Bioidentical Hormone Replacement Therapy (BHRT) In Londonderry

Bio-identical hormones have the same chemical structure as those that occur naturally within our own bodies. They are derived from plant sources, such as diosgenin which comes from wild yams and betasitosterol from soya bean plants. These are then manufactured into products which can be taken orally or through creams and skin patches.

Some people also market the treatment as BODY-identical hormone replacement therapy.

As bio-identical hormones have an identical chemical structure to our own hormones, the body does not reject them, nor consider them to be foreign in any way, and the way that they are handled by the body is the same as for your naturally occurring hormones. For this reason, bio-identical hormones are often referred to as ‘natural’, due to their likeness to the natural molecular structure of our own hormones, (and not because they come from sources found in nature).

Synthetic hormones, used in conventional Hormone Replacement Therapies (HRT), which are synthesised by pharmaceutical companies, have a chemical structure that is similar, but not exactly the same, as the hormones produced by our bodies. These chemical differences can mean that synthetic hormones act differently in the body and can produce different effects, as well as some unwanted side effects. Bio-identical hormones can therefore be beneficial to those who have a hormone imbalance or who have previously tried other treatment options, including conventional HRT, and have experienced unwanted side effects; or are concerned about any associated health issues.

HRT has been around since the 1930s and their use to alleviate menopausal symptoms has been commonplace in the UK since the 1960s. The hormones used may be derived from the urine of other pregnant mammals such as Premarin® (progesterone) which is taken from mares (female horses). Oestrogens can also be synthesised from other sources, and some have been chemically altered from plant-based extracts.

BHRT has only been used within the NHS to treat women for menopausal symptoms if there is a medical reason why they cannot receive the conventional HRT hormones prescribed for this condition. They have been used for approximately 20 years in Europe.

Sadly, there is a lack of large-scale, long-term clinical study evidence to support BHRT, even though it is true that there is no evidence that these bio-identical hormones cause the same side effects as conventional HRT. The rise in interest in bio-identical hormones was linked to the 2002 reports on HRT risks and side effects which caused a stampede away from HRT. Research into the long-term effects of HRT has been linked with many side effects such as an increase in uterine, ovarian and breast cancers and heart disease. The latest study published in 2016 seemed to suggest that the warnings released in 2002 underestimated the detrimental effects of HRT. It is not yet clear whether these side effects are due to their structure the medicated dosage, or the way that they are metabolised within the human body.

Not surprisingly this meant that doctors and their patients were reluctant to use HRT to treat menopausal symptoms such as hot flushes, sleeplessness and tiredness. Up until 2002 is was not unusual for women to be given HRT when the menopause commenced, and well beyond, in a very long-term course of treatment. Currently, the guidance is for the lowest dose possible for the shortest amount of time. The risk of developing any of these side effects reduces once the HRT course is completed. The other problem with conventional HRT is that the pills come in certain predetermined dosages and can only be prescribed in this way by a GP.

Bio-identical hormones are not synthesised or extracted from other animals but come directly from plant sources. They do however have to be processed to make them suitable to be delivered into the human body; to make them absorbable so they can have their effect on their target cells and be broken down metabolically. They can also be prescribed to an exact measure for each patient and made up by a pharmacist to that individual prescription. Therefore, they are becoming a more widely available option for private clinics to offer to their clients.

A BHRT programme starts with a consultation and a saliva, urine or blood test to determine if there are any hormone deficiencies. As hormone levels in the human body fluctuate, a hormone level check is only a moment in time and any deficiency should be carefully considered and monitored, along with a discussion of symptoms or problems being experienced over time.  

This depends on why you are considering this treatment. If it is to treat the symptoms of the menopause, then an appointment with your GP would be a sensible place to start. If you are not satisfied with the origin of the conventional HRT available, or you are concerned about possible side effects, then a private consultation for BHRT may be useful. Bear in mind that this will usually entail a consultation fee, even if you decide not to proceed, and a long-term cost if you do.

BHRT is rarely available for free through the NHS.

If the reasons are concerned with anti-ageing or feeling younger, then research clinics that specialise in this type of BHRT treatment and ask about their experience and results.

Many bio-identical hormone products are available online. Most experts state that these are not high doses enough to achieve desirable results, and obviously, self-medication is never recommended. Attending a clinic for a consultation would always be preferable to self-selection from the Internet.

Careful discussions regarding your reasons for wanting Bio-Identical Hormone Replacement Therapy are very important. You must also make sure that this treatment can deliver what you want. The duration of the treatment is also important. Any potential risks from hormone supplementation increase with the length of treatment. Taking the current medical advice for conventional HRT - the lowest dose for the shortest period of time – may be advisable to apply to BHRT too. There is currently limited data to confirm that long-term use of bio-identical hormones is any different, so caution may be pertinent. Your practitioner should be able to answer all these questions.

A medical history should be taken to make sure that there are no reasons why you shouldn’t undertake treatment. You will be asked to sign a consent form which means that you have understood the potential benefits and risks associated with the treatment programme and any associated tests.

Photographs (if there is an anti-ageing solution or alleviation of visible medical symptoms being sought), and possibly questionnaires to establish mood or symptom rating scores may also be taken by the practitioner for comparison later.

The initial consultation will lead to a blood, urine or saliva test and some cells may be taken from the inside of your cheek, with a swab, to check telomere length, which can be analysed to assess internal ageing. Your DNA strands are protected by a cap called a telomere. There is a lot of research which indicates that these telomeres shorten as you get older and your DNA may then start to deteriorate. Telomere length can be used to measure your internal age. These tests may be offered as part of a general health check rather than for any specified symptoms.

The next consultation will take you through all the indicators that have been examined and measured by the tests. These may include hormone levels such as oestrogen, progesterone, and testosterone as a comparison to your chronological age; thyroid and adrenal hormones; cholesterol levels; vascular health; telomere length etc. It would seem to be common sense that before embarking on any hormone replacement therapy you should begin by establishing if there is any deficiency that matches up with the symptoms that you are describing. The tests performed and the indicators measured may vary from one clinic to another so it’s important to get a thorough evaluation.

The clinician can tell you what these test results indicate and prescribe BHRT accordingly. This prescription will be individualised for your body. Hormones must be prescribed, as they are regulated as medicines, but other dietary supplements which may be recommended alongside might be available over-the-counter from a pharmacist. It is worth asking about this as it could make a huge difference to the price that you pay for the overall treatment programme.

BHRT may be taken orally, as a tablet or lozenge, or topically as a cream or patch which may be delivered through the skin or through the genital region.

This is a very complicated area and you should feel fully informed before you undertake this treatment. Your individual situation and your personalised prescription and medical history should be taken into consideration. The most common complications seem to be a change in mood, similar to experiencing pre-menstrual tension or PMT, or skin problems such as acne. Long term effects have not yet been established by any large sample medical study.

DHEA (dehydroepinandrosterone) is one bio-identical hormone available to both men and women. It is a pre-cursor hormone produced naturally by the adrenal glands and can lead to the production of testosterone and oestrogen (both hormones are naturally occurring in both sexes). The side effects may occur because of an imbalance between the male and female hormones and may cause opposing secondary sexual features such as an increase in facial hair, lowering of the voice or thinning of the hair on the head in females. Adrenal imbalance refers to low levels of this hormone which peaks at around the age of 20 years and then declines.

Incidentally, most of these hormones would show up in a drug test and are therefore not suitable for those competing in sports at a serious level.

Bio-Identical Hormone Replacement Therapy is a growth area in the USA and therefore likely to increase and become more commonplace in the UK as awareness spreads.

There are valid reasons for those experiencing menopausal symptoms to consider their options carefully and to prefer a more ‘natural’ hormone to alleviate their condition. For other less specified symptoms, it may improve them but there are only personal testimonials to vouch for this. Everyone is different and has different requirements and motivations for seeking this sort of therapy. As each prescription is individualised the outcome will be too. To discover if they would work for you, you must put your trust in a well-researched doctor or nurse prescriber at a specialised and experienced clinic. It will take some time before there is any long-term scientific evidence about the effectiveness and safety of BHRT, so if you proceed you may be part of this innovation.

BHRT has arisen in response to concerns about the conventional HRT given to menopausal women to alleviate their symptoms. They are not synthesised to mimic natural hormones or extracted from the urine of other animals, but derived from plants and have the identical chemical structure of those found in humans, making them indistinguishable. The ‘raw material’ does have to be processed to allow it to be delivered in an effective way into the human body and subsequently broken down. This initial interest in BHRT has led to other applications to achieve other results, such as anti-ageing and wellness, which highlight the potential for the wider use of bio-identical hormones in medically-led private clinics.