Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Greenfields on June 04, 2015, 07:50:03 PM
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Has anyone got any experience with bioidentical hormones?
If I move back to Canada, that will be the treatment I'll be getting as it seems to be treatment protocol there - for example see: http://www.canadabioidenticaldoctors.com/ - here's one docs page here (BTW I just pulled this off the website - am not actually seeing him or advertising his practice in particular) http://www.torontobioidenticaldoctor.com/
However I noticed Dr Curry has a post that's quite negative about them here: http://www.menopausematters.co.uk/article-bioidentical-hormones.php
This contrasts with an article which positively references them here:
http://www.theguardian.com/books/2014/apr/11/jeanette-winterson-can-you-stop-the-menopause
So am a bit confused. I have been told that utrogestan is basically bioidentical progesterone. But I don't know much about bioidentical estrogens.
If anyone could clarify the differences in the types of hormones from what I'm getting now (Utrogestan 100mg and Evorel 50 patches) I'd be grateful. I'm a little worried about having to start all over again with a new regime in the future.
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Green fields
I have absolutely no experience with hrt apart from the one I've been on since 2000, elleste solo (hysterectomy so no progesterone) I've only recently learned that it is bio identical, I had all menopause symptoms bar flushes 6 months after hysterectomy and this was the first one they tried and it took all my symptoms away, the only thing that changed was the dose, from 1mg to 2mg, it's also available in patch form
Annie xx
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You are using all bio identical hormones at the moment Greenfields. Most Oesteogens in HRT preparations are bio identical these days - it is only Conjugated oestrogen's in Prempak and Premique that are not bio identical. I think Utrogestan is the only bio identical progesterone and in fact Dr. Currie and other doctors describe this as 'breast friendly'. In the article you are referring to, Dr. Currie is talking about 'Compounded bio identical hormones' which are not same as the HRT preparations we get here. Unfortunately there is some confusion about use of the term 'bio-identical' - I believe in the USA pharmacies will make up their own HRT preparations based on questionable saliva testing and these won't have gone through the stringent controls that our HRTs go through so could be harmful. Hopefully others will be along who are more knowledgeable to give advice. DG x
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I've posted this numerous times before, but I find that there is a misunderstanding in the UK about what other countries consider as "bioidentical". The UK is one of the few countries that actually uses the term to describe "regulated" HRT. Personally I wish the term wouldn't be used at all on MM because it just confuses a lot of people who aren't from the UK. When I first came here I was confused and alarmed by all these people advocating compounded hormones (or so I thought). Perhaps "natural regulated" HRT would be a better term to use here.
The important thing to remember is that in most countries "Bioidentical" is actually just a marketing term coined by the people who advocate and prescribe compounded hormones. It is not a scientific term, so its use really should be avoided on MM. There is a lot of nonsense posted on the internet promoting compounded (bioidentical) hormones, but all you have to do is look at reputable sites like the Australian Menopause Society, North American Menopause Society, anything written by Prof Studd and Dr Vliet, and this very site, to find that most doctors are not in favour of compounded (bioidentical) hormones.
There are a lot of reasons for this. The one very big reason is that there still isn't any evidence that progesterone used externally (ie as a cream) is strong enough to oppose estrogen. There are also a lot of other negatives like there not being enough control over how the compounded hormones are manufactured by the pharmacists, and the fact that there have been cases where doctors have been found to get kickbacks from the pharmacists for prescribing the compounded hormones, or the doctors have actually had a conflict of interest by owning the compounding pharmacy.
I personally know people who use compounded hormones, and they are quite happy with them. I personally wouldn't take the risk, but it gets down to personal choice.
Here are a couple of links for you. These will be far better for you to read that anything someone posts on the internet (who usually has a vested interest in selling/prescribing this stuff).
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
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Just did a google search for a Canadian Menopause Society and found the Society for Ob/Gyn of Canada, which seems to be similar. This is a section where they specifically mention BHRT (Bioidentical HRT). While it doesn't totally dismiss it, they certainly don't advocate it either. So if you want to continue using regulated HRT I would certainly be very specific about that when you see your new doctor in Canada. They should respect your wishes as regulated HRT would be just as easily available there as anywhere else.
http://sogc.org/publications/menopause/
Bioidentical hormone therapy (BHT) is another type of hormone therapy. There are concerns about BHTs because, often, they are custom-mixed recipes that are not regulated or approved, and thus there is no scientific evidence of the effect they may have on the body. Currently, there are no long-term studies on bioidenticals that demonstrate their effectiveness or safety. Before taking BHT, talk to a health-care provider.
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Just did a google search for a Canadian Menopause Society and found the Society for Ob/Gyn of Canada, which seems to be similar. This is a section where they specifically mention BHRT (Bioidentical HRT). While it doesn't totally dismiss it, they certainly don't advocate it either. So if you want to continue using regulated HRT I would certainly be very specific about that when you see your new doctor in Canada. They should respect your wishes as regulated HRT would be just as easily available there as anywhere else.
http://sogc.org/publications/menopause/
Bioidentical hormone therapy (BHT) is another type of hormone therapy. There are concerns about BHTs because, often, they are custom-mixed recipes that are not regulated or approved, and thus there is no scientific evidence of the effect they may have on the body. Currently, there are no long-term studies on bioidenticals that demonstrate their effectiveness or safety. Before taking BHT, talk to a health-care provider.
Thanks Dana - I'm going to follow up on these links and the information.
I was told by the Dr in Toronto that I could have similar treatment to what I am having here in the UK (patches and tablets) - so I'm hoping that is the case. Unfortunately, HRT isn't covered by OHIP in Ontario so one has to pay for it and accessing HRT via the public health system takes time - you have to get a referral to a gynaecologist and this can take a long time (my understanding). As I'm only allowed to take 3 months medication max from the UK, I don't want to run out of UK meds before I get some Canadian ones. So the quickest way for me to get treatment is to access it privately but I've been quite confused about this whole bioidentical thing and the way it's put across in Canada.
I did contact the local health unit in the city I hope to return to (not Toronto) and just got a response back saying the medications I take are not licensed for use in Canada! Which was not helpful!
I'm playing things by ear at the moment because I don't know if and when I'm going to be well enough to return.
I've just read one of the links you posted - which was helpful - but am now worried about the treatment the Toronto Dr is offering - it's been so hard to find information out on HRT and access to it in Canada as it seems to be such a different system from the UK with respect to accessing Dr's and specialists who can prescribe it :( I'm really terrified of going back and then finding I can't access what I currently take and then getting very very ill - it's hard not to worry about it when I think about it (which I try not to do too much).
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Hi I think there is a misunderstanding - whilst it is true that bio-identical hrt can sometimes be creams specifically made up for you - I was given progesterone cream, I am prescribed estradot and utrogestan which they class also as bio-identical. I think you are over-thinking things a little greenfields! Yes you may nee d to see a private gynaecologist to initially get your prescription, but as I said, I went to a walk-in clinic and was given a repeat prescription for the next year.
Perhaps you're not quite ready to make the decision about moving back to canada! I understand that as it's a big decision but there are millions of women here using hrt in a variety of different forms! What is certainly true is that they tend not to prescribe he older types like Premarin etc ....
Just for the record, my bio-identical progesterone cream was great as it was specifically formulated to deliver a dose suitable to ensure a bleed without messing around with vaginal use of utrogestan .... It was also very inexpensive!
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Hi Greenfields,
I am living in Canada and I just go to my gynaecologist for my hormones which are "bio identical" and they are estradot 50 patches and prometrium which is the same as utrogestan. No need to go to a compounding pharmacy, these can be picked up at regular ones like shoppers or at Walmart no problem!
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Hi Greenfields,
I am living in Canada and I just go to my gynaecologist for my hormones which are "bio identical" and they are estradot 50 patches and prometrium which is the same as utrogestan. No need to go to a compounding pharmacy, these can be picked up at regular ones like shoppers or at Walmart no problem!
Thank you so much for telling me that! I posted in the hope that there would be a few Canadians out there!
Poppyflower - did you manage to access a gynaecologist easily? When I (hopefully) move back to Canada, I am going to try and find a Dr to register with but if I can't, I plan on going to a walk-in clinic ... am hoping that I can get quick access to a gynaecologist? But if not, I will go private if I have to. The NHS in the UK will allow me to take a maximum of 3 months prescription with me so its something I really need to sort out quite quickly on my return as I really don't want to run out HRT given how much it's helped me.
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Hi I think there is a misunderstanding - whilst it is true that bio-identical hrt can sometimes be creams specifically made up for you - I was given progesterone cream, I am prescribed estradot and utrogestan which they class also as bio-identical. I think you are over-thinking things a little greenfields! Yes you may nee d to see a private gynaecologist to initially get your prescription, but as I said, I went to a walk-in clinic and was given a repeat prescription for the next year.
Perhaps you're not quite ready to make the decision about moving back to canada! I understand that as it's a big decision but there are millions of women here using hrt in a variety of different forms! What is certainly true is that they tend not to prescribe he older types like Premarin etc ....
Just for the record, my bio-identical progesterone cream was great as it was specifically formulated to deliver a dose suitable to ensure a bleed without messing around with vaginal use of utrogestan .... It was also very inexpensive!
Oh thanks Suzyq! It's just so hard to make sense of things sometimes and I am - I will freely admit - absolutely paranoid about making sure I have access to meds once I get back to Canada! :o After the experiences I've had the last few months, I certainly do not want to be as ill again ever!
Re: moving back to Canada - well I don't think I'm ready yet but I am a lot better than I was. I have such a good Dr's practice to go to now and I feel so very cared for - its just a shame I had to suffer the worst month ever prior to that and experiencing really poor medical practice. I was describing my experiences to someone recently at the practice I was at and they were stunned and said I should write and complain - but I cannot be bothered because I've heard so many other stories since of poor practice at that practice - it's whole culture is poor.
All that said, the longer I stay in the UK, the more I feel the pull of it and my support worker said to me last week that she thinks that I could stay in the UK and figure out a way of making a living - but it's so scary with the high rents here - so I'm still a bit on the fence on that one and am going to see how things go over the next couple of months. I've been through such a lot emotionally since March that I'm just grateful to be alive, have a roof over my head, food in my belly and enough savings to last me a while even though I don't want to drain them longterm.
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I just found this pdf document on the http://www.menopauseandu.ca/about_us_e.aspx, which seems to be associated with The Society of Obstetricians and Gynaecologists of Canada (SOGC). It shows all the HRTs available in Canada, so that might answer some of your questions.
www.menopauseandu.ca/documents/HTbooklet11.pdf
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Thanks so much Dana - I will look through it and see what matches the medication I take now. I am thinking of emailing the Canadian health unit of the city I emailed before and if I give them the details of the Canadian medications maybe they can tell me how easy it is to access them in that city.
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Dana it looks to me like the Canadian equivalents of what I am taking are Prometrium and Estradot - although I'm not sure of which level of patch with the latter (my UK patch is called Evorel 50 and contains 3.2mg estradiol and delivers 50 micrograms of estradiol a day).
I might email the Toronto Dr and ask her whether I can get these through her - as I don't want to switch to compounded bio-identical hormones and go through all the physical adjustments with that if I find the current UK treatment suits my body longterm - providing I can get through all the side effects I'm having.
I will also email the health unit and ask them where I can get these in the city I will be living in again (hopefully!).
Thanks so much for posting this Dana - I really appreciate it.
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No problem. I hope you can get all this sorted out quickly. :-*
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Hi Greenfields I use estradot 50 here in UK, and it is equivalent to Evorel 50. The number after the patch is the number of mcg per day the patch is designed to deliver into the system. Most patches come in several doses - from 25 mcg to 100 mcg. It shouldn't make a lot of difference although I find Estradot, being very small and more convenient, don't leave such big marks and stick very well (I used Evorel when I first started HRT)! So - no worries there that you can't get the equivalent. I'm not sure of the formulation of Prometrium but I am sure there are one or two other overseas members who may use it and can tell you. Not sure if it can be used in the same way as utrogestan ie vaginally but I guess so if it is also used as a fertility product.
Hurdity x
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Hi Greenfields,
Whenever anyone mentions bio-identical hormones, it's always followed by a lot of arm waving about how natural doctors are trying to cheat us with made up preparations to make a lot of money...etc etc...etc
Bio-identical hormones are basically hormones that have the exact same molecular structure to our own hormones. They're what our bodies are used to. Unless you were brought up in a stable, it's unlikely you ever had horse hormone in your body so to call some HRT "replacement therapy" is completely incorrect. Hormones made from pregnant mares has never been made by our own bodies, and I guess it's no great surprise that these are then seen as carcinogenic.
I am a great proponent of sticking with nature and using products natural to our bodies. Unfortunately compounded hormones (which are not any witch doctor's magic but simply generic hormones tailored to our needs) aren't available within the standard NHS doc's offering so instead I've gone with branded varieties. I'm currently on Oestrogel and Utrogestan - both are bio identical. These are the first hormones I've ever taken and I'm pretty impressed with the results.
Bio identical hormones are used widely throughout Europe and have a greater safety record than non bios, with some good overall benefits to our bodies too such as protection against oesteoporosis, cardio vascular issues and also colon issues (one I've fallen foul of).
GG x
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There are a lot of reasons for this. The one very big reason is that there still isn't any evidence that progesterone used externally (ie as a cream) is strong enough to oppose estrogen.
A lot of HRT is taken via the skin or as a pessary - this is actually better for the body as it avoids "first pass", where the liver breaks down the hormone, with only a lower amount reaching the blood. A higher dose is thus required for any hormone taken by mouth.
the fact that there have been cases where doctors have been found to get kickbacks from the pharmacists for prescribing the compounded hormones, or the doctors have actually had a conflict of interest by owning the compounding pharmacy.
...totally unlike the big pharmaceutical companies of course who make over 5 billion dollars a year from branded HRT, ahem (and use a large percentage of that wooing the local GPs).
Generic drugs cost a lot less than a boxed product, look at aspirin for example. The issue is because generic hormones aren't within the NICE guidelines our GPs have little option but to prescribe some expensive brand name. Fortunately there are a number of bio-identical hormones available with a name, but not in the same proportions are our bodies have previously been used to (eg with a mix of estradiol, estrone, estriol).
GG x
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Prometrium is ultrogestan in canada. It can be used vaginally
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A lot of HRT is taken via the skin or as a pessary - this is actually better for the body as it avoids "first pass", where the liver breaks down the hormone, with only a lower amount reaching the blood. A higher dose is thus required for any hormone taken by mouth.
Please note that I said “there still isn't any evidence that progesterone used externally (ie as a cream) is strong enough to oppose estrogenâ€. I said nothing about taking estrogen externally, and using a progesterone pessary is not “externalâ€.
...totally unlike the big pharmaceutical companies of course who make over 5 billion dollars a year from branded HRT, ahem (and use a large percentage of that wooing the local GPs).
Generic drugs cost a lot less than a boxed product, look at aspirin for example. The issue is because generic hormones aren't within the NICE guidelines our GPs have little option but to prescribe some expensive brand name. Fortunately there are a number of bio-identical hormones available with a name, but not in the same proportions are our bodies have previously been used to (eg with a mix of estradiol, estrone, estriol).
I'm not going to get into a discussion about generic vs branded or anyone's personal opinion about the actions of pharma companies, because what is relevant in one country is not relevant in another.
Regarding compounded hormones, I'll just refer you back to the links I posted from respected and reputable menopause information sites (not pharma companies). I have nothing more to add.
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Prometrium is ultrogestan in canada. It can be used vaginally
Yes, Prometrium and Utrogestan are the same thing - just different names.
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I'm not going to get into a discussion about generic vs branded or anyone's personal opinion about the actions of pharma companies, because what is relevant in one country is not relevant in another.
I'd have thought an English woman was pretty damn similar to an American, an Australian, a French woman....and many other different varieties. Unfortunately the pharmaceutical companies must think differently, hence the reason they've petitioned the FDA to ban some natural hormones in the USA whilst actively advertising these in Europe (one such example is Wyeth, bio-identical estriol). When cash is king, ethics and the patient are rarely at the forefront....
GG x
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Hi Greenfields I use estradot 50 here in UK, and it is equivalent to Evorel 50. The number after the patch is the number of mcg per day the patch is designed to deliver into the system. Most patches come in several doses - from 25 mcg to 100 mcg. It shouldn't make a lot of difference although I find Estradot, being very small and more convenient, don't leave such big marks and stick very well (I used Evorel when I first started HRT)! So - no worries there that you can't get the equivalent. I'm not sure of the formulation of Prometrium but I am sure there are one or two other overseas members who may use it and can tell you. Not sure if it can be used in the same way as utrogestan ie vaginally but I guess so if it is also used as a fertility product.
Hurdity x
Thanks Hurdity x
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Just been reading through the discussion between GG and Dana - and I wondered is Oestrogel the same as what's in Evorel?
The reason I ask is that I'm still getting side effects from the HRT I'm on (Evorel and Utrogestan) and I'm wondering whether there is anything else that might be a bit easier on my body? N.B. I'm still only into the second cycle of these medications though.
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I've just done a quick google - Estrogel is trans dermal oestradiol (in a gel format to be rubbed in), Evorel is a patch but appears to be bio identical oestradiol too?
I haven't used a patch but am tempted, however I want to make sure my dosage is right first. I've only been taking the Estrogel for 6-7 weeks and I've halved the dose the doc suggested as it gave me heavy breasts. I'm taking one pump per day and it seems to be working for me. I'm not sure you'd have quite the same flexibility with patches, though I guess you can cut them in half? They're probably less messy too...
I would have preferred an oestradiol / oestriol mix but don't think there's a (branded ) option that offers this in cream / pessary or patch form. I noticed on the forum someone had had oestriol prescribed as a generic drug, I'll chat to my meno doc next time I have an appointment.
If you're only in the second cycle it may be worth waiting a little longer to see it if settles? Or perhaps tweak the dose slightly if that's at all possible? I've tried a higher dose, a lower dose and no dose and it's become clear that I definitely need the oestrogen but there's a fine line for me between the right dose and too much.
GG x
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Thanks GG. I'm seeing my Dr Wednesday. The side effects I've had this second cycle so far (I'm in Day 13 at the moment) have been quite different from the first cycle so I guess I should wait and see how I am by the middle of July when I will have completed 3 cycles. I guess I'm just desperate to get fully well again :'(
I was talking to a really nice therapist this morning who I'm going to see for the next little while even thought its private and its going to cost more money - I was talking about going to Canada for a week in July - but by the time I'd driven home from the therapy session I was exhausted - I took an antihistamine last night for the hives I currently have and because I'm so sensitive to medication, I still wasn't 100% this morning so I'm hoping that is the reason why I was so tired.
So I spent part of this afternoon lying down resting for an hour ... and although I try to stay positive, part of me was thinking, who am I kidding in terms of being able to be well enough to make a trip to Canada in July? But I really need to try and sort things out before my flat tenancy is up in mid-September (and the landlord will want to know whether I'm renewing by mid-August) otherwise I will be stuck in the UK for another 6 months and drain even more of my savings. It's hard to stay positive sometimes :'(
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Just to update on this thread, I heard back from the health unit in the city in Canada that I want to move back to and they have told me where I can get Estradot and Prometrium prescribed for me! Which is great. It will cost though - don't know how much but hopefully less than what the Dr in Toronto was quoting me.
All I need to do now is just get really really well so I can make a trip out for a week and see how I manage things - but it needs to happen before August ideally.