Written By Kate Organ
Hormone replacement therapy or HRT is the medical term for the hormones we replace in women as they lower in the perimenopause and menopause. There are many different types of HRT and they have progresses since the ‘first generation HRT’ became available in the 60’s.
Body-identical HRT are hormones identical to those produced naturally within our bodies. Importantly they are regulated medicinal products by the Medicines and Healthcare products Regulatory Agency (MHRA) in the U.K. These are different to ‘compounded’ bioidentical hormone replacement therapy (cBHRT), which are considered as unregulated and untested for efficacy.
What you should know about compounded bio-identical HRT They are manufactured as creams, lozenges and vaginal preparations by ‘Specialist Pharmacies’ and heavily marketed. These compounded bio-identical HRT products:
Do not follow the same regulatory pathway of evaluation by the MHRA
Have not been through the rigorous process of drug development
Have not been scientifically evaluated in controlled randomised clinical trials for effectiveness and safety
Body-identical HRT vs first generation HRT There are three hormones involved in HRT:
Oestrogens
Body identical oestrogen, called ‘17 beta-estradiol’, is derived from the yam plant and has the same molecular structure as the oestrogen you produce naturally from your ovaries. Body-identical oestrogen is absorbed through the skin and enters the blood stream in the body-identical form. Body-identical oestrogen absorbed through the skin is known as transdermal oestrogen and is manufactured as patches, gels or sprays. First generation HRT, taken orally, contains a mixture of different types of oestrogens, often sourced from horses urine and known as equine oestrogen, these are not body-identical HRT and carry unwanted side effects.
2. Progesterone Progesterones are an essential part of your HRT treatment if you still have a womb and haven’t had your uterus removed through a hysterectomy. The progesterone protects the lining of your womb from overdeveloping and becoming abnormal, a condition call hyperplasia, this can lead to uterine cancer in some women. There are synthetic progestogens such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel.
The body-identical progesterone, micronised progesterone, is chemically identical to the human hormone and derived from the yam plant. Micronised progesterone, branded as Utrogestan in the UK, is manufactured as an oral capsule. Occasionally we recommend this progesterone to be be used vaginally. Micronised progesterone is better tolerated and considered safer than the first generation synthetic progestogens.
3. Testosterone Low levels of testosterone seen in menopause can cause reduced libido, energy and motivation. Testosterone is also very important to maintain muscle mass and bone strength. Testosterone is only licensed for HRT to treat reduced libido. There isn’t a licensed preparation of testosterone in the UK for women, however we often use a product called Androfeme . This is a body identical female testosterone which we import under special licence from Australia. It is a regulated medicinal product in Australia and hopefully in the UK shortly.
Key Messages
Only use regulated medicinal products
Body-identical hormones are generally associated with fewer side effects and risks
Ask if your HRT is body-identical and regulated.
Kate Organ, Consultant clinical pharmacist with specialist interests in the menopause and mental health. Founder The Menopause Specialists