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[Miranda_lady]

Hi, My private specialist is happy to prescribe above licence doses as this alleviates my symptoms, but NHS are not. I've had incredibly mixed opinions and some say there is a risk of cancers , but some references say there is not. Is anyone on high doses of oestrogen?

[Mary G]

I would go with the advice of the private specialist 100%.

The NHS are extremely conservative when it comes to HRT and they prescribe the barest minimum oestrogen dose and they are reluctant to prescribe testosterone.

They over prescribe progesterone too and this is because they don't monitor women with regular uterine scans. Basically they worked out how much progesterone women need to keep the womb lining thin and then doubled it as a catch all but it means most women are taking far too much progesterone and often destroying their HRT regime and wiping out the benefits of oestrogen.

The NHS really isn't great when it comes to HRT and the menopause.

[Miranda_lady]

Thank you so much for your reply. I understand that GPs have prescribing limitations. I didn't know about the progesterone over prescribing though! I've had to increase my progesterone to 300mg cycally and this seems to counteract the oestrogen effects! After a year's wait I had a video consultation with an NHS menopause consultant and he said it was crazy about the dose of oestrogen I was taking and I should be concerned about breast cancer. However, private specialists are saying he is incorrect! It's so tricky navigating. I've tried to do research and an happy that the licenced doses are safe, but there doesn't seem to be much research on over 100mcg oestrogen. Thanks again for your reply

[sheila99]

I agree with Mary. Also, the NHS don't test the level on your blood. Depending how you absorb you can put a lot on your skin and still have little in your blood. Imo cost control is more important to the NHS than adequate doses to control symptoms.

[bombsh3ll]

There is no evidence of a dose response relationship between estradiol and breast cancer.

Estradiol alone is actually protective against breast cancer, it is the progestogen component that is responsible for the small increase in breast cancer risk with combined HRT.

Additionally we should think about the amount absorbed, which can vary up to tenfold between individuals.

Even if you assume the worst case scenario and  believe estrogen poses harm, who is at greater risk, the woman on 50mcg patches with a plasma level of 1000pmol/L or the woman on 300mcg in patches with a plasma level of 400pmol/L?

Drs Newson and Glynne recently published a really good paper on this which you can search up and read, no pay wall.

[Furyan]

I recently switched private prescribers and I got the impression they are open to me taking above a 100 patch if needed. As it is, I recently changed progesterone types and quickly found I got much relief by increasing my oestrogen dose by adding a pump of Estrogel. In truth, I have room for more and I’m going to discuss this at my next appointment because, like you, I’ve heard from the NHS and ‘oestrogen dominance’ forums that I will have an increased cancer risk from taking anything above 100 patch.

That said, it’s encouraging to come here and see that some ladies are taking substantially more oestrogen than I am with positive effects on symptom control. I also read that a few women my age need to increase their oestrogen by quite a bit before reducing it again closer to 60. Dunno how widespread that need is though…

[Miranda_lady]

Thank you so much for your replies. I really appreciate talking to you all. My private specialist checked my oestrogen levels and they were high end. She said this was fine as I was peri and would be spiking and reducing which is why one can get symptoms, but that I'm absorbing. My testosterone was very low, so I'm on that now and it's made a world of difference to energy, libido, clarity. I'm listening to Estrogen matters on Spotify ( audio book) and it's pro oestrogen and reports it doesn't cause breast cancers. I just struggle to comprehend how a NHS specialist consultant can not have the correct information! I did have a cervical polyp ( removed on NHS) and the doctor said likely oestrogen fed, but still private specialist not concerned ( she also works in gynae NHS) I've had a knee jerk reaction and reduced by one pump as I'm so worried about the NHS opinion. Scans under private are so expensive. The specialist did also suggest the mirena coil, but I'm petrified of synthetic progesteron as I couldn't take contraception as it really affected my mental health. I understand that this is gold standard for keeping the endometrial lining thin though, so I'm considering this.

[Miranda_lady]

There is no evidence of a dose response relationship between estradiol and breast cancer.

Estradiol alone is actually protective against breast cancer, it is the progestogen component that is responsible for the small increase in breast cancer risk with combined HRT.

Additionally we should think about the amount absorbed, which can vary up to tenfold between individuals.

Even if you assume the worst case scenario and  believe estrogen poses harm, who is at greater risk, the woman on 50mcg patches with a plasma level of 1000pmol/L or the woman on 300mcg in patches with a plasma level of 400pmol/L?

Drs Newson and Glynne recently published a really good paper on this which you can search up and read, no pay wall.

I've read the Newson & Glynne paper on oestrogen dosing and effect on endometrial lining and it's really reassuring.

[Mary G]

Picking up on what Sheila said about blood tests, the NHS put out the line that hormone blood tests are worthless.  There is some truth in this pre menopause when hormones can fluctuate wildly but there is no truth in it post menopause when women are using HRT and need to know how well they are absorbing HRT products.

I think it's time for the NHS to be honest and if they can't afford to fund anything other than the most basic bog standard HRT at low doses, they should come out and say so.

[bombsh3ll]

Also what you have to bear in mind is that the NHS as a state funded system is designed to provide basic level care to the masses for the lowest expenditure.

Guidelines developed within such a framework focus on population level outcomes and cost is a strong consideration. They are not about providing optimal care at the level of the individual.

The NHS simply doesn't have the resources to provide either the necessary training, clinician-hours or the treatment itself to adequately meet the needs of every peri/menopausal woman.

Using universally low dose estrogen and heavy handed doses of progestogen works out best for the system as it avoids the need for any monitoring, minimises bleeding related consultations and investigation, and stops most women complaining of hot flushes, keeps them economically productive and their vaginas in a usable condition for men, outcomes which are considered the ceiling in terms of therapeutic objectives.

[Hurdity]

Hi Miranda-lady

 

Just to emphasise that if you are peri-menopausal then as Mary G says as well as your specialist - your oestrogen levels will be fluctuating and are likely to be very high around ovulation irrespective of the oestrogen dose you are using.

So I'm not clear what oestrogen dose  and delivery method are you are taking/using - are you saying you are on higher than 100 mcg or are hoping to do so?  If so what specifically are you hoping to achieve ie what symptoms do you want to alleviate? As you've already been told, during peri-menopause the fluctuations will add to your symptom burden though the added oestrogen is designed to cushion the blow from the oestrogen crashes. I'm also confused because you mentioned decreasing by one pump (ie gel) and then also you mention 100 mcg which is from patches?? Can you clarify please?

Also when you say you've had to take 300 mg progesterone - is this due to bleeding problems or simply due to the high oestrogen dose? Again it's tricky if you are peri. Can you tell us how long you've been on HRT and what your periods were doing in the months leading up to starting HRT - if you had them - this will give an indication of where you are in menopause.

Finally re scans. Ideally of course they should be available on NHS but they are not expensive (relatively speaking - though I realise not affordable for some). Yes they willl be if you have them done through your private specialist, but you don't need to. There is an organisation called "ultrasound direct" (easily found by googling) that will do basic scans very cheaply (and also do other investigations for menopausal women - which cost more) - started off for pre-natal baby scans.

They do a basic endometrial scan which is actually for fertility but I assume you can ask for this even if not for fertility - the website seems to have changed since I last had one. These are £90 but they do a post-menopausal scan which looks at other things which is a post-menpausal pelvic scan and that is expensive - it's £195. I don't like talking about pricing stuff because I realise it's out of reach of many but as you mentioned scans, thought I would say you don't have to pay a fortune....

Glad the testosterone is helping...

Hope this helps also

Hurdity x