The Daily Telegraph and the Sun published articles on Monday 19 December, relating to the prescribing of higher than licensed doses of oestrogen in HRT.
The British Menopause Society is aware that high doses of oestrogen are being provided routinely to women in some clinics. This could increase the risk of abnormal bleeding requiring investigation, endometrial hyperplasia and endometrial cancer.
Most women will respond to licensed doses, and it is important to make women aware that some symptoms, such as low mood and anxiety may have other causes and may require other additional treatments. This is safer than increasing the amount of oestrogen provided (outside of license). NICE NG23 recommends using the lowest dose of oestrogen that controls menopausal symptoms. That does not mean that the dose should be increased out of license or that different forms of oestrogen should be added together to control symptoms. In the event of a significant event occurring (such as endometrial hyperplasia or cancer) in women using different formulations of oestrogen, outside of license, the prescribing clinicians are responsible for having put patient safety at risk.
There is no recommended systemic level of oestrogen in association with use of HRT and response to treatment with HRT should be based on symptom control. Checking serum oestradiol levels is influenced by many factors including the timing of the dose and type of assay and cannot be assumed to be indicative of levels over a 24-hour period.
Routine testing of oestrogen levels is unnecessary and is associated with an unnecessary cost both to the NHS and patients in private clinics.
Higher doses of oestrogen require a higher dose of progestogen to ensure adequate endometrial protection (Tools for Clinicians: Progestogens and endometrial protection).
The British Menopause Society educates and supports healthcare professionals to ensure that women who require HRT can access treatment safely. The necessary guidelines are available on the website for all healthcare professionals and are not restricted to members.