Bio-identical HRT prescription confusion

[Helenahandkart]

Is anyone else taking bio-identical or body-identical HRT and can tell me what their prescription consists of please?
I’m desperate to start mine, but there have been delays and now my doctor has gone away for a month leaving me with ambiguous instructions.

My original prescription was estriol and testosterone cream, applied once a day every day.
Plus progesterone cream applied twice a day from day 11 to 23 (I have 23 day cycles)

While I’ve been waiting to start treatment my periods have completely stopped.
She has therefore left instructions to say that I should now use the progesterone every day at a reduced dose, but says confusing things about the Estriol/testosterone cream, as if I no longer need to take that at all, but it isn’t at all clear.

So my question is - if you’re taking similar HRT to me, are you using Oestrogen after your periods have stopped?
I’m really surprised that her suggestion seems to be that I only need progesterone now, so I think I’m misunderstanding her email.
Thanks

You definitely need the oestrogen! That’s the key part! The progesterone is also important to stop the womb lining thickening- to reduce the risk of developing cancer. All sounds very confusing!

My regime (45 still have periods)

Oestrogen gel ( 4 pumps daily)
Progesterone tablets ( only 12 days a month)
Testosterone cream ( tiny pea sized amount) daily

Mine is body identical not bio identical.

I thought progesterone couldn't be metabolized topically and had to be orally or vaginally?

I think you’re supposed to be on the oestrogen all the time.

Mine is
2 pumps of oestrogen gel (oestrogel)
200 mg of progesterone tablets (Utrogeston) for 14 days (2 weeks on, 2 weeks off)

I’m 50, periods regularish before starting.

I agree it’s confusing, I’m not sure my GP told me the right thing. Take a look at Menopause Matters for more info.

I no longer have periods and have two
pumps of the Estrogel daily and one Progesterone tablet. It's made a world of difference to how I feel in general. For those taking testosterone has it restored libido ?

I’m on compounded bio-identical (and don’t @ me, I’m happy with my choices) lozenges. Lozenge is a twice daily dose containing oestrogen, progesterone, T and DHEA. I used to have the oestrogen as a cream but it was too difficult to get the dose exactly right.

Full blood screen twice a year, pelvic ultrasound every 18 months or so. I’m 58.

Also use Vagifem daily.

I'd also really like to hear from anyone on testosterone. I don't think GPs in the UK prescribe it that much and I am wondering if it would help- what does it add to the progesterone & oestrogen?

I used to be on the Oestrogen patch and utrogestan daily ( 100mg)
Due to continuous bleeding and pain, I’ve now been given bijuve. It’s the first body identical Oestrogen and progesterone combined capsule
( 1mg) .

Not sure how I will get on, but need Oestrogen somehow.

Op, your regime sounds a tad complicated. It sounds like bio identical compounded hormones?

I would head over the the menopause matters site, where you will find a thread called alternative treatment. Here, many ladies are discussing this type of HRT and may be able of offer clarification.

Good luck 🤞🤞🤞🙂

@Dullrugby I’m on T. It’s pure gold - good for maintaining muscle, brain clarity, recovery, libido, assists the take up of the other hormones (as does DHEA). I don’t know if it’s available on NHS. I wouldn’t be without it and my specialist has pretty much all of her patients on it.

@JosephineDeBeauharnais - I'm also taking T but via androfeme cream - and only added it to my regime 2 weeks ago.

I'm not noticing much difference ... yet. In fairness I've heard it takes a while to be noticeable.

You are really positive about T for you, which is great. Can I ask how you know the T is making such a difference given it sounds like it's compounded together with the other hormones in your lozenge?

Hopeful for some encouragement!

In the UK, bio-identical (not the licensed body-identical) is not licensed or considered safe.

The cream based progesterone can't be absorbed in sufficient amounts.

Are you aware of the British Menopause Society statement on it?

I have a private meno gynae and use body identical HRT. If bio was safe, I'd be given it.

Please do reconsider. The fact your dr has left you in the lurch with inadequate information is a bit of a red flag.

58. Take oestrogen every day (2 pumps) and I tablet Utrogestan daily.

Would also like to know if I should ask for testosterone.

@Tulipomania

58. Take oestrogen every day (2 pumps) and I tablet Utrogestan daily.

Would also like to know if I should ask for testosterone.

Testosterone is only available privately as it is not licensed for women. You'd use the male version in a smaller amount.

Women I know who use it go to a private dr for the first prescription and then their GP may agree to prescribe repeats.

The safety concerns around compounded Bioidenticals are largely to do with the laboratory conditions- these labs are not inspected so quality and hygiene standards are unknown. Best to check that your potion is being compounded in a UK lab, as these will likely be working to proper industry standards. Ask questions of your doctor about the diligence they carry out on their labs. Make sure that your doctor makes their CQC inspection report available for you to read. In other words, carry out your own diligence.

This is the email. DH and I have read it about 15 times and can’t really decide exactly what she wants me to do.

On the one hand she says to ‘just take the progesterone’ and it may be that I need to ‘introduce some oestrogen later’.

Or, she means that I only take the progesterone once a day now, and take the current oestrogen prescription, and she might introduce more oestrogen later.
After reading your responses, I’m thinking it’s the latter interpretation.

’If your periods have now stopped i would just take the progesterone 1 pump twice a day but every day now as we cant time it around your cycle anymore. It may be that now your periods have stopped your oestrogen levels will start dropping, in which case we may need to introduce some oestrogen however for the time being you can take what's prescribed as the DHEA capules will also boost your oestrogen too.’

I forgot to mention in my OP that I was also prescribed DHEA.
I think the hormones are body-identical rather than bio-identical but can’t quite remember.
I will query the topical progesterone application, as that seems to be getting flagged up as problematic.
The Estriol/testosterone is a vaginal cream.

She is a private menopause GP working for a national women’s health clinic.

@Helenahandkart

She is a private menopause GP working for a national women’s health clinic.

I expect it's the one in London? I know it's your choice, but honestly, I don't think their products are safe and neither do all the other NHS/ private meno specialists who could prescribe bio HRT if they felt it was safe.

There are many excellent menopause consultants (not GPs- consultant gynaecologists) working privately who will give you tailor- made HRT regimes, using licensed and safe forms of HRT.

I found it really confusing looking for a menopause doctor. I’m not sure if we’re talking about the same company, but I ended up choosing one who ran clinics in my local town, thinking I would be able to have face-to-face consultations - although this wasn’t possible in the end because of covid.
I rejected a few who’d been mentioned to me by friends because their experiences seemed fairly negative, but I did find it difficult to find anyone who had good reviews. I don’t think it helps that I’m older than many of my friends, so not many of them are dealing with this yet.
Like I said, I think the HRT I’ve been prescribed is body-identical, not bio-identical.
Happy to receive south-east recommendations!

Like I said, I think the HRT I’ve been prescribed is body-identical, not bio-identical.

I don't think it is :)

Here are some links for you.

thebms.org.uk/publications/consensus-statements/bioidentical-hrt/

wwwmenopausematters.blogspot.com/2017/01/bio-identicals.html

lizearlewellbeing.com/podcasts-videos/podcast/making-sense-of-hrt-nick-panay/ Bullet point about 2/3rds way down the list.

Almost all estrogen given in the UK is body -idenetical.
Oestrogel is, (topical) as are estrogen-only patches.

The only body identical progesterone is Utrogestan. This is a capsule that can be used orally, or (off-label) vaginally.)

I've never heard of estriol and testosterone being used vaginally (unless the estriol is purely for vaginal dryness.)

The more I read about this the more confused I get about what I’ve been prescribed.
My initial appointment was several months ago and I can’t remember exactly what I was offered now - but I think I was advised that I could do:
standard NHS HRT, in standardised doses
Or Bioidentical tailored HRT
Or Body-identical tailored HRT

I think I opted for body-identical tailored HRT

Further reading suggests that body-identical HRT is the standard NHS HRT, so there are only two options not three, so I’m really confused about my prescription.

The British Menopause Society website isn’t particularly user friendly (why no search function?) so I’m struggling to find the particular statement about topical progesterone that was mentioned upthread. I don’t see my clinic/doctor mentioned in their recommended list. My doctor is a ‘real’ doctor with proper training, but appears to be open to non-NHS treatments as well. Not sure how I feel about that in this world of snake oil salesman.

Obviously before embarking on this I did as much ‘due diligence’ as possible - hours of searching for clinics and doctors and reading reviews and asking for recommendations. I thought that I’d made a reasonable choice - a GMC registered doctor with particular training in gynae, obstetrics and menopause.
I had never heard of the British Menopause Society before today. Their website never came up in all my previous clinic searches. Otherwise I’m sure I’d have opted for a BMS recommended practitioner.
It’s a minefield.

I’ve been through Louise Newsons’s clinic recently and have been very happy (I saw one of her doctors). Was expensive h I felt necessary as have been battling my own doctors in the surgery so I just needed to get it sorted. Had a video appt (about 50 mins) where I was able to discuss full history and have received prescriptions and follow up since

Would recommend (although there is a waiting list, I waited abt 3/4 months from initial sign up).

The British Menopause Society website isn’t particularly user friendly (why no search function?) so I’m struggling to find the particular statement about topical progesterone that was mentioned upthread.

It is in the article from the BMS. You have to read the whole article to find the part about endometrial protection. It IS there as I copied the whole sentence for another poster in the US using bio HRT, just 2 days ago.

The article I lined to is under 'Publications' and then under Consensus Statements' on the drop down list.

In addition to the issues related to purity, potency and safety of cBHRT, many such products deliver progesterone transdermally in cream or gel preparations. The absorption of the latter is variable with fluctuating tissue availability and as a result may not provide sufficient endometrial protection.

This is in PART A - unregulated Bhrt

Thank you for the links.
Something that occurs to me (and it’s an observation rather than me discounting the info you’ve provided, for which I’m very grateful) is that I’ve waded through dozens of websites today, all of which purport to be giving the most accurate information about HRT, many of which recommend bio-identical HRT. They all look like the Liz Earle website you link to (photos of smiley trustworthy looking doctors displaying their credentials etc). Without knowing the names of particular menopause specialists, I wouldn’t say the website you’ve linked to looks any more legit than the ones giving contradictory information. It’s almost impossible to find any consensus, or to be able to know whether you’ve found legitimate advice or not, particularly when so many of the ‘official’ websites for ‘official’ bodies are just made up by companies pushing their own agendas.

Obviously I’m going off on a tangent now, but trying to find any kind of trustworthy medical info online is horrendous.

Thank you for all the info you’ve given me. I certainly need to ask a few more questions once my doctor returns, as I’ve either woefully misunderstood what I’ve been prescribed, or I’ve been misled somewhat.

(As a side note, I’ve previously been prescribed vaginal oestrogen as part of IVF treatment to help thicken the endometrium, so I don’t think vaginal dryness is the only reason for it to be prescribed)

@Helenahandkart The link to the Liz Earle website was to her interview with Nick Panay. He is one of the foremost menopause consultants in the UK, running the menopause specialist clinic at the Chelsea & Westminster hospital (NHS). (It's for women with specialist meno needs and premature menopause.) He used to be the chair of the BMS and and wrote the paper on bio (not body!) HRT that is on the BMS website.

I am going to PM you!