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[michelleu]

Hi ,   can anyone please help i have  asked my GP for bio  identical hormones , she seemed a little confused but eventually  i have been given utrogesten which i believe is the natural progesterone and  a estradoil by Sandrena 0.5mg , Is this a natural estrogen ?  I have read you are not to rub it in  your fatty areas as it can cause cellulite, but the instructions say to rub into thighs, so a little confused . Is anyone using these and are they safer than normal HRT as the research says they are .

[Dana]

I'm afraid it can be a bit of a mistake to use the term "bio-identical" with a lot of doctors. I know it's a term that is commonly used on MM, but doctors tend not to use it because it's not really a medical term.

In fact in a lot of countries it is only used as the marketing term for the very expensive and non-regulated compounded hormones. I think that may be less of an issue in the UK, but IMO it's a term that should be avoided with doctors because of the confusion it can cause. The whole HRT/menopause issue is already confusing enough for women, with oftentimes little support from the medical profession, so let's not make it even more confusing by using unnecessary terms.

You're better off actually asking for what you want ie micronised progesterone (Utrogestan/Prometrium) and estradiol. These are the "natural" hormones. However, at the same time, don't get into too much of a mindset that these are the only types of HRT you can use. Lots of women use other types with no issues at all because they are the types of HRT that actually work best for them.

At the end of the day, be totally open minded about HRT because you just never know what is going to end up being the best kind for you as an individual.

[Dancinggirl]

Oestrogen gel rubbed into fat will not make cellulite - this is an old wives tale. Weight gain creates cellulite.
BEst place to apply the gel is inner thighs - just don't use any moisturiser or moisturising shower gels when using oestrogen gel as it may prevent absorption - skin must be clean and dry..  DG x

[Hurdity]

.. and just to add the instructions do not say to rub it in unless you have different instructions - rather, as Dancinggirl says to "apply it".

Great that you have been given the "bio-identical" hormones ie estradiol and progesterone - but yes not all GPs will understand it if they have only heard of the compounded "bioidentical hormone replacement therapy" (BHRT) as Dana says - where this unregulated industry (mainly in US) has hi-jacked what is the proper term for these hormones and ended up confusing everybody!

Hurdity  x 

[Dana]

Hurdity and I agree on most things, but we do have different opinions on the "bioidentical" term - but friends can disagree right?

Out of interest I checked the NHS site because I wanted to learn more about the use of the "bioidentical" term in the UK, and I found that the NHS doesn't use the term for regulated HRT or recommend the use of "bioidentical" hormones. They use the word in the same context as other countries (ie compounded hormones or BHRT), and this points to the reason why so many GPs give blank looks when they are asked for "bioidentical" because it's simply not a term they use.

http://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/Alternatives.aspx#bio-identical

Bioidentical or "natural" hormones

Bioidentical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones.

Practitioners claim these hormones are a "natural" and safer alternative to standard HRT preparations. However, bioidentical preparations aren't recommended because:

•   they aren't regulated and it's not clear how safe they are – there's no good evidence to suggest they're safer than standard HRT
•   it's not known how effective they are in reducing menopausal symptoms
•   the balance of hormones used in bioidentical preparations is usually based on the hormone levels in your saliva, but there's no evidence that these levels are related to your symptoms

Many standard HRT hormones are made from natural sources, but unlike bioidentical hormones they're closely regulated and have been well researched to ensure they're as effective and safe as possible.

When you search for the different types of HRT the term isn't used there either, even when talking about things like patches and progesterone. http://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/How-it-works.aspx

Even Dr Currie lists bioidenticals in the "Alternative Therapies" section, so it's really little wonder why doctors are getting confused when asked for bioidenticals. http://www.menopausematters.co.uk/otherpreps.php

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)

Sorry, I don't want to turn this into a debate, but it's an issue that bothers me a lot especially for ladies new to the site, or to menopause and HRT. They could be getting mixed messages by reading one thing about bioidenticals from Dr Currie, where she clearly doesn't endorse them, and then something totally different on the forum. There are many women who will just read the posts on the forum and not necessarily post any questions to clarify anything or read the other information posted by Dr Currie, so they could be going along quite happily using compounded hormones because they are seeing people saying "bioidentical" hormones are the preferred option.

Technically there may have been a medical basis to the term at some point, but the popular culture meaning took over a long time ago (probably around the time of the WHI study or even before), to the point where doctors themselves don't use it and the FDA categorically states on their website that they only recognise it as a marketing term and not as a scientific term. All other menopause/medical organisations that I've researched (ie the Australian Menopause Society, The North American Menopause Society and The Society of Obstetricians and Gynaecologists of Canada - and now the NHS) all say more or less the same thing.

Like I said above, menopause is such a confusing time for a lot of women, where they are bombarded with so much information so I hate to see them get confused about something that shouldn't be confusing. I've seen other posts similar to michelle's on MM where women ask for something that the doctor gets confused about, then they get anxious and stressed on top of what they are already going through. I honestly feel it would be better to say exactly what is being referred to, ie estradiol, progesterone/Utrogestan/Prometrium (if that's the preference) or testosterone, as opposed to the "synthetic" HRTs, as these are terms a doctor will definitely understand and there can be no confusion.

PS ..... Sorry Michelle. I hope I haven't confused you even more, but I think it is important that people do understand that if the term bioidentical is to be used at all it should be used with a lot of caution and a lot of explanation.

[Hurdity]

Of course we can Dana   . Thanks for posting that.

What I feel strongly about is that women really do understand what is meant by the word "bioidentical" in molecular terms, the reason being that we have read of women who have gone to the docs asking eg for estrogel and utrogestan and been given something else - so need to be able to argue the case as to why they want patch or gel with separate progesterone. There really isn't any other word for it - but I suppose in the consultation the woman would have to explain!

Maybe in UK we actually don't need to use it so much in terms of oestrogen because estradiol is the hormone mainly used for HRT on NHS, whereas in US at the time it was developed and promoted as an industry - HRT consisted chiefly of Premarin and MPA? However there still remains the question of asking for progesterone becase unfortunately this word is often used for all progestogens (the correct term) rather than reserved for "bioidentical" or biologically identical progesterone.

We are saying the same thing - ie the hormones are the same - but I agree it is very important to avoid any confusion about what we mean and I think in most posts where this is raised by women, we do distinguish and clarify the difference between the BHRT and the actual hormones themselves, and we will have to continue to do so - as you have done so clearly!

Hurdity x

[michelleu]

Thank you so much  ladies for your replies  , I do understand what you are saying about bio identical  hormones as opposed to saying the word natural  ,  i think i have read so much in the last two years , including lots of literature from America  regarding HRT  in basically trying to find a formula that  i am not terrified to try.

My Mother died of thrombosis  ( not through HRT )   yet when i finally visited the  Dr and asked for estrodiol and utrogesten she just gave me 3 months prescription  and never asked anything about my background or family history. I  am now just 4 days in with the estrodiol  and  i cannot help feeling a bit worried , well frightened  if i have done the right thing  because i feel like i am self medicating without any help. advice or reassurance from the Dr .  How can you have two separate camps of of highly educated professionals giving such different accounts of the same treatment ? .  One side saying if you take them  you will get breast cancer and have lots of side effects that may be worse then the  symptoms you are trying to treat and then the other side saying it is great for your moods, hair ,skin and basically feeling young ?   Am i wrong to think that HRT will be the answer to all of this I am 49 years old still trying to look after a family , work and be the best version of me i can be . Maybe i am looking for a conclusive answer when there is in fact not one .

Can i just say I so appreciate you all taking the time to read and offer advice this is the only place i feel i can turn to now

[Dana]

It's great to try to help educate women, but most women aren't medical professionals and I think it is more important to use words that are in common usage, and quite frankly bioidentical is not a word that is in common usage when talking about conventional HRT, and as it turns out, not even in the UK. If women are asking for specific products and not getting what they ask for, then that goes back to the doctor's poor performance or perhaps a lack of communication, but using a word that the doctors (who aren't prescribing compounded hormones) don't use is only going to cause more confusion and frustration.

To be honest I don't see a lot of clarification given on MM when discussing bioidentical hormones. I see the term being used all the time by lots of women, without anyone saying they are NOT talking about compounded hormones. Going by the links I have provided from Dr Currie and the NHS, bioidentical is definitely recognised by the medical community to mean "unregulated or compounded" hormones. So using the word bioidentical on MM (regardless of what it is intended to mean) is actually going against the recommendations and terminology used by the NHS, and by Dr Currie on her own website.

I will keep saying that this is a very important issue. No one lives in a bubble. This isn't just an issue in America, because anyone doing any kind of googling on the subject, which we all do especially when you're scared and searching for answers, you are inevitably going to come across many American websites and you are going to be reading about bioidentical (compounded) hormones. Then you come here and see people talking about bioidenticals and you are bound to think they are one and the same thing.

I'm sorry to take this off topic Michelle, but it's a subject I'm quite passionate about because I know only too well what confusion this can cause (and not just on this forum). The doctors who are still advocating the "dangers" of HRT are not keeping up with current research. There will always be those who are anti-HRT, but an awful lot of those people are the ones who advocate things like alternative therapies and compounded hormones, and there is a financial incentive for them to do this. They really don't have women's best interest in mind.

[dangermouse]

Maybe the best term to use then is plant based? This is after all what differentiates BHRT from HRT as there are no pharmaceuticals involved, apart from the small extra ingredient they have to add (like valerate to estradiol and whatever creates the micronised bit of Utro) to be able to classify it as a drug to get a patent.

I think it's also important to recognise the difference between compounding pharmacy BHRT products, which are based on the traditional way medicines used to be put together on the premises in measurements personal to the individuals needs and require an MDs prescription, as opposed to one size fits all BHRT creams sold online, which are certainly not compounded and no doc is required!

It's impossible to get compounded products without a prescription because I tried with the London Compounding Pharmacy, assuming they were negligible strengths like the online creams, and was refused without an MD's prescription. Herbalists or homeopaths also cannot prescribe them.

This is for the UK though so I'm not up with the rules in the US as some complementary therapists there need doctorates to be certified so they may then have prescribing authorities.

[Dana]

Most compounded hormones are obtained by prescription though, even if some of them are obtained by doing nothing more than talking to a doctor on the phone. What you generally buy on the internet are just the progesterone creams which at best are probably mostly moisturising creams, although certainly would contain enough progesterone that they shouldn't be used unsupervised.

What is actually very interesting though is that prescription compounded hormones and conventional HRT use the exact same base ingredients. There really isn't any difference. Compounding pharmacists don't make anything from scratch. They obtain the active ingredients from the pharmaceutical companies that make the conventional HRT. So in a sense they are identical. HOWEVER, the real difference is that there are no controls over the compounding pharmacies, and investigations have found that quite often what is dispensed isn't accurate and sometimes the incorrect estrogen is used (estriol/estrone) which apparently is cheaper, instead of estradiol. Then there is the whole issue of using progesterone cream to oppose estrogen for womb protection. There is also evidence that there has been monetary kickbacks paid by the compounding pharmacies to doctors to give them incentives to use compounded hormones.

Here are a couple of very good overall explanations of all things bioidentical (compounded) hormones.

http://www.menopause.org.au/for-women/information-sheets/34-bioidentical-hormones-for-menopausal-symptoms

http://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy/compounded-bioidentical-hormones-what%27s-the-harm- (click on "view transcript")

We live in a global village, and if something is available on the internet everyone gets to read it regardless of what country you live in. So when you have these kinds of legitimate sites, plus the NHS and Dr Currie, talking about the problems of "bioidenticals", other sites extolling the virtues of "bioidenticals", and then "bioidenticals" being recommended on the MM forum, you can see that a lot of women would be getting very confused.