Hormone replacement therapy warned after increase in number of women referred for urgent checks for uterine cancer

The rising use of hormone replacement therapy (HRT) and the risky prescribing of high doses has led to a rapid increase in the number of women needing urgent cancer tests, according to a report from Britain’s top menopause specialists.

The medications, which are given to relieve some of the worst symptoms of menopause, are safe and effective for the majority of women, but can cause side effects, including irregular bleeding.

Although this often occurs within the first six months of starting HRT, irregular bleeding in postmenopausal women after this may be a symptom of uterine cancer and should therefore be investigated immediately, the NHS guidelines say.

Over the past three years, rising numbers of patients taking HRT and reporting irregular bleeding have resulted in a 43 percent increase in the number of patients tested for uterine cancer, top women’s health doctors claim.

That’s the concern that the British Menopause Society (BMS) last week issued new guidance on prescribing HRT and treating side effects of bleeding.

Since 2018 there has been an explosion in demand for HRT, driven by celebrity campaigners – including TV presenter Davina McCall – who have pushed for greater awareness

Hormone Replacement Therapy (HRT) pills used by women to relieve menopause symptoms

Timothy Hillard, a consultant gynecologist at University Hospitals Dorset NHS Trust, Poole and one of the authors of the new BMS guidelines, said: ‘These figures will come as no surprise to anyone working in gynaecology.’

Since 2018, there has been an explosion in demand for HRT, driven by celebrity campaigners – including TV presenter Davina McCall – pushing for greater awareness.

According to official figures from the NHS Business Services Authority, the number of patients prescribed HRT has risen by almost a third in just a year – from 1.8 million in 2021 to 2.3 million in 2022, leading to periodic shortages medicines.

Along with a general increase in HRT use, Mr Hillard said another reason bleeding is increasing is that women are being prescribed HRT at a younger age: during perimenopause, the years leading up to menopause when hormones fluctuate.

‘During this time, women are still having their periods, so there may be confusion about who should be referred urgently to investigate bleeding,’ he said.

‘In postmenopausal women there is a one in ten chance that irregular bleeding is a sign of cancer, but in younger perimenopausal women the risk is lower.’ Part of the reason for the new guidelines – which were drawn up with input from the Royal College of Obstetricians and Gynecologists and other leading women’s medical bodies – was to address this so that patients were not referred for unnecessary tests, he added to.

The BMS guidelines also cite ‘an increasing tendency for marketing authorization holders to prescribe higher doses of estrogen with sub-optimal doses of progestogen’ as a reason for the problems.

The medications, which are given to relieve some of the worst symptoms of menopause, are safe and effective for the majority of women, but can cause side effects, including irregular bleeding.

HRT contains the female hormones estrogen and progesterone, which decline in middle age

HRT contains the female hormones estrogen and progesterone, which decline in middle age.

Typically, women are prescribed estrogen in the form of a patch, gel, or spray, and the drug is absorbed through the skin. Progesterone is usually given in the form of a capsule.

Both hormones can also be combined in one pill. Estrogen is safe when prescribed within approved dosages, but experts believe that excessive amounts, along with inadequate doses of progesterone, cause the uterine lining to thicken abnormally – known as endometrial hyperplasia.

This can lead to heavy bleeding and an increased risk of uterine cancer. Therefore, it is necessary to investigate hyperplasia if it is discovered.

A Mail on Sunday investigation published in April last year raised concerns about a private clinic, Newson Health, which was prescribing higher than permitted doses of HRT to one in five patients.

The company, which treats around 4,000 women a month all seeking treatment for menopause, is led by Dr Louise Newson, a GP and advocate of high dose prescribing.

Dr. Newson (right) has campaigned prominently on the issue of menopause on behalf of women

Dr. Louise Newson, pictured next to Mariella Frostrop, left, with MP Carolyn Harris, Penny Lancaster and Davina McCall at a march campaigning for menopause awareness. She was criticized after allegedly prescribing HRT to patients in higher doses than recommended by the NHS

She emphasizes that women may need double the allowable amount of estrogen if they are struggling with psychological symptoms of menopause, and that her approach is not risky.

However, following our article, the British Menopause Society (BMS), the Royal College of General Practitioners, the Royal College of Obstetricians and Gynecologists and others all signed a joint alert warning that estrogen HRT should not be prescribed at doses higher than the permitted dose. limits ‘to ensure patient safety’.

Experts we spoke to say that until a few years ago they rarely, if ever, saw women taking such high doses of HRT.

“We have all seen a huge increase in the number of patients coming to us for cancer research,” said BMS chair Dr Paula Briggs, consultant in reproductive and sexual health at Liverpool Women’s NHS Foundation Trust.

‘Most don’t have cancer, but it is really worrying for the woman and the tests are not pleasant.’