Blog

Body Identical Hormones

What are “body identical” hormones? Are they the same as “bio-identical hormones”?

There are so many different types of HRT available.  This means that the dose and type of HRT can be altered to suit your individual needs and will also depend on your health and risk factors for other conditions, for example if you have had a clot in the past or have high blood pressure. Many women want to take “natural” products for their menopause but you have to be very careful how you define “natural”. There are many medicines available which are derived from plants, so therefore they are “natural”, but many are unsafe and have been shown to be harmful to your bodies. For example, although black cohosh has been shown to be of some benefit in the treatment of hot flushes, some types of black cohosh have been shown to be associated with liver toxicity.

The oestrogen that I usually prescribe for women is a type of oestrogen called 17 beta oestradiol. This is a “body identical” oestrogen and has the same molecular structure as the oestrogen which decreases in your body during the menopause. It is safer having the oestrogen as a patch or gel as this then is absorbed directly through the skin and has less side effects and risks. These types of oestrogen can be given to women with migraines and those with a higher risk of clot as there is not increased risk of clot using these types of oestrogen. It is also natural in that it is derived from a plant chemical which is extracted from yams, which are tropical root vegetables.

Some types of older HRT contain a mixture of different types of oestrogens and are made from pregnant mares’ urine. So this type of HRT is “natural” but it is not “body identical” as it contains many types of oestrogens that you do not need in your body. This type of HRT is not often prescribed by doctors any more.

There are many different types of progestogens (progestogens is the name for a synthetic progesterone) available for women. If you still have a womb (uterus) it is important that a progestogen is combined with the oestrogen for your HRT. When you take oestrogen the lining of your womb can build up which can increase your risk of cancer. However, taking progestogen completely reverses this risk which means there is no increased risk of cancer when you take HRT.

The type of progestogen I commonly prescribe for my patients is called micronised progesterone (Utrogestan). This is a “body identical” progestogen as it has the same molecular structure as the progesterone in our bodies. This means that is usually is associated with fewer side effects than other types of progestogens. Side effects of progestogens can include bloating, spots and mood swings. Micronised progesterone is also made from yams.

The additional advantage of micronised progesterone is that studies have shown that it is not associated with an increased risk of breast cancer for the first five years of taking it. After this time the risks of breast cancer are very low and seem to be lower than the risk for a woman taking the older types of progestogen.

All these body identical hormones are usually available on the NHS although micronised progesterone is not available in Scotland.

Many private clinics are using “bio-identical” hormones

These are not the same as the “body identical” hormones I have just described to you. These are not regulated and are not subject to any quality control. It is important that you do your research before you commit to anything you buy. Also, check that the HRT is NICE-approved (National Institute for Health and Care Excellence).

These bio-identical hormones are compounded. This means that they are custom made in order to prescribe hormones in combination doses or preparations that are not routinely available.

Some of the hormones used in these bio-identical hormones contain hormones that are not approved for women such as a hormone called DHEA (Dehydroepiandrosterone) or prednisolone. Many women are given progesterone creams which are actually not well absorbed in the body and are not available on the NHS.

Some “natural” progesterone creams for your skin are available in some places over the Internet. These are not recommended as they are not absorbed into the body well and also many contain too little amounts of hormone to be effective.

I see many women in my clinic who have spent considerable amounts of money on these bio-identical products and have experienced numerous side effects. The products used in this way are not regulated or approved and so could potentially be harmful. They have not been subjected to the same tests of safety, efficacy or dosing consistency as the type of HRT that are prescribed to you. In addition, there is no evidence that these compounded hormones have fewer side effects or are more effective that “body-identical” HRT.

In summary, the risks of the hormones you are taking depend on your type of HRT and also your individual risk factors and health. It is very important that you are given the right type and strength of HRT for your individual needs and that the benefits and risks of your HRT are discussed with you by your GP or menopause doctor.

Date updated: May 2018

My Menopause Doctor
Dr Louise R Newson BSc(Hons) MBChB(Hons) MRCP FRCGP
GP and Menopause Expert

Menopause changed my life for the better

by Sharon Vibert in Menopause

Talking openly about gynaecological problems and menopause isn’t always easy. These are deeply personal issues that we may not -understandably – want anybody other than those closest to us to know about.

But since going through surgical menopause two years ago, I’ve discovered that it’s helpful to talk. Not just in a cathartic way for me – which it is – but also that my friends are grateful to find out about my experience and arm themselves with information regarding what they might expect.

I’ve actually had many years of gynaecological problems, starting around 11 years ago when I had an ovary removed shortly after the birth of my second child. Although my C-section had been straighforward, I had a lot of pain in my side afterwards. I was referred for a scan and some keyhole exploration – and when I came round from the surgery I was told my ovary had been removed as it had become contorted, twisted and was starting to gangrene, which was what was causing my severe pain. The surgeons also noted that I had some endometriosis.

Coping with surgical menopause

The next couple of years were governed by pelvic pain and heavy periods, with more keyhole surgery to cauterise the endometriosis. When my periods became extremely heavy I was recommended for an ablation, a procedure where the whole lining of the uterus is cauterised.

I then started to get breast pain, and my gynaecologist said my remaining ovary was starting to shrivel and not working well and it should be removed.

So, nine years after my first operation, my second ovary was surgically removed – known as an oopherectomy – sending me into surgical menopause.

If I’d known then what I know now, I may well have tried to boost my hormones using natural methods in order to stave off or prevent surgery, as I felt pretty awful afterwards. My consultant wanted to put me on HRT but I felt I knew better and wanted to manage symptoms holistically. Next a visit to a medical herbalist, who gave me lots of supplement, food and lifestyle advice and herbal tinctures. I felt okay, and my symptoms were just about manageable but in general I felt lethargic and not myself. I was under a lot of pressure in my recruitment job and when I returned from a holiday I was made redundant.

Looking back, I feel sure it was because my performance was being affected by menopause. My manager was a young man in his 20s and didn’t really understand what I’d been through – a lot of pain then surgery followed by menopause.

I soldiered on for some time, trying to keep active by walking and running, but noticed I was gaining weight. This was alarming as I’ve always been fairly slight. The back fat was the worst part. No matter how well I ate I’d either put on weight or stay the same, especially around my middle, it was demoralising to say the least.

By now I’d found another job, helping women return to the workplace after a career break. Although it was rewarding, my memory was awful, I lacked confidence and the hot flushes in meetings and at events were demoralising, I never felt I had clarity. Only now do I realise that it was due to my falling hormones. This company were supportive and great at looking after me – I do remember though going to my interview with them and sitting pouring with sweat!

HRT: lifting the cloud

The worst thing for me came last summer when I started suffering from really awful vaginal dryness. I was in so much pain and I was miserable. This was my rock bottom point, I’d tried healthy eating, herbs, supplements and still felt awful. I went to my GP who gave me anti-fungal tablets, pessaries and creams. We didn’t discuss HRT and these didn’t help.

Finally I found a menopause specialist in the area. Sadly they are few and far between and only available privately. When I filled out my initial consultation questionnaire I ticked nearly the entire sheet of symptoms. I cried in the waiting room through realisation. Even my heightened tinnitus, which I had never associated with menopause! She told me in no uncertain terms that I couldn’t continue down this route “your life is going to be miserable and we need to get you on decent oestrogen.” For me the benefits outweighed the risks.

She put me on patches, tablets and suppositories. Within a month of starting the HRT I felt like a different person, the dryness started to subside. The tablets didn’t agree with me. So then we did have to re-adjust slightly to get the right type of HRT for me. It’s important to take control and do your own research as there are lots of options.

It was like a cloud had lifted. Finally I could wake up without aching and I sleep so much better now. The family noticed I wasn’t shouting, crying, or being grumpy quite so often. Now I’m much more on the level. The house is so much calmer because I’m not getting antsy about the smallest thing. I thought that was just part of my personality, but it turns out it was my hormones.

I wanted to do something positive with my experience. There was no support group in my area so I set about starting my own on Facebook. People can read my story, find advice and share their own experiences and we can support one another.

Now I’ve got my confidence back after being on a rollercoaster of emotions, including paranoia, anxiety, depression, not wanting to go out and not wanting to be alone. I feel generally much calmer and able to cope so much better with life. I’ve met new people by starting a new hobby and I’ve even been up on stage pole dancing!

I’ve started a clean-eating regime. And I work out with a personal trainer, strength training, and now my back fat is subsiding. Hurrah!

Menopause wasn’t easy. But it’s enabled me to become a better version of myself. I’m now focused on my long term health and wellbeing. 

About Sharon Vibert

I went into surgical menopause following a full oophorectomy in my mid 40s. Managing my symptoms using a blend of natural methods, diet, fitness and HRT, I am using my journey to support other women through menopause and beyond. Find out more at my Facebook page

 

 

Meno Me

women_empowered

Bringing regular exercise & downtime into your life
Exercise, Relaxation & Information for Women
Build bone density Improve flexibility
Weight management  Improve sleep
Improve cognitive behaviour & mood
Stress Management
Learn to listen & adapt with your body
Dates: Tuesday 26th June for 4 weeks &
4th September for 6 weeks
6:00-7:30pm
£3 donation per class
The Cabin
82 St Leonards Rd, E14 0QU
Tel: 0203 069 7401
Jayne.clavering@poplarharca.co.uk

How to get the most out of your doctor’s appointment

Diane Danzebrink

So you have decided that it’s time to visit your doctor to discuss the seemingly unrelated mixed bag of symptoms you have been trying to cope with. You might have a sneaking suspicion that these could be related to the menopause but you may never have considered it and are just completely fed up with feeling tired and lifeless, anxious, tense and sleep deprived or hot one minute and chilly the next and sometimes tearful, irritable and unhappy for no particular reason. The problem is that for many women we don’t understand what is going on for us and that can affect our partners, families and work life too.

So where do you start when planning your visit to your doctor?

  1. Do your research, take a look at the NICE guidelines on menopause, there is a section in the guidelines for patients and knowledge is power. When you know what your doctor could offer you in terms of treatment and support it will enable you to have an informed conversation.

  2. When you book your appointment ask the receptionist who in the practice has a special interest in menopause and don’t be afraid to ask for a double appointment.

  3. Make a list of all your symptoms and everything you have tried so far to deal with them. You can print and complete the PCWHF symptom checker to take with you https://www.pcwhf.co.uk/documents/pcwhf-menopause-and-hrt-pads-1.pdf Having everything written down is so helpful as it avoids that feeling of panic when you sit down in front of the doctor and your mind goes blank.

  4. Take a supportive friend or family member with you to your appointment. This can be particularly helpful if you are feeling very low or anxious, having some support can be invaluable.

  5. Ask questions; if you don’t understand what your doctor is saying always ask them to explain so that you can have a clear understanding of what they are suggesting.

  6. Be prepared to wait for answers; if your doctor is unsure about menopause and seems reluctant to discuss options with you ask him or her to consult a colleague or read the NICE guidelines on menopause before coming back to you.

  7. Ask for a referral to a menopause clinic; it’s only fair to say that these are thin on the ground with approximately twenty six in the whole of the U.K they do have long waiting lists but if you feel that you are not making any headway with your doctor then you can ask to be referred to your nearest clinic.

Remember that you know your body better than anyone else and if you feel that things are changing for you that should be listened to and respected. Hopefully you won’t need my hints and tips when you see your doctor but I sincerely hope that they empower you to take control of your menopause if you do.

Diane Danzebrink is a Menopause Counsellor and Personal Consultant with nurse training in Menopause specialising in working with women in mid life. To contact Diane go to http://www.menopausesupport.co.uk

Take part in a survey about the menopause and work by University of Bristol

bigstock-Menopause-written-in-search-ba-97675367-compressed

 

Following our report ‘The effects of menopause transition on women’s economic participation in the UK’ for the Government Equality Office, we are conducting a survey of working-age women and men and their knowledge, views and experiences of menopause at work. The survey aims to provide an insight into all women and men’s views and experiences, so we would like as many people as possible to take part. Follow the link to start the survey and distribute the link widely!

https://efim.onlinesurveys.ac.uk/menopause-survey

The survey does not require you to provide a name or contact details, so your anonymity is guaranteed.

We have been working with a range of organisations to address the menopause taboo and implement changes in workplaces. But we still know very little about how people feel about menopause at work and who is affected how. This is especially the case for workers in manual and/or low-paid employment, the views of colleagues and line managers, and how the experiences of mid-life working women and mid-life working men compare. The results from the survey will allow us to understand menopause issues in workplaces better.

We will make an overview report of the findings publicly available via the channels used to distribute this survey.

Please participate in the survey and distribute the link to your professional and social networks.

Vanessa Beck (University of Bristol)

Jo Brewis (The Open University)

Andrea Davies (University of Leicester)

Survey: https://efim.onlinesurveys.ac.uk/menopause-survey