HRT is a confusing subject for many of us. And wondering what is the difference between HRT and bioidentical HRT is something that lots of women struggle with. Bioidentical is a term that’s bandied around when talking about hormone replacement therapy HRT. The implication is that it’s better than the NHS-standard HRT because it’s privately prescribed and made in compounding pharmacies.
What is bioidentical HRT, and can my GP prescribe it? The truth is that NHS HRT is also bioidentical. The difference with the expensive blended stuff – apart from the price – is that NHS HRT is licensed and standardised rather individually ‘compounded’.
The dangers of compounded HRT
At first glance, compounded bioidentical hormones might appear to be the gold standard of treatment. They are prescribed by private doctors, often out of clinics with prestigious Harley Street addresses. Tailored to your hormone profile, compounded 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 Hylda-contributor and leading menopause expert Dr Louise Newson, they also unsafe. They are, says Dr Newson, 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.
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“Every week, we see women who have come from private clinics, and are spending up to £500 a month on these compounded hormones,” says Dr Newson, who sees patients at her Newson Health Menopause & Wellbeing Centre in Stratford upon Avon.
Dr Newson outlines the typical scenario for a woman paying so much money. “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,” she says. Symptoms including hot flushes, night sweats and mood swings all respond well to HRT.
READ MORE What are the 34 symptoms of menopause?
“Women often can’t receive the right help from their GP. This means they end up going to these private clinics,” says Dr Newson. (It’s worth noting that Dr Newson’s clinic is private but she does not prescribe these compounded hormones. She would have preferred to work as a menopause specialist within the NHS, but such clinics are few and far between.)
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What does bioidentical HRT mean?
These compounded ‘bioidentical’ hormones aren’t worth the money, says Dr Newson. Instead, you can get regulated bioidentical hormones on the NHS, where they are called ‘body identical’.
“The term ‘bioidentical’ simply means that they have the same molecular structure as the hormones in the body,” says Dr Newson. “Regulated bioidentical hormones are usually referred to as ‘body-identical hormones’ (rBHRT). This differentiates them from these compounded – and unregulated – bioidentical hormones (cBHRT).
“Compounded bioidentical hormones do often contain oestrogen, so women who take them will start to feel better,” she says. “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 HRT progesterone and oestrogen formulations that are body identical, for example. All oestrogen patches and gels are body identical, while the only type of progesterone that is body identical is called Utrogestan.
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A lack of quality control
Compounded bioidentical hormones from private clinics do not undergo the same quality control as the regulated NHS body identical hormones. In fact, they are classified as supplements rather than medicine.
“These hormone preparations are not subjected to the same tests of safety, efficacy or dosing consistency as regulated HRT,” says Dr Newson. 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 UK Government’s Medicines and Healthcare products Regulatory Agency (MHRA) for use.
Women are often prescribed bioidentical progesterone in the form of a cream. This hasn’t been shown to protect the lining of the womb in the same way as body identical oral progesterone (Utrogestan) has.
Is HRT safe?
Does HRT increase the risk? “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.
A report, published in The Lancet medical journal in 2019, raised fears about HRT. It reported that the increased risk of breast cancer from taking it is double what was previously thought.
“There is no need to panic and I am certainly not going to stop taking my HRT,” says Dr Newson categorically. “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 privately-prescribed 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.