Bio-identical hormones

What are Bio-identical Hormones and how they differ from standard HRT?

The peri-menopause and menopause are times of significant hormonal changes and may result in a range of symptoms such as hot flushes, weight gain, sleep and mood disturbances as well as being linked to an increased risk of heart disease, bone and muscle mass loss.

Bio-identical hormones (BHRT) are chemically identical to the hormones our own bodies produce, with a molecular structure that is an exact match of the hormones found in the human body. I see BHRT as a way of hacking into body’s biology to optimize function and prefer to use them alongside lifestyle changes including food plans, addressing stress (cortisol) and mapping one’s emotional needs. I strive for a mind-body-and soul approach to medicine that is rooted in science.

Bio-identical hormones are derived from pre-cursors found in soya beans and yams and undergo further transformation in a lab to become identical chemically with body’s own. They can be prescribed in a dose that is tailored to each individual's requirements and I believe adding in lifestyle changes may allow for smaller doses to be used for maximal benefit. 

BHRT can provide an alternative to conventional HRT.  Having the same structure as the body’s natural hormones, they are metabolized by the same pathways and their effects are consistent with your normal bio-chemistry (or what your normal bio-chemistry would have been prior to the onset of hormonal problems) and therefore side effects are usually minimal. 

Some but not all hormones which are licensed by the pharmaceutical industry and used as part of standard hormone replacement therapy (HRT) also have the same structure with the one’s naturally produced in the body (estradiol, estriol, progesterone) however their doses are part of fixed formulations and cannot be tailored to your individual needs. There are many estradiol licensed preparations delivered by patch or gel (Estrogel, Sandrena). The only licenced body-identical progesterone is Utrogestan (Progesterone) as a capsule of 100mg. Currently blood testing for levels is not recommended by NICE.

Most other HRT options however contain synthetic progesterones (progestins) , which are different to the naturally occurring human progesterone. They work well to protect the endometrial lining against the effects of estrogens (when given alone, estrogens can cause endometrial proliferation, an increase in the lining of the womb and have a high risk of endometrial cancer).

Progesterone, in addition to protect the lining of the womb, can have other benefits, such as improved sleep and a calming and anxiety relieving effect (mediated through GABA- a neurotransmitter with calming effects on the brain). I can discuss these in detail with you as they can also be another option if preferred.

Another benefit of bio-identical hormones in contrast to conventional HRT is that it may include other hormone supplementation, such as testosterone, which may have other additional health benefits.

Tests: I may recommend tests to determine exactly what hormone imbalances are affecting you. More detailed hormone tests may be required if detailed oestrogen metabolism is helpful; these tests will be discussed with you at the time of consultation.

Once we have this information, I will review your case and issue you with a personalised prescription. If this is for bioidentical hormones they may be taken as transdermal creams, oral lozenges, or topically to the genital region.

You will then need to telephone London Specialist Pharmacy on 0207 637 1055 to obtain the prescription.  You pay them over the phone by credit card. 

Bioidentical hormones are tailor-made for each individual person and are therefore quite expensive although they last some time.  As an indication here are some of the commonest prescriptions that I am likely to prescribe:

Hormone creams £65-£125 for 60ml  which will last for for 80-160 days

Lozenges £85-£105 per tray which will last 2-4 months depending on dose.

Monitoring with a pelvic ultrasound is usually required yearly for safety monitoring and the cost is usually around £150. Blood tests monitoring may also be required to adjust dose and take into account how our metabolism slows down with age and may vary from person to person.

Nutritional support

Our bodies function optimally when hormones are in balance. Hormonal balance can be disrupted by a range of factors:

  • Nutritional deficiencies and certain foods and diets

  • Chronic stress

  • Chronic inflammation

  • Increased body fat (hormones are also produced in fat cells)

  • Food allergies and intolerances.

Many symptoms of menopause can be alleviated with nutritional and lifestyle interventions, which I can discuss with you.