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[GeordieGirl]

Before my appointment with gynae doc next week, I've been avidly reading up on anything and everything menopause. I'm erring on the side of bio-identical hormones at the moment (a great book by Jonathan Wright helping to sway me on this, as well as others). The theory behind them makes perfect sense and there doesn't seem to be the same longer term dangers as with patented hormone preparations - though in practice I guess the proof will be in the pudding and I won't know exactly how they suit me until I try them.

Are many on here using bio-identical hormones? Have you had any side effects, and if so, was this simply a matter of getting the right dosage? It seems there's a bit of a science involved in getting the right personal mix. 

Having read on here a number of people concerned about their doctor trying to withdraw HRT, I have been gearing up for a bit of a battle with my gp who has totally avoided The Chat previously.  I was surprised to find then that the bio-identicals are available over the counter without prescription?  Does this give us more control over our own bodies rather than having to convince often out-of-date GPs?

Any feedback gratefully received 

Thanks,
GG x

[Cassie]

I use what is considered bio idential hrt in the form of the oestrogel plus utrogestan they are only available on a Drs script though, perhaps you are talking about the progesterone creams etc that contain wild yam, my gynae recommened not using them for myself as they would not be strong enough to do the trick as I was going through early meno....am sure that there will be someone who can be more helpful in this respect.

[GeordieGirl]

Is this the same thing Cassie?  [link removed]

An interesting article from the Daily Mail too:  http://www.dailymail.co.uk/femail/article-1197933/Should-middle-aged-women-taking-natural-HRT.html

GG x

[GeordieGirl]

Actually, that article still raised inconsistencies. The area really is a minefield. 

"The good news is that a bio-identical form of progesterone, called Uterogestan, has been licensed in the UK in pill form. 'Having a progesterone pill marks a big change,' says Dr Panay, 'as it delivers a more effective dose than a patch.'"

That's at complete odds to a lot of research which suggests hormones are best not swallowed, as then they're not affected by the gut or liver...  Perhaps he's been reading the drugs' companies own PR for the pills?

GG x

[Winterose]

Am sure Hurdidty will be along soon with a good breakdown on bio identicals - basically stay away from anything with Horse urine in it. 

[Cassie]

No those hormone treatments are made up by compounding pharmacists, the oestrogel and utrogestan is manufactured by a phamaceutical company and is fully licenced etc, not the same as the creams made up by compounding pharmacists, but Hurdity i am sure will be able to explain the greater details.

[Cassie]

I do agree about the hormones not being swallowed, the gel is rubbed in and the utrogestan I use vaginally.

[oldsheep]

I take a Utrogestan pill every night. The doctors I've seen at the meno clinic in London believe you're getting an exact dose. Other methods less exact, or so I was told. They weren't hostile to vaginal, just pointed out that if I needed help with sleep (I do) the pill is better.
They became hostile when I mentioned over the counter creams. They saw this as ineffective and self medicating and said they aren't strong enough to counteract the oestrogen.

It's whatever works, I think. My first experience of HRT was via a (non HRT-ish) gynae I saw and he put me on the mare's urine one. I had some breakthrough bleeding and also headaches for a few months, but it worked a treat when it came to sleeping. However I then had an aural migraine , cue general panic and I was moved on to gel after a referral to another gynae who worked with HRT.  Within days my breasts were like an unmilked cow and sore. That settled, then the gel stopped working entirely within 3 months. So he put me on pills. I started feeling weird and having bp spikes. By then I was a patient at the meno clinic. They moved me to patches, which they regard as the safest and surest.

[Cassie]

Hmmm....I would have imagined that vaginally the utrogestan goes more directly to where it is needed, but I am no expert and as you say what works for one, may not necessarily work for another, its a bit of a trial and error to begin with but I have been very happy on that combo as have many so perhaps chat to your Dr about prescribing and trying it for a couple of mths, it is bio.

[Essexragdoll]

I also did a bit of an investigation on BHRT last year, the initial consultation, blood tests etc is quite expensive and i was not sure if it actually worked, however I am also a member of another menopause forum where the majority of the women are from the USA or Canada and a lot of them are using this, and have given very positive feedback. As far as the Serenity Cream goes, I know numerous ladies that have tried this and only one of them has said it works !!

[Hurdity]

Hi GeordieGirl

I haven't had time to read this thread in detail nor time to do it justice at the moment (working away part of this weekend and preparing now!).

However just a quick post to say please do read these links about bio-identical hormones:

http://www.maturitas.org/article/S0378-5122%2809%2900263-1/fulltext
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049311.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219716/
https://nwhn.org/natural-hormones-menopause

Do also listen to this Youtube viedo by Dr Elisabeth Vliet explaining all about them:
https://www.youtube.com/watch?v=9XfpAATJkC8

Also do read her book "Screaming to be Heard" - very very good ( have got it and dip into it but not read it all!).

You've probably gathered that this is mainly an American phenomenon which started as a response to the previously widespread practice of prescribing Premarin (from horse urine) & synthetic progestogens. Also almost certainly arose because of their different healthcare system allowing lots of independent practitioners and theories to spring up and products sold on the back of these. Even mainstream American medicine has to speak up to counter this trend as you can see from the links.

Fortunately as others have said we have the NHS and can get bio-identical hormones (ie identical to hormones in our bodies) quite easily as Estradiol and progesterone (available as Utrogestan and the lesser used and unlicensed (for menopause) Cyclogest and Crinone). Had a quick glance at the DailyMail article and also I think as others said it contains inaccuracies.

By the way Nick Panay is one of the most eminent gynaecologists in UK!

If you come across other theories or anything which contradicts the information you find on this website then it is likely that it is not (yet) supported by evidence - this website reflects the most accurate state of knowledge as we know at the moment, and the ways to treat menopause, as well as pointing to sources of information and latest findings in the news items. Of course research is going on all the time.....

Sorry I don't have much time to discuss in detail at the moment but the links will explain better than I can and there are probably more around!  There was another one with some interesting information but it was part of a commercial site selling products - from US - and we are not allowed to post these, and nor would I want to promote certain products either!!

I hope you find the links helpful!

Hurdity x

[Hurdity]

Bump....This is the one - post below adds to the chemistry lesson thread info of Dana's. 

Hurdity x

[Dana]

I think Hurdity might have meant to put a link in, but I'll just repost what I said. I'll also add a few other thoughts – sorry to bore anyone, but I get a bit fired up about this subject.     .....lol…

It always concerns me a bit when I see people on MM talking about “bioidentical” hormones (when I know they are really referring to the regulated type of estradiol/progesterone HRT) because a lot of people will think that they are supporting the use of compounded hormones. I know I certainly did when I first came here. I don't think compounded hormones is something that is as much of an issue in the UK, but the problem comes from the fact that in countries like USA, Canada and Australia the term “bioidentical” actually means “compounded” hormones.

I'm certainly no expert on HRT, but over the last 5 years or so I have seen a lot of things said and written about "bioidentical/compounded” hormones. I even dabbled in them briefly right at the very beginning, but soon found out that the doctor I saw was a complete freak, and he blamed me for my symptoms when the progesterone cream he prescribed didn't work. Of course I needed estrogen, but he told me my problems were all psychological. That's the kind of doctor you may be dealing with in the compounded hormone industry.

Anyway, I first became aware of bioident/compounded hormones when I saw a show about it on Oprah about 5 years. Looking back, the fact that people like Robin McGraw (Dr Phil's wife) and Suzanne Somers were on the show, extolling its virtues, should have rung some alarm bells, because they're both pretty whacko. They were saying things like compounded was the only way to get “natural” hormones, everything the drug companies produce are “synthetic”, and basically scaring the bejesus out of all the women in the audience. I believed them, but then I knew absolutely nothing about HRT back then, but neither does the majority of women.

The people who advocate compounded hormones always purposely skew all the information they give and never tell the truth about prescribable hormones, simply because there is a lot of money to be made out of the alternate menopause treatment industry. So it always makes me laugh (or maybe I should cry) when I see people criticising the money that regulated drug companies make out of HRT. Do they honestly think that the compounded/alternate menopause treatment industry is a charity? At least the drug companies are regulated so you can be confident about what you're getting. With the compounded industry what you get could be anyone's guess.

(**edit - I'll just quickly add that the prog alone cream that the doctor prescribed cost me around $70 per month. The combined compounded cream from the internet company would have cost just over $100 per month. However, the cost of my regulated est/prog HRT costs around $20 per month - Aust dollars. So who's really making the money here?)

=================================================================================================

I'm part way  through a huge book by Jonathan Wright and Lane Lenoard on bio identical hormones and it's a real eye opener. Whilst the big drug companies have the huge budgets to push the sale of horse hormones,  they have very little interest in bio-identicals because they can't patent them.  That said, despite the lack of the multi million pound spends, this hasn't stopped the research, a lot of which has been carried out in Europe where the use of bios is much more widespread. There are a wealth of studies that also investigate the role of progesterone on our bodies, and the benefits this has on insomnia, depression, oestrogen related blood clots and bone density to name just a few. (Check out the PEPI study of 875 women, which used saw gains in bone density against a placebo group when progesterone or even progestin was used).

The term "bioidentical hormones" is really a term that shouldn't be used because it has different meanings in different countries. In countries like USA, Canada, and Australia it means compounded hormones, which most menopause experts don't advocate. Bioidentical is actually a non-scientific term, and most regular doctors don't use it. It is a term that has been adopted by the alternate medical community to try to convince women that it is the only way of getting “natural” hormones, and this is totally untrue.

The people who advocate compounded hormones (and it sounds like that is what the authors of the book you mentioned are doing) always seem to push this lie that drug companies don't use "bioidenticals" because they can't be patented, and this is not correct. They are just playing into the insecurities and confusion of women who are suffering the effects of menopause.

Drug companies already manufacture "bioidentical" hormones in the form of patches, gels, pills and capsules and they are prescribed as estradiol and progesterone by a regular doctor and dispensed by a regular pharmacist. This is something that these compounded hormone advocates always neglect to say, despite the evidence. They always just refer to the equine estrogen and progestin HRTs, without acknowledging that there are other natural types of HRT readily available.

In some cases, companies will even prescribe these compounded hormones over the phone/internet without you ever sitting face to face with a doctor. The treatment will be based on a saliva test which is even more unreliable than a blood test. Most doctors don't even bother with a blood test because of its unreliability. In my early stages of menopause I investigated one of these companies, and it was going to cost me in excess of $100 per month to get some creams posted to me, but I never actually got to talk to the doctor prescribing them. This was also about 4 years ago, so I'm sure it would be more expensive now. They seem to be able to get around the non-doctor thing because they aren't specifically regarded as “medication”.

Some other ladies have mentioned the book by Dr Elizabeth Vliet called "Screaming to be Heard", and IMO that would be a far better book for you to read than the one you are reading. It can be a bit heavy going in places, I will admit that I haven't read it cover to cover, by it is a very good reference book if you need to know something.

Of course women should be free to use whatever treatments they want in menopause, but they should always make their choice after they know ALL the information, and not just go by the purposely skewed information given by these advocates of compounded hormone treatments. These are just a few of the downsides.

•   Compounded hormones are expensive to buy
•   It has been found that some doctors prescribe compounded hormones either because they get kickbacks from the compounding pharmacy, or they themselves own the compounding pharmacy
•   No studies have confirmed that using progesterone topically (ie as a cream rubbed on the skin) will sufficiently oppose the estradiol/estrogen to protect the uterine lining
•   These hormone creams are made in a private compounding pharmacy so there is no overall quality control, and it has been found that incorrect ingredients and quantities have been used

These are just also a few links to recognised medical experts/sites that don't support compounded hormones.

http://www.studd.co.uk/bioidentical_hormones.php

http://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy/compounded-bioidentical-hormones-what%27s-the-harm-

http://www.menopause.org.au/for-women/information-sheets/34-bioidentical-hormones-for-menopausal-symptoms

https://www.youtube.com/watch?v=9XfpAATJkC8

[Cassie]

Spot on Dana.... my Dr also told me not to use the Progesterone cream as it was not strong enough to oppose the Oestogen.

[GeordieGirl]

A contentious area, and, I've been reading everything in sight on this over the past couple of weeks (anyone got shares in Amazon?  )

Ok this is how I see it (blame Dr John R Lee, Dr Jonathan Wright, Dr Marion Gluck, Michael Platt and a number of forums/ Facebook groups). A simplified version but I was reassured to see, in the Wright book in particular, huge lists of research studies with supporting evidence.

Which is better for you? A pre-packed ready meal in a box, lacking in essential nutrients, high in sugar but low in protein and containing chemicals that are alien to our body, or a meal made of delicious organic vegetables and lean meat?  A while ago we cut out as much of the boxed food as possible, the refined carbohydrates, the excess sugar and I now make the vast majority of our meals from scratch – we all feel so much better for it, even my teenage girls admit it and are now reaching for fruit for snacks rather than yearning for crisps and rubbish.

The premise of working as nature intended is logical and that's what bio-identical hormones are meant to do. We're not horses so why on earth should we be ‘replacing' the equillin in our bodies? We have never ever produced this hormone (unless you're reading this from your stable, have 4 legs and a shiny coat). It's no wonder therefore that this has longer terms effects on our bodies.
Copy nature – no more, no less. Replace what truly IS missing, and in the exact quantities for the individual. So why is this route not used more widely?

Bio-identical hormones are derived from natural products and as such, these can't be patented. Although there are a few branded products available, any company can produce these. The pharmaceutical companies prefer to push their own patented product as that's where the money is made (Premarin was the 5th most commonly prescribed drug in the 1970's before the Women's Health Initiative research proved its deficiencies). Currently in the US, drugs companies are trying to ban estriol, an oestrogen hormone common in our bodies and that is anti-carcinogenic….whilst at the same time seeking approval for a synthetic version (Trimesta).  Oh, and  at the same time they're also widely selling estriol in France. Our European neighbours are far more atuned towards natural replacements than we are.  Check out any report dismissing bio-identicals and the chances are the author usually has some link to a pharmaceutical company somewhere.

Copy nature – it's logical isn't it? These hormones have been keeping us ticking along for most of our years, produced by our very own bodies, so surely it makes sense to continue with these rather than something from another species or that originated in a test tube?

There are hundreds of research studies that prove the efficacy of bio-identicals, Much of this is published in cancer journals eg the International Journal of Cancer 2004, with research proving that BHRT does not have the same carcinogenic properties as HRT, and that some bio-identical hormones such as progesterone is not only anti-carcinogenic, but also helps in building bone density (not just protecting it). Oh and it's good for cardio-vascular and cognitive function too, as well as protecting against fibroids and cysts. Synthetic progestin does not share all these properties.  The pharmaceutical companies, trying desperately to protect their profit margins and sales of their own products suggest that because the WHO survey showed the significant increase in cancer risk with horse HRT, this must apply to bio-identicals too. That's like saying because Coca Cola is bad for you, natural orange juice will be too. Fortunately these claims are widely dismissed and indeed disproven by many studies.

A practitioner specialising in bio-identicals would ideally tailor the treatment to the individual. This starts off with a hormone test to see what is and isn't deficient. How many standard GPs do that? Most of my friends who are on HRT have simply been given a box, without knowing for certain whether their problem lay in their oestrogen, progesterone, testosterone, DHEA, thyroid or any other hormone levels. A ‘one-size' fits all approach leads to the fact so many women often don't ‘feel themselves' or simply can't get on with HRT. A friend who had a breast lump the same time as me did have a hormone test and it showed her to be oestrogen dominant – rather than prescribe progesterone or look at restoring her overall hormone balance, she has been offered anti-depressants by her GP.  (Shocking but I hear from a number of other forums this isn't uncommon)

The advantage of the tailored approach is that not only is the treatment specific to your needs, but (and this is something my own budget conscious GP is interested in) the prescription is not made of expensive branded product, but a mixture of cheaper natural hormones. For comparison , think the price of generic aspirin at 50p a bottle compared to Lemsip at £4 a box.  Unfortunately there are increasingly fewer compounding pharmacies available who do compound a prescription from scratch – most are now pill counters, our NHS being based on branded, patented product.  Fortunately my local hospital has a compounding pharmacy, but it took some searching out - my doctor initially really didn't know where to start on this.

A practitioner in BHRT will check their patient and if there is no relief in the symptoms, will finely adjust these – as our hormone levels can change over time, it's recommended to have a 6 monthly hormone test and review.  I'm not sure if this happens generally with HRT - a number of people on FB seem to have been given a box of pills and to come back if they still have symptoms.

The logic is sound and, when the dosages are correct, the practice is well acclaimed, the problem seems to be getting the treatment.  A lot of GPs are not experts in menopause or hormones and I was quite taken aback at what my own GP wanted to prescribe me without even looking closer into what my body was or wasn't doing.  (A friend who works at Liverpool Medical school confirms the lack of focus this has in the curriculum for doctors). Fortunately my doctor has actually been very open to discussing BHRT and is now looking into the options she's allowed to follow within her practice. I suspect it won't be akin to anything like the treatment I'd get from someone like Dr Marion Gluck or other leading physicians in this, but hopefully there's a mid point.

I guess we all instinctively look for the treatment that's best for us, but given the fact I feel so much better cutting out the unnatural substances and alien chemicals in our diet, for me it's only logical to look at a similar approach on a hormonal level.
I've a follow up discussion with my doc shortly (she was actually a lot more interested in it than I'd have expected), fingers crossed there's some way forward on doing this the right way and giving it a chance.