Private GP Archives - Linbury Doctors

What is Hormone Replacement Therapy (HRT) and Bioidentical HRT?

Posted on March 19, 2023May 19, 2023 by Linbury Team

Private GPs

Our private GPs, Hala and Lucy, have a special interest in the menopause and are members of the British Menopause Society. In this blog post, they delve into the treatment of menopause symptoms and how Hormone Replacement Therapy (HRT) works. If you’re experiencing any symptoms of menopause or would like to talk to a healthcare professional, do get in touch with our private doctors on 0333 050 7338.

What is HRT?

Hormone Replacement Therapy is used for the treatment of menopause symptoms, such as night sweats and hot flushes. It works by replacing hormone levels that drop as you approach the menopause.

All types of traditional HRT contain oestrogen so it’s often started at later stages when progesterone levels are very low and oestrogen levels start to drop.

Administering HRT

HRT is also needed in premature menopause to maintain bone density. It’s important to note that, if you still have a womb (no hysterectomy) and just take oestrogen, the womb lining could build up and become a cancer risk. Therefore, HRT is co-prescribed with a generic dose of progesterone to stop this from happening.

Sometimes both oestrogen and progesterone are synthetic, and sometimes just the progesterone is. This means that these synthetic hormones are not identical to the ones found in the human body and are given in standard doses. If you are still having periods, it will be given in a cyclical manner. If your periods have stopped, it will be given continuously.

The benefits of HRT include reduction of night sweats and flushes, reversal of vaginal changes, improved mood and sleep. It can also help with joint aches and pains, skin and hair texture, as well as reduced bone thinning. Evidence concerning heart disease and dementia prevention is still controversial.

What are the risks?

The risks of taking HRT include blood clots in the veins, breast cancer in women over 50 (note there is no increased risk in women under 50), a small increase in risk of stroke, and possible increase in risk of ovarian cancer which goes on stopping the HRT.

The most important thing to bear in mind when discussing risk is to consider personal and family medical history. So, each case must be thoroughly discussed with a doctor. Our private GPs can help advise you in the best course of action. If you’d like to get in touch, please contact 0333 050 7338.

Contraception

HRT doesn’t act as a contraceptive. So, you would need to continue your method of contraception for two years if your last period took place under the age of 50, or for one year if your last period took place when you were over 50.

HRT can be given in combined tablet (carries a clot risk), a combined patch (no clot risk) or in the form of a gel or patch (no clot risk) in combination with a Mirena coil.

Bioidentical HRT

The aim of bioidentical HRT is that both hormones – oestrogen (in the form of oestradiol) and progesterone – mimic those that are produced naturally before the menopause.

It would be wrong to call bioidentical HRT ‘natural’ as you are still replacing something that a woman wouldn’t be producing after going through the menopause.

Bioidentical HRT is normally given in the form of an oestradiol patch or gel along with a progesterone capsule called Utrogestan that is taken at night. The benefits of it from the point of view of reliving menopausal symptoms should be identical to that of traditional HRT.

About 1 in 20 women cannot absorb through the skin and therefore find the patches and gels ineffective at relieving their symptoms. This is the same for both the traditional and bioidentical HRT approach. Bioidentical HRT is still relatively new but, to date, the safety data is looking really good; it is pointing towards the fact it may be lower risk than the synthetic HRT approach.

Here at Linbury Doctors, we are delighted to offer doctors with specialist menopausal training; they are experienced in prescribing bioidentical HRT. If you’d like to speak to our private GPs, please call the practice on 0333 050 7338, or email info@linburydoctors.co.uk.

What are the Alternatives to HRT?

Posted on March 18, 2023May 19, 2023 by Linbury Team

Private GPs

In this post, our private GPs have summarised some of the symptoms you may experience during the menopause and some non-hormonal approaches for managing them. Members of the British Menopause Society, our private doctors Hala and Lucy have a special interest in the menopause.

Many women opt to avoid using Hormone Replacement Therapy (HRT) during the peri-menopause and menopause due to concerns about risk (which we address in this blog post). This may be due to personal or family history of breast or gynaecological cancers.

Vaginal Dryness

Vaginal oestrogen creams, pessaries or a vaginal ring which contains oestradiol can treat Vaginal dryness. This mimics the oestrogen a woman would produce before becoming menopausal. Unlike HRT, there is no systemic absorption so these don’t carry the risks that HRT would.

Vaginal rings can help prevent recurrent urine infections women can be plagued with following the menopause. Vaginal moisturiser and silicone-based lubricants are also very good if sex has become painful.

Ospemifene is a selective oestrogen receptor modulator that has an oestrogen-like effect in the vagina. It is non-hormonal and is being used to treat vaginal atrophy, and it may prove invaluable for oestrogen receptor-positive breast cancer sufferers.

Prescriptible Drugs for Hot Flushes and Sweats

The jury is still out about this, but low doses of SSRIs and SNRIs (forms of antidepressants) have been shown to reduce hot flushes and night sweats, as has a drug called Gabapentin which is often used for atypical pain or epilepsy.

Pregabalin is a controlled drug which has similar results to Gabapentin. It seems to be better tolerated but is more expensive. Clonidine is the only licensed medication at present but isn’t suitable for patients with a low baseline blood pressure.

Potential Alternatives to HRT

Always seek a medical professional to discuss the management of menopause symptoms. If you’d like to speak to one of our private GPs about the alternatives to HRT, please call our practice on 0333 050 7338.

Pregnenolone – This seems to work well for the ‘mind fog’: poor concentration, poor memory, and poor sleep cycle associated with perimenopause and menopause. This is a non-licensed drug via private prescription only.

5HTP – This is a non-licensed drug via private prescription only. The dosage is 100mg at night; it is also said to be good for sleep.

Vitamin D – Low levels of vitamin D are associated with low bone density and tiredness. It’s an essential vitamin to take especially during the British winter. 800-1000 units a day are recommended for maintenance therapy.

Evening primrose and fish oil – This works well for breast tenderness.

Magnesium – This proves to be good for anxiety and labile mood.

Chromium – Good for sugar cravings.

Multi-Vitamin B – Some evidence suggests that vitamin B may help with stress-induced anxiety.

Black cohosh, isoflavones and St. John’s wart – the jury is still out on this. Don’t take this without telling a doctor as it can interfere with liver metabolism and stop other important prescription medication from working. Breast cancer survivors should not use them.

Acupuncture – women do report some improvement in symptoms after having acupuncture treatment but studies show this is likely to be a placebo effect.

CBT – there’s good evidence that CBT can help with low mood and anxiety caused by the menopause.

One of the most important factors to consider is lifestyle as this can play a huge part in symptom relief. Cutting back on alcohol, spicy food and caffeine will help ease symptoms. Plus, weight loss (if BMI is over normal range) can be very helpful.

Smoking will make hot flushes worse and increase cardiovascular risk. Aerobic and weight-bearing exercise reduces flushes and sweats and it could increase bone density.

If you’d like to speak to our private GPs about the alternatives to HRT or to find out more about the symptoms of menopause, contact us on 0333 050 7338.

What are the Benefits and Risks of HRT?

Posted on March 18, 2023May 19, 2023 by Linbury Team

Private GPs

Here at Linbury Doctors, our private GPs Hala and Lucy, are members of the British Menopause Society and have undertaken training in the menopause. This series of blog posts delves further into the science behind menopause, and how to treat symptoms. In this post, we discuss the benefits and risks of Hormone Replacement Therapy (HRT).

If you haven’t read our previous blog post about what HRT is, you can do so by clicking here.

Misconceptions of HRT: The Million Women Study

Concerns over HRT safety were raised in 2002 and 2003 by the Million Women Study. The two main concerns raised were an increased risk of breast cancer and a raised risk of cardiovascular disease.

An urgent safety warning was released and the numbers of women taking HRT fell by 66%. That has only just started to change after 10 years so we have a whole decade of women who have mostly been denied the opportunity to benefit from HRT.

Many doctors stopped prescribing it and the workforce deskilled. The women in the study were north American, mostly overweight, often in their mid-sixties and therefore were not representative of who HRT would be appropriate for from a risk profile point of view. There has since been a retraction of some of the findings and recent studies have shown there is no increased cardiovascular risk on women who start HRT within ten years of starting the menopause.

HRT risk can be lowered if:

Taken for the correct reasons
Taken for as long as necessary at the lowest possible dose
HRT users have access to their GP at least once a year

Proven Benefits:

Control of menopausal symptoms
Maintenance of bone density and reduced risk of osteoporotic fracture

Potential Benefits

Reduced coronary heart disease risk
Reduced risk of Alzheimer’s when started early
Reduced colorectal cancer risk
Reduced risk of type 2 diabetes

If you’d like to speak to our private GPs, please get in touch with us on 0333 050 7338. Here at Linbury Doctors, we put our patients at the core of everything we do and always provide premium healthcare and advice.

Risks of HRT

Blood Clots

This risk is only applicable to oral preparations and not on the patch or gel. There is a raised stroke risk when oral HRT is started in women over 60.

Cardiovascular risk

This risk is only if HRT is started over the age of 60. Studies have shown that if HRT is started within 10 years of the menopause, it may actually reduce the risk of cardiovascular disease.

Breast Cancer

HRT does not affect the risk of dying from breast cancer. HRT with oestrogen alone is associated with little or no increase in breast cancer. HRT with oestrogen and progesterone can be associated with a small increase in the risk of breast cancer.

The current view is that HRT may promote the growth of breast cancer cells already present rather than causing the breast cancer itself. It should be noted that being overweight or drinking more than 14 units of alcohol a week carries a higher breast cancer risk than HRT.

There is likely to be an extra 3-4 cases of breast cancer per 1000 women after 5 years use of HRT after the age of 50, if started within a ten-year window of the menopause.

Linbury Doctors Private GPs

If you’d like to find out more about the benefits and risks of HRT, get in touch with our private doctors on 0333 050 7338. We can advise you on the best course of action if you are suffering from the symptoms of menopause.

6 Wellbeing Tips to Improve Mental Health during Lockdown

Posted on February 19, 2021February 19, 2021 by Linbury Team

There’s no denying that this lockdown has been tough and, as private family doctors, we understand that it has affected people of all ages. It’s so important to take care of your mental health as well as your physical health during this time and remember to be kind to ourselves.

It’s common to feel anxious, bored, lonely, unsure, frustrated or worried, and this is okay – there is no ‘right way’ to live through a global pandemic! For most, these uneasy emotions pass over time, but we thought we would share our advice on how you can help improve mental wellbeing at home.

As private family doctors, we encourage you to reach out for further support if you feel like you need it, whether that be speaking to a friend or family member, or getting in touch with your GP. If you’d like to speak to one of our private doctors, don’t hesitate to get in touch with us on 0333 050 7338. Find out more about membership here.

1. Set a routine

For many, the loss of routine during lockdown has been particularly difficult. However, by setting simple tasks throughout the day, we can help ourselves feel more productive and structured. From making the bed to walking the dog, eating breakfast to going for a walk, these tasks don’t have to be difficult, but it’s all part of regaining a sense of control during these uncertain times.

2. Move your body

Exercise can ease anxiety levels and getting outdoors in the fresh air can help boost our immune systems. Taking a simple walk is all it takes to release those endorphins!

You could also partake in some at-home workouts and there are lots of instructional videos to follow online.

3. Stay in touch

It can sometimes feel difficult, but keeping in touch with your friends and family is really important. Whether it’s a phone call, text, or video call, there are lots of ways to keep the connection.

As private family doctors, we often direct our patients to MIND.org.uk for self-help advice. Connecting with other people who are going through similar experiences is often helpful; you’re not alone.

Always seek medical help if you need further support; our private doctors have urgent, flexible and out-of-hours appointments, and we also offer home visits. Find out more about becoming a member here.

4. Spend time away from your screen

Although it’s good to be in the loop with what’s going on, make sure to take time away from news sources, social media sites and television screens every once in a while. Constant news updates can often feel overwhelming, especially when we have little control over them. You could turn off news app notifications, set dedicated time away from your phone, and swap the TV for your favourite podcast in the evenings.

The Forest app helps you stay off your phone screen and focus on life around you. In the app, you plant a virtual tree, which will grow as you stay off your phone – eventually, you could grow a whole virtual forest!

5. Make time for yourself

Whether you’re working from home, home-schooling the kids, or have a never-ending to-do list, it’s often easy to forget to make time for yourself. Dedicating as little as 10 minutes of the day, first thing in the morning or last thing at night, can make a big difference. The Headspace app has guided meditations and mindfulness techniques, which can really help you focus on the present.

As well as this, what we eat has a big impact on how we feel so to ensure you’re eating a healthy, balanced diet, set aside some time to plan out your meals for the week ahead.

6. Get a good night’s sleep

As private family doctors, we know that getting a full night’s sleep isn’t always easy. Here are a few simple ways you can help yourself ‘switch off’:

Stay away from screens at least an hour before bedtime
Have a warm bath
Read a book instead of scrolling through social media
Listen to a podcast or audiobook – the Calm app has some brilliant materials to listen to before you sleep, from nature sounds to relaxing music, sleep meditations to bedtime stories.

Here at Linbury Doctors, our team of private GPs are experienced in general practise as well as mental health. If you’d like to find out more about becoming a member, get in touch with us on 0333 050 7338.

Meet the Linbury team:

Private GPs – Dr Hala, Dr Lucy, Dr Rachel

How does the COVID Vaccine work?

Posted on December 17, 2020August 21, 2023 by Linbury Team

We would like to share more insight into how the COVID vaccine will work, but before that; it is important to start this blog post by saying vaccines, in general, save more lives than any other medicine and come only second to clean water when it comes to preventing disease. Vaccines have been given to billions of people and have shown to be safe. They have become so successful that we have lost sight of many fatal diseases like measles, mumps and rubella. Instead, we’re left with no disease, and all everyone sees is a side effect from the vaccine, so they often get a bad press.

How do they work?

Most vaccines work by stimulating the immune system so it thinks it has met the disease before and fought it off. A lot of the vaccines we are used to are ‘attenuated pathogens’. This means taking a virus or bacteria and making it so it doesn’t cause that infection anymore but induces an immune response. They are called ‘replicating vaccines’, and some precautions sometimes need to be exercised in the immunosuppressed.

With Influenza, for instance, we take the virus, grow it, render it non-infectious by vaccinating with parts of the virus which triggers an immune response. This means if you were to come into contact with it, your body would be able to respond by releasing the immune cells needed as it had been tricked into thinking you’ve had it before.

There are several myths around, such as ‘the flu vaccine gives you flu’. But there is no possibility of this as the ingredients are inactive. We know it’s safe and it works.

Side effects are common, such as a short-lasting fever and a sore arm. Sometimes, the vaccine doesn’t work as well as we would like but that’s about matching the seasonal strain. We believe it to be a good match for the 2020 year.

What safety checks does the COVID vaccine have to pass before it can be used?

As the different variants of the COVID vaccine are being rolled out, they will be in rigorous trials. Once the trials have passed through the relevant stages, the regulator gives approval for the vaccine.

In the UK, the regulator is the MHRA. The Pfizer vaccine was approved by the MHRA a few weeks ago and has just received emergency approval from the FDA (American regulator).

Even after the vaccine receives approvals, safety checks are still carried out and any effects are reported and reviewed.

Who decides who receives the vaccine?

The joint committee on vaccination and immunisation has independent experts who decide how the vaccine programme is rolled out.

mRNA Vaccines (Pfizer/Moderna)

Both the Pfizer and Moderna jabs use technology known as mRNA, which introduces into the body a messenger sequence that contains the genetic instructions for the vaccinated person’s own cells to produce the antigens and generate an immune response.

It does not alter human cells but merely presents the body with instructions to build immunity to Coronavirus. These are new, but not completely new, as they have been used in oncology and other clinical settings.

Concerned by the speed of the COVID-19 vaccine development?

With most vaccine development, it takes a long time to study and get the evidence as the infection pool is so small. With COVID-19, there was a huge infection pool, so we have been able to study the numbers needed in a small period of time.

The mRNA vaccines have been tested on up to 40,000 individuals, so they have been tested on the same number of individuals as any other previous vaccine in circulation. We know these vaccines are not causing severe adverse effects at this scale. Acute side effects are common, like being feverish next day or having a sore arm, but this is a strong signal that they are giving the immune system a kick and reassures you that your body is mounting a good immune response.

We know the first two vaccines prevent people from becoming unwell with COVID-19 and prevent serious illness. However, we don’t data have to see if they block transmission at present. As private doctors, we know that the risk of having serious consequences from getting COVID-19 – even if you’re not in a vulnerable category – is significantly higher than the risk of suffering mild side effects from the mRNA vaccines.

There have been some concerns raised that the mRNA vaccines may influence your chromosomes, but this is a myth; they are particularly safe as don’t penetrate the nucleus of cells. Plus, they are cleared from the system within 72 hours. There is therefore no link to mRNA vaccines and genetic modification.

The Pfizer vaccine has passed rigorous safety checks and, very recently, we received the welcomed news it has also passed emergency FDA approval so it will be rolled out in the United States.

The MHRA are continuing to monitor for side-effects, but only 2 people out of the thousands who received the vaccination in the first week developed allergic reactions.

Therefore, the advice has changed so that people with previous severe allergic reactions are unable to receive the Pfizer vaccine and the situation is being monitored.

AstraZeneca/Oxford Vaccination

The Oxford vaccine works like a traditional vaccination, more like the attenuated vaccines already discussed. It uses a harmless virus altered to look a lot more like the pandemic virus. An attenuated ‘spike protein’ of the virus is injected which the immune system builds up a response to as if the real virus has entered the body. Therefore, if you then come into contact with COVID-19, the body’s immune system will recognise this ‘spike protein’ and raise the immune response.

Source: BBC https://www.bbc.co.uk/news/world-us-canada-55149138

Two full doses of the Oxford vaccine gave 62% protection, a half dose followed by a full dose was 90% and overall, the trial showed 70% protection.

Should I have the vaccine if I have had COVID?

Yes, is the short answer. The current recommendation would be to have the vaccine if offered, even if you have had a proven COVID-19 infection.