Bridging The Gap (Part 1 of 3)

Published Dec 10th 2021

Cardiology!
Endocrinology!
Let's Talk

"If I had not been, dare I say, as 'bolshie' as I am, I would be on a plethora of cardiac drugs, NOT on HRT and still experiencing severe cyclical cardiac symptoms. I feel duty bound to explore every avenue possible, to be able to inform others living with similar experiences to myself."

The following is the main body of an email I sent to the SCAD specialist - 12/10/2021
(excluding personal information)

"Firstly, thank you for both your and Dr Wood's prompt email replies, with regards to my referral conundrum, Scotland to England. Success has been achieved (!) thanks to an extremely competent GP.
Secondly, it was great to hear your talk at the Beat SCAD online conference a couple of weeks ago.
[25th September 2021]
It's great to know that I am much less likely to develop 'normal' heart disease !

I was interested to hear the advice regarding HRT - “smallest dose for the shortest period of time”  and ”if you can get through the menopause without it, all the better'“.

Having researched many papers and read the current guidelines on HRT, I would very much appreciate discussing them further with you.  
Having personally experienced the benefits of HRT in drastically reducing my cardiac symptoms, it seems that the message on HRT is contradictory and I would love to hear your expert opinion.  Maybe we could even arrange a discussion with the menopause specialist Dr Louise Newson of The Newson Health Clinic? www.newsonhealth.co.uk

I note that on the Beat SCAD website, HRT is not a contraindication for SCAD patients.
If the above advice is not specific for SCAD patients, but more general, then may I  draw your attention to the most current guidelines regarding Menopause/HRT, Breast Cancer and Cardiovascular Health, as the above advice is now outdated.

Understanding the Risks of Breast Cancer

Re the breast cancer risk:
It is now known that the media reporting of the WHI study in 2002,  resulted in an over-exaggeration of the risk, leading to both the public and Healthcare professionals being mis-informed.
Yes, using HRT does slightly increase the risk of Breast Cancer but the risk is the same as for those using the combined contraceptive pill, whilst oestrogen only HRT actually reduces the risk of Breast cancer.

And, this risk is actually less than for those who drink approximately 2 glasses of wine a day - and yet there are no Breast cancer health warnings on bottles of alcohol! I have attached a pdf, dated 2017, from the British Menopause Society - Understanding the Risks of Breast cancer

HRT as a Protective Health Care Measure:
Due to the ongoing/future health implications for women living up to a third of their lives without the protective benefits of oestrogen, progesterone and testosterone, 
HRT is now regarded in some quarters as a health protective strategy, rather than purely to relieve the menopausal symptoms.
I have attached a pdf of an article from Primary Care Cardiovascular Journal on the topic 
PCCJ article

The NICE guidelines state:

"Prolonged lack of oestrogen affects the bones and cardiovascular system
and postmenopausal women are at increased risk of a number of long-term conditions, such as osteoporosis."  
https://www.nice.org.uk/guidance/ng23/chapter/Contex
Cardiovascular disease  
 https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#long-term-benefits-and-risks-of-hormone-replacement-therapy   

Menopausal symptoms include breathlessness and heart palpitations - irrespective of whether the patient has had a SCAD or not.
I note that the European Position paper on SCAD points to the fact that progesterone (in the form of the Mirena coil) has beneficial effects for women experiencing ongoing cyclical chest pain.
Also, The British Heart Foundation notes that Microvascular Angina "occurs most commonly in women at the time of the menopause between the ages of 45-55" 
So it would appear that evidence is already out there.

My severe ongoing chest pain continued post SCAD, until I began closely monitored HRT from a menopause specialist, Dr Hodson at -www.newsonhealth.co.uk

Without going into full details, it is now definite that the Utrogestan (progesterone) has completely relieved my ongoing chest pain.
(I tested it 3X, much to the horror of my menopause specialist Dr Hodson - however, point proven - whilst off progesterone my cardiac symptoms return, whilst on it - I have none)
I fully appreciate that I am not a medical professional, so may I refer you to the work that Dr Louise Newson [and her entire team] is doing in working with the public, the MHRA and manufacturers of hormone packaging, to name but a few, to increase  awareness of the evidence based information on HRT and the menopause.

With the guidelines from NICE and the evidence in  journals/papers such as European Journal of Cardiology et al, all seemingly agreeing on the benefits of HRT for women in relation to cardio health, plus the majority of SCAD patients being females with an average age of 44-53 (ie. potentially/probably menopausal) I feel that it is vital that the correct information is out there so that women can make informed decisions about their health. 

Although I have an appointment with you in May 2022, do you offer private appointments? I would dearly love to discuss this further.  I had a number of questions regarding the above, submitted for the Beat SCAD conference,  but they became very lost in translation.
As an extremely body aware Physical Therapist, who now has the good fortune to be in contact with both yourself AND a menopause specialist -

I feel duty bound to explore every avenue possible, to be able to inform others living with similar experiences.
Or maybe we could arrange a discussion with the menopause specialist Dr Louise Newson?  With that in mind, I have copied them into this email.
I look forward to hearing from you with regards to having a conversation, whenever you have time to reply.

Thank you for reading this.
12/10/2021.

STOP. THE. PRESS!!

The very next day I received an email from Dr Adlam:

"Many thanks for these very interesting insights.
I am going to take a bit of time to read through and digest this.
Your experience is certainly very interesting and thought provoking."

A week later I received a letter to say that my Virtual consultation with Dr Adlam had been brought forward from May 2022 to the beginning of December 2021.
I went back to my notes and pulled out the list of questions that I had prepared for my local cardiologist, which hadn't been answered.
You can see the full list of questions, and their answers in my next blog - Bridging The Gap - (Part 2 of 3)

Aaaand I'm done!

If you have read this far - bloomin' well done! Apologies that this post has been very 'wordy' and lacking in pics - has been the nature of the beast.

To sound like a radio presenter, "Tune In next time" for my continuing quest for information!

Have I have had any questions answered?
Have I been able to affect a conversation between cardiology and endocrinology (Heart doctors & menopause Specialists to you and me)
Will Jilly ever be on the Lorraine Kelly couch with Adlam and Hodson and Newson?!