Private menopause tests risk undermining NHS care, doctors say
Expensive, over-the-counter hormone tests for menopause are clinically useless and risk undermining women’s healthcare, senior doctors have warned.The testing kits, offered by private clinics and available to buy for self-testing, claim to offer tailored insights through measuring hormone levels.But they have been described by experts as misleading and medically unnecessary.“There are lots of private healthcare and telehealth clinics offering tests and increasing numbers of medically untrained, self-proclaimed ‘experts’ giving advice on social media and podcasts to get these tests done,” said Dr Stephanie Sterry, who recently co-wrote an editorial for the BMJ titled Menopause Misinformation is Harming Care.“Unfortunately, these tests are not evidence-based,” she added.
“They’re not giving us any new information or making treatment more effective.All they are doing is encouraging women to spend hundreds of pounds on tests that don’t make any difference to the treatment they should be given.”There are two types of menopause hormone kits in the UK: rapid urine-based tests – some of which claim to give results in just two minutes – and finger-prick blood tests, which are sent for laboratory analysis with results guaranteed in one to two days.Urine tests are available in high street shops including Asda and Superdrug for about £8.Blood tests range from £32 at Asda Online to £189 at Bluecrest Wellness.
Guidelines from Nice, the American College of Obstetricians and Gynecologists and the British Menopause Society agree that for women over 45, menopause should be diagnosed based on symptoms alone,Hormone levels fluctuate daily and, experts agree, offer no reliable diagnostic value,“These tests are marketed to patients and clinicians as necessary for ‘individualising’ hormone therapy,” Sterry said,“Yet in reality, these tests are of limited clinical use because there is no clearly defined therapeutic window for menopausal hormone therapy, and some testing techniques do not offer accurate or precise assessment of hormone levels,”For perimenopause and menopause, she added, hormone testing offers no reliable way to determine who will benefit from treatment, when the final menstrual period will occur or whether it is safe to discontinue contraception.
Dr Paula Briggs, chair of the British Menopause Society, agreed.“Things have gone very wrong,” she said.“The growing popularity of these tests has led to women having unrealistic expectations about what HRT can offer – particularly around mental illness and the existence of a ‘quick fix’.That, in turn, leads to the rise of unregulated treatments like expensive bioidentical hormones.”Briggs emphasised the need for collaborative, NHS-led care.
She said that she is so concerned about the commercialisation of women’s health that she no longer practises privately.Dr Susanna Unsworth, a menopause and women’s health specialist, agreed that hormone tests were “absolutely” harming care and are a “significant” problem.“I am definitely seeing this more,” she said.“Women often ask me before their appointment if they need blood tests done first.My answer is almost always no but increasingly, they turn up with pages of results they have organised themselves.
“The trouble is, most of these results cannot be interpreted meaningfully and that puts us both in a difficult position: the companies often advise women to take these results to their menopause doctor, so when I explain that they do not add value, it undermines their trust in me,” she added.Dr Martin Thornton, medical director at the private clinic Bluecrest, defended his use of the tests.Pointing out that they offer a GP consultation with the data results, he said: “A lot of this is about empowering women by providing them with data to correlate to their symptoms, because a lot of the symptoms are not straightforward.“Testing allows people to open up a dialogue with their doctor and can help you understand if it’s the menopause or something else,” he said.But Sterry rebutted that: “There is no evidence that the symptoms a women experiences in perimenopause or the severity of those symptoms, correlates to data received from blood tests.
“If a women has symptoms and her tests show no signs of menopause, then that can be very confusing,” she added.“This leads to underdiagnosis and undertreatment.“The principle of evidence-based practice is that a test should be done only if its result will directly guide patient care,” she said.“Hormone testing in menopause treatment is not supported by evidence and does not improve care.Treatment should be guided by a patient’s individual symptoms and not by treating the numbers.
”Asda has been approached for comment.A Superdrug spokesperson said: “Following customer feedback we launched the FSH [follicle stimulating hormone] test as women told us that they would like the choice to be able to measure their FSH levels.“Your result comes with tailored medical advice from our doctors based on a combination of the assessment answers, and the test result.”
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