Is your HRT dose safe?

Is my HRT dose too high

Hormone replacement therapy (HRT) and the menopause are rarely out of the news as celebrities and doctors alike have – rightly – raised the often devastating impact of menopausal symptoms on women and made wider accessibility to HRT a matter of national debate.

The question of HRT prescribing has recently come under the spotlight and reignited the controversy over what level of oestrogen it is safe to prescribe.

“We have seen some patients in the last couple of weeks concerned about their HRT dosage in light of recent press attention, and it is important to put their minds at rest,” explains GP London W1’s Dr Justine Setchell. “As a practice, we follow recommended guidelines, and I’m on the British Menopause Society’s specialist register. Very occasionally, some patients do require a slightly higher than normal dose, but this should always be prescribed with additional progesterone to protect the uterus as well as more frequent scanning.”

Women who are suffering from primary ovarian insufficiency (POI), also known as premature ovarian failure, which is when the ovaries stop working normally before the age of 40 or those who have experienced surgical menopause before the age of 51 need HRT to mitigate the long-term health risks.

“I have a patient who had gone into premature menopause in her early 30s, and she’s now 41 and needs higher doses of oestrogen. The recent press exposure had made her anxious so she wanted to know if she should drop her dosage, and I had to reassure her that she needs it to protect her bones, her brain and her heart until at least the age of 51, the average age of the menopause.”

Are you applying HRT properly?

If you’re still experiencing menopausal symptoms on HRT, it might not always be the dose that’s the problem. It might be the delivery system if you’re not absorbing enough HRT. So, if a patch isn’t working, you may do better with a gel or spray.

Application can also be an issue. It is essential to wait until oestrogen gel is dry, but this can sometimes be forgotten during the morning rush. Similarly, it is vital that the skin does not have any oils on it. If we use SPF in the areas we apply HRT, then this can reduce its efficacy.

Alternatives to HRT

“HRT is perfectly safe in the recommended dose, and you shouldn’t suffer from menopausal symptoms. It’s also important that patients know that there are increasing numbers of alternative, effective non-hormonal treatments available should HRT not be appropriate/wanted.”

Drugs such as Fezolinetant have been groundbreaking in the non-hormonal treatment of vasomotor symptoms such as hot flushes and research is ongoing looking at similar drugs for use in breast cancer patients who are unable to use oestrogen.

“We are also seeing a lot more younger women who are concerned they are perimenopausal. Often, they are still ovulating, if not quite as regularly, so they may not ovulate every cycle. Rather than prescribe HRT, I’ll often start then with a plant-based product that acts similarly to oestrogen in the body, and this may be enough at this point.”

Lifestyle changes and the menopause

“Alongside prescribing HRT, it is also vital that we talk to our patients about their diet, exercise, work, life stressors, sleep patterns, and other lifestyle factors. I see high-flying executives who have extremely high cortisol levels that probably won’t improve unless they are able to address some of these issues.

“It’s impossible to fix everything with just a patch or a gel, and other significant health problems may arise in the future if these lifestyle factors aren’t addressed.”

For more menopause advice, call +44 (0)20 4580 1152 or email [email protected] to arrange a consultation at GP London W1.