In her latest column, Editor-in-Chief Katy Sunnassee shares her views of the Panorama menopause documentary and why it missed the mark for her.

Did you see the BBC’s Panorama: The Menopause Industry Uncovered on Sep 30? It’s put the cat among the pigeons for sure, sparking heavy debate on social media. Menopause heavyweight Davina McCall spoke out in terms of both her respect for presenter Kirsty Wark but also her disappointment at how she felt the show was a setback in terms of menopause care.

I was away at the time but watched the controversy play out, even wading in with my own comments on Davina’s post. But whatever my viewpoint, one thing was for sure: the show was a witch hunt against Dr Louise Newson.

The reporting centred around how doctors at her clinic prescribed doses of oestrogen often 2-3 times greater than what is considered in the UK as the safe upper limit, which is 100mcg of estradiol.

As a result, some women experienced severe side effects. Some patients shared that when symptoms persisted, the answer was often to increase their dose. An undercover reporter made an online appointment during which she was told she could triple her dose of estradiol, despite saying she was already on a 100mcg patch. But Newson Health won’t be the only place in the UK doing this.

Another doctor said many GPs often go “off label” and prescribe higher doses. Why the focus on Dr Newson? I guess it was easier to target her as she’s been the “poster child”, as it were, for HRT since it rocketed into mainstream consciousness around five years ago, as she’s so often on TV promoting its safety. Perhaps the main point of the show was to provide a counterbalance to what has, to date, been largely only positive praise for HRT in the media. If so, it did its job!

More detail please

But for me, there was a glaring question left unanswered: did any of the women featured do a DUTCH test prior to taking HRT? I suspect not. The DUTCH test is a urine test that shows how your body metabolises hormones, i.e. how you process them so they’re either excreted or re-circulated. Estrone (E1) and estradiol (E2) become either 2-OH, 4-OH, and/or 16-OH metabolites.

In a nutshell, 2-OH is the safer pathway, 4-OH can be toxic and potentially cancerous, 16-OH-E1 may contribute to oestrogen-sensitive tissue growth (breast, endometrial), while 16-OH-E2 (also known as E3) may have protective properties – confused.com indeed! The above is a more detailed version of the comment I posted on Davina’s Insta, which to date has received 25 likes so must have struck a chord with others feeling the same.

I got the numbers a bit wrong on the post as I was writing off the top of my head, but the above detail comes from the DUTCH test website – I’d encourage you to read the full article.

We need to know which pathway our body favours before taking any hormones. This was first explained to me by Future Woman when I did their test. I meant to write more on it at the time, but the documentary has highlighted how important these tests are, so I’ll do a newsletter on the topic – possibly even a live with some hormone experts if they’ll come on to chat…

For details on my own test, see katyperimenopause.substack.com. Also check out future-woman.com who helped me understand this!

Read Katy’s ‘Katy Perimenopause’ column in each issue of Top Santé, or read past columns here.