Bio Identical Hormone Therapy

In our late 30s, women’s hormones start to change; we make less progesterone and oestrogen resulting in a decline in our fertility. As we move into our 40s, sometimes early 50s, we start to experience the ‘perimenopause’, the transition into menopause.

This transition into the menopause can be a difficult time, it’s really easy to feel confused and unable to cope with situations that we wouldn’t have batted an eyelid at before. Hormonally, we’re still experiencing a drop in the levels of progesterone and oestrogen produced by our ovaries and now our ovaries are becoming less reactive to the control hormones, Luteinising hormone (LH) and the Follicle stimulating hormone (FSH), resulting in a higher level of these control hormones; a blood test can confirm if you’re experiencing hormonal changes. This is more accurate than just looking at your symptoms as some symptoms can easily be over-looked or put down to something else, like stress. These changes in your hormones cause physical and mental symptoms which can often be difficult to understand and know what’s going on in your body. In fact, many of us can be left feeling unable to cope with some of everyday situations, which we may have taken in our stride previously.

You are considered to be in menopause once you’ve not had a period for one year. This is generally when we are in our 50s. Approximately five out of 100 women experience menopause before they’re 45.

The first thing we tend to consider when we’re perimenopausal and/or menopausal is the symptoms, however it’s important that we consider the long-term health implications of the menopause, even if we’re infrequently or no longer experiencing symptoms. The menopause causes changes which increase the risk of osteoporosis, cardiovascular disease, cancer and metabolic diseases. For this alone, it’s worth considering a form of hormone replacement therapy, either traditional or BHRT, as HRT decreases all-cause mortality after the menopause, as outlined in the BMJ Editorial from Royal College of Obstetrics and Gynaecology 2019.

Bioidentical Hormone Replacement Therapy (BHRT) is an alternative treatment to HRT, often prescribed by GPs. The hormones used in BHRT are identical in their chemical structure to the hormones naturally produced in your body; this is different to the hormones in traditional HRT, as these are synthetic.

In traditional HRT, you are prescribed the synthetic hormones that have a chemical structure that is similar, but not the same, as the hormones produced by your body. Bioidentical hormones are structurally identical to the hormones your body produces.

The slight differences in the chemicals mean that the synthetic hormones used in HRT act differently in your body which means that you can experience a range of side effects.  Bioidentical hormones replicate your hormones exceptionally closely, so we find that the frequently associated side effects of HRT (synthetic hormones) are less likely experienced. This often makes BHRT an appealing treatment for those of us experiencing menopausal symptoms.

As with all treatment, there is no ‘one-size-fits-all’ approach with Bioidentical Hormone Replacement Therapy as there is with the traditional HRT treatment. Afterall, it would be very unlikely that you would need the same type of hormone to be replenished in the exact same quantity as another woman. Those choosing bioidentical hormone treatment will have regular tests to screen the hormones present in your blood so that you can receive a personalised prescription of bioidentical hormones to firstly achieve a healthy level of hormones in your body and then maintain them if necessary. BHRT is focused precisely on your individual needs.

You are considered to have started your menopause one year after your last menstrual period and continues until the end of your life. Some of us will experience menopausal symptoms continuously, with the average person experiencing symptoms for two to six years. With an increasing life expectancy, we are spending more and more of our lives in a menopausal state so it is time well spent looking into ways we can make this part of our life more enjoyable.

As we age our bodies slow down. As a result, women make less and less of the two sex hormones, oestrogen and progesterone, and many suffer unpleasant or distressing symptoms such as hot flushes, night sweats, loss of libido, anxiety, depression, headaches and mood changes. These and other changes in the body can have a major impact on the quality of our lives in many ways. BHRT replaces your depleting hormone levels, fixing your hormonal imbalance with hormones that are identical to your own; this is what helps with your menopausal symptoms.

Your GP can offer a treatment known as HRT (hormone replacement therapy). This may help, but are you getting the right sort of hormones?

The HRT your doctor supplies is a generic form so it is not possible to tailor doses to the individual needs of the patient, increasing the risk of side effects. Traditional HRT can raise your risk of both breast cancer and heart disease. The risk is small – about seven extra cases per 10,000 for heart disease and eight for breast cancer.

Official NHS advice, if you are suffering the side effects of conventional HRT, is to try antidepressants or complementary treatments such as herbs, yoga and aromatherapy. It also says there is no evidence they work. If you are suffering the side effects of traditional HRT or you are looking for an alternative to HRT then it may be worth exploring Bioidentical Hormone Replacement Therapy.

Why didn’t my GP tell me about BHRT?

Although BHRT was discovered in the 1940s, most doctors are not familiar with it. Firstly, they often do not recognise hormonal imbalances and often put symptoms down to other factors, such as stress. Secondly, pharmaceutical companies conduct doctors’ further education, and as BHRT cannot be sold ‘off the shelf’, it remains off their radar.

Usually doctors learn about BHRT from their patients. It is important to create demand for such a successful treatment and encourage your doctor to learn more about how you have benefited from BHRT.

Is BHRT safer than traditional HRT?

When the results of the Women’s Health Initiative (WHI) trial – a big randomised controlled trial which found that non-identical HRT slightly raised the risk of heart disease and breast cancer – came out in 2003, prescriptions of HRT dropped, and there was a sudden surge of interest in bioidentical hormone replacement therapy.

The research that has been done certainly suggests that bioidenticals are safer.

What are the benefits of BHRT to my health?

The menopause triggers a range of psychological and physical symptoms with each of us experiencing a different combination of and difference in severity of these symptoms. BHRT helps to stabilise your hormones reducing or eliminating these symptoms from perimenopause all the way to the end of our lives.

In the long-term, BHRT can help to prevent cardiovascular disease and osteoporosis. It will also help to stop changes in our body composition and stabilise the health of our tissues.

What are the side effects of BHRT?

There are no side effects if the hormones are given in doses that are appropriate to your needs, as they are part of our physiology. However, high levels of oestrogen can cause bleeding and breast tenderness. High levels of progesterone can cause tiredness and depression. To prevent any of these side effects, we always start off on the lowest possible dosages.

When can I start BHRT?

You can start bioidentical hormone replacement therapy as soon as you start showing symptoms of the menopause. This does not mean that you have to be going through the menopause, you can treat these symptoms prior during the perimenopause. A blood test will confirm if the symptoms you’re experiencing are as a result of a hormonal imbalance; everyone has this blood test prior to starting treatment.

When is the menopause over?

One year after your last period is the beginning of your menopause, and it continues till the end of your life. However, menopausal symptoms can last on average between two and six years, and some women experience menopausal symptoms continuously.

Is BHRT and HRT simply delaying the menopause?

No, because the physiological cause of the menopause is a lack of responsiveness of your ovaries. BHRT is stabilising your hormones. Those who come off of BHRT or HRT experience no menopausal symptoms or less severe symptoms than before they started their treatment.

I think I’ve been through the menopause but I’m still experiencing symptoms, is it too late for me to have BHRT?

No, you can start BHRT within ten years of your last menstrual period.

How long can I stay on BHRT? 

You can stay on this treatment for as long as you and your practitioner choose. There is no rule for how long you should remain on the treatment. If you have noticed an improvement in the quality of your life and are seeing health benefits, there’s no reason why you should come off of BHRT; the longer you remain on treatment the bigger the health benefits should be in your later life.

Can BHRT stop working?

No, over time your hormone levels may decline so your prescription may need adjusting but BHRT won’t stop working. One of the reasons why your practitioner keeps a close eye on your hormone levels by running blood tests on you is to make sure you are still getting the level of hormones you require.

How long does the treatment take to work?

Often some results can be noticed almost immediately, but commonly results are seen between three and six weeks. Mostly, patients can see significant improvements after six weeks.

Sometimes it takes more than a single cycle for the treatment to take effect. If the hormonal imbalance is severe, and the woman is still on a cycle, it can take three to four months to experience the desired improvement.

Where do my bioidentical hormones come from?

These hormones are converted from plant sources (diosgenin from wild yam or beta-sitosterol from soya beans) and manufactured into powder form. They are then made available in oral or transdermal forms.

Each prescription is made in a lab known as a compounding pharmacy. Compounding facilities are often used in hospitals and provide a range of drugs for doctors all the time. They are tightly regulated and overseen by the General Pharmaceutical Council or the MHRA.

Are the hormones you prescribe natural?

In the case of the hormones we use, the word ‘natural’ is used to refer to the structure of the hormone molecules, which are produced from natural plant sources. This chemical structure is 100% the same as that of the naturally occurring hormones produced by your glands. This means their effects are more consistent with the normal biochemistry of your body than those of synthetic hormones.

After I have visited the Clinic, where do I get my medication from?

There are no over-the-counter prescriptions. Each prescription is individually compounded and made up to your exact dosage requirements as per your medical practitioner’s prescription.

In the UK, the medications are available and can be dispensed from specialist compounding pharmacies including the Specialist Pharmacy. Your practitioner will give you further guidance.

How much will the medication cost me?

A private prescription for daily doses per hormone will cost you between £1 and £3. Less than a cup of coffee a day!

How long is my prescription valid for?

A prescription is valid for 12 months from its date of issue. It is worth bearing in mind that your requirements may have changed from what you needed at the time your practitioner writes your prescription so it is recommended that you discuss this with them if you are considering postponing your treatment.

Can BHRT actually slow down the ageing process?

Yes. Bioidentical hormones can help with multiple effects of ageing on our bodies. Skin changes, especially loss of elasticity and dryness; worsening cognition, memory and organisational skills; and declining energy and sexual function all occur as our hormones decline.

Balancing hormones can prevent some of these effects of ageing and possibly prevent certain conditions from developing, such as osteoporosis.

Can I tell my GP that I’m on BHRT?

Yes, of course. As medical professionals we are happy to write to your GP on request.

Initial Consultation: (45mins) £200

Blood test: starting at £90 depending on what is required.
Please note that your blood tests cannot be organised through your GP. This is a private service which cannot be combined with NHS Services. Blood tests will be repeated from time to time as indicated by patient symptoms and protocol.

Follow-up by phone (two weeks after initial consultation): free of charge

Follow-up clinic consultation: £100 per follow-up 

This is a 30-minute meeting which, following the initial consultation, takes place at six weeks, three months, six months, twelve months and then annually.

You pay for your prescription directly to the specialist pharmacy, not the Clinic, and they post your prescription out to you. The cost will depend on the dosage and how often you need to repeat the prescription, which is approximately every 4-6 months. As is the nature of the treatment, this will vary between individuals.