Oestrogen is given usually through the skin to help menopause symptoms, and is very effective at controlling menopause symptoms. However, there are well known risks of blood clots, breast and endometrial (womb lining) cancer, which need to be discussed and managed. We know that up to 100 micrograms of oestrogen can be safely prescribed, along with a progesterone medication in most cases. A private clinic in the UK has hit the headlines with concerns raised around their use doses of oestrogen above the highest licenced recommended dose.
Dr James Read is a director of the York Clinic, and is also Director of Prescribing Safety at one of the largest NHS GP practices in the UK. He commented, “the problem is that high dose oestrogen is not known to be safe, and nor is it established practice. All medication has risk, and as responsible clinicians, we must know the risks and discuss these with patients before issuing a prescription.” “Doctors across the country have been aware that a private clinic has been issuing very high dose oestrogen, and this is something we have been refusing to support. Although doctors often prescribe drugs outside their licenses, for example in children or in pregnancy, this has to be discussed with the patient, and most importantly must be within established practice.”
Dr Helen Bedford is a BMS accredited GP, and a director of the York clinic. “There are rare situations where doses higher than 100 micrograms can be used but this must be carefully managed by measuring blood oestrogen levels until they get into the correct range. It should not be standard practice to prescribe doses over the licensed dose set by the UK medicines regulator. In all women, the amount of progesterone given to protect against endometrial cancer needs to increase as the dose of oestrogen increases, even within known oestrogen limits.”
The York Clinic will not prescribe doses higher than 100microgram. There are rare exceptions, but this would only ever be where blood levels can be monitored, and with the opinion of two expert clinicians – not as standard practice. This is in-keeping with the British Menopause Society (BMS) position and established medical practice.
