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[Pollyanna]

Good morning ladies

It was suggested to me by another fan of BHRT, that I should start a new thread on this topic.   

Like most of us, I've explored many treatments for my own hormonal ups and downs.     I've researched things thoroughly, and listened to other ladies experiences of BHRT. 

Because the clinics that advise and treat people, using compounded (tailor made) hormone treatments are private, it can be quite an expensive journey, until you get things right... for you.  Just like anything in life, the more successful a doctor becomes, the more their fees hike up.   None of us want to throw money away but for me, I decided to go with my gut and with a clinic that was mid range, price wise, had a good reputation and longevity, and had experienced doctors for consultation. 

The doctors tend to treat a range of problems that are hormonal, not just menopausal.  They also treat men and younger people too. 

A male friend of mine was treated at the Marion Gluck clinic.  He is 60 and had been struggling enormously with exhaustion and low mood/libido.  He is a new man now.  And yet, he was very cynical about going there originally. 

I'd just like to add at this point, that on all forums, there will be many different types of women. Some have very strong views based on what they have experienced. Some will have a prejudice with anything that is outside of the GP's surgery.  I understand that, but all I am doing is sharing my own experience.  I accept we are all different and are entitled to make choices that are good for us.   

I'm a great believer in looking at things holistically, taking into account, not only physical symptoms, but also environment, relationships, stress, nutrition, sleep.   It can become so confusing when you're exhausted to figure out what is causing symptoms.    It can feel as if you're climbing a greasy pole, can't it?   

I have the view that if someone has good results from a complementary or alternative treatment, then I'm very pleased for them. I have an open mind to most things. 

I try my utmost not to give advice and it can be unwelcome when others do. Unless its requested of course.

The whole point i feel, is to share personal experiences. We are all intelligent adults and our bodies all react differently to others.

The Marion Gluck clinic is quite famous now. She is a doctor and specialised in obgyn, then went on to open her clinic around ten years ago. Her qualifications are on LinkedIn, for anyone who wishes to check her out.  And there is the her website of course.  She had worked for many years in Sydney and Germany, before coming to London.

I was going to try Prof Studd first of all, as I had read good things about him, but his fees are ridiculously high by comparison and personally, I felt I wanted to see a woman who had a more contemporary and holistic view of women's health. The MG Clinic are progressive and the consultation also may include looking at your diet and any possible auto immune conditions. 

My experience with my GP's practice has been appalling and (apart from the fab Jan at Oxford Brooks, who is lovely), have taught me that they haven't a clue about menopause or any of the other associated conditions. 

I may go back to the Gluck clinic if I hit a stone wall with NHS, as at least you're treated as an intelligent woman there, and not an idiot. 

Just to add to this.. .but not to bring in another subject.  I was diagnosed with CFS/Fibromyalgia a few years ago... by my GP.  Interestingly, this is an umbrella term for a whole load of symptoms that are very common in post menopause.   They tend to be triggered by stress, too much exercise and emotional trauma.   I have met a few women with this nightmare condition who, since having their hormone levels sorted at a private clinic, have almost no Fibromyalgia/CFS symptoms.   There is a strong link between low testosterone in a woman and CFS.  They also have been advised to take certain good quality supplements that the condition requries. 

Really, just another reason to look outside of the box of the limited, and sometimes outdated advice that the NHS is able to offer. 

Because of my own experiences and belief system, I would love to work in this field.  There's nothing more inspirational to other women who are struggling, than to speak to someone who has benefitted from things.   It can be a very isolating place, menopause.   
 
   

[coldethyl]

How refreshing to see an alternative take on treating menopause with hormones - I can't take anything as I am post ovarian cancer treatment but for women struggling with standard NHS treatment it is good to know that alternatives exist - especially ones that aren't in the realms of plain weird and wacky - again from reading round for cancer support , it is so important that we look at the whole picture and not just focus on one aspect - sadly the NHS is cash strapped and often I think somewhat blinkered to what is out there that might help women in the menopause - sometimes the benefit may indeed be centred round the placebo effect as if you feel you are being heard , the mind is a great healer of the body.
Welcome to the forum and keep posting xx

[CLKD]

 

[CLKD]

Certainly with thyroid function tests, GPs seem to be reluctant to do further testing despite patients presenting with repeated symptoms.

[dazned]

I always say use WHATEVER works for you individually,cos thats what we all are. Great to hear that you've had success and shared it with us. Thanks.☺

[babyjane]

I get excellent treatment from my NHS endocrinologist.  I would not get better if I paid, I would just get my appointments at a time that suited me, that's all.  He is a brilliant man at the top of his field, sees every patient as an individual and gives you as much time as you need at each appointment.  I can also contact him with a message via his secretary if I need to.

You are right, thyroid function is crucial to both physical and emotional well being.  The thyroid affects every system of the body.

Regarding the reference range, one person's 'high' can be another person's normal and one person's 'normal could be another person's low.  It is as individual as that.  My 'normal' is low to mid range and I always knw if my levels are not right for me.

It must be the same with the meno hormones too, each person being an individual and no 'one size fits all'.

[CLKD]

   BJ

[Hurdity]

Wow Pollyanna – you raise a lot of issues in your post – and I agree with perhaps almost all of them as I expect you realise if you've read my posts!

My main view also  - as I frequently express - is that a holistic approach to women's health encompassing many lifestyle issues are vital as we approach menopause and it's no good thinking that any sort of magic pill will suddenly make everything OK. This is also the view of the enlightened medical profession – and including the national and internationally menopause societies – that most of us should lose some weight (to within the healthy BMI range), take more exercise, eat a healthier diet, reduce refined carbs, extra fat and added sugar, eat more fish fruit veg nuts pulses and complex carbs, get more sleep if we can, reduce stress (!), learn to relax, reduce alcohol intake and stop smoking if we need to.... absolutely with you on that one.

Ditto the view of looking at our whole hormone health and also the links with CFS/ME and fibromyalgia – which like you, I have pointed out several times - and not just  eg oestrogen, in isolation, although this is a complex and contentious issue.  Although I don't have a thyroid condition, I have a close friend who has and has suffered  (also with fibro) who has explained it in detail to me – and of course the importance of looking at the individual not simply a reference range above which you need treatment and below which you are fine and are told what's the problem? From what I gather the knowledge and testing/treatment of thyroid conditions is inadequate especially when it comes to menopausal women.

The testosterone issue too – is a huge area which is under-researched and treated – so much more work needs to be done here so that women get the treatment they need and not fobbed off with a “there there you're getting old, should expect aches and pains, and perhaps you have fibromyalgia” which is what my doc said to me.

However what I also feel very strongly about is that treatments offered should be evidence based – for efficacy and safety (which is where this website comes in)  – whether mainstream or “alternative” – whatever that means. Otherwise we are into the realms of belief – while acknowledging  the power of the placebo effect  which is intriguing – but medicine cannot and is not based on this alone. So for example the placebo effect will not give you insulin if you are deficient, and in the same way nor will it make your bones stronger if they have been weakened by prolonged oestrogen deficiency, but may help with hot flushes, anxiety, panic attacks etc.  It can have some effect on some physical conditions – and also comes into its own for some emotional and mental issues for some people. Positive thinking aids recovery from all sorts of illnesses etc etc – a whole topic of its own!

The heading of this thread though was compounded BHRT – and this has been covered many times before – and is not recommended by gynaecologists, not only those who work for the NHS but not recommended by the Menopause Societies for reasons given before and recently – and best outlined in Heather Currie's blog – former Chair of British Menopause Soc. http://wwwmenopausematters.blogspot.co.uk/2017/01/bio-identicals.html  Of course we all would like a personalised approach – but in fact some private and very expensive gynaes ( like John Studd for example) – tend to have more of a one-size fits all approach to his treatment – judging by the reports on here – but correct me if I'm wrong! Ie 2-4 pumps of gel, 7 days prog per month and a blob or more of testosterone – titrated up or down to suit.

On this forum we share not only personal experiences but also information we have gleaned from reading or our own consultations which many of us share – and advice when we are asked, or just because we want to help others! I can't believe anyone would be so narrow (and in fact haven't come across this on here?) as to think that their GP is the fount of knowledge for all things menopause. There are some shining examples but most of us would benefit from a specialised menopause service from a practitioner that knows their stuff and can look at us as individuals – this is what we need on NHS!

As for the NHS vs private – it's not a question that one is narrow and out-dated and the other is open minded – it's a question of – if it is an evidence-based treatment – then it should be available to the many and not just the privileged few and this is what drives me especially to say the things I do on here, because I am aware of the hundreds if not thousands of women who come to this website who could not begin to afford private treatment of any sort – and would never advise them to put the cost on their credit card. I want everyone to feel that the basic treatment they need is within their grasp) and freely available (sadly not always testosterone but lifestyle changes cost very little!) and there are lots of us on here encouraging and cheering everyone on, to challenge their GPs if they are out of date, get those referrals to specialist clinics, make those lifestyle changes..... it's also a question of educating GPs and I know that there is a lot of work being done to get them up to speed on what is available on NHS - since the NICE Guidelines on menopause were produced.

Soap-box anyone? 

Hurdity x

[Mary G]

Pollyanna, thanks so much for starting this thread, it will help so many women who have yet to find the right HRT regime or feel there must be something better out there.  Marion Gluck is indeed a well known hormone specialist and I think most of us have heard of her.

My personal view is that HRT has been in a rut for a long time with development of new medication held back because of the now discredited health scare a few years ago.  I like the sound of a tailor made regime and this could and should be the future of HRT.  I realise that many women do well on the bog standard brands but there are many women who don't and really struggle.  I can only speak for progesterone intolerance which is a huge problem and very difficult to combat without taking drastic measures i.e. a hysterectomy.  A new generation of HRT could help with that and many other problems that women have.  I have noticed that some of the younger women who have had a full hysterectomy find it difficult to get the right balance of hormones and a tailor made combination of different hormones might be just the treatment they need. 

I have complained on here many times about the lack of choice and new HRT medication available and the current rigid and dogmatic approach to HRT.  Perhaps compounded BHRT and the new Duavive (for post menopause women who are progesterone intolerant) will open a whole new chapter in menopause treatment - it won't be before time.

The important thing is to be open to new ideas. 

[Hurdity]

The reason compounded BHRT is not recommended is for the reasons Dr Currie gives in her blog - her are the last three paragraphs:

Finally, it should be noted that individualisation is indeed the key and that even the use of natural type estrogen and progesterone in government regulated and approved form may not suit the woman. It is always necessary to be prepared that often changes in type and/or route of hormone therapy may be required to provide treatment which provides benefit while minimising side effects, but at all times regulated, government approved hormones should be used rather than compounded, non-government approved hormones.

Recently published national and international guidelines support this advice with NICE guideline on Diagnosis and Management of Menopause stating “..bio identical formulations that are compounded for an individual woman according to a healthcare provider's prescription are not subject to government regulations or tested for safety or quality and purity of constituents, therefore their efficacy and safety are unknown”.

The recently updated International Menopause Society recommendations on women's midlife health and menopause hormone therapy state that “Prescribing of compounded BHT is not recommended due to the lack of quality control and regulatory oversight associated with these products, together with lack of evidence of safety and efficacy.”

http://wwwmenopausematters.blogspot.co.uk/2017/01/bio-identicals.html

I am sure we all agree that individualisation is paramount in all treatments and I totally agree that we should all be open to new ideas - and once there is sufficient evidence as to their efficacy and safety ( as per the blog) - we will all be jumping around with excitement !!

Treatments like Duavive -  - will revolutionise HRT treatment for women and especially if they could be made with "body-identical" oestrogen. Let's hope there are products like this in the pipeline which can help a new generation of menopausal women . Maybe someone knows?

Hurdity x

[Dana]

It's interesting to me, as a non-UK person, that BHRT (or more precisely compounded hormones – BHRT is nothing more than a marketing term) is now becoming an issue in the UK. It has been around a long time in countries like USA, Canada and Australia, and you will be hard pressed finding any medical or menopausal authority in ANY country that will support or endorse it. It's not new or innovative. It's just a marketing enterprise that is not supported by NHS, FDA, TGA etc.

There are many reasons for this, and the most concerning of all is that progesterone cream has not been proven to be effective enough to oppose estrogen if you have a uterus.

It became a huge issue in those countries mainly because of medically untrained Oprah Winfrey, Suzanne Somers and Robin McGraw pushing it, and because of the supposed “dangers” of conventional HRT reported by the WHI which of course we all know have been totally discredited now. People who push these kinds of hormones will always purposely skew the findings in current medical studies about HRT to make women scared of using it. They are also incredibly and needlessly expensive. Testing for compounded hormones is often done by saliva testing which is even less reliable than blood tests for hormones. Therefore it is impossible to create a "tailor made" hormone treatment which is one of their common sales pitches.

By all means use whatever methods work for you, but please don't make the mistake of thinking that compounded hormones are somehow more “natural” or “holistic” than conventional HRT. They are just as “synthetic” as conventional HRT because they actually use exactly the same active ingredients (estradiol and progesterone). In fact the ingredients are manufactured by exactly the same laboratories. The major difference is that compounded hormones have no regulations, quality assurance or testing, unlike the highly regulated and tested conventional HRT.

No doubt my opinions will be dismissed by those who don't want to hear them. However, I will post some links to legitimate information (including Dr Currie from this site). I encourage all women who may be considering using compounded hormones to read this information, so that you are fully informed about compounded hormones. You need to make sure you do your own research and educate yourself as much as you can because you can't always believe everything those who advocate compounded hormones will tell you. At the end of the day if you still want to use compounded hormones, it is your choice. I personally would not take the risk when there is perfectly good conventional HRT which I know has had rigorous testing and regulations, and is much cheaper.

https://www.menopause.org.au/hp/information-sheets/212-bioidentical-hormones-for-menopausal-symptoms

https://www.menopause.org.au/hp/news/334-endocrine-society-encourages-clinicians-to-avoid-prescribing-compounded-hormones

http://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/Alternatives.aspx#bio-identical

https://sciencebasedpharmacy.wordpress.com/2009/03/13/bioidentical-hormone-replacement/

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

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049311.htm

http://www.menopausematters.co.uk/pdf/article Bio identicals 2017.pdf

[Dana]

I don't really follow the science of this to any great degree, not having used any forms of HRT myself, but surely Dr Currie is just expressing her opinion. There must be many other doctors who think otherwise. I know my own GP is very holistic in his approach and thinks out side the box, when it comes to treatments. Often that is where new innovation begins.

If it's not illegal I am sure it's up to the individual to assess the risks. We are all grown ups after all.

You will find that it is not just Dr Currie's "opinion". It is the widely held opinion of all medical authorities worldwide.

[CLKD]

Why all this continual quoting and references to links, it's a good job that we aren't on dial-up though not many of you are old enough to remember those days, however, I am losing the will 2 live!  The suggestion to read the various treatments in the green box is surely sufficient  .  After all these are 4 guidance so that ladies can make decisions. 

I never read blogs: as I think that the info should be available on MM : so any information that Dr Currie may suggest goes by me.  I never read Links and these threads are now so [too] long that I gloss over so any info that may be of use to me or friends is lost ..........

When I feel ill the last thing I want is to have to dig for info. in the form of blogs or be faced with long spiels about what ladies *should* be doing rather than being able to have a quick read round to see if info. is appropriate for how I feel at the time.  I actually don't care about the medical authorities world-wide, I expect my GP and Practice Nurses to have the knowledge to discuss with me when necessary. 

There will be continual scare stories about various medications whilst people read daily newspapers  . 

[Dana]

I frankly don't care if you click on those links or not. It's your choice, but all of them are from legitimate medical sites because I want to be sure peope can't just dismiss things as "other people's opinions".

[babyjane]

I sense a slight feeling of contention creeping in to the tone of posts again.  this seems to happen when HRT is under discussion.

It certainly is a minefield with the potential to cause some strong feelings  .