TV menopause doctor concerns probed by watchdog
BBCEngland’s health watchdog, the Care Quality Commission (CQC), is looking into “information of concern” at clinics run by one of TV’s best-known menopause doctors.
Dr Louise Newson has also lost her British Menopause Society accreditation, over the prescribing of high doses of hormone replacement therapy (HRT), BBC Panorama has learned.
More than a dozen patients from her privately-run clinics, Newson Health, told the BBC they had experienced complications. Some developed a thickening of their womb linings, a potential precursor to cancer.
Newson Health said it used a “wealth of clinical experience and data” to treat patients on an individualised basis to “provide the best possible menopause care”.
It also said its approach was consistent with national guidelines and that the British Menopause Society (BMS) was a charity and not a regulatory body.
The CQC told Panorama it was following up information it had received “to understand if there are any risks to people using the service and whether further action is warranted”.
Newson Health says it has addressed all points raised by the CQC and has not been notified of any resulting concerns. It also says it is confident in the quality of care it provides and maintains a Good CQC rating.
One woman told us that despite her HRT dose from Newson Health being three times the licensed maximum amount, her menopause symptoms had worsened.
“I had hot flushes all the time. It was relentless. Anxiety. Couldn't sleep. Didn't sleep for days.”
Four former Newson Health doctors have also voiced concerns to Panorama, with one warning that women could “come to harm”.
The British Menopause Society (BMS) told the BBC it removed Dr Newson from its register of menopause specialists last year because of concerns that “aspects of her practice” did not fit with “established guidance”.
It said this had led to the BMS, along with five other bodies including the Royal College of GPs, issuing a joint safety alert about high-dose prescribing.
The chair of the British Menopause Society (BMS), consultant gynaecologist Prof Janice Rymer, said high doses of oestrogen put women at risk of having unnecessary interventions.
The Menopause Industry Uncovered
Kirsty Wark speaks to women seeking menopause help away from the NHS and looks into prescribing practices at online clinic Newson Health, which is run by one of the world’s most well-known menopause specialists.
Watch now on BBC iPlayer or on BBC One on Monday 30 September at 20:00 (20:30 in Northern Ireland and Wales)
For many years, Dr Louise Newson has been seen as a positive force in the menopause debate, supporting women and empowering them to fight for the right care. She makes regular appearances on popular BBC and ITV programmes, and is described by some as the medic who kickstarted the UK's menopause revolution - which has seen more women being prescribed HRT and many workplaces introducing menopause policies.
Newson Health says it has seen 45,000 women since 2020 and employs dozens of doctors, nurses and specialist pharmacists. An initial consultation with a doctor costs £295, with a follow-up priced at £230. Many appointments take place online.
In some NHS trusts, women may have to wait between six months and a year for specialist support at a menopause clinic. This means some end up seeking private treatment.
When women are perimenopausal - the transition to menopause - their hormone levels fluctuate, then drop when they are in full menopause.
HRT is routinely used to help alleviate their symptoms, such as brain fog, hot flushes and mood swings.
It contains oestrogen, which reduces symptoms - but as this can thicken the womb lining, another hormone, progesterone, is often prescribed to protect the womb.
ITVHRT can be administered as a gel, spray, tablets or patches. The highest licensed dose of oestrogen for patches is 100 micrograms (mcg) per day.
Women can seek advice from their doctor on the licenced levels of other preparations.
100mcg is the level at which manufacturers have established safety and efficacy through clinical trials, which is then approved by the UK’s Medicine and Healthcare Products Regulatory Agency (MHRA).
Dr Newson says she sometimes prescribes over the licensed dose of 100mcg, stating some women are poor absorbers of oestrogen and that she tailors doses to meet their needs.
General Medical Council (GMC) guidelines allow UK specialists to prescribe above the licensed HRT dose if they think it will help the patient. Clinicians should explain the risks so they can make an informed decision.
The 15 women who spoke to Panorama said they had experienced complications after being Newson Health patients.
Of these, 13 said they had been on higher than licensed doses and some said they had developed a thickening of the womb lining - a potential precursor to cancer which can be caused by too much oestrogen and not enough of the second hormone, progesterone.
One of these women was Rachel Osmond from south London, who first started experiencing symptoms of the menopause during the pandemic. Due to lockdown she struggled to access her local GP, so started taking over-the-counter medication to try to relieve her brain fog, anxiety and hot flushes.
But “nothing was helping”, she says.
After seeing adverts for private menopause clinics, the 56-year-old decided to book a remote consultation at Newson Health. She saw one of the doctors and was prescribed 50mcg of oestrogen which she self-administered through patches.
A few months later, the doctor began increasing her dose. Rachel says she entered a cycle of her dose being upped, and her symptoms getting worse.
“I just kept getting told some women need higher doses and that ‘it all depends on your body,’” she says.
Over the course of eight months, Rachel’s oestrogen dose increased from 50mcg (half the maximum licensed dose) to 300mcg (three times the maximum licensed dose).
HRT has been shown to be safe and effective but the safety of prescribing higher doses has not been established in clinical trials.
Dr Paula Briggs, a sexual and reproductive health consultant and a former chair of the BMS, says while HRT can make a huge difference to women, it is when “things stop being regulated and safe” that “most experts would have concerns”.
Dr Newson told the BBC that there is no evidence to link higher doses of oestrogen to an increased risk of long-term harm. She says harm is more likely to be caused by failing to give women the doses they need.
Several women the BBC spoke to said the doctors treating them at Newson Health had continued to increase their doses of oestrogen despite worsening symptoms. Some said they had not been informed that the safety of doing so has not been established.
One of the clinic’s former doctors who wanted to remain anonymous told the BBC: “I have concerns that the continued current opinion and directions being offered by Dr Newson will, in time, cause women harm.”
As Rachel’s dose continued to rise, she says her symptoms became worse and she also started to feel nausea and pregnancy-like symptoms, such as morning sickness.
At the same time as the oestrogen was increased, Rachel’s progesterone dose - the second hormone that protects the womb - was halved.
Rachel started to experience heavy bleeding and pelvic pain. She emailed Newson Health with her new symptoms but she felt she received little support in return. By that stage, she had spent £2,300 at the clinic.
The clinic's email response included a price list, and made it clear she would have to pay for any follow-up appointments.
Rachel replied saying she'd had several consultations with Newson Health, her symptoms had become worse, and she had been having a difficult time. As a courtesy, she says, they gave her a free 10-minute call with a pharmacist.
In the end, she says she went to her GP, who eventually referred her to a team of NHS specialists who diagnosed her with endometrial hyperplasia - a change in the lining of the womb, which can lead to cancer.
Prof Janice Rymer, consultant gynaecologist at Guy’s and St Thomas’ NHS Foundation Trust - and chair of the BMS - believes Rachel’s womb changes were due to her treatment by Newson Health.
“I’ve never, ever prescribed that dose of oestrogen to anybody, and that dose of progesterone would not have been enough to counteract the effect of oestrogen on the lining of her womb.”
One of the former Newson Health doctors spoken to by Panorama said she felt the solution to reported issues “was always to prescribe HRT or to increase the dose of oestrogen”.
Another told us they believed Dr Newson had changed the face of menopause care “for the better” - but they wished she would “pause and reflect, accept help and collaborate for the overall better health of women going forward”.
Newson Health told us it “strongly refutes” the “characterisations” from the former doctors we spoke to. It says that it operates a “responsible audit practice” to ensure “patient safety and consistent levels of care”.
It also said that it “would not comment on individual cases” but operates a “shared decision-making framework”, as provided by NICE - the National Institute for Health and Care Excellence - and “adheres to the GMC’s guidelines for decision-making and consent”.
Rachel, who is still experiencing debilitating symptoms from the menopause, is slowly lowering her oestrogen dose, with the hope that will reduce the thickening of her womb and, in turn, reduce the risk of cancer.
If that doesn’t work, she has been advised she may need a hysterectomy.
“I’m scared,” she says. “Although I want it over and done with and finished, you know, a hysterectomy is not an easy surgery.”
Additional reporting by Kevin Anderson