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[Bissal]

Hello,
I am torn between two doctors to see for bioidentical HRT - a Dr Sharma, and a Dr Paivi Ahtonen.
Just wondering if anyone seen either of these doctors and what they thought?
Thanks.

[Tinkerbell]

I haven't seen them, but I see a brilliant Surrey based one, who is a great believer in bio identical HRT.
Just wondering as Google shows those doctors practicing from London.

[Hurdity]

Hi Bissal

You do not need to see a private doctor to get bio-identical HRT - ie the hormones that are biologically identical to those made in our own bodies. These are available on NHS. It is not advisable to go to a private doctor to get compounded "bio-identical hormone therapy" using creams etc. Here is what it says on this site about this type of treatment:

BIO-IDENTICALS Bio-identical hormones are marketed as being naturally produced hormones which aim to resemble our own hormones and which replace the hormones according to individual requirements. They are in fact very similar to the hormones used in Hormone Replacement Therapy, which are also produced from natural sources, but, unlike HRT hormones, are given in uncontrolled, unregulated amounts, with little evidence available on effect and safety. Measurment of salivary hormone levels is often used to determine the amounts of bio-identicals which are prescribed, but salivary hormone levels bear no correlation with hormone levels which are required to treat menopausal symptoms, or to provide beneficial effects on bone or the cardiovascular system. For more information, see this article on bio-identicals from our magazine. (PDF 1Mb)

http://www.menopausematters.co.uk/otherpreps.php

Please don't waste your money and do start with your GP and then ask for referral to a menopause clinic if no joy from your practice.

Hurdity x

[Tinkerbellj]

Hurdity is right. I got mine on the nhs from the meno clinic and the script went to my own doc who filled the prescription. Good luck

[Tinkerbell]

Mine wouldn't prescribe it for me 
After 3 years of fighting to get treatment I gave in and paid.
Cross that I had to resort to it, but my repeats are now on the NHS.

[dangermouse]

I actually wonder if its not so easy to get when you're peri as, even on the treatments section here, Oestrogel and Utrogestan are not included in the list for perimenopause, only post-menopause. I was told by one of my GPs that even if I am 'allowed' HRT on the NHS, I won't get the bio-identicals as they're not normally prescribed for my age (46).

Perhaps its just not first-line, so only after you have problems with the Femistan etc.? As some here seem to get it easily and others have to fight/beg/nip to Spain.

I am finding the Oestrogel quite oestrogen dense compared to the pill, so perhaps HRT is a lot stronger than the synthetic pill hormones and that is why they prefer to use the pill and milder HRT in perimenopause?

[Hurdity]

Hi dangermouse

The products are listed or referred to on both peri and post and under separate treatments. If you look under peri and scroll down to progestogens - this is what it says:

As well as being given as part of a ready made combined therapy, the following progestogens can be given with estrogen only regimes:
http://www.menopausematters.co.uk/perimeno.php

and then it lists the two available including utrogestan - so it's clear that you then need to go to the oestrogen section to look up the different types here:

http://www.menopausematters.co.uk/treatafter.php

It says at the bottom:

"All estrogen only preparations can be used in patients who have not had a hysterectomy, as long as an appropriate progestogen is given in addition."

This is not rocket science so any doc can find this out in a few seconds (obviously they need to understand the biological basics of HRT....)

Going to Spain for HRT is not an option nor desirable for most and not recommended as you will see from the other thread.

Synthetic oestrogens are actually much more potent than estradiol which is why they are taken in smaller doses, so HRT is generally much weaker than synthetic pill hormones in the BCP. The oestrogen dose in BCP (combined) has to be very high in order to suppress ovulation whereas in HRT it does not. The reason the pill is recommended in peri is precisely because of this - suppression of ovulation because it is the extreme fluctuations which cause so many of the mood swings and awful symptoms during peri - and suppressing ovulation eliminates these. Milder HRT as an alternative is used because when the hormones swing upwards - to give the oestrogen peaks which can occur, a medium/high dose of oestrogen can add to this and sometimes give rise to additional side effects.

Hurdity x

[Keepgoing]

I am in peri and 45 and on estrogel and utro, I was started on prempak c which I think is a go to for gps. Wasn't agreeing with me came on here got advice went to docs asked for femseven patches also didn't agree with me back to docs asked for gel and utro doc looked it up and gave me it. I am very happy on it and I am lucky to have really good doctors. Admitted she did not know loads about menopause and I told her about this site, took down details and said she's going to have a look at it. She is younger than me but obviously interested as I think all good doctors should be. Would be good if all doctors looked at this site xx

[dangermouse]

Thanks guys. I'm really not sure what to do about trying to get the HRT from the GP tomorrow (I'd booked the appointment last week when the other GP had said I'd have to see a specific GP who she'd just checked with as it wasn't their recommendation - despite the NICE guidelines). She said if I do get to go on it, it will go down on record as me starting early and then I can only take for 7 years - they stick strictly to the 5-10 year rule (which they calculate as 7 years on the nose) and I'm not sure if they are this rigid all over the NHS if this is NICE's recommendation?

I figured if that was the case it was best I stuck with the pill from the GP and source the gel elsewhere (hence via an online private doc or from Spain, which is the same manufactured stuff, you just don't need a prescription like on the flip side where some of our OTC meds you need a script for in Spain), and then switch when they tell me I'm too old for the pill 

(Sorry Bissal for hijacking your thread! - Many here recommend Prof Studd who is a private gynaecologist who can provide the bio-identicals we're all discussing. His fees are similar to seeing the bio docs and you may be able to get your private prescription converted to and NHS one to save on that end).

[Bissal]

hi everyone,
Thanks for your comments.

I have made a decision to go on bioidentical HRT as these are safer than non-bioidentical, and yes the ones i'm on are from NHS (only one GP in my practise has agreed to prescribe them, under guidance of hormone doc).

For those of you on the bio HRT from your docs, how often, and what kind of tests, are done to monitor you? Oestrogen can mess up with other hormones unless everything is monitored closely, and progesterone can cause issues too.

I saw the professor in London, but didn't like how he prescribed, and trying to discuss things with him was very difficult, hence my search for another doc. I want one that prescribes them mimicking a natural cycle, not static dosing, as again, this is more natural. As far as I am aware only private doctors will do this, unless anyone knows differently ??!


Tinkerbell - who is your doctor, and do they prescribe them in cyclic dosing?

Thanks 

[dangermouse]

Yes you need a private BHRT doctor for that as the HRT will need to be compounded for all the different daily doses. Suzanne Somers uses the rhythmic cycling too and I like the link to the bio rhythms, so it really is as natural as you can get!

If I can afford it I may consider when I'm post meno as it wouldn't work in peri with all the natural fluctuations already going on.

I think more testing is done with the BHRT docs as its a specialist service you are paying for. They do often include email support as well so I'd definitely ensure that's included as it will no doubt take a while to work out what your body needs.

I like the 2nd recommendation the best, she seems feisty if you read about her issue with the London practice licences!

[Hurdity]

Bissal - why do you want to cycle your oestrogen? If you go with sequential HRT then you will be cycling progesterone anyway. If you have separate progesterone and oestrogen then there is nothing to stop you making up your own cycle from the average amount you are prescribed. eg say you are prescribed 2 pumps per day of gel - well you could work out your own cycle to average this and try one pump some days and 3 pumps on others - especially if you are peri-menopausal. Most women are relieved when they become post-menopause precisely because the hormonal fluctuations (which cause the problematic symptoms) cease!

There really is no need to have compounded hormones nor go to a private practitioner, nor get meds from Spain.

Dangermouse - you really don't need to stop after 5 - 10 years - it is your decision. Also it is not an age thing in that if you start HRT at a particular age then it's not early or late - it's the stage that's important. The years of taking HRT before the average age of menopause ( of 51-52)  do not count in terms of risk anyway.

Hurdity x

[dangermouse]

Thanks Hurdity - someone else mentioned that the 5-10 years is from post meno but one of the 2 GP experts on HRT at my practice told the GP I was with to tell me that it was a risk to start now in case I don't go into menopause for another 7 years, as I then couldn't have HRT when I needed it. They clearly don't understand this important point about the 5-10 years being from post meno! I cancelled seeing that expert today and will see the other one if/when I need to - she seemed more informed when I'd met her about my pill.

[Hurdity]

Ah - well if you don't know when you are post-meno because you are on HRT (as I didn't but guessed) - then you can go on approx age using the info on this site: http://www.menopausematters.co.uk/balance.php . You still don't need to go on the time limits.... especially if you have an early/premature menopause!

Hurdity x