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[CLKD]

 The Daily Telegraphy have it as the front of their 'features' issue  today.  By Charlotte Lytton. 

Not worth the paper it's printed on.  Nil of nowt.

[Gilla999]

Just as a side note on the yearly check up thing: I tried that with my GP a couple of months ago, they practically laughed at me as if to say "why are you bothering us" and when I suggested maybe a blood test as it had been over a year I was told they "don't do them".

I don't want to beat down on the NHS because we all know the strain it is under, but I do get annoyed at the suggestion that we get decent levels of treatment when we so often don't.

[Nas]

My main issue with Newson is her over promotion that women must have oestrogen HRT to protect their bones and hearts, insinuating that those who do not are being ignorant and will come a cropper without it. It gets repeated everywhere, including this forum. The evidence is actually very weak on this for menopausal women (only younger women).

Totally agree with this.

This is particularly worrying for me, with metastic breast cancer. I don’t want to keep reading that I’m at risk of heart and bone issues because I can no longer take HRT. And where do all these oestrogen figures for good bone and heart health come from??

[lor.com]

Interesting to me as I have just started HRT for health benefits rather than against any symptoms. Surely a hormone we produce anyway can’t be that harmful. Panorama is known as Paranoia in our house for a reason!

[Mary G]

There was another strange case earlier in the programme with the woman who had consulted Newson during lockdown and apparently ended up with endometrial hyperplasia.  She said they were trying to sort out (?) the hyperplasia and she might have to have a hysterectomy.   This wasn't adequately explained either and sounds rather vague.  Are we to assume she is is being treated with heavy duty progesterone and they are just going to "wait and see" if he goes on to develop endometrial cancer and then give her a hysterectomy?

Surely she had a biopsy and either cancer cells were detected or they were not.  It seems highly unlikely that a consultant would take any risks and adopt a wait and see approach, they would immediately perform a hysterectomy.. 

[Gnatty]

Nas, I think you have a point. Nick Panay has just headed up a White Paper for the International Menopause Society and he talks about this at quite some length. At the moment there simply isn't the research to say we should be taking hrt for preventative heart or brain (or even bone benefits except in exceptional circumstances) and should be taken really just to relieve menopause symptoms. Even transdermal if taken in too high a dose could have a negative impact on I think he said vascular health but don't quote me on that. It was along those lines. He talks about alternatives and how important other factors are and other options for women. I think you would find the paper quite reassuring. I found it by searching White Paper, International Menopause Society. And I think it's very interesting that it's Nick Panay who is very highly respected on this forum.

[sheila99]

Even the NHS thinks hrt improves bone health so I'm assuming it's true. I don't think there's any clear evidence either way about hearts? Of course not taking hrt doesn't mean you'll get osteoporosis, it just makes it more likely. There are genetic and environmental factors that may have a greater influence on your susceptibility.

[Nas]

Thanks jaypo and Gnatty.
Your thoughts and shared information, are comforting.

I just wondered where the often quoted oestrogen figures on here have come from; whether directly from the NHS or from more influential medics, such as Nick Panay or Dr Paula Briggs for example.

I do agree though, that genetics and external factors can play a big part in influencing susceptibility. That’s why a well balanced holistic approach and attitude, is vital when discussing menopause and the effects of HRT. Otherwise women can become worried very quickly.

I wonder how menopause treatment is regarded in other countries ( particularly non European). Does HRT exist in Japan for example?

Just thinking aloud now 

[Gnatty]

Sorry Sheila yes you are correct re bone health. I think it's an international paper so not every country is on board with this. I think there are lots of risk factors involved. Particularly early menopause, being underweight, smoking, drinking, lack of weight bearing exercise etc etc

[CLKD]

I believe that for many years Japanese women didn't have as many peri or menopause with problems because they ate a soya based diet from an early age.  Since the fast food outlets arrived, I read somewhere that they are more aware of hormonal changes.  Now don't ask me where I read it  as it is several years ago.  If I get the energy I will have a lookC.

Also: a lot of our young people will have bone density issues because of all the dieting and avoiding dairy products .......... as well as Education Authorities having sold off playing fields for housing! 

I have noticed with regards bone issues that I am developing a Dowager's hump ........ from my paternal side. When tired or carrying a heavy tray of items I tend to lean forwards and don't always straighten up enough.  When I see that old lady staring back from a shop window I have to pull myself up!

However: my grandparents and ancestors had a seasonal diet with lots of exercise: they didn't have 'treats' and there were no fruit/veg imports all year round; Brazli nuts at C.mas; no vehicles so everyone walked or cycled.  Or rode a donkey ........ lots of fresh air for those living in the countryside.  Don't know about how people were in towns or cities, not my families experiences.

Both my grandmas died in their early 80s, having worked hard in Service then raised families. One had bile cancer the other dropped dead from some kind of rare brain condition: rare at the age of 84 

[AKatieD]

[quote author=CLKD
What happened to Nick Panay?

He is still going and chair of this that and the other. I attend his practice although see another doctor as cheaper and more appiintments available.

Hope they are not going to panic!

[CLKD]

Tnx.  Hopefully the medical profession will take a step back and review the programme as well as the letters to national press which should appear, and not rush into altering anything!  I am waiting with interest to read letters to the editors. 

[Seasidegirl]

This feels like it may be another WHI type watershed where treatment for many woman is adversely affected by what should be a discussion about a specific issue - ie off licence oestrogen. 

I am also a Newson patient,  forced to pay because my GP refused me HRT (in favour of AD's).   The GP has  taken on my prescription but refuses to prescribe at 75 rather than 50 despite me still being symptomatic at 50.

I'm now paying again to try testosterone as GP regards T inside the reference range (0.101 upwards)  as being OK, again despite me being symptomatic in line with the nice guidelines. 

This is another pop at LN after the "how dare she prescribe T" guff from a couple of months ago.

I really fear this noise is going to make it even harder for woman to access HRT going forward as it creates confusion in already under informed HP's.

75mcg is within the licenced prescription, why does your GP refuse to go over 50?

She listed an additional risk of blood clots and that I wouldn't be able to stay on it very long.    All incorrect but she wasn't having any of it.

I took the success of her taking on the prescription and I'm going back to see another GP.    Baby steps

It's hard work and it wastes appointments

[bombsh3ll]

Where does the evidence come from that hormone therapy has long term health benefits regarding osteoporosis and heart disease?

It comes from a time when women were routinely prescribed physiological doses of estrogen, not minimal doses just to keep them off the floor, and only then if their symptoms are dreadful.

There are many, many published studies on this.

However many women on NHS treatment today are unlikely to be getting these benefits as the doses are so low, and blood tests are seldom done to confirm a bone protective plasma level of 250-300pmol/L.

I am in no way saying that everyone should take HRT or that nobody can have a healthy old age without it, but everyone should have the choice.

Certainly there is enough evidence to convince me it is the right decision - I don't know whether I would experience symptoms or not (I didn't with chemical menopause) but when the time comes I will just take my last birth control pill one day and my first HRT pill the next - since both my parents have osteoporosis I don't plan to ever find out what natural menopause is like.

I would also like all those affected by breast cancer to know that tamoxifen is also bone and heart protective, even though it may not help quality of life as much - it is a SERM with estrogenic activity in these tissues.

As a non carrier within a BRCA family I have given a lot of thought to what I would do if I got it, and I would regard tamoxifen as my "estrogen" in that instance.

[Gilla999]

I never really understood the 250-300pmol level a day thing and how that gels with the studies done on low dose combined contraceptive pills and progesterone only pills. The former (ie Zoely) showed an average circulating estrogen level of 183 pmol and POPs lower at circa 110 pmol. Obviously there are a lot of variances, but they are the averages. I read quite a few of the studies that were conducted regarding bone health and the POPs and they all concluded that at these levels there was no additional risk to bone health. I never really understood how that fits with the 250-300 pmol a day that I've always heard about. If bone health was at risk lower than 250-300 I don't think women would be allowed to take POP pills as contraception for decades?

In case anyone is interested in having a read, here's the link to one of the studies:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203087/