The HRT conundrum

Written by Fiona Catchpowle

Creator & Founder of The Menopause School. Passionate about educating the world on menstruation to menopause.

May 15, 2022

If you’re thinking of taking Menopause HRT to support your journey along the Hormone Highway, which ones do you ask for?  The information broadcast predominantly on social media by non-menopause specialists has become a little confused of late. There is more to HRT than Bio v Body identical, but let’s start there.

  • Bioidentical hormones are exact duplicates of the ones made in the body. The label comes from two words – biologically and identical
  • Examples of bioidentical hormones in the case of menopause hormone therapy are – estradiol, progesterone and testosterone.
  • Bioidentical hormones are synthesised in a laboratory, derived from an ingredient called Disogenin – a steroid found in plants sources such as wild yams.
  • Disogenin is used as the precursor to many hormones. Initially it is converted to progesterone in a 3 step chemical process.
  • The raw ingredients created are then placed in to products. These products are classified as medicines.
  1. Regulated Bio-identical Products: (rBHRT)

Ones that choose a standard formula and meet the regulations set by the MHRA are for example: Oestrogel, Sandrena gel, Lenzetto, (estradiol formulations) or Utrogestan (a progesterone formulation), Testogel* ( a testosterone formulation ) *The manufacturer’s statement on this product is, ‘This medicine is not indicated for use in women.’

All of the above can be prescribed by a doctor working in the NHS, for example.

  1. Unregulated Bio-identical Products: (cBHRT)

Ones that choose to custom mix the raw ingredients, also known as compounded, into preparations that do not meet the regulations set by the MHRA. These products do not have brand names, do not come in packaging that is recognisable by a patient and cannot be prescribed by a doctor working in the NHS.

Summary:

  • Both products contain bio-identical hormones.
  • One is regulated and considered safe
  • One is not regulated and not considered safe

A BMS statement published online in 2017 stated ‘Trustees and Members of the MAC of the BMS are concerned about the safety of unregulated bioidentical hormonal therapy which is being prescribed by clinicians who do not usually have any recognised menopause training and provided from compounding pharmacies.’

There is another kind of hormone replacement product called Non-bioidentical, which contains hormones that are termed biocompatible and differ very slightly in molecular structure to those made by the body.

An example of a non-biodentical hormone is Levonorgestrel, which is the key ingredient in the prescription medication known as the Mirena Coil.  Levonorgestrel is a progestogen (non-biodentical) similar to Progesterone (the one made in bodies) used in contraception and hormone therapy.

Other examples of progestogens (non-bioidentical progesterone):

  • norethisterone acetate (an ingredient in Evorel Conti patches)
  • dydrogesterone (an ingredient in Femoston tablets)

Non-bioidentical ingredients are used in many hormone replacement products and are often combined with bioidentical ingredients to form regulated preparations prescribed by doctors.

Both bioidentical and non-identical ingredients are synthesised in laboratories. However the non-bioidentical ingredient is termed synthetic as it falls outside the biologically identical terms of reference, which is considered the same as our own naturally produced hormones. However for absolute clarity – both are manufactured.

What then are Body Identical hormones? Why is everyone talking about them and why is it important to define what they are?

Body Identical hormones are also known as regulated bioidentical hormones. The exact same. Biologically identical to the hormones made by your body. Just a different name for marketing purposes. That’s all the fuss is about.

The word bioidentical was adopted as the single word to use by those in the unregulated market, to sound ‘natural’ versus synthetic. Natural is of course another word that has been hijacked for brand marketing, because it implies gentle and kind. However, bioidentical hormone ingredients that are blended together to create a customised mixture for you are not considered safe to use by the MHRA. Regulated bioidentical e.g Oestrogel and regulated non-bioidentical eg. Mirena coil are both considered safe to use by the MHRA

Key takeaway: No one goes to a wild yam farm and treads around on them to squeeze out the estradiol

 

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