Do you feel like you’re drowning? In a social media post, these eerie words struck a chord with Paula Rastrick.
The advertisement for a private clinic specializing in menopausal treatment appeared to mention all of her symptoms, including anxiety, insomnia, exhaustion, and lack of libido. They were symptoms that Paula had previously attributed to stress. She had lately endured unemployment, an abortive house transfer, and the start of a new business.
But the 45-year-old psychotherapist and mother of one began to feel like she was drowning. Could her hormones be to fault as well? If this post was any indication, then the answer was affirmative. Additionally, there was a treatment that could assist. “You may once again feel like yourself,” said another post.
Paula scheduled an appointment at the clinic in an attempt to find anything to alleviate her stress.
A few weeks later, a 30-minute interview was brief and to the point: the doctor informed Paula that she was perimenopausal, the stage before menopause in which a woman is still fertile and has periods, but levels of the female hormone estrogen fluctuate, causing symptoms.
She should immediately begin using HRT patches and tablets.
Paula asked a few inquiries. She states, “This was a specialized menopausal clinic, and the doctor was highly regarded.”
I was unfamiliar with hormones and scarcely knew what estrogen was. However, I was not feeling well. I only did what was suggested.
Paula was promised that the drug would help her feel better.
In actuality, that February 2017 appointment marked the beginning of a year-long ordeal that Paula is still attempting to come to terms with — one in which her symptoms worsened, her mental health deteriorated to the point of breakdown, and her marriage nearly fell apart.
When she returned to the clinic, despite her fragile condition, the specialist – whose identity The Mail on Sunday cannot disclose for legal reasons – simply increased her HRT dosage.
Following this, she says that, at her lowest point, she contemplated “driving off a cliff and ending it all.”
And, unexpectedly, she began to have significant monthly flow. After six months of worsening health, Paula finally visited her primary care physician.
He promptly informed her that the ‘alarmingly high’ dose of HRT she was taking was to blame.
Paula was initially administered the maximum dose patch, although she was unaware of this at the time. When adjusting her medication, the private menopause doctor doubled the dosage.
Both of these actions violate standard guidelines developed by health watchdogs and drug manufacturers.
According to Paula’s primary care physician, the doctors who later treated her, and the gynecologists consulted by this newspaper, her bleeding was a direct side effect of the medication.
Her psychological issues, which included tearfulness, fear, uncontrollable, illogical wrath, and suicide ideation, could have been at least aggravated by the hormone medications.
Today, Paula is, fortunately, feeling better. She is still using HRT, albeit at a moderate dose, at age 50.
Antidepressants alleviated most of her distress, and she reports: ‘I’m doing well. It was difficult to get here, but the hardest part is over.’
While discussing her toughest moments on The Mail on Sunday’s Medical Minefield podcast, her emotions are still raw.
Paula has decided to speak out to warn other women since she is sadly not alone. Private physicians are prescribing large amounts of HRT to a growing number of women, according to numerous credible specialists with whom we consulted.
The majority of field medics adhere to guidelines established by the National Institute for Health and Care Excellence (NICE). They warn that an increasing minority of employees are ignoring the guidelines.
HRT is amazingly efficient at alleviating many menopausal symptoms, but it is not risk-free, especially when administered in excess.
There can be devastating consequences, as Paula nearly too late realized.
Paula recalls her mental state before booking her first private visit, which cost approximately £300, as follows: ‘Life had been tremendously stressful for a very long period. I simply desired to feel well. These social media posts struck a chord with me, and I thought, “They understand what I’m going through.”
Although I was not experiencing hot flushes, I felt apprehensive, tight, and angry. I had difficulty sleeping and concentrating, and had lost interest in sex and life. I often found myself crying for no apparent reason, despite feeling fatigued.
Before my visit, I filled out a detailed questionnaire on this topic, but we did not address it. During the consultation, the physician stated that my symptoms were caused by a shift in my hormone levels.
Paula was prescribed Evorel, one 100 microgram patch twice each week, and Utrogestan, a medicine containing progesterone, another female hormone, to be taken daily for two weeks every month.
A follow-up appointment with the same doctor in two to three months was recommended.
Paula says, “I felt relieved at that time.” I had an explanation for why I had been feeling so poorly and was receiving treatment to help me recover.
But this was not the case. Paula was taking her prescribed medication, but she admits, “My life was still hectic.” I was attempting to create a new business, which was something I had never done before. I had recently completed eight months of arduous redundancy negotiations. I felt unable to take a break and was desperately fighting to remain afloat.
In the following months, Paula’s mental health deteriorated.
She states, “I began to get quite furious and aggressive.” “At home, I would lash out at the smallest provocation and rage at my husband.
“When a friend indicated that I didn’t appear like myself, I exploded in wrath at her.” I cringe to think about it now, but at the time I was incapable of rational thought.
I began drinking two or three glasses of wine every night, and more on the weekends, to help me fall asleep.
In May of that year, Paula’s next appointment at the menopausal clinic was scheduled. She recalls, “I emphasized that I had not improved and felt worse.”
“In retrospect, I believe I was depressed. After the birth of my son, I had been prescribed antidepressants, so it would not have been the first time.
I also stated that I had begun to hemorrhage between cycles.
In a follow-up letter to Paula, the doctor stated, ‘It is understandable that some of your worries are due to begin a new business, but I believe that some of your symptoms are hormone-related. You are not clinically depressed and do not need antidepressants at this time.
Paula was instructed to increase her Evorel dosage to two 100-microgram patches twice each week and was also supplied testosterone gel, a hormone medicine. She states, “I thought it would make me feel better.” At this moment, though, she “began to unravel.”
Paula says, ‘I became quite anxious, and my anxiety skyrocketed. My spouse and I were frequently squabbling.
“One Sunday morning, following a raucous argument, I was sitting in my car outside the church in my village. The sound of the bell’s chimes prompted me to conclude that this was the end. I’d simply drive off a cliff.
I wanted to end it because it was so horrible.
Thankfully, Paula did not carry out her plan. Following that, I moved out briefly, staying first in a motel and later with a friend.
And worse was still to come.
“One evening while I was in a pub, I got the most awful sensation, like if my insides were falling out of me.” I stood up and inspected the seat.
It was splattered with blood. I exited the building and contacted my husband, who arrived to pick me up. I don’t recall anything else because I was so distraught.
Paula, realizing something was awry, made an appointment with her doctor. ‘ I did not make the connection between the HRT and what was occurring. I requested another prescription from my general practitioner.
He looked at what I was taking and asked, “What are you doing with this much hormone replacement therapy?” We cannot possibly provide it to you.”
‘He explained that the bleeding and probably also how I was feeling were the results of the drug. He stated that my dosage would need to be reduced. I initially resisted because I was worried that I would disintegrate without HRT.
Paula was informed that she must undergo testing for womb cancer. The likelihood of getting the condition is increased by high doses of estrogen, and severe bleeding can be a sign.
She continues, “He asked me if I wanted to file a complaint with the General Medical Council regarding the specialist.” But I was too stunned to even consider it.’
Paula consulted a gynecologist and got scans the following week.
“At this moment, I simply broke down crying,” she said. Antidepressants and drugs to control the bleeding were prescribed to me.’ Thankfully, the cancer tests were negative.
The doctor gradually decreased my dose of HRT. And I gradually started to feel more like myself again, albeit it was a slow process. In 2020, Covid occurred, and we were forced to temporarily close the firm. I seized the chance to prioritize my health and my marriage. It has been difficult, but I believe I have finally recovered.
NICE and the Primary Care Women’s Health Forum have suggested that menopausal or perimenopausal women should begin hormone replacement therapy (HRT) with a low dose of estrogen.
If symptoms persist after a month, a dose increase within the permissible range should be explored.
The guidelines state that smaller doses can cause fewer side effects, including breast discomfort and vaginal bleeding while minimizing dangers [including uterine cancer]. The majority of women feel that a 50-microgram patch is sufficient for symptom alleviation.’
Four strengths of Evorel patches are available: 25, 50, 75, and 100 micrograms. According to the drug’s manufacturer, the lowest effective dose should be used for the commencement and continuation of therapy for menopausal symptoms. A 100-microgram dose… should not be exceeded.’
If a high dose of estrogen is administered, the British Menopause Society suggests that larger doses of progesterone should also be administered.
Progesterone has a preventive impact, decreasing the likelihood of severe menstrual bleeding and womb cancer. This further modification did not occur for Paula.
Gynecologists caution that certain private physicians routinely prescribe medications outside of the standards. A top medical source told The Mail on Sunday, ‘We are all aware of what is happening, and it is a major cause for concern.’ It has been the subject of high-level meetings.
Many of us have tried to communicate to these doctors that what they are doing is not best practice, but their ears appear to be deaf.
Dr. Paula Briggs, an expert in sexual and reproductive health and the chairperson of the British Menopause Society, asserts, “Guidelines are essential; they’re what keep patients safe.”
High amounts of estrogen and insufficient progesterone place women in danger.
Dr. Annice Mukherjee, a consultant endocrinologist, and women’s health expert state that Paula’s tale is not the only one of its like she has heard and adds, ‘It is best to practice to start patients on a low or standard dose of HRT and gradually increase it. If we administer higher-than-recommended doses of a drug – a practice known as off-label prescribing – it is vital that the patient receives justification and is fully informed of the potential hazards.
‘It is also important to note that not every midlife problem a woman experience is caused by menopause. Simply delivering HRT and administering additional hormones when a patient does not respond is an overly simplified approach to a woman’s health.
Paula’s encounter has left her rattled. Last year, she called the clinic and sought to file a complaint.
She explains, “As I chatted with the individual on the phone, however, I realized I could not go through with it. It was simply too painful to relive.
“I am still on HRT, although at a reduced dose. I wonder if I could stop altogether because I am currently in a nice mood.
I do not want anyone to fear taking this drug or to believe that HRT is hazardous. However, I received too much. I cannot say that drugs were the sole source of my issues, but I do believe they made matters worse.
What most terrifies me is that this is happening to other women.
