The Truth About Expensive Bioidentical HRT

Bioidenticals
What is ‘bioidentical’ HRT and is it your best option? Don’t believe the hype. As medical experts issue warnings against pricey bioidenticals, we unravel the confusion and get to the HRT facts.

You might have heard of bioidentical hormones, and thought, should I be having those? Are they better than the HRT I can have prescribed by my GP? But you need to do your research.

At first glance, bioidenticals might appear to be the gold standard of treatment. Prescribed by private doctors, often out of clinics with prestigious Harley Street addresses, and tailored to your hormone profile, bioidentical hormones can cost hundreds of pounds a month. They sound like a no brainer: who wouldn’t want tailored HRT that matches the hormones your body produces? 

In fact, they are not only overpriced, according to doctors including MPowered’s Dr Louise Newson, but also unsafe, unregulated and should be unnecessary, too. Both The British Menopause Society and the Royal College of Obstetricians and Gynaecologists have advised women against taking them.

“Every week, we see women who have come from private clinics, who can be spending £300 to even £500 a month on these compounded hormones,” says Dr Newson, who sees patients at her Newson Health Menopause & Wellbeing Centre in Stratford upon Avon. “The typical story is that once women finally realise they are menopausal, which is the reason for their poor quality of life and dreadful symptoms, they try and get treatment and help. They often can’t receive the right help from their doctor, so they end up going to these private clinics.” (It’s worth noting that Dr Newson’s clinic is private but she does not prescribe compounded hormones. She would have preferred to work as a menopause specialist within the NHS, but such clinics are few and far between.)

What does bioidentical mean?

According to Dr Newson, these compounded ‘bioidentical’ hormones aren’t worth the money. Instead, you can get regulated bioidentical hormones on the NHS – where they are called ‘body identical’.

“The term ‘bioidentical hormones’ simply means that they have the same molecular structure as the hormones in the body,” she says. “Regulated bio-identical hormones are usually referred to as ‘body-identical hormones (rBHRT)’ to differentiate them from these compounded – and unregulated – bioidentical hormones (cBHRT).

According to Dr Newson, these compounded ‘bioidentical’ hormones aren’t worth the money. Instead, you can get regulated bioidentical hormones on the NHS – where they are called ‘body identical’.

“Compounded bioidentical hormones do often contain oestrogen, so women who take them will start to feel better. But then the women we see in our clinic have often started to experience side effects or don’t feel properly better. It’s true that we only see the women who have problems. But we want to tell women there is safe, effective menopause care available on the NHS, too.”

Dr Newson will only prescribe body identical HRT, but not all HRT that is regulated and/or available on the NHS is body identical. There are no combined progesterone and oestrogen formulations that are body identical, for example. All oestrogen patches and gels are body identical. And the one type of progesterone that’s body identical is called Utrogestan.

A lack of quality control 

The biggest problem is, compounded bioidentical hormones from these private clinics are not the same as the regulated bio-identical HRT  available on the NHS and some private menopause clinics. That’s because compounded bioidentical HRT does not have quality control – strangely, it is not classified as medicine but supplements.

“These hormone preparations are not subjected to the same tests of safety, efficacy or dosing consistency as regulated HRT,” says Dr Newson. And they don’t carry the required safety warnings that you’ll find on regulated HRT. This may make you assume they are safer, but that is not the case, she says.

Also, some of the hormones given in compounded bioidentical formulations – for example DHEA (dehydroepiandrosterone) or pregnenolone (a precursor for sex hormones) aren’t approved by the MHRA (Medicines and Healthcare products Regulatory Agency) for use.

Women are often prescribed progesterone in the form of a cream, which hasn’t been shown to protect the lining of the womb in the same way as oral progesterone.

Is HRT safe?

New research, published in The Lancet medical journal, has raised fears about HRT, by reporting that the rise of breast cancer from taking it is double what was previously thought. 

“This is an epidemiological study looking at numerous studies which have been done in the past,” says Dr Newson. “They are reporting that women who are over 50 taking HRT may have a higher risk of breast cancer than previously thought.

“There is no need to panic and I am certainly not going to stop taking my HRT. This is not a randomised controlled study which is the gold standard study to demonstrate cause and effect.”

Dr Newson clarifies that some body identical HRT is not addressed by the new research. “HRT containing oestrogen with older types of progestogen have a higher risk compared to taking oestrogen only HRT or oestrogen with micronised progesterone (body identical HRT),” she says. “This report does not discuss micronised progesterone.”

Even more reason for women to understand the different types of HRT, and which one they are being prescribed. “It is essential that women receive individualised consultations regarding taking HRT and they are given all the facts regarding the benefits and risks,” she says. 

Do you need a blood test?

These compounded hormones are marketed as bespoke. You may have a blood or a saliva test to determine your hormone levels, and be told that the prescription is tailored to suit your personal hormone levels. But watch out for this claim, says Dr Newson.

“These hormone preparations are not subjected to the same tests of safety, efficacy or dosing consistency as regulated HRT,” says Dr Newson. And they don’t carry the required safety warnings that you’ll find on regulated HRT.

“Some of the healthcare professionals who prescribe compounded hormones claim to be able to determine the precise requirements of each woman by undertaking a series of serum and saliva tests,” she says. “This costly practice has never been substantiated through rigorous research, it is not recommended by the menopause societies and it is unnecessary.”

If you are prescribed regulated body identical HRT, your doctor will monitor your symptoms to see if your prescription needs any adjustment. This is considered to be best practice by menopause societies worldwide, as symptoms are more relevant than a hormone level in a blood test.

The bottom line is, these expensive compounded drugs are not necessary, says Dr Newson. “Approved, registered, regulated bioidentical or body identical regulated hormonal drugs that are produced in monitored facilities are widely available for women,” she says. If you can’t get good help from your GP, ask to be referred to a menopause clinic.

Read more from Dr Louise Newson at Menopausedoctor.co.uk


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