Hi sheila
I don't think they do that version of Trisequens any more - just the one that gives a bleed.
That contains the bio-identical oestrogen - estradiol - together with a synthetic progestogen - norethisterone.
Most HRT types contain the bio-identical estradiol - which can be given orally in tablet form (as you had) or transdermally - patches or gel.
The only types that don't contain bio-identical oestrogen are the Prem types ( Premarin, Prempak etc) that are made from pregnant mares urine to produce conjugated equine oestrogens.
Most HRT types are given in a combi pack with either cyclical or continuous progestogen and most of these are synthetic. The most commonly prescribed bio-identical progesterone is micronised progesterone marketed as Utrogestan, but must be taken alongside an oestrogen (estradiol) patch, gel or tablet.
All of these different types are listed under HRT preparations in the green menu on the left:
http://www.menopausematters.co.uk/treatment.phpThere are lots of papers and information about all of this but the best summary at the moment is the paper to be found here ( which I have downloaded to my computer and printed off!) "The 2013 British Menopause Society & Women's Health Concern recommendations on hormone replacement therapy" by Nick Panay et al
http://min.sagepub.com/content/early/2013/05/23/1754045313489645.1.full.pdf+htmlThere is too much information for me to quote here but throughout the paper there are references to the merits of transdermal oestrogen, and also progesterone rather than progestogens - especially for older women. If there is anything in there you don't understand please ask!
Re HRT and stroke the paper states that studies are conflicting - "
caution should be exercised when prescribing HRT in women over 60 (that's me) particularly when they have a risk factor for stroke or thromboembolism. In these groups, current evidence would suggest that the transdermal route may be advantageous"Re Heart attack:
"Early harm can occur when therapy is commenced in women over 60 with relative overdose of oral oestrogen" This was from the WHI study using oral - equine oestrogens and a synthetic progestogen.
In relation to this it says:
"When prescribing HRT for the first time in women over 60, the lowest effective dose should be used"Re bio-identical. My use of the term (for "body identical" hormones available on the NHS is not to be confused with compounded bio-identicals used and sold at great expense in America. The paper says:
"Unregulated compounded bio-identical hormones are not recommended due to lack of data for efficacy and safety"I hope this helps clarify a little!
Hurdity x