- Surge in cancer screenings linked to hormone replacement therapy (HRT)
- British Menopause Society issues new HRT management guidelines
- Rising demand for HRT raises concerns over irregular bleeding
Emerging cancer tests for women have increased dramatically in response to the dangerous high-dose prescribing and increased use of hormone replacement therapy (HRT), according to a report by the foremost menopause specialists in the United Kingdom.
Although the medications prescribed to mitigate some of the most severe menopausal symptoms are effective and safe for the vast majority of women, they may induce irregular bleeding, among other adverse effects.
Although irregular bleeding is common during the first six months of HRT use, it can be a symptom of uterine cancer in postmenopausal women after that point and should be investigated immediately, according to NHS guidelines.
Leading women’s health physicians have asserted that an increase in the number of HRT patients reporting irregular menstruation has led to a 43% rise in the number of patients undergoing womb cancer screenings over the past three years.
As a result of this concern, the British Menopause Society (BMS) issued new recommendations regarding the prescription and management of HRT-associated bleeding adverse effects last week.
One of the authors of the new BMS guidance and consultant gynecologist at University Hospitals Dorset NHS Trust, Poole, Timothy Hillard, stated, “These numbers will not come as a surprise to anyone practicing gynaecology.”
Since 2018, the demand for hormone replacement therapy (HRT) has skyrocketed due to the efforts of prominent advocates, such as television host Davina McCall, who have been advocating for increased awareness.
According to official data from the NHS Business Services Authority, the number of patients prescribed HRT in England increased by nearly a third in just one year, from 1.8 million in 2021 to 2.3 million in 2022. This surge in demand caused intermittent shortages of the drug.
In addition to a general increase in HRT use, Mr. Hillard stated that women are being prescribed HRT during perimenopause, the years preceding menopause, when hormone levels fluctuate, which contributes to the rise in hemorrhage.
“Women are still having periods at this time, so it may be unclear which ones require an immediate referral to investigate bleeding,” he explained.
There is a one-in-ten chance that irregular bleeding is indicative of cancer in postmenopausal women, whereas this risk is lower in younger women during perimenopause. He added that this was addressed in part by the new guidance, which was developed with input from the Royal College of Obstetricians and Gynaecologists and other prominent women’s medical organizations so that patients would not be referred for unnecessary investigations.
An increasing tendency for off-liability prescribing of higher doses of estrogen with suboptimal concentrations of progestogen is also cited in the BMS guidance as a cause of the issues.
HRT contains progesterone and estrogen, which are female hormones that diminish with age.
Obesogenic hormones are commonly prescribed to women in the form of patches, gels, or sprays; absorption occurs via the epidermis. Progesterone is typically administered in capsule form.
Additionally, both hormones can be combined in a single tablet. Progesterone deficiency and excessive estrogen, which are both considered safe when used within the prescribed dose range, are thought to induce endometrial hyperplasia, an aberrant thickening of the uterine lining.
This can result in excessive hemorrhage and an increased risk of uterine cancer; therefore, hyperplasia must be investigated if it is detected.
An investigation by the Mail on Sunday, which was published in April of last year, exposed concerns regarding the prescription of higher doses of hormone replacement therapy (HRT) by one in every five patients at Newson Health, a private clinic.
Approximately 4,000 women seek treatment for menopause at the firm each month. It is managed by Dr. Louise Newson, a general practitioner and proponent of high-dose prescribing.
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She insists that women experiencing menopausal mental health symptoms may require twice the approved dose of estrogen and that her method is not hazardous.
In contrast, the British Menopause Society (BMS), the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, and other organizations issued a joint alert in response to our article, cautioning that “to ensure patient safety,” estrogen HRT should not be prescribed in doses exceeding the licensed limits.
Before the past few years, specialists stated that they rarely, if ever, observed women taking such excessive doses of HRT.
“Everyone has noticed a tremendous increase in the number of patients seeking cancer investigations at our facility,” said Dr. Paula Briggs, chair of the BMS and consultant in reproductive and sexual health at Liverpool Women’s NHS Foundation Trust.
Although the majority do not have cancer, the woman is extremely concerned, and the tests are not enjoyable.
