Resources / Is there a problem with high-dose estrogen?

Is there a problem with high-dose estrogen?

UK media reports have raised concerns about the use of high-dose estrogen in hormone replacement therapy (HRT). In this article, we explain why these concerns exist.

How is HRT typically prescribed?

When HRT is prescribed to women with a uterus (womb), it’s routinely given as a combination of estrogen and progesterone (or a synthetic version of progesterone called a progestogen). If estrogen is given on its own, it causes the lining of the uterus to build up (called hyperplasia) which carries a risk of uterine cancer. Progesterone (or a progestogen) reduces or removes this risk.

Recommendations based on research studies exist for how much progesterone is needed to protect the uterus for a standard dose of estrogen. Where higher than the standard licensed doses of estrogen are used, there are no clear data on how much to increase the dose of progesterone, so one can’t be sure how well the uterus is being protected. If the progesterone is being delivered via a Mirena coil, it’s likely that the protection will be better than when given orally, but there are no studies to show this.

Where higher doses of estrogen are recommended

It’s important that when higher than standard doses of estrogen are prescribed, people are aware of the risks. It’s also important to be clear about why a higher dose of estrogen is being recommended, as sometimes the problem being treated might not be solely due to menopause. For example, although estrogen is known to be very effective for the treatment of menopause-related low mood or depression, these may also occur for reasons unrelated to menopause, and other management may be necessary.

Estrogen-only HRT

Where the uterus has been removed (hysterectomy), estrogen may be given without progesterone, but high dose estrogen even in this situation may potentially carry other risks, such as the risk of a blood clot (deep vein thrombosis or pulmonary embolism), especially if given orally.

HRT at standard does is safe for the majority of women

It’s important to remember, though, that for the majority of women under the age of 60 or within 10 years of menopause onset, HRT is safe in standard doses, and the risks described above are very rare.

All NewWoman Health doctors practise and prescribe HRT according to national and international guidelines.

Why New Woman Health?

At NewWoman Health we have a commitment to educating, advising, treating, and supporting women approaching, during, and following menopause. Our wide range of medical and lifestyle interventions helps women to manage or minimise their menopause symptoms and improve their quality (and potential longevity) of life in an aspirational and uplifting way.

If you’re concerned about your menopause transition and/ or other menopause-related problems, including treatment options, we can support you with our personalised medical consultations with menopause specialists. Take the next step in ensuring your long-term health and quality of life by booking a consultation with us today.

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You are not alone. As a local example, in Manchester over 46% of council employees are female and over 40 years old. In a CIPD survey (2019) over 30% of women said they were unable to work because of menopausal symptoms.

Only 25% said they could tell their manager the real reason for their absence. The Council account for nearly 7% of all employment in Manchester. They implemented a new Menopause policy in March 2022. CIPD survey | Manchester Council Menopause Policy | CIPD Manchester

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