From the outset it is very important to point out that THIS DISCUSSION IS NOT ABOUT THE NORMAL HRT YOU GET FROM YOUR GP. That type of HRT is perfectly fine. It is regulated and tested and is not the issue here or even part of the discussion.
What seems to be causing all the confusion is the “bioidentical†word. So I will just ask people to put aside that word for now and think in terms of “conventional HRT†(the kind you get from your GP – patches, tablets, gels) and compounded hormones (or what the marketers call BHRT). I posted a lot of information in my first post to which I got very dismissive and sarcastic responses. I would have been perfectly happy to have answered questions or explained things more simply if I'd been asked, but when I get that kind of response it's not very likely that I will put too much effort into my responses. I really do have better things to do.
Now that I've gotten that out of the way, I am perfectly happy to provide more information for those who don't want to click on a lot of links. However, just be aware that this isn't something that can be explained in 25 words or less. You will need to do some reading. If it's of no interest to you, that's fine. Just move on. No need to comment or be sarcastic. If you use “BHRT†or compounded hormones and are happy that's fine too.
Basically we've had one person create a post saying how great BHRT/compounded hormones are. They say they have done a lot of research to back up their positive comments, but I haven't actually seen any evidence of their research. So it basically then comes down to just one person's opinion.
On the other hand both Hurdity and I have posted links to medical information. Emma on behalf of Dr Currie has also posted information. Some may say that we are just posting our opinions too, and that's fair enough. I guess you have to decide for yourself which evidence you want to consider. I have posted what doctors and scientists say about it, and when I say “doctors and scientists†I'm talking about National Health Service (NHS), Federal Drug Administration (FDA), Australian Menopause Society (AMS), Endocrine Society etc. So I'm not just talking about “some†or “a few†doctors. We are talking about major medical authorities who have access to far more international research than any of us do. Now it's up to everyone if they want to read this information or not, but if you choose not to please don't then complain that no one will explain anything to you or post disparaging comments. This is supposed to be an adult conversation. Please don't encourage drama when there is no need for it.
It appears this BHRT issue is a fairly new phenomenon in the UK, so it is understandable there is a lot of confusion. However it is not new or something to get that excited about. It's been around a long time in other countries, so there has been plenty of opportunity for the compounding industry to show proof of their claims about BHRT, but they have chosen not to, or been unable to. For a long time I've been warning on MM against using the “bioidentical†word to describe the normal HRTs you get from your local GP. I've seen how that confusion has affected women in Australia and USA. Now it's happening in the UK as well. While it may have had some scientific meaning at one point, it was “hijacked†years ago by the compounded hormone industry to describe their version of HRT. Doctors don't actually use the word "bioidentical". Try asking your doctor for "bioidentical HRT" and they probably won't know what you're talking about, unless they are familiar with prescribing compounded hormones, which most doctors won't touch with a barge pole.
“Bioidentical†is actually nothing more than a marketing term, and it's that version of HRT that doctors are concerned about. The promoters of BHRT (compounded hormones) make a lot of promises and claims that really haven't been or can't be proven. The reason it has been allowed to flourish is mainly due to all the scare mongering women have endured since WHI. These “BHRT†promoters are really just cashing in on that fear by claiming that what they produce is more “natural†and “safer†than conventional HRT when it isn't, and Emma, on behalf of Dr Currie, has already confirmed that.
I will repost the links I put in my first post, and I will highlight some important information from each one. However like I said earlier, it is difficult to just reduce it down to a few lines so please click on the links and at least try to read what you can. Most of what is in these links is “important informationâ€, so it is very hard to pick and choose what to post.
I will repeat again, at the end of the day it is an individual choice for each woman. I'm only posting the medical information, so don't shoot the messenger. I am by no means an expert in this matter, but I do know what I have personally experienced and what I have read and been told by those who know more than me. If you have any genuine questions please ask – nicely.
Australasian Menopause Society (Australia)
https://www.menopause.org.au/hp/information-sheets/212-bioidentical-hormones-for-menopausal-symptomsKey points
• “Bioidentical hormones†are defined as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.
• There is inadequate scientific evidence to show that:
Compounded bioidentical hormones are effective.
These compounded hormones are safe and free of adverse side-effects.
These compounds are pure and free from contamination.
• Conventional MHT/HRT often contains the same form of bioidentical hormones as compounded therapies.
• If a doctor elects to prescribe an unregistered complementary or alternative therapy the woman must be fully informed that this therapy is unproven and that there may be risks.
• The AMS does not endorse the prescribing of compounded bioidentical hormones.
What are Bioidentical Hormones?
• (Compounded) Bioidentical hormones are hormones synthesised to resemble identically, the natural hormones produced by the ovary. These so-called 'natural' hormones are supplied by compounding pharmacists as creams rubbed on the skin or troches placed in the buccal cavity of the cheek both of which allow the compounded bioidentical hormone to be absorbed through the buccal mucous membrane or the skin.
• While there is evidence that these routes of delivery are viable, there is very little evidence that HRT delivered in this format is able to achieve physiological levels capable of preventing endometrial stimulation, inhibiting osteoporosis, a reduction in cardiovascular damage or a positive influence on neurological function.
• Progesterone is very rapidly degraded in the human gut, liver and circulation so it has been difficult using oral therapy to maintain a level of progesterone sufficient to inhibit hyperplasia or prevent cancer in the endometrium. Progesterone can be absorbed through the skin but the amount circulating after a measured amount of progesterone cream has been applied to the skin, is insufficient to have any effect on the endometrial cells. There is some evidence that progesterone can be absorbed through the vaginal epithelium and through the buccal mucous membrane, but at present there are no reliable studies available to confirm that the amount absorbed from this source has a protective effect on the endometrium.
• Some of these compounded products contain abnormally high levels of hormones making them unsafe for women.
• Compounding pharmacists often state that these compounded bioidentical hormones are a unique mix of oestrogens but fail to add that all natural bioidentical hormones are processed in the body in the same way as regular prescribed HRT.
• There is inadequate scientific evidence to show that compounded bioidentical hormones are effective, safe and free of adverse side-effects, and contamination.
• There are no studies comparing the effect of doses of compounded bioidentical hormones to conventional HRT.
• The risk of cancer of the uterus may be increased with the use of compounded bioidentical hormones when estrogen is used with compounded progesterone cream, as the progesterone is poorly absorbed and therefore does not protect the uterus. (See AMS HRT pamphlets)
• There is inadequate scientific evidence documenting interactions between the compounded hormones, or between these hormones and other drugs which may be taken at the same time.
• Following reports of salivary hormone results patients may be told they have abnormal ovarian, thyroid or adrenal function and as a result may be started on a variety of unnecessary hormones. This may cause serious health problems.
Australasian Menopause Society (report on behalf of the Endocrine Society)
https://www.menopause.org.au/hp/news/334-endocrine-society-encourages-clinicians-to-avoid-prescribing-compounded-hormones new Scientific Statement issued by the Endocrine Society advises clinicians to avoid using compounded hormone medications to treat menopausal symptoms, female sexual dysfunction and other hormone conditions.
Compounded hormone medications can be unsafe when inappropriate practices are used. More than 60 people died from cases of fungal meningitis attributed to compounded medications in a 2010 case.
"In extreme cases, advertisers have marketed compounded products as being able to prevent the ravages of aging and implied they are risk free," said Nanette Santoro, MD, and the chair of the Society task force that developed the statement. "Few, if any, of these claims are supported by science."
NHS (National Health Service) (UK)
http://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/Alternatives.aspx#bio-identicalBioidentical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones. Practitioners claim these hormones are a "natural" and safer alternative to standard HRT preparations. However, bioidentical preparations aren't recommended because:
• they aren't regulated and it's not clear how safe they are – there's no good evidence to suggest they're safer than standard HRT
• it's not known how effective they are in reducing menopausal symptoms
• the balance of hormones used in bioidentical preparations is usually based on the hormone levels in your saliva, but there's no evidence that these levels are related to your symptoms
Many standard HRT hormones are made from natural sources, but unlike bioidentical hormones they're closely regulated and have been well researched to ensure they're as effective and safe as possible.
North American Menopause Society (USA)
http://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy/compounded-bioidentical-hormones-what%27s-the-harm-What is a bioidentical?
It's not a lot of things. It is certainly not a scientific term. There is no uniform definition of it in any medical dictionary.
How does BHT harm patients?
BHT has not been tested in good clinical trials. There are very little safety data. Natural doesn't equal safer. There is no clinical or patient package insert documenting safety or efficacy, no black box warning, no uniform manufacturing standards, and there is no formal review of the accuracy of any of the advertised claims. One problem with this is it doesn't even matter, probably, to the people who are really committed to taking these products. And the other problem is that if this is true, why are there so many prescriptions being written for this stuff?
Federal Drug Administration (USA)
https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049311.htm "BHRT" is a marketing term not recognized by FDA. Sellers of compounded "bio-identical" hormones often claim that their products are identical to hormones made by the body and that these "all-natural" pills, creams, lotions, and gels are without the risks of drugs approved by FDA for menopausal hormone therapy (MHT). FDA-approved MHT drugs provide effective relief of the symptoms of menopause such as hot flashes and vaginal dryness. They also can prevent thinning of bones. FDA has not approved compounded "BHRT" drugs and cannot assure their safety or effectiveness.
Menopause Matters (Dr Currie)
http://www.menopausematters.co.uk/pdf/article Bio identicals 2017.pdf Compounding bio identical pharmacies have been practicing in USA for a number of years and have recently appeared in the UK. Investigations in the USA are being reported. In 2001 the Food and Drug Administration (FDA) collected and analysed 29 compounded drugs. Two of the compounded hormone drugs failed analytical tests because of contamination risks. In 2012 “More†magazine commissioned laboratory tests of bio identical hormones produced by 12 compounding pharmacies. It was found that these hormones were of unreliable potency and would not meet the standards for the FDA requirements for commercially manufactured drugs and in fact because of the variable hormone levels, concern was expressed that endometrial cancer risk would be increased
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 efficicy and safety are unknownâ€. 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 the lack of evidence of safety and efficacyâ€.
I'm so sorry that this post is so long and wordy, but it simply can't be written as a short memo. However it really just boils down to something very simple....
If you are using or want to use HRT talk with your GP and make sure you are prescribed regulated conventional HRT, the type that comes in patches, pills, and gel (eg Estradot, Femoston, Utrogestan, Provera - anything that is shown on MM under the "HRT Preparations" in the menu above). According to medical research you should avoid anything that is described as BHRT, Bioidentical Compounded hormones or anything that has to be manufactured specially by a compounding pharmacist. If you choose to use BHRT ("bioidentical" compounded HRT) please make sure you are fully aware of what you are being prescribed.
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Topic: Bioidenticals are NOT safer or more effective than HRT (Read 8279 times)