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Bio Identical HRT or HRT? I am further confused…

Written by Fiona

August 22 2019

I have noticed a lot more chat on the internet about Bio Identical Hormone Replacement Therapy (BHRT). It is claimed this is a better solution to menopause symptoms and is usually a treatment offered by private clinics.

This means that BHRT comes with a price and I am often suspicious – although, also curious – of such things because I have access to the NHS. Also, I am not so well off that I usually seek the help of a private clinic because I worry about the cost. (Note: In Scotland, NHS prescriptions are free.)

Recently, I received an email from The Menopause Clinic. It is based in Manchester, which is not a place I am likely to attend due to the distance from Glasgow but I was interested by their promotion of BHRT.

They contacted me after I complained via Facebook that I felt a poster they had shared on social media appeared to suggest that the main causes of menopause symptoms are reduced progesterone. I said I thought it was a lot more complicated than this.

Read my post: I’m confused about: How reduced oestrogen and progesterone affect women?

What is Bio Identical Hormone Replacement Therapy?

Back to my email from the Menopause Clinic. It said: We are no longer limited in our choices between enduring and suffering menopausal symptoms, or risking the side effects of synthetic hormone therapy.

Here at The Menopause Clinic, we can help you with the wide range of peri-menopause and menopause miseries including hot flushes, depression and anxiety with hormones, which is often referred to as Bio Identical Hormone Replacement Therapy (BHRT). 

Unlike synthetic hormones which can cause undesirable side effects such as bloating, headaches, weight gain and fatigue, natural hormones are substances that our bodies produce and the BHRT treatment is designed to be identical on a molecular level and completely replicate your naturally occurring chemical structure without any of the undesirable side effects related with the conventional HRT synthetic treatment.  

The menopause and the decline in hormone production is a direct cause of premature ageing, we only prescribe specifically compounded hormones and we are committed to your well-being.  

You will be invited to a consultation at The Menopause Clinic to ensure that we understand your symptoms and can tailor the treatment and personalise it just for you. A blood sample will be taken and sent off for analysis and from there we can work with you to create a custom hormone therapy plan that matches your body’s needs, working to make you younger from the inside out by returning your hormones to their youthful levels.

As your hormones become imbalanced, you may find that you suffer with one of the following conditions:

  • Hot flushes
  • Depression and anxiety
  • Mood swings
  • Memory loss
  • Low libido
  • Difficulty sleeping
  • Night sweats
  • Sexual dysfunction
  • Osteoporosis
  • Wrinkled skin
  • Dry skin
  • Vaginal dryness
  • Heavy, irregular or painful periods
  • Constipation and diarrhoea
  • Breast tenderness.

The benefits of your personalised BHRT treatment plan will include:

  • Better Concentration
  • Mood elevation
  • Stress resistance
  • Better quality of sleep
  • Reduce anxiety levels.

We are able to compound the following Hormones into a lozenge or cream;

  • Oestrogen
  • Progesterone
  • Testosterone
  • DHEA

We also test Vitamin D levels.

Note: I had no idea what DHEA is: Apparently, it’s Dehydroepiandrosterone, also known as androstenolone, which is an endogenous steroid hormone. It is one of the most abundant circulating steroids in humans, in whom it is produced in the adrenal glands, the gonads and the brain.

The Menopause Clinic costs:

The annual consultation fee is £250, the blood test, blood test analysis and prescription service is £245 to establish the personalised course of treatment.

The consultation and blood test are required annually to maintain optimum medication for your personal needs.

Each prescription will last two months and the cost of the personalised hormones will vary from £75 to £120 for each prescription.  The prescription service is included in the initial cost, all that will be required from you is to make contact directly with the Specialist Pharmacy to arrange delivery directly to your home.

 You will also require a telephone consultation six months after your initial treatment the cost of this is £130 for your next six months repeat prescriptions.

Annual clinic and medication costs roughly average about £1250 a year, this works out to be less than £3.50 a day, which on an average is similar to a takeout coffee. 

This got me thinking…

Should I be seeking a clinic in Scotland that can offer me BHRT? Is the HRT from the NHS not as good as it could be? I can see that £3.50 per day might not seem like a lot but many women have peri and menopause symptoms for up to 10 years. Even if you chose to go private for just five years, this still amounts to a lot of money. This is money that many people do not have.

In addition, if the BHRT are not synthetic – I quote from the clinic’s email: “Unlike synthetic hormones …. the BHRT treatment is designed to be identical on a molecular level and completely replicate your naturally occurring chemical structure” – what are they made of?

So I did a bit of Goggling.

I read this: The Truth about Bio Identical Hormones for Menopause. It’s interesting.

What I discovered:

  • HRT does not fall into two camps, standard GP-prescribed therapy on the NHS (often perceived as synthetic and having health risks) and bioidenticals available via private clinics (seen as a “natural” plant derived alternative).
  • HRT (that most of us are on) does contain hormones that are identical to our own and they are regulated for safety.
  • Bioidenticals are also available on the NHS, such as in the form of Oestrogel (oestrogen gel), Utrogestan (a bioidentical progesterone tablet), vaginal oestrogen such as Vagifem (estradiol) or topical Ovestin cream.
  • It is true that a generic HRT as prescribed by GPs who are pushed for time and have limited resources might not be perfect but many women  find them to be adequate. also reports that: “There’s no credible evidence that BHRT is more effective than HRT.”

The article continues: “Bioidentical hormones are different from those used in traditional HRT in that they’re identical chemically to those our bodies produce naturally and are made from plant estrogens. The hormones used in traditional HRT are made from the urine of pregnant horses and other synthetic hormones.

“Supporters of bioidentical hormones claim their products are safer because they are ‘natural’ and identical in makeup to the hormones the body produces naturally. But most experts believe the risks of BHRT and HRT are similar and, indeed that compounded bioidentical hormones may carry even more risks.”

Even more interestingly

I read this on the British Menopause Society website: “Licensing in UK – Medicines and Healthcare products Regulatory Agency (MHRA): Compounded bioidentical hormone replacement therapies are manufactured as creams, lozenges and vaginal preparations by ‘specialist pharmacies’, which have proliferated both physically and online in the UK and abroad.

“Their products are not authorised by the regulatory authorities (MHRA in the UK) as they are marketed as natural supplements and hence do not require approval by the MHRA.

“As a result, they have not been through the rigorous process of drug development, which conventional medicines and products such as rBHRT undergo. As such, they have not been scientifically evaluated in clinical trials for effectiveness and safety.”

Hmmmm…. untested scientifically doesn’t sound so good.

Maybe they are not so natural, either

I have read that while bioidentical hormones are described as “natural” they are actually commercially processed and made from synthesised substances, just like HRT.

Also, just because a substance is derived from something natural, it doesn’t mean it is safe, for example, tobacco, which is a green leafy plant.

So it’s clear that we shouldn’t always believe the marketing hype and that the messages about hormone therapy and the menopause are confused. If you know anything more or you are an expert in this field of medicine I would be grateful for your response.

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