Bio-identical HRT

[teentantrums]

I have been prescribed this by my doctor (I am not in the UK) and it is the only HRT I have access to. I am a bit scared to take it now after reading that it is not recommended by British doctors! Is anyone on it and can tell me whether they have had any problems? I have been prescribed lozenges of estradiol and estriol (I think!) Thanks.

cBHRT isn’t recommended but rBHRT is, is that what you mean?

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

Yes. I guess what I have been prescribed is cBHRT.

It's not recommended for the reasons explained by the BMS.
Mainly as the doses aren't quality controlled in the same way.
What type of progesterone are you using (if you take the bio type?)

It's quite unusual for other countries to offer this as it's usually only offered where licensed HRT is available as well.

If you come to the UK at all you could get HRT privately and have an annual review.

You might also be able to get it through a video consultation with UK based consultants.

I haven't started taking it yet but I have the prescription. It is only estriol and estradiol, no progesterone. I did try a private consultation in the UK but they said they couldn't prescribe if I wasn't coming at least 3 times a year which I can't do. Aargh...this is so frustrating!

You can't use estrogen-only hrt unless you've had a hysterectomy.
So this in itself should be a loud warning bell.
You should at least ask why.

I am sure there are other private doctors in the UK who will not insist on on such regular appointments. My HRT is private with a consultant gynaecologist and (unless I need advice etc) my appointments are usually once every 6 months - sometimes a little longer. During Covid and lockdown they were by video for quite some time.
My advice is you look around for a dr who's more flexible with this.

It does all sound a bit odd. I am using oestrogen only - but only because I have had a hysterectomy. I have a lot of friends on HRT as we're all that age... but none are on tablets/lozenges, we're all on patches, gel or sprays. Doctors in the UK tend not to prescribe oral oestrogen HRT any more unless it's the only option, not because it's dangerous, but because HRT absorbed through the skin is safer.

Interested in which country you're in - the attitudes to HRT in southern European countries like Greece, Spain, Italy, Portugal are worlds away from attitudes in UK, Ireland, Scandinavia, Germany.

@CharityShopChic I am in Italy.

Just looked back at the prescription and I got it wrong - sorry! There is also progesterone:
BIEST 1,25mg (estradiolo bioidentico 0,25mg estriolo bioidentico 1mg) PROGESTERONE bioidentico 100 mg Lozenges Sublinguali

I asked about patches but it doesnt seem to be a thing here.

I'd read and re-read the BMS info.

The risk is that the amount /ratio of estrogen to progesterone isn't quality assured or right for you. Unlicensed labs are sometimes used and the quality assurance of pharma isn't always there.

Sublingual lozenges are the progesterone part you've been given. Dissolve under the tongue.

The concern about compounded bio HRT is that it's made in unlicensed doses, determined by your saliva or blood tests. These tests are not accurate.

I'm sure you could find a UK specialist working remotely who'd help you.

Thanks. I am pretty sure it is a licensed lab. This seems to be more of a thing here that medicines are "made to order" rather than already made up. I did look for a UK specialist who would prescribe online too but they said that, due to Brexit, UK prescriptions cannot be used in the EU. It has been a long and expensive journey just to get this far!

You probably can't get HRT dispensed in Europe from a UK prescription, but perhaps you could have the HRT posted from the UK? I know of women using private drs for HRT and the HRT is posted out from a UK pharmacy.

Or- make a couple f trips to the UK each year?

Its not so much the lab being licensed, but the fact that the HRT is made to measure from blood tests or saliva- which aren't accurate.

@teentantrums I'll send you a PM.

Its not so much the lab being licensed, but the fact that the HRT is made to measure from blood tests or saliva- which aren't accurate.
It isn't being made based on my tests, though!

@JinglingSpringbells I cannot get it sent from the UK either as packages seem to get lost much more nowadays, or stopped by customs or charged extortionate customs fees.

Do Italian women just suffer then?

Apparently! I don't know anybody taking it and I have been to two GPs and two gynaecologists who say they don't prescribe it.

The link you left from the BMS covers this point. Saliva tests etc not accurate- it's one of the bullet points.

The author of that guidance is Prof Nick Panay one of the best meno gynaecologists in the world.

@JinglingSpringbells No, I see that. My point was that my prescription is a standard dose, not calibrated for me in particular.

Is it from a compounding pharmacy OP?

It is quite popular where I am (also not in the UK) but the doses are made up for each individual.

You have to go to them direct though, as in my experience, a regular gynae wouldn't prescribe CMHT (compounded menopausal hormone therapy) and they are not made up in a normal pharmacy.

A lot of women are happy on it though. I have never considered it though, as I understand it, normal hrt is also bio-identical.

Why is it the only option available to you though? What would your gynae prescribe for you?

Sorry I misread that bit.

Are other types not available?

In Spain, licensed HRT is available over the counter. During the shortages over here women were bringing it back from Spain for themselves or friends.

Yes it is a compounding pharmacy - although I didn't realise that was what it is called! But just to make it even more complicated - it is through a gynaecologist! They wouldn't let me go direct. The gynae wrote me the "standard" prescription for the compounding pharmacy - standard in the sense that she said she would start me on the standard dose (not on the basis of any blood tests or anything) and see how it goes. Everything is so bloody complicated here! I didn't know that about Spain @JinglingSpringbells . It's certainly not as easily available here - maybe I should look at online appointments with Spanish gynaecologists to get an EU prescription!