Our bodies gradually slow down as we get older. 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, headaches and mood changes.
Your GP has a fairly effective remedy – a pill or patch containing drugs to replace the missing hormones – a treatment known as HRT (hormone replacement therapy).
HRT may help but are you getting the right sort of hormones?
The HRT your doctor supplies 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. You may think that’s a small price to pay for banishing night sweats and getting your sex drive back. But for some it is still a worry while others find HRT just doesn’t agree with them. It can cause bloating, swollen ankles, headaches, breast tenderness and bleeding.
So what else can you do?
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’s no evidence they work. There is another option, however, known as bio-identical hormones. Like HRT, this involves taking a hormone replacement but the chemistry is slightly different. They are identical to the ones your body is used to.
Many people don’t realise that the hormones supplied in HRT aren’t exactly the same as the ones made by your body. You can see the difference very clearly from this diagram of a molecule of a natural oestrogen and a molecule of the non-identical oestrogen Premarin, which is used in regular HRT. Premarin comes from the urine of pregnant mares.
So why is the version of HRT your doctor supplies not identical? Surely it’s sensible to replace like with like?
The problem the drug companies originally faced was that progesterone couldn’t be put in a pill because it is destroyed in the stomach. The solution was to alter the molecule slightly creating a non-identical hormone drug called progestin. This had two big benefits. It could pass safely through the stomach and, because it was different to natural progesterone, it could be patented. You can’t patent something found in nature; without a patent a drug won’t make large profits.
But for a long time only a few clinicians, who were interested in natural medicine, thought it was worth prescribing the identical versions of oestrogen and progesterone on the grounds they would be safer and more effective. These included the late Dr John Lee in America and Dr Shirley Bond in the UK.
This all changed in 2003 when the results of the Women’s Health Initiative (WHI) trial came out. This big, randomised, controlled trial found that non-identical HRT slightly raised the risk of heart disease and breast cancer. Prescriptions of HRT dropped and there was a sudden surge of interest in bio-identicals.
So are bio-identical hormones safer and more effective?
This is where the controversy starts. Doctors who specialise in treating menopausal symptoms with the non-identical hormones used in regular HRT say there is no evidence they are; they also warn they could be dangerous. Although many studies have been done on bio-identical hormones, they are officially not drugs and so don’t need the expensive, large-scale trials used to test drugs. Trials often don’t pick up drug risks anyway. HRT had been licenced on the basis of favourable trial results for years before the WHI study.
The research that has been done certainly suggests that bio-identicals are safer. For instance, long running research has found that women taking progesterone plus natural oestrogen had no raised risk of heart disease or cancer. This was the conclusion of a big French study of 80,000 post-menopausal women. Those who took only oestrogen had a 29% rise in their risk of breast cancer. But for those on progesterone as well the cancer risk disappeared. Combining oestrogen with various non-identical progestins, however, pushed up the risk by as much as 69%.
The official bodies also object to the personal treatment patients receive in bio-identical clinics. The HRT establishment believes that the ‘one-size-fits-all’ approach of regular HRT is adequate. But it would be surprising if the same amount benefitted everyone. So every patient getting bio-identical treatment has regular tests to find how much of the different hormones they have in their blood already and then gets a personalised prescription to acheive and maintain a healthy level if necessary. Patients very much appreciate this focus on their individual needs.
Each prescription is made in a lab known as a compounding pharmacy. The critics say these labs can get the doses wrong or sell contaminated batches of hormones. But compounding facilities are often used in hospitals and are providing a range of drugs for doctors all the time. They are tightly regulated and overseen by the General Pharmaceutical Councilor or the MHRA.
Many women report they feel much better on bio-identical hormones and recent American research estimated that between 30% and 60% of post-menopausal women getting hormone replacement are taking some form of bio-identical hormones.