Is there a reason why body identical progesterone isn’t available in a patch or cream on the NHS?

[Backtothe80splease]

I would like my hrt to be as body identical as possible. I’ve tried utrogestan (both orally and vaginally) but it just exacerbates my existing digestive issues and leaves me so bloated, with awful nausea, diarrhoea and a very upset stomach in general. My IBS and functional dyspepsia has become unbearable as it is in peri and I can not afford to fee worse than I already do.

I’m trying to research what is the best hrt for me (I also have endometriosis so wary of exacerbation this) but it’s a bloody minefield which I find completely confusing, not at all helped by the fact that none of the GPs at my surgery appear to be very well educated on the subject. My GP was against me taking utrogestan because she said oral progesterone causes blood clots. Well a) I have no history or risk factors for clots and b) she was obviously thinking of oral synthetic progesterone?!

She trialled me on patches but I really don’t want synthetic hormones and they just made my endo pain worse. My body appears to reacted negatively to hormones (synthetic and seemingly my own natural hormones too as I’ve had years of gynae issues). My mum has bc and so too have several of her female cousins so I don’t want to add to my risk by taking synthetic hormones. I would like to try body identical in a cream or patch but just cannot find any information about this. Does progesterone not absorb well through the skin unlike oestrogen?

Does something like this even exist and if not does anyone know why? Why does there appear to only be one body identical progesterone available on the NHS.

I think you need to see a sepliclist. You have a complicated medical history, the number of women in your family with bc means you shouldn't be taking any oral HRT anyway and I really don't think a GP unless they have a speciality in this area is equipped to help you.

I'm sorry I'd don't know if what you are looking for exists 😔. Are the symptoms you experiencing really difficult to cope with?

Are the symptoms you experiencing really difficult to cope with?

The symptoms of peri or with the HRT?

Tbh, I’ve struggled with both. I am hoping for something which will level out the horrible symptoms I currently have but I really struggling with the symptoms of hrt so not sure what to do next. As long as I can ease my high anxiety, depression, gut issues, low libido and general malaise which seems to be greatly exacerbated since I hit the age of 45 (51 now) I really don’t care if that’s via hrt or any other way. I’ve tried various antidepressants and am very careful with my lifestyle (ie I keep my weight down, I exercise, only drink water, am careful what I eat due to my existing digestive issues, meditate etc) but nothing is helping.

I do have an appointment with a private gynae who is supposed to specialise in endo and HRT/meno but she’s cancelled twice due to theatre emergencies and my appointment has been out back to August now.

But I think you are right, I don’t think topical progesterone exists other than the wild yam stuff like Wellsprings which appears to be a bit hit and miss! I do wonder why it’s not available though, maybe it just isn’t affective via that method?

To answer the question in your subject line @Backtothe80splease , that product doesn't exist anywhere.

Micronised progesterone only comes as tablets and this is a fairly recent thing. I have my HRT privately and have done for over 15 years with an excellent specialist. If there was a cream option I'd know about it.

I know this sounds obvious, but have you sought as much help as you can for your IBS including the FODMAP diet? Even perhaps seeing a dietitian who's trained in it ( and properly registered.)

Well technically you can’t use HRT without using synthetic hormones, but biosimilar progesterone can be used orally or off licence vaginally. Maybe that would suit you better?

Regarding oestrogen, a patch or gel is safest for you but both are “synthetic” so even if your progesterone is biosimilar your oestrogen won’t be.

I thought as much tbh. Hopefully when I (eventually) get to see the private specialist she may be able to suggest something that could help me (I live in hope).

I do wonder why it’s not available topically though, I can not seem to find any answers via Google, it just seems that it’s not and that’s that!

Regarding the gut issues, I’ve suffered from these for half my life. Sadly, there is nothing I haven’t tried to ease the issue. I’ve spent a small fortune. I’ve worked with gastroenterologists and NHS and private dieticians (have followed the low fodmap diet for around 10 years and avoid all my known triggers). Everything was much more manageable before I turned 45 and then it all went haywire and absolutely nothing I do or try eases the issue, it’s a daily thing which does seem to have been made so much worse by peri. If I could just ease this issue I’d be a much happier person and I’d put up with everything else. I was hoping hrt could help.

This is where the whole hrt thing confuses me. I genuinely thought products like oestrogel were body identical and as synthetic free as you can possibly get?

What product would I be looking for if it is bio similar? Is that available via then NHS or only privately?

The more I delve into hrt the more confused I am tbh. All I know is that ideally I want as body identical as possible and as risk free to my health (ie breast cancer and exacerbation of my endo) as possible.

Jen Gunter has an interesting section on this in Menopause Manifesto. Basically it is really difficult to get progesterone to be absorbed into the body which is why oral micronised progesterone is the first line treatment and there are very, very few transdermal routes. I would also flag her take on body/bio identical - that neither is a sign of safety, that both are overused as marketing terms and that it's better to rely on studies of the safety of different options rather than assuming that something that is described as natural is better than something described as synthetic - as you say, you seem to react to your own natural hormones!

One option you might consider is the mirena coil - it's progestin rather than progesterone but as it's delivered locally you need a lot less, plus while it does get into your system a bit it's much less than with oral medication. There are also medications containing selective estrogen receptor modulators like bazedoxifine - which isn't a progestogen but stops your womb absorbing the estrogen - there are downsides to this but it gives you another option to research.

One other point is I think there's some confusion in your description of the convo with your GP as it's oral estrogen that's linked to clots - but that's relatively easy to circumvent by taking it transdermally which is much lower risk.

This might help: https://vajenda.substack.com/p/stop-using-body-identical-and-bioidentical

Thank you, I’ll take a good look at those and mention your suggestions to the private specialist when I see her.

It is all very confusing to the lay-woman because even the NHS mention body-identical hrt as though it’s the most safest form.

I can’t have a Mirena. I have had a uterine ablation (biggest regret of my life) and now have scar tissue which means there is no way of getting a Mirena in!

Even Louise Newson says it’s the safest form, what are we supposed to believe?

@sidge All estrogen now other than conjugated equine estrogen (CEE) is body identical.

CEE is rarely used now except in certain products like Prempak and Premarin (usually available in the U States.(

It is all very confusing to the lay-woman because even the NHS mention body-identical hrt as though it’s the most safest form.

The correct term is body-identical meaning it's the same as our own.

Bio-identical is a marketing term and it applies also to compounded hormones made in a lab (unlicensed) based on saliva samples. These can be bought in the UK at private clinics but are not endorsed by UK specialists or the BMS. (They have a detailed statement on their website on this.)

All estrogen now in the UK is body-identical unless you use Prempak or Premarin.

Body identical estrogen and micronised progesterone are considered safest because of a) most estrogen now is transdermal and avoids the clot-risk of tablets and b) micronised progesterone has been shown in some studies to have a lower risk of breast cancer.

The screenshot you have left from Dr Newson contains slightly incorrect wording. The risks of micronised progesterone and breast cancer appear to be neutral for at least 5 years' use. So no added risk.

But there are very few longer-term studies. There are some- French studies - which monitored women using it over 11 years and they found no added risk. However, one of the papers in that study was re-examined and raised some questions.

There is a clear order of risk, with MPA being the highest, Norethisterone next and the hormone in the Mirena coil around the same as Norethisterone in a low dose combined patch (25mcgs.)

The risks of SERMS which @UnaOfStormhold mentions are that they appear to have an increased risk of stroke. They are more often prescribed for/ to prevent osteoporosis.

Thank you JinglingSpringBells

I agree it's confusing - it doesn't help that body and bio identical are both used in different ways in the US and UK! But the thing I would emphasise is that neither natural or body-identical tells you whether a product is safe.

Curiously, conjugated equine estrogen is the only non-synthetic estrogen product - it's processed but you get the same estrogens the mares were producing. More modern forms (which I'd say are preferable for many reasons, including animal welfare!) are generally derived from yams or soya, but it's all done in a lab, generally through a process called marker degradation, which changes molecules found into the yams (which aren't estrogen) into an estrogen molecule that has the same structure as the main estrogen women's bodies produce. So these modern estrogens are either synthetic or semi-synthetic - and that's not a problem if the studies show they're safe and beneficial to use.

At the end of the day Gunter and Newson agree that micronised progesterone is the lowest risk form to take unless there are specific reasons for going for other options. I don't think Gunter would go so far as to say there are no risks associated with Utrogestan, but if you need it that's the best option.

@JinglingSpringbells I know, but we’re advised to refer to it as biosimilar rather than bio identical as it’s not literally identical. Pedantic but probably guided by the defensive medicine practice!

The word you're told to use doesn't exist in medical literature.
Is it unique to the practice where you work?
Including 'bio' seems the worst of both worlds because 'bio' is not supposed to be used at all and 'similar' is not a medical term.

I think until recently, even the NHS website was using bio-identical.

BIO-identical is incorrect (as you say, it was a marketing term) and the BMS has a statement on that. They use body-identical, as do menopause consultants. The product is identical, not similar.

@UnaOfStormhold But women aren't mares!
I've never heard of Gunter but if she's in the US, they sometimes have different ideas on HRT.

I think Dr N tends to downplay risks because there is no definitive evidence beyond 5 years' use of Utrogestan.

UK specialists are calling for trials (you can see them doing a Q&As on Youtube where this is discussed) but it's never going to happen for a long time, if ever. It would need thousands of women, double blind placebo or using synthetic options (good luck finding women for that!) and a timescale of at least 10 years or more with a) treatment and b) follow ups.

All stats so far are from observational studies, often with women self-reporting.

<sigh>

@JinglingSpringbells I’m not sure how it came about, it came up on my recent annual update. The consultant suggested it was terminology to use, but we didn’t spend long on it.

It’s splitting hairs really, oestrogen is oestrogen and women are told it doesn’t really vary in UK prerparations, but the progesterone can vary.

It potentially confusing for women when one practice or one consultant decides to use yet another term that still includes 'bio' when there's been a big 'push' to stop using that. There needs to be uniformity across the profession. Unless there has been a change, there was an agreement to use 'body-identical' to differentiate it from compounded (unlicensed) 'bio' HRT. The most important thing is that women understand that the estrogen in HRT is not the same as in the Pill (because a lot of women refer to problems they had with the Pill.)

Absolutely, I always make it clear. Some women think they can't have HRT because they couldn't have combined hormonal contraception.

I think the whole narrative around HRT has become so complex with too many different people using too many different terms.

I use this

emerita.com/products/pro-gest-balancing-cream

Does it help with your symptoms?

It's unlikely to help. It's not regulated for use with HRT as the progesterone.
It's just another brand of the old 'Wellsprings' progesterone cream.
I don't have all the science to hand, but there is a good explanation out there on how the progesterone in these creams cannot be converted through the skin into the type of progesterone that works.
Any supposed effect is purely placebo.
These creams have been around for decades and none is endorsed by doctors.

I know these aren’t recommended by menopause experts and doctors yet there appears to be quite a few women on the menopause FB groups I follow who say these type of products help them (none endorsing them, some of these ladies have become friends).
They could of course have purely placebo effects but in all honestly right now I’m prepared to try anything whether it offers up a placebo effect or not! I just don’t want anything setting off my endo pain or gut issues as the utrogestan and patches have.

Just trying to find something (anything!) to help with these awful issues which appear to have become so much worse in peri and I am getting nowhere with the NHS, it is driving me to distraction.

I understand your concerns.

But those groups and women saying it helps have been around for decades. The whole progesterone cream 'scam' was started by Dr John Lee, in the US, last century. He tried to flog the cream to compensate for 'progesterone deficiency'. The progesterone in those creams cannot be absorbed by the skin and changed into a hormone that actually works.

Look at it this way- if the progesterone in those creams worked, why would that be any 'better' than using Utrogestan?