good - I skimmed through it.

However I quite agree that it is appalling that incorrect and outdated information should be used in a current review article that goes to GPs, and especially as I see it is used for CPD!

What is worse is that the two references given under monitoring HRT are this website and the British Menopause Society but as you say ellie66, as far as I understand nowhere on this site does Dr Currie recommended cessation after 5 years and the British Menopause Society's own consensus statement on HRT says the oppostie.

The relevant info from this article:
When commenced after the age of 51, most guidelines suggest discontinuing after five years.1,2 Commencing HRT after the age of 60 is not recommended and is associated with increased risk of CVD.

The relevant statement from BMS:

    The decision whether to use HRT should be made by each woman having been given sufficient information by her health professional to make a fully informed choice.
    The HRT dosage, regimen and duration should be individualised, with annual evaluation of pros and cons.
    Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.
    HRT prescribed before the age of 60 has a favourable benefit / risk profile.
    It is imperative that women with premature ovarian insufficiency are encouraged to use HRT at least until the average age of the menopause.
    If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of administration.
    It is imperative that in our ageing population research and development of increasingly sophisticated hormonal preparations should continue to maximise benefits and minimise side effects and risks.
    This will optimise quality of life and facilitate the primary prevention of long term conditions which create a personal, social and economic burden.

http://www.thebms.org.uk/statementpreview.php?id=1

Despite the overall high quality of the rest of the article, it is really quite worrying that such a crucial point which many women face, is simply wrong, and that we are better informed than the author in this respect.

Many times in the past I have posted the link to the last paper from the BMS/Women's Health Concern by Panay et al in 2013, updating info on HRT and recommendations. Here it is again:
http://min.sagepub.com/content/19/2/59

The BMS consensus statement will be based on these findings

Hurdity x

[ellie66]

Thanks so much Hurdity you have referenced what I was trying to say so well 

[Hurdity]

Intrinsa Patches,

http://binscombe.net/blog/?p=672   read comments.

It seems that they maybe still available but unlicensed, testosterone gel is licensed I believe.

Testosterone is considered a secondary treatment.

Its difficult to judge about some women being denied HRT after 60 a because we only know what we are told in a post and probably non of the full medical history of the poster, non of us are experts or medical professionals.

I can't just reply and can only quote - maybe my computer or the system?

Anyway here is the info from BMS about testosterone. No licensed product for women. Intrinsa was licensed but withdrawn.

Testosterone replacement can have a huge impact on general quality of life as well as the libido of many women in the menopause.

The expected announcement by MSD of the withdrawal of testosterone implants has recently been circulated to health professionals. This is a global profitability decision by the company which follows closely on from the withdrawal of estradiol implants.

Even more disappointingly, this decision followed on closely from the withdrawal of the Intrinsa testosterone patches, leaving no licensed female testosterone replacement preparations available in the UK or abroad.

The BMS and all other menopause societies globally, have already protested the withdrawal of estrogen and testosterone implants, which will disadvantage a significant proportion of menopausal women who have struggled with alternative preparations. Whilst the decision by MSD to withdraw hormone implants was immoral, it was not illegal and cannot be reversed.
http://www.thebms.org.uk/newsitem.php?newsid=67

Also - I would say that the stories women report on here about being denied HRT after the age of 60 are usually full and detailed and it is unreasonable to suggest otherwise.

As for not being experts - well most of us are not medical professionals at GP level or higher, but there are nurses on here, and I would suggest that quite a lot of us are experts - amateur maybe - but very well informed about the subject and are able to correct misinformation given by the medical professionals - you only have to read all threads to see this!

Hurdity x

[Rowan]

"In theory it can still be prescribed on the NHS (I believe it is still on the market and supplies are available), but there are two issues that might be a problem. The first is that your doctor may be unhappy to prescribe it now that it is unlicenced, as that does mean extra risk for the doctor. The other is that, with the price rise and the loss of its licence, your local CCG may have black-listed it, which means that local GPs will be heavily criticised if they prescribe it. Unfortunately these are consequences of what can happen when the drug companies make these changes. If you were on it before the change and it worked well for you then you could try appealing the decision with the CCG."

A comment on the article.

Quote form NHS Choices site

"Most experts agree if HRT is used on a short-term basis (no more than five years), the benefits outweigh the risks.

If HRT is taken for longer, particularly for more than 10 years, you should discuss your individual risks with your GP and review them on an annual basis"


We will have to agree to differ hurdity.

[Hurdity]

We don't need to agree to differ silverlady as my posts are not my opinion especially - but just what the various papers and authorities etc say!

Re the Intrinsa - I didn't disagree with you - but just quoted what the BMS statement said and clarified that testosterone gel is not licensed. I didn't mention anything about the availability - it has been withdrawn from license and manufacture too I believe. Having looked at your helpful link - this was an eye-opener - it seems that another company bought all the remaining stock after it was withdrawn and sells it for £395 per box of 8 patches. I went to the company's website and through clicking various options got to the point where the patches were offered. Unbelievable! How immoral is that! Of course this is as good as there being none available - because as said in the quote, few doctors are going to prescribe a now unlicensed product and even fewer at that super-inflated cost. I presume anyone who is able to get them does so through a private gynae at that ludicrous price!!! How inequitable!

Re the stopping HRT at 60 etc, it's not a question of differing!  I reported the BMS recommendations. The NHS Choices gives the prevailing guidelines and even so does not say that women should stop at 60 - in fact it implies that women may take it for 10 years, and of course individual risks should be discussed. This is completely different from an arbitrary cut-off point imposed by many GPs - many times have we heard women so "I have been told I have to come off at 60". It would be welcome indeed for all women to be given the opportunity to discuss individual risks with their GP!!

Also this guidance (the NHS) differs from Dr Currie's on this site - where the benefits and risks are not time dependent but broadly age dependant - other things being equal. This advice must also be at the root of the problem where women who have been on HRT for longer than 5 years and still under 60 are told they need to come off - whereas the advice on this site is that under 60 the benefits generally exceed the risks irrespective of the time on HRT.

There is some NICE clinical guidance about stopping HRT on the web somewhere which I have posted in the past and will do so again when I find it.

Hurdity  x

[Rowan]

Perhaps we need to differ to agree Hurdity 

[CLKD]

What's CPD?

[ellie66]

CPD=Continuing Professional Development ie GP ongoing training.

[CLKD]

 

[ellie66]

A lovely reply from Dr Currie she is contacting GP Magazine. 

Thank-you for letting me know about this. Most of this is good, but I agree, it is incorrect to say that HRT should be stopped after 5 years. I frequently hear of women having to battle with their GPs to be "allowed" to stay on HRT--it should be their choice! I have fed this back and asked for a response. Have also asked them to refer to 2012 BMS guidelines on HRT.
Thank-you
Best wishes
Heather

[honeybun]

Result.

Now we have to hope someone listens.


Honeyb
x

[Rowan]

I think that the GP magazine is excellent and I have certainly book marked it, as it is for professionals you have to register to read all the articles

Here is another good report by Dr Gwen Lewis on Menopause and HRT

http://www.gponline.com/hormone-replacement-therapy/womens-health/menopausal-and-hrt/article/1221738

When I go for my estrogen patch, my doctor always goes through the risks and benefits and we go through any health and problems I might have or had, then says you are aware and understand as you are well over the five year recommendation. To me this is a holistic approach, not all women are suitable for HRT.

I don't agree that if a women has been on HRT for years and is obviously thriving even though she is over 60 then she should not be made to come off and it should be her choice., if she accepts any current guidelines and is aware of risks. To my mind this is correct procedure, good patient, Doctor practice.
 

[Rowan]

I have read through the article again from the GP, it does not say that HRT should be stopped five years

"Stopping HRT

There are no strict rules about when to stop HRT, but most guidelines recommend cessation after five years.

The decision should, however, be patient-centred, with knowledge of potential risks and benefits"

As a layman I cannot find fault with that.

[Taz2]

Maybe it's the part under Monitoring HRT?

"When commenced after the age of 51, most guidelines suggest discontinuing after five years"

Taz x

[Rowan]

Taz it says "suggest" when "monitoring" the GP must make educated decision according to his patient, history and well being, a good GP will use his discretion.