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[Bissal]

Hi ladies,
I am new to this group.
I have been diagnosed with premature menopause, and my main symptoms are rapid aging of skin, reduced breasts (size and firmness), thinning hair, osteopenia, anxiety/depression.

I am only interested in Bioidentical HRT and ave been doing loads of reading about them.
I have seen a specialist in London, but am not happy as I am not having my questions answered properly.
From what I have learnt, it is paramount to get the right dosage and levels of hormones (and I think it is beneficial to consider more hormones than oestrogen, testosterone and progesterone.

Is there anyone on here who is on bioidentical hormones and found a good practitioner? I understand it is expensive (the person I saw cost £900 which I don't think was worth it) so, to prevent more money wastage) I am really looking for someone who considers the whole picture, will listen to me and take good tests to look at ALL of my hormones, and know what optimum levels should be (not the "normal" ones the NHS go on).

Many thanks in advance. I just want to get back to me asap.
x

[Niamh]

Hi there and welcome to the group

I'm quite new to hrt, im 41 and peri and I see Professor Studd in London id say along with annie Evans (who is in Bristol) and Nick panay (London but don't have any personal experience) they are your top specialists. I have found Professor Studd a little tricky at times but ive got used to him and found my way with him and recently he's been very helpful and supportive. I think he's really leading the specialist on all of this. I take bio HRT and his prescription of ostrogel, testim and Utrogestan and I have to say he's changed my life.

With the tests I don't think there are optimal levels everyone is so different and so any specialist will go by normal levels and then how you feel....they can also vary from day to day so no one golden levels exists

I might be wrong but I don't think any other ladies are using any other hormones it tends to just be progesterone and ostrogen that are prescribed. You'll only get testosterone privately.

I'm sure the ladies could help on here with more advice and tips.

What are you taking? It does all take a while to find the right hrt, im still a bit up and down 4 months in and Prof Studd tweaked things over the phone for me last week

Hope that helps
X

[Mary G]

Hello Bissal and welcome to MM!

I was going to say pretty much the same as Niamh, I also went to Professor Studd in London and it changed my life too!

He originally prescribed 3 pumps of oestrogen gel, 100mg of Utrogestan for 7 days each month (I use it vaginally) and a small bead of testosterone every day.  I have since reduced my gel dose to 2 pumps every day but this regime certainly works well for me.  I have to be careful because I am severely intolerant to all types of synthetic progestins and also to Utrogestan if I take too much of it but I now split my gel dose to 1 pump every 12 hours to keep the oestrogen levels up and it seems to be working.

As Niamh says, the most well known specialists are Professor Studd, Dr. Annie Evans and Dr. Nick Panay who are all very good and know what they are talking about and I would recommend you see one or them.  I realise that you might have already seen one of them and not clicked with them and if so, you could try one of the others.

We are all different and one size does not fit all so you definitely need to have a tailor made regime that suits your particular needs. 

[Briony]

I had no problem getting bio identical hormones from my GP (NHS) and many others have found likewise. The dose you take needs to be suited to you as an individual - it is not a case of private specialists automatically giving higher doses. I went to a DRCOG qualified GP who was brilliant, knew this site and was happy to go along with what I wanted to try. After the recent NICE guidelines, I think more GPS will agree that a transdermal route is best. The harder part is getting the bio identical progesterone (eg Utrogestan), but from experience, if you go in asking for the right thing, many GPs are obliging.

Good luck, B

[Briony]

I meant to add, don't be surprised if you 'don't' feel like me' straight away. I started hrt at 41 (later moved to a bio identical contraceptive) and it took at least three months before I had even a hint of old me. I'd expected instant results so the reality was pretty depressing!`   

[Cassie]

Proff Studd recommends bio identical hormones, many ladies are on them on this group, they def are fab, hope you feel better soon .

[Hurdity]

Hi Bissal

  from me too.

Sorry to hear about your premature menopause diagnosis and also that you spent £900 unnecessarily!

How old are you and what have your periods been doing over the past 12 months or so - have they stopped completely yet?

Mary G and Niamh have told you about the top specialists depending on where you live - but I agree with Briony - you do not need to go privately - unless you want/need testosterone as well.

I have been on bio-identical HRT as in oestrogen patch and progesterone (Utrogestan) for 9 years now since age 53 and have worked out a regime that suits me. As you suspect you do not need to be persuaded into thinking that these very expensive "bioidentical HRT practitioners" will be able to tailor your dose to your needs based on blood tests, saliva tests or anything else. Yes it's a good idea to have several blood tests early on as a baseline (for estradiol) - and to give a rough idea where you are - but they are generally unreliable. Symptoms are a much better guide and how you yourself are feeling. If you find a good GP - or in your case ask for a referral to a menopause clinic due to your diagnosis ( unless you are already with one?) you should be able to tailor your dose to your needs. The main thing is that the doc needs to understand menopause, HRT and what bio-identical hormones are.  All this is available on NHS as Briony says.

If you look at the list here - most of them are bioidentical (not the prem ones = conjugated equine oestrogens) - the best are patches or gel. If you don't mind fiddling about and applying the stuff every day if you are starting out I would suggest gel as you can tweak it more easily yourself (I apply T gel every day). I have only ever used patches from the start but they work fine for me and haven't needed to tweak (until recently when I started testosterone too).
http://www.menopausematters.co.uk/treatafter.php
http://www.menopausematters.co.uk/to_progestogens.php

To get T I just went to Annie Evans (Bristol) for one consultation and got a huge box - and hope to get a refill on NHS otherwise will need to go back to get a prescription but the box has lasted me almost a year! She is way cheaper than Pany and Studd anyway. She doesn't test for T as this is unreliable because the lab range is set for men so the test is not really sensitive enough, althluhg some gynaes do it. Also she doesn't organise blood tests on the day and if you request them will have to go back. Hopefully you can get these done on NHS anyway, due to your early menopause?

Hurdity  x

[Dana]

Hi Bissal

What do you think of when you say "bioidentical hormones". Are you thinking normal prescriptions you get from a normal doctor, or are you thinking about compounded hormones that you have to get made by a special compounding pharmacist.

I suspect, seeing as you have quoted a huge amount like £900, you are referring to the compounded hormones, or what are marketed as "bioidentical" hormones. This type of hormone treatment is completely unnecessary. You can get "natural" hormones (estradiol and progesterone) from normal doctors and they are properly regulated and tested, unlike the compounded hormones.

Also you really don't need to have a whole heap of blood tests done (and definitely not saliva tests), or have all your hormones evaluated. In most cases doctors will prescribe based on symptoms because hormone testing is very unreliable, and usually the only hormones you may need are estrogen (estradiol) and progesterone, and in some cases testosterone. All the rest of the stuff is just marketing and a way to part you from your hard earned money.

[Dancinggirl]

Hi bissal and welcome to MM
You have been given good info from others on this thread - you do sound very anxious and I'm not sure which specialist you saw but you clearly didn't get the result you felt you needed which is a shame. I would ask to be referred to a NHS Menopause clinic and see what they suggest - what they will prescribe will be the tried and tested HRT preparations - I really wouldn't go for anything else. Keep us posted. 

You mentioned in your original post that you thought there were other hormones that you would need apart from oestrogen, progesterone and testosterone - what exactly to you mean?. I am also concerned that you are worried about getting the levels right - this can only be trial and error as there are no real tests that can prove you are getting the correct amount of hormones - you will know if you are on the right hormones as your symptoms will improve. I had a premature menopause which started in my mid 30s and I've never needed testosterone - some women don't need this.  I'm not sure what you think you need.  Oestrogen is actually the vital hormone that you need following an early menopause - progesterone is only needed if you still have a uterus so that the womb lining doesn't become thickened and cause problematic bleeding.
As to bio identical - most oestrogen in HRT preparations that are prescribed in the UK is already bio identical. Utrogestan is a bio identical progesterone and this does suit many women but not all.
Finding the right balance is important but I was put on Oestrogel daily (just one pump) with a Dydrogesterone for 10 days each month to induce a withdrawal bleed and this worked very well fro me fro many years and has protected my bones quite well - I am now 60 and my density is not bad.  I must say that it is not just hormones that you need to consider but for additional support for your bones and heart a good diet and exercise regime is advisable. Keep us posted.  Dg x

[Bissal]

Hi everyone,
Thanks very much for your replies.
Yes, it was one of the specialists mentioned who I saw. I have started estradiol gel and testosterone and my anxiety went up. I contacted the doctor but haven't really had any questions answered, and was just told "you were anxious about taking them"!

Well, from what I have been reading, I think many symptoms can come from an imbalance of other hormones too....human growth hormone, DHEA etc I'm sure diet and stress plays a massive part, and I have had 3 horrendous years (which is why I thought my periods were erratic). I am 43.

I have osteopenia and often ache, my hair is thinning, my skin and breasts are sagging and am putting weight on. I get so depressed with how I look, and going to the gym etc isn't helping! I've literally gone from looking young for my age with perky breasts, to looking old and flat chested....it is so depressing, and a shock!

I read different things about what helps/doesn't help with bones....sigh...it's so confusing! I wish it was 10 years ago....life was far simpler!

My GPs have never heard of bioidentical hormones!!! Hence why I feel very much alone in my (expensive) journey!

There's much differing information about risks etc I just don't know what to believe...and in the meantime I feel crap and feel I don't have time to feel this bad as I was wanting to start a family (my mum didn't hit menopause til after 50 so thought i'd be OK). SO...I am considering egg donation but need to feel better!

Anyway, thanks for getting in touch. I feel far too young to be going through all this, but have to accept it and now just want to feel better.
x

[Briony]

Being 43 and childless too, I know how you feel. It's a nasty shock initially, but you will gradually get more accepting of what's happening and will then be able to consider your options.

I think your best bet regarding hrt is not to ask for 'bio identical' hrt, but instead ask for patches (or gel) and micronised progesterone. I found printing off the info from here helpful (menu at the top).

I totally agree with what the others said about blood levels not being helpful. Within a few weeks, aged 39, my estrogen went from post menopause levels (40 pmol) to sky high on its own. I suspect, at times, it's fluctuating on a daily level sometimes (I can tell from the symptoms). Many GPs therefore go by symptoms alone.

The crucial thing, at our age, is to ensure we have enough estrogen to protect our bones and heart (the stated hrt risks are based on older ladies).

Have you thought about emailing Dr Currie on this site? I found it £25 very well spent.

Good luck, B

[Dana]

Well, from what I have been reading, I think many symptoms can come from an imbalance of other hormones too....human growth hormone, DHEA etc I'm sure diet and stress plays a massive part, and I have had 3 horrendous years (which is why I thought my periods were erratic). I am 43.

Unfortunately if you do too much research on the internet you will become very confused. What you have to remember is that there are a lot of sites that are set up specifically to sell you stuff - like DHEA and progesterone creams etc. Don't fall for the hype.

I have osteopenia and often ache, my hair is thinning, my skin and breasts are sagging and am putting weight on. I get so depressed with how I look, and going to the gym etc isn't helping! I've literally gone from looking young for my age with perky breasts, to looking old and flat chested....it is so depressing, and a shock!

I have osteopenia too. It's not the end of the world and probably isn't what is causing the aches (more likely a lack of estrogen). All it is is that your bones aren't at optimal density, but things like estradiol (estrogen), exercise, healthy diet with good calcium rich foods, maybe some calcium supplements, all go towards improving this condition. Later down the track there is a medication you might need to consider called Fosamax. I'm a lot older than you and I've had osteopenia since my 40s and I now take Fosamax and it has helped tremendously. It's only one tablet once a week for Oesteopenia.

My GPs have never heard of bioidentical hormones!!! Hence why I feel very much alone in my (expensive) journey!

A lot of doctors don't use the term "bioidentical" when it comes to hormones, because it's not actually a medical or scientific term. It actually started as a marketing term by the compounded hormone industry in the USA (ie flakes like Suzanne Somers etc), and it has now worked its way into common usage. Even the FDA in America specifically states on its website that they don't recognise the term BHRT or bioidentical hormone therapy. It causes a lot of confusion, even on this site. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049311.htm

If you want these kinds of hormones you would be best off just saying that you want "natural" hormones like estradiol and progesterone, as opposed to compounded hormones or synthetic estrogen (equine estrogen which is made from horses' urine) or progestins.

However, it must be said that some women actually prefer these types of hormones and actually do better on them, so everyone is different and you have to go through some trial and error to find what's right for you.

[Dancinggirl]

Great post Dana - really fab and balanced information.  DG x

[Hurdity]

"Like" too Dana!

Bissal - do keep on with the oestrogen (and progesterone which is needed to keep the womb lining thin) - it is so important at your age. We will try to help and support you during the rough ride if we can .....

Hurdity x