Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: CazzaC on August 08, 2025, 04:07:19 PM
-
I am on 2 x 100 patches and 2 pumps of gel. I have been on HRT for 8 years and started on 1 x 75 patch. Gradually over 4 years my dose was increased to deal with my symptoms. I have been feeling fine on this dose for 4 years. My NHS GP has now said that I must reduce down to 1 x 100 patch They say high dose HRT can cause womb cancer. I have tried 3 times in the last 10 months to reduce my dose but even losing 1 pump of gel brings back symptoms. I am crying for no reason, very low mood, dry eyes and bad reflux being a few. Can a maximum dose of 100mcg be right. Are they not supposed to treat the symptoms
-
Hi 1 x 100 patch is the highest dose within licence, so GPs may insist on this. Some private menopause doctors will prescribe more.
-
I know that a lot of other medication is prescribed off licence so why not HRT?
-
Itsup to the GP…some will prescribe and some won’t.
-
Well I think that is ridiculous. They should want to do the best for each patient. They should be prescribing to deal with the patient’s symptoms
-
Guidelines advise treatment should be individualised however there is often pressure on GPs from the health board not to prescribe above 100mcg of estradiol.
Unfortunately healthcare has always been rife with misogyny and this is yet another example. Funnily enough the same beliefs about restricting and rationing treatment don't seem to apply around treating other conditions - a diabetic is never told sorry, that's the maximum dose of insulin you're allowed.
Higher doses of estrogen have not been shown to increase the risk of endometrial cancer for two main reasons
a) It is the amount ABSORBED that matters, not the amount taken. For example one woman can use a 50mcg patch and achieve a high plasma level of estradiol, and someone else can use the amount you do and have barely above menopausal levels on a blood test.
b) as long as you are using adequate progestogen to protect the endometrium, which can be assessed by ultrasound, then there is no increased risk.
Unfortunately however many of those who need a higher dose to achieve therapeutic treatment do end up having to self fund this.
Have you had any blood tests done to assess absorption?
Another thing to consider is that some people just don't absorb well through the skin, and oral estradiol at doses considered standard can do a much better job than tons of patches and gel in these individuals.
-
I agree, imo the NHS is more interested in saving money than the welfare of women. Some (like mine) are too frightened to prescribe anything off licence, even topical oestrogen that everyone except them agree is safe. You could try and NHS meno clinic though you'll probably wait at least for an appointment. And after 2 years wait they suggested that as 100 estradot wasn't controlling my symptoms I should reduce to 2 sprays lenzetto. You might absorb better from an implant but 2 months ago they weren't taking on anyone new for it because of supply problems. I gave up at that point and went to Newson who is happy to prescribe more but you pay for it yourself if your GP won't prescribe on their recommendation. Other options are online pharmacies if you say it's for long term travel or go to Spain where you can buy it OTC at some pharmacies. You could test your oestrogen levels and argue you're a poor absorber but it's still at the discretion of your GP.
You should see them floundering for another excuse when the thickened lining doesn't wash as you have a mirena...
-
I have had a blood test and my level was 455 which is well within an acceptable level. I waited 8 months to be seen at an NHS menopause clinic but the consultant just said you must reduce to 100mcg. I was also sent for a womb biopsy which is not very pleasant to go through. The results were benign. I am lucky enough to be able to afford to go to Newson Health but not everyone can. Women should not have to pay to get the dose of medication that deals with their symptoms. My GP surgery was happy to prescribe the high dose for 4 years. The change in their attitude came after the BBC Panorama programme
-
Hello CazzaC and welcome to the forum.
You say you are on two 100mg patches plus two pumps of gel, which does seem like a lot. Has your GP asked you to reduce to one patch but not mentioned the number of pumps ? Perhaps you are a poor absorber which would explain why it takes this regime to reach the level that works for you.
It is worth contacting Newson Health as I am sure that they will support you on this level of HRT.
Btw I completely sympathise with the emotional effects of low oestrogen, crying and low mood are my main problems though thankfully I seem to have escaped dry eyes and acid reflux.
Wishing you well and take care.
K.
-
Usual story, unfortunately. There is no other health condition that gets treated so differently from GP to GP but this. But after all you've said it does sound like private treatment is the way you'll have to go & I agree totally - you shouldn't have to.
-
Thank you for your kind words. I have contacted Newson health and they are very supportive. I now have a letter from them to discuss at my GP appointment in about 2 weeks time. It just all feels very frustrating There are a lot of women suffering who cannot afford a private consultation never mind funding the purchase of their HRT.
-
Let us know how you get on? I'm in the same boat and expecting my GP won't prescribe more either. Your blood levels may not help as they seem to think you have enough if it's 250-300.
-
Still a couple of weeks before my appointment but I will let you know how I get on
-
I have had my GP appointment and the Doctor said that they are under a lot of pressure from the NHS and the local health board to only prescribe a maximum of 100 mcg. Other drugs are prescribed off licence but they do not want to do that for HRT My surgery is having a meeting next month to decide what to do. My GP warned me that I might have to purchase my HRT privately to top up the shortfall. She did say that in 20 years as a GP she has never experienced anything like this for a medication. Women should not have to pay for the medication that they need to treat their symptoms
-
It's awful, but I admire them for being honest with you about the situation.
Such hypocrisy around "licenced doses" - I bet you could get an antidepressant prescribed in a heartbeat and those aren't licensed for menopause treatment at all, at any dose.
-
Hi CazzaC,
I’m sorry to hear about your situation with your GP not prescribing off license. I’m new to the forum and just wanted to reach out and say I’m in a similar position, because I found your posts really helpful.
I’m on 100mcg Evorel patches but my blood test with Newson Health showed my oestrodiol levels were low and they recommended increasing the dose to 150mcg. However my GP won’t. I’m experiencing some symptoms and am terrified of returning to the crippling morning anxiety and suicidal ideation I experienced last year so have paid for
a private prescription to stop a downward spiral. However, I admire you for fighting it with your GP and feel I should go back to my GP in future. Good luck and keep us updated.
-
Hi
It is worth going back to your GP. Some guidelines do say that they should be treating the symptoms. Could you see a different doctor in your surgery? The best GP in my surgery is female and going through the menopause herself. I’ve found that some male GP’s just don’t understand.
Good luck