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[Dalhousie]

I seem to spend a lot of my free time researching things on the net for different health conditions.  My head is full of half remembered facts.  Just found out about bio-identicals.

Are bio-identicals a healthier/better option as they are more in tune with your body?

Do you have a blood test to see what your own hormones are doing before going on them?

Thanks for any help/advice.

[Hurdity]

Hi Dalhousie

There are a lot of misconceptions about "bio-identicals".

What they are - are hormones with the same molecular structure as the ones in our own bodies. That's all there is to it - ie oestradiol (for the oestrogen) and progesterone (for the progestogen).

There is a big movement in US and I think also in Aus, where specialists unfortunately charge a lot of money to undertake various tests to determine your hormones levels and then prescribe an expensive, supposedly tailored, specially compounded combo of "bio-identical" hormones that you need.

There is a great American gynae called Dr Vliet who has debunked all of this. You can find lots of info on the web clarifying what bio-identicals are. There's a youtube video of her explaining it here:
http://www.youtube.com/watch?v=9XfpAATJkC8 - it relates to the US experience but a lot of it is relevant to UK

In UK we can get bioidentical hormones free (or more or less) on NHS through our doc. I have used bio-identical HRT for most of the 7 years I've been on it.

Yes they are much better for you naturally - because they are in effect exactly the same hormones!

You can have a blood test before starting HRT but many doctors go on symptoms and periods because blood tests are unreliable during peri-menopause especially. Obtaining the correct dose of oestrogen is usually trial and error - dosage with all types of HRT is started low and increased if necessary after 2-3 months until symptoms are controlled.

Hope this is helpful!

Hurdity x

[Dalhousie]

Hurdity - Thanks for your reply. I had a blood test done a long while ago which shows I'm perimenopausal.  In July I'll be officially post menopausal as in no period for a year.  My GP said she would revisit the HRT thing then as I was only a couple of months away from that the last time I saw her.

Is there a list anywhere of bio identical HRT drug names.  I've looked under the HRT preparations tab but I suspect they are the synthetic ones. 

[Hurdity]

Hi Dalhousie

Actually, the good news is that most of the oestrogens in the HRT preparations are bio-identical. The only ones that aren't are the ones beginning "PRE" - which are made from horse urine. The oestrogen in HRT is estradiol, or sometimes in the form estradiol valerate.

Most of the progestogens are synthetic.

The only licensed progesterone to use as part of HRT is Utrogestan (micronised protgesterone). There are other formulations (eg Cyclogest) but not so widely used for HRT.

I find it incredible that your GP would not consider HRT to relieve symptoms until you are almost post-menopausal! I think I've probably commented on this before!

The HRT I use is: Estradot 50 mcg patches, with Utrogestan 200mg vaginally ( on  6-8 week cycle). The Utrogestan regime is unlicensed in UK but my GP is happy for me to be using it in this way.

Hope this helps!

Hurdity x

[Dalhousie]

When I started with menopause symptoms I tried Climagest but it gave me diarrhoea then I tried a patch I forget the name & that did the same.  I then changed GP & other health issues were my priority.  Recently I asked about HRT & she said I may as well wait 3 months then I could try post menopausal HRT without the bother of a  period. 

I take it Utrogestan is bio identical progesterone.

Some bio identicals are only partially so then - the estrodiol is but not the progestin.  Is it not better to take 100% bioidentical with Utrogestan in it??

[Dana]

If you want to take a combined HRT (containing both estradiol and a progestogen) so you can be period free you won't be able to be 100% bioidentical because none of the progestogens in combined HRT are bioidentical.

To be 100% bio, you would need to take estradiol and progesterone (Utrogestan) separately. Depending on how well you tolerate the Utro, you may or may not be able to have a period free routine. Some women can tolerate the Utro 25 days a month, which allows them to be period free, but a lot of women can't and need to take it as part of a cycle. Even some post-meno women need to do this.

Ideally I suppose it's best to try to be 100% bioidentical, but in the real world that doesn't always work out. Basically you need to just find the method that works best for you.

[Dalhousie]

To be 100% bio, you would need to take estradiol and progesterone (Utrogestan) separately. Depending on how well you tolerate the Utro, you may or may not be able to have a period free routine. Some women can tolerate the Utro 25 days a month, which allows them to be period free, but a lot of women can't and need to take it as part of a cycle. Even some post-meno women need to do this.

Ideally I suppose it's best to try to be 100% bioidentical, but in the real world that doesn't always work out. Basically you need to just find the method that works best for you.

Why is the Utrogestan not well tolerated?   What side effects do people get that they can't take it?

[peri]

Hi Dalhousie, I know some ladies on here have problems with it but speaking personally I haven't had any problems. I take 200mgs x10 days a month vaginally and it's the best hrt routine I've been on, hope this helps x

[honeybun]

Utrogestan irritated my bladder and gave me some of the most painful bleeds I have ever had. I used it vaginally. After trying a sequi regime I switched to conti and then the bladder problems started.

Thing is everyone is different and react in different ways. I am on Evoril conti and I tolerate the progesterone fine. Other women don't get on with it at all.


Honeyb
x

[Dalhousie]

I had a 'phone consultation with my GP the other day about going on continuous combined HRT as I become post meno on 14th July.  I asked her about the breast cancer risk if taking if for less than 5 years & she said there is still a risk and cases of breast cancer do occur.  It was posted on here that the cancer risk doesn't kick in till you've been taking it 5 or more years which isn't the case.  Her favourite drug is Femoston conte.

She wanted me to go in for an appointment and get my blood pressure checked even though I know it's low as it always is.  A relative has a BP machine.  She said she wanted to show me tables in (BNF) British National Formulary etc which I have a copy of so I've had a look through them.  I'm back to sitting on the fence again about HRT.  I have lot of other issues going on with various appointments and it's very difficult for me getting in to the surgery at the moment and I don't need to have to cope with any extra health issues.

When you become post meno I guess it still takes several years for symptoms to fade to acceptable levels.  I wonder over the next year whether things might fade just a little.

[Suzyq]

If you are on the fence about it then don't rush into it! My symptoms were severe and I couldn't get hrt fast enough. It sounds like yours aren't too bad which would suggest that you probably don't need it. It's a personal decision for everyone ...

[Hurdity]

Hi Dalhousie

There is a lot of info on this site about the risks - if you look at the green menu on the left under Hormone Replacement Therapy there are sub tabs on risks and benefits and balancing these.

There is a back article about breast cancer on this site here:
http://www.menopausematters.co.uk/article-breast-cancer.php

and the latest information about the risks and benefits of HRT here:
http://www.menopausematters.co.uk/article-hrt-risks-and-benefits.php

These articles are written and/or endorsed by Heather Currie who runs this site and is a leading gynaecologist so this is the information to go on. The data quoted - including the 5 year riks is based on the flawed Women's Health Initiative trials, the data for which have now been re-examined. The study did not use bio-identical HRT, but horse oestrogens and a synthetic progestogen.

Bio-identical HRT is not a drug - you are replacing missing hormones. Femoston conti contains bio-identical oestrogen. The progestogen is a synthetic one but is the closest available in pill form to natural progesterone which is only available in licensed form as Utrogestan. Of the tablet HRT this one is the one that is best tolerated.

If you are suffering from symptoms that are affecting your quality of life then there is no need to suffer. It is up to you, not your doctor, whether you take HRT and which type you choose.

Also - many women find that continuous combined HRT doesn't suit them - if they are progesterone intolerant - and are better off on a cyclical HRT - which does give a regular bleed. Takes some nerve after you've stopped bleeding though but you soon get used to it again!

From a safety point of view - if you were going to go onto HRT eventually then it's better to start sooner than later in terms of risk. I can't remember how old you are?

Also - estrogen levels fall for 2-3 years following the last period until they reach an all-time low. For many women, the worst symptoms do not begin until this point or they begin to get worse not better. It depends on the individual. Longer term health effects like bladder problems and vaginal atrophy do not often kick in until later anyway so whatever you decide I would urge you to start some form of local oestrogen before VA sets in ( which happens in many women).

There's a back article about it here:
http://www.menopausematters.co.uk/article-vaginal-atrophy.php

Hope this helps!

Hurdity x

[Dalhousie]

I'm 50 years old by the way.  I think when I'm able to go in to the surgery after my latest round of hospital appointments is over I'll print off some of the literature Hurdity has highlighted.  From the chats we've had about it I feel that maybe my GP doesn't want me to go on HRT.  She keeps mentioning antidepressants which would help with the hot flashes but that treats only one of the symptoms and that is not my greatest concern.  Anyway I'm already on low dose Nortriptyline to help with pain at night.  I think adding more antidepressant medication to my current drug regime will make me very drowsy and hungover.  She agrees my key troublesome symptoms sound very hormonal - pms - bloating, tension, tight back muscles and joint pain (with my chronic back pain problem I already have a shed load of tight muscle pain and joint pain), low mood and crying on and off all day plus all the hot flushes which are worse in summer.  I don't think I would cry as much if I wasn't so disabled, virtually housebound and pained up with no quality of life.  I'm being assessed for a spinal cord stimulator (SCS) which hopefully should ease the back pain situation and improve my quality of life.

It's difficult when GP's who are your medical guide aren't as well qualified as they should be on HRT.  You do tend to listen to them and take that they roughly know what they're talking about!  She has admitted she is clueless about SCS for my back and then went on to say "don't take it for granted that this will help you".  I know a few people with similar back conditions that it has helped and you have to go into it with a positive attitude.