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[Elliebee]

Lots of people have questioned her on this on her Instagram post. Have a read of the post Dr Currie posted on here re this article :-

https://vajenda.substack.com/p/a-master-class-in-hormone-levels

[bombsh3ll]

I watched the Liz Earle video and thought she made some good points but puzzled over the comment that higher levels of progesterone are not needed for higher levels of oestrogen unless I have misunderstood her point there? One contributing factor for endometrial cancer can be unopposed oestrogen.

There are not currently any scientific studies proving that higher doses are needed with higher doses of estrogen. That's not to say it isn't the case, they simply haven't been done.

I think the issue is that if woman A uses a 50mcg patch and woman B uses 200mcg, but they both have a plasma level of 300pmol/L due to individual differences in absorption and metabolism, there is no logic to woman B taking 4 times as much progesterone.

In practice however, particularly within the NHS where plasma levels are not checked and endometrial thickness is not monitored, a more cautious approach is needed.

Personally I think everyone should know their levels, and get a pelvic scan every 1-2 years as part of routine well woman screening.

[Mary G]

In practice however, particularly within the NHS where plasma levels are not checked and endometrial thickness is not monitored, a more cautious approach is needed.

Personally I think everyone should know their levels, and get a pelvic scan every 1-2 years as part of routine well woman screening.


Perhaps it's time for the NHS to own up and have an honest conversation about it.  It's obviously about cost but instead of admitting it, they have a zero tolerance policy towards any low/lower dose progesterone regimes (including lower dose coils) and refuse to admit that it's possible and safe to deviate from their rigid guidelines even under supervision ie transvaginal scans. 

The NHS party line on hormone blood tests is that they don't work.  There may be some truth in that pre menopause but post menopause, it's complete nonsense and it's the only way to find out how well a woman is absorbing HRT.

[Seasidegirl]

Re progesterone doses,  I can't remember if I've said it already here but I saw a comment from an HCP elsewhere who said she's seeing gynaes ramping up progesterone doses widely to reduce the demand of unscheduled bleeding. 

For those of us who struggle with progesterone this is a nightmare scenario. 

[Penguin]

In practice however, particularly within the NHS where plasma levels are not checked and endometrial thickness is not monitored, a more cautious approach is needed.

Personally I think everyone should know their levels, and get a pelvic scan every 1-2 years as part of routine well woman screening.


Perhaps it's time for the NHS to own up and have an honest conversation about it.  It's obviously about cost but instead of admitting it, they have a zero tolerance policy towards any low/lower dose progesterone regimes (including lower dose coils) and refuse to admit that it's possible and safe to deviate from their rigid guidelines even under supervision ie transvaginal scans. 

The NHS party line on hormone blood tests is that they don't work.  There may be some truth in that pre menopause but post menopause, it's complete nonsense and it's the only way to find out how well a woman is absorbing HRT.

Totally agree with this!

[CLKD]

I've done a search to C whether Liz Earle has any medical background and can find that she's into beauty and nutrition rather than having any medical qualifications  . 

[CLKD]

It's about cost.  Recently Two drugs that will help patients with Alzheimer's have been approved but NICE have rejected them.  Menopause is a huge 'alternative' industry which means that the Government of the day can ignore the reality of those women that require educated conversations regarding peri-and menopause with professionals who know about this 'time of Life', i.e. The Change.

But that would mean 'them' having to listen and take on board that women need to be valued throughout our lives and not ignored when symptoms cause some to stop working because they feel too ill to continue.   .

Education needs to begin from the bottom upwards, i.e. GP Trainees with ongoing updating throughout their careers: listening to how women suffer and why some need to seek private or alternative treatment options. 

[Nas]

Agree with Mary G and CLKD.

It’s time for the Government/NICE/NHS to face the music. Women are living longer, working high powered jobs, and often carrying the burden of caring for elderly relatives and teens. It is not good enough for a woman to have to sit in front of an ill menopause trained medic and be told “ no, you can’t have HRT, no, you can’t exceed 4 pumps of gel, no you can’t stay on HRT for life” Then have to spend £££ on private consultations, to feel remotely human and listened to.

As Mary mentioned in one of her earlier posts, women cannot live and die by often outdated and unreliable statistics.

I would often like to know what some of these ( often female anti HRT GPS in particular) would do, if menopause jumped up and bit them on the butt and stopped them dead in their tracks?

Put menopause on the National Curriculum and get rid of some of the other crap.

Enough is enough. If you need 5/6/20 pumps of gel to function, then that’s what you need!

Oh and ditch the stupid guidelines. Women are human beings, not robots 

[ElkWarning]

There's no possibility of ditching guidelines because you can't run a huge service like the NHS without policy.

That's said, research should be academic rather than industry based - where the first priority is always profit. Similarly, treatment should be provided on the basis of need not privilege in terms of who can afford what.

Until we sort out the above, nothings going to change.

[sheila99]

This just highlights the difference in approach. LH is trying to help women feel better, the BMS and the NHS guidelines are doing everything possible to prevent it. The increasing number of women who find they need more than 100mcg to feel normal are showing the guidelines to be suspect. So naturally the answer is to discredit LN rather than to question the guidelines. I find it a bit scary that their answer is to suggest ADs, cbt etc instead - where have we heard that one before?? And, as above, the use of 'there is no evidence for' when they really mean 'we haven't done any research'. Most women don't see a private specialist because they want to spend money, they do it because the NHS has failed them and now they seem to be trying to take that option away.
  A tenner to a charity of your choice if in 20 years time when it's too late for us they don't finally admit 100mcg isn't enough for many women.

[CLKD]

Good points sheila99 


My Charity will be Search and Rescue ;-) [they helped when my friend's dog was stolen 12 months ago]

[ElkWarning]

This just highlights the difference in approach. LH is trying to help women feel better, the BMS and the NHS guidelines are doing everything possible to prevent it. The increasing number of women who find they need more than 100mcg to feel normal are showing the guidelines to be suspect. So naturally the answer is to discredit LN rather than to question the guidelines. I find it a bit scary that their answer is to suggest ADs, cbt etc instead - where have we heard that one before?? And, as above, the use of 'there is no evidence for' when they really mean 'we haven't done any research'. Most women don't see a private specialist because they want to spend money, they do it because the NHS has failed them and now they seem to be trying to take that option away.
  A tenner to a charity of your choice if in 20 years time when it's too late for us they don't finally admit 100mcg isn't enough for many women.

I'm confused. You seem to be saying that until there's reliable research findings it's ok that it's all personal decisions, i.e. up to individual doctors and patients. This isn't a scientific way of doing things. Medicine and medical treatment has to be scientific not based on anecdotes.

You also seem to be saying that in the absence of any reliable data that confirms these anecdotes, we should keep looking until we find it. This isn't a scientific methodology either.

As others have said, HRT is one element of menopause. I agree there should be more research, but not that HRT should be prioritised within that research.

[Penguin]

I do think they need to actually do the research before they can say it isn't safe though. I don't think Sheila is talking about doing more research until they get the answer they want, rather that insufficient research has been undertaken in the first place to either prove or disprove. That requires a large enough scientific trial of women using the higher doses, with safety mechanisms in place, such as scans to check for hyperplasia, to see if it actually does happen. The evidence will only ever be anecdotal until the research is done.

[CrispyChick]

The same also applies at the lower end of the spectrum where woman ate using bhrt clinics to get bespoke amounts of E and P because the standard doses don't suit. 

This is frowned upon by the BMS, the NHS and, many times, by vocal members on this forum.

Nope, they don't have the scientific studies either - but they do test, adjust, test again and insist on scans. I know which I think is safer.

It s very very obviously not 'one size (or perhaps 4 in the NHS) fits all'. Look at the problems many woman have with 100mg utrogestan. No other natural prog option. Yet some of these woman could be on tiny doses of E. Bonkers.

It's the biggest medical mess I've come across so far in my life.

[CLKD]

There probably isn't any1 who will sponsor any Research into Menopause because Companies are already manufacturing specific doses of medication across the board which includes HRT requirements.  Until women are actually asked how symptoms affect them and how different regimes help, these issues will continue.