Hormone replacement therapy warning after rise in women referred for urgent womb cancer checks

Surging usage of hormone replacement therapy (HRT) and risky precocious dose prescribing has triggered a accelerated emergence successful women being sent for urgent cancer tests, says a study by Britain's apical menopause specialists.

The drugs, fixed to alleviate immoderate of nan worst symptoms of nan menopause, are safe and effective for nan mostly of women but tin origin broadside effects including irregular bleeding.

Although communal wrong nan first six months of starting HRT, aft that irregular bleeding successful post-menopausal women tin beryllium a denotation of womb crab truthful must beryllium investigated without delay, NHS guidelines state.

Over nan past 3 years, rising numbers of patients connected HRT reporting irregular bleeding person resulted successful a 43 per cent summation successful patients being tested for womb cancer, nan apical women's wellness doctors person claimed.

Such is nan interest that past week nan British Menopause Society (BMS) issued caller guidance connected HRT prescribing and guidance of bleeding broadside effects.

Timothy Hillard, a advisor gynaecologist astatine University Hospitals Dorset NHS Trust, Poole and 1 of nan authors of nan caller BMS guidance, said: 'These figures will travel arsenic nary astonishment to anyone moving successful gynaecology.'

Since 2018 location has been an detonation successful request for HRT driven by personage campaigners – including TV presenter Davina McCall – who person been pushing for greater awareness.

The number of patients being prescribed HRT successful England roseate by almost a 3rd successful conscionable a twelvemonth – from 1.8million successful 2021 to 2.3million successful 2022, according to charismatic figures from nan NHS Business Services Authority, starring to intermittent supplier shortages.

Along pinch a wide emergence successful nan usage of HRT, Mr Hillard said different logic bleeding is expanding is because women are being prescribed HRT astatine a younger age: during nan perimenopause, nan years anterior to nan menopause erstwhile hormones fluctuate.

'During this time, women are still having periods truthful location whitethorn beryllium disorder astir who requires an urgent referral to analyse bleeding,' he said.

'In post-menopausal women, there's a 1 successful 10 chance that irregular bleeding is simply a motion of cancer, but for younger women successful perimenopause that consequence is lower.' Part of nan logic for caller guidance – which has been drawn up pinch input from nan Royal College of Obstetricians and Gynaecologists and different starring women's aesculapian bodies – was to reside that, truthful that patients were not referred for unnecessary investigations, he added.

The BMS guidance besides cites 'an expanding inclination for off-licence prescribing of higher dose oestrogen pinch sub-optimal dosages of progestogen' arsenic a logic for nan problems.

HRT contains female hormones oestrogen and progesterone that wane successful mediate age.

Typically, women are prescribed oestrogen successful patch, gel aliases spray form, and nan supplier is absorbed done nan skin. Progesterone is usually fixed arsenic a capsule.

Both hormones tin beryllium mixed successful a pill, too. Oestrogen is safe erstwhile prescribed wrong licensed doses but experts judge excessive amounts, on pinch insufficient doses of progesterone, origin nan womb lining to thicken abnormally – known arsenic endometrial hyperplasia.

This tin lead to dense bleeding and an accrued consequence of womb cancer, which is why it's basal to analyse hyperplasia if it is discovered.

A Mail connected Sunday investigation, published successful April past year, revealed concerns astir 1 backstage clinic, Newson Health, prescribing higher than licensed doses of HRT to 1 successful 5 of its patients.

The firm, which sees astir 4,000 women a period each seeking curen for nan menopause, is led by Dr Louise Newson, a GP and advocator of high-dose prescribing. 

She insists women whitethorn request double nan licensed magnitude of oestrogen if they are struggling pinch intelligence wellness symptoms of nan menopause, and that her attack is not risky.

However, pursuing our article, nan British Menopause Society (BMS), nan Royal College of General Practitioners, nan Royal College of Obstetricians and Gynaecologists and others each signed a associated alert, informing that oestrogen HRT should not beryllium prescribed successful doses higher than nan licensed limits 'to guarantee diligent safety'.

Experts we said to opportunity that until a fewer years agone they rarely, if ever, saw women taking specified precocious HRT doses.

'We've each seen a immense emergence successful patients coming to america for crab investigations,' said BMS chair Dr Paula Briggs, who is simply a advisor successful reproductive and intersexual wellness astatine Liverpool Women's NHS Foundation Trust.

'Most don't person crab but it's really worrying for nan female and nan tests aren't pleasant.'