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[Emma]

News from the European Menopause Conference 2015

http://www.menopausematters.co.uk/newsitem.php?recordID=161/European-Menopause-Conference

[CLKD]

Yippeee - sense at last 

So a GP should work with the lady concerned discussing symptoms and prescribing as necessary to alleviate those symptoms.

What is 'verbal' memory as opposed to ………. 

[GeordieGirl]

"Bio-identical hormones cannot be assumed to be safe"

Confusing.
On another thread here, a poster has had a consultation with Nick Panay who has prescribed bio-identical hormones - Utrogestan and Estrogel I think it was.  Both of these hormones are used widely, alongside a number of other bio identical hormones, as indeed they are in Europe too, where synthetics aren't quite as widely embraced.

So if the Menopause committee don't think bio identical hormones are safe, why are they prescribing them?  As I understand it, none of the studies that suggested a link between HRT and cancer actually used solely bio-identical hormones (ie not in combination with a synthetic variant)? There are also studies that suggest natural progesterones are a safer alternative to progestins:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1974841/

So does the statement above mean that the Committee suggest synthetic products are safer than natural?

GG x

[Dancinggirl]

It is all very confusing - I think it's to do with the terminology that different countries use. My understanding is that 'bio-identical' hormones often refers to HRT preparations in the States compounded by chemists or pharmacists but haven't gone through rigorous processing and testing that regulated HRT preparations have had. I could have completely misunderstood this but I think that these compounded preparations are tailored or adjusted so the balance of hormones, their efficiency and therefore their relative safety cannot be guaranteed.  Utrogestan has gone through all the necessary testing etc. so, whilst 'bio-identical', enough is known about it to deem it safe when used within recommended guidelines.
Most oestrogens in the UK preparations are bio-identical anyway.
I think there is still much to be learned about the longterm effectiveness and safety of the various HRT preparations. Many gynaes do deem Utrogestan as more 'Breast Friendly'!
I hope someone will be along to clarify this better than I have.  DG x

[GeordieGirl]

Or could it be Utrogestan (and a number of other bio identicals) are in a box ? (Call me a cynic...)

I know The Industry is against compounded hormones (even though these can be much more closely tailored to an individual), but bio identical and compounded are not necessarily the same thing, there are a number of bio identical hormones available in branded boxes.

Does the comment mean that bio identical hormones per se are bad?  Then why are they prescribed?
Does it mean that they're worse than synthetic hormones? (A wide number of trials suggest otherwise)
Does it mean that they can't be assumed to be better than synthetic hormones (a number of trials also suggest otherwise)

It's an ambiguous statement in the news summary and it would be good to have this clarified.

GG x

[Dr. Heather Currie]

Bio identical are generally the combinations that are made up in pharmacies, are unregulated and not recommended.
The hormones that we can prescribe and are standardised, regulated and well researched are those which most closely mimic our own hormones, estradiol and progesterone. These are now often referred to as "body-identical".
I hope that makes sense.
Best wishes
Heather Currie

[GeordieGirl]

Thanks Dr Currie...

I'm a little confused. Is this simply a matter of terminology? I understand a bio identical hormone is one with the exact same molecular structure to those hormones our bodies produce.  The compounded hormones have the same molecular structure. Do the preparations such as Utrogestan, Estrogel etc (which you refer to as body-identical) have the same molecular structure ? 


GG x

[Dancinggirl]

Thank you Dr Currie - there is a great deal of confusion about this and many of us refer to the HRT preparations we get from our doctors as bio-identical - I think 'body-identical' is a better description. 
DG x

[GeordieGirl]

Thank you Dr Currie - there is a great deal of confusion about this and many of us refer to the HRT preparations we get from our doctors as bio-identical - I think 'body-identical' is a better description. 
DG x

I'm concerned we're being mislead by the pharmaceuticals in this - I have chosen Utrogestan and Estrogel believing they're identical in structure to our own natural hormones (ie biologically identical).  If they're not then .....hmm. I want to take hormones that my body identifies.

According to the Endocrine society  “bio-identical” hormones as “compounds that have the exact same chemical and molecular structure as hormones that are produced in the human body". Likewise  the American College of Obstetricians and Gynecologists (ACOG) defines “bio-identical” hormones as “plant-derived hormones that are biochemically similar or identical to those produced by the ovary or body.”

So what exactly is  the difference in structure between those hormones (the estradiol and progesterone) in a boxed product such as Utrogestan, and one that is not boxed, such as...erm, progestrone? 

GG x

[Dancinggirl]

GeordieGirl - I have messaged you. DG x

[GeordieGirl]

Hi DG,
Got the message - thanks.

Basically my query is this. Let's strip aside names, packaging, and manner of delivery and look at molecules. We are talking of 3 categories :

1. Molecule 1 is the molecule that makes up our own, natural hormones in our bodies.
2. Molecule 2 is the molecule made from plants but which is identical to Number 1.
3. Molecule 3 is the molecule ....erm, made from plants but which is also identical to Number 1. And Number 2 ?

Or have I misunderstood this, and Molecule 3 isn't identical at all? (in which case I'm dropping my Utrogestan).
Is the main difference between 2 and 3 is that one is called bio-identical, one is now being referred to as body-identical?  If they're the same molecule does it really matter?

I understand there is an industry mistrust of compounded hormones rather than something in a box, but this is delivery rather than the molecule.  I'm not particularly commenting on this here, I just can't understand why, if a molecule is identical, it is called something different.

Perhaps an over simplified view but I'm sure you get my drift.

GG x

[Dancinggirl]

Sorry - I can't help with the biology of all this. I believe the Utrogestan I am using is the same progesterone I would produce naturally - but I could be wrong about this. I would actually be a bit sceptical about taking a compound put together by a pharmacist - would it really contain what they claim it contains? Just because something is bio identical doesn't necessarily mean it is any safer - progesterone in itself may be the cause or problem - I still get some nasty side effects(headaches) using Utrogestan, just as I did when I produced all my own hormones over 20 years ago.  Perhaps you could do an email consultation with DR Currie to really get your answer?  DG x 

[GeordieGirl]

Just because something is bio identical doesn't necessarily mean it is any safer - progesterone in itself may be the cause or problem - I still get some nasty side effects(headaches) using Utrogestan, just as I did when I produced all my own hormones over 20 years ago.

The WHI study that discovered the link between HRT and cancer used horse hormone, other similar trials used a mix of hormones but one of which included a synthetic hormone. Doctors who favour the natural route point out that there is (allegedly) no trial using exclusively bio-identical hormones (ie hormones with the same molecular structure as our own) that has found  these to be carcinogenic. They also point to trials such as the PEPI  trial that have proven the benefits of bio-identical hormones (oral micronised progesterone) over synthetic preparations, as well as a French cohort of 50,000 women has also shown that the risk of breast cancer decreased significantly when using bio-identical, micronised progesterone.

You mention you get the same effects from Utrogestan as with your own natural hormones - no great surprise if it's the same molecular structure. The side effects are not necessarily what makes something safe or unsafe though - that's what is happening inside our bodies, often unbeknownst  to us until much further down the line. We don't know whether our cancer risk / cardio risk/ or indeed any other factors are being affected by our choices and that's where clarity from the professionals is important. 

  Perhaps you could do an email consultation with DR Currie to really get your answer?  DG x

I think it's good to discuss this on a forum to clarify it? A wide number of us here use Utrogestan and bio-identical estrogens (or whatever term they want to call them) thinking that they're natural.  If they're not, are we being hoodwinked?  My Meno Clinic doctor insisted these were bio-identical hormones.

If this is simply a matter of syntax, then so be it - if a hormone matches my own, I really don't care how it's referred to. Perhaps we should just use the term "identical" to avoid confusion.

GG x

[Hurdity]

Hi there

Not had time to read the link and just got back from working and just saw this so quick comment!

Short answer - THEY ARE EXACTLY THE SAME MOLECULES!

Long answer - the main problem is that the term "bio-identical" has been hijacked,appropriated or whatever you like to call it - by the industry (mainly US based but also I think in Oz and NZ) which produces compounded so-called tailored hormone therapy using prepared formulations of the same hormones ie estradiol, and progesterone - which as far as I know are both derived from plants. It's impossible to find anything about the actual manufacture of these hormones (I've googled unsuccessfully) but I would imagine there are labs/factories out there which manufacture estradiol and progesterone into some sort of basic preparation, and which they sell to the various pharamceutical companies that produce the different branded products (I may be way off here - maybe each pharma has its own lab to produce their own hormones as well as the branded prep??).

So as you say Geordiegirl - there are American organisations and respected gynaes that are trying to point out that there is no mystique about "bio-identical hormone therapy" - because estrogel and utrogestan for example are branded bio-identicals - and are generally available.

The confusion as already pointed out by Dr Currie, is by this industry which began as a reasonable alternative to equine oestrogens and synthetic progestogens (maybe before branded bio-identical hormones were widely available in US?) but which now has seemingly by default claimed sole right to use this term. It used to be called "Bio-identical Hormone Replacement Therapy" or BHRT - in some circles - and implicit in this was that the hormones were individually tailored. (The validity of this is itself is open to question).

It is a great pity because in the UK (and I imagine in parts of continental Europe) we haven't had this problem and we know what we mean!

Long-winded way of saying the same as Dr Currie but as you asked further questions I thought I'd answer!

It is the so-called tailored BHRT and compounding pharmacies which are not well-regarded by the academic and medical establishment, not the actual hormones that they use - although the preparations that they make from the (body-identical) hormones (however this is done) is the bit that's not regulated.  I am assuming that they are actually using properly synthesised body-identical hormones which they then manufacture into creams and gels themselves?

Oh dear that really is long-winded but I'm very tired as well as having a lot on, and just wanted to say something!

Hurdity x

[GeordieGirl]

Thanks Hurdity - I did suspect this was simply a matter of syntax rather than stating that hormones with the same molecular structure were unsafe.  So it's not the hormones that are unsafe, but rather the distribution that is viewed with caution.

There seems to be a lot of flag waving when identical hormones are mentioned (whatever one wishes to call them), even though these seem to have fared better than horse pee in clinical trials and it would be a shame if these were suddenly dismissed because of any ambiguity.

It's actually quite sad compounded hormones come under such a cloud, the underlying principle of using the main hormones in the exact quantity needed to suit  the individual is surely better than a  'one size fits all' approach of some medication - a 100mg or 200mg pill may not always be the right answer. An individualised approach rather than a "standardised" one.  A shame also for NHS coffers too, prescribing a 'plain', generic hormone such as estriol ,estradiol and progesterone would surely end up much cheaper in the longer term than branded boxes. I guess where that falls flat though is it would need a more structured approach from the GP - or at least a GP who had more of an idea of what they're prescribing.  Unfortunately at the moment these seem to be a bit of a rarity where HRT is concerned (call me a cynic).

Anyway, at least it's clear that identical hormones are not actually being deemed unsafe after all 

GG x