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[Lamplighter]

Me again, yet another question.  I have found over the course of my enounters with the many and varied forms of HRT (due to discontinuation and so-called shortages) that while on paper the ingredients of particular HRTs are identical, the effect on me has been dramatically different.

This led me to question whether the actual estradiol used in HRT preparations (eg Estradiol Hemihydrate) is the same in different products.  That is, that the estradiol comes from different sources, or different manufacturers etc.  I've been unable to find anything at all that answers this question, including asking different doctors, so wondered if anyone on here knows about this.

Could it be that the estradiol in one preparation, albeit in name seemingly identical to that in another, in fact comes from a different source or manufacturer and is therefore not identical (this in my view would account for the differing efficacies and side effects of the different products.)

Ideas and opinions very much appreciated.

Thanks

LL

[Alicess]

Almost all HRT products use estradiol hemihydrate, the route of administration makes a difference though.

https://en.m.wikipedia.org/wiki/Pharmacokinetics_of_estradiol

Estradiol valerate is different as it is a prodrug but as you use estradiol hemihydrate that's not the issue in your case.

The progestin of progesterone can make a difference too. Every progestin of progesterone has it's own properties and side-effects.

[Lamplighter]

Thanks Alicess 

[Hurdity]

Just to add to Alicess's post - here is some iinformation on estradiol hemihydrate - the most commonly used formulation of estradiol I gather:
Hemihydrate

"A hemihydrate form of estradiol, estradiol hemihydrate, is widely used medically under a large number of brand names similarly to estradiol.[159] In terms of activity and bioequivalence, estradiol and its hemihydrate are identical, with the only disparities being an approximate 3% difference in potency by weight (due to the presence of water molecules in the hemihydrate form of the substance) and a slower rate of release with certain formulations of the hemihydrate.[162][163] This is because estradiol hemihydrate is more hydrated than anhydrous estradiol, and for this reason, is more insoluble in water in comparison, which results in slower absorption rates with specific formulations of the drug such as vaginal tablets.[163] Estradiol hemihydrate has also been shown to result in less systemic absorption as a vaginal tablet formulation relative to other topical estradiol formulations such as vaginal creams.[164] Estradiol hemihydrate is used in place of estradiol in some estradiol products.[165][166][167] "

https://en.wikipedia.org/wiki/Estradiol_(medication)#Hemihydrate

Lamplighter - any differences you have experienced from using different HRT products will be due to the different mode of delivery and more to the point the added ingredients which will affect how much and how quickly you absorb the oestrogen, as well as differences in your own biology and eg with transdermal HRT where you apply the patch or gel etc.

Also where you are in menopause - ie if still peri-menopausal - will have an enormous effect independent of whatever formulation or HRT type you are using.

Estradiol hemihydrate will be exactly the same molecule wherever it is used and whichever product it is used in, and however it is manufactured. The compound used will be manufactured by different companies but the final product will be a pure compound (it has to be) with no (or presumably negligible) traces of the original products, chemicals etc it has been made from.

Hurdity x

[Lamplighter]

Hurdity, thanks for that very informative reply - I am relieved to know that the estradiol doesn't vary from one form of HRT to another, as I couldn't for the life of me work out why Nuvelle (which was most inconveniently discontinued    ) worked brilliantly but Kliofem, the only available similar HRT at the time, not only didn't work particularly well across the board, but seemed to be increasing the very symptoms it was meant to be treating.

But it's a bad state of affairs when purportedly similar if not identical products have such wildly varying results, and doctors unable to pinpoint why.

xxx