navigating the world of hrt
The types of HRT can be very confusing for women, with terms like “traditional” “body-identical”, '“nature-identical”, “bio-identical” and ‘compounded” HRT being bandied about, with some claiming superior effectiveness and lower side-effects than others. Let us help you navigate the world of HRT.
In the USA, the original (and until recently) the only licensed form of HRT available on a prescription was made from horse urine. It came under the name “Premarin” (PREgnant MARes urINe). It was (and still is) available as a tablet; either on its own or with another ovarian hormone (progestagen) added in. These products have names like Prempak-C, Premique, Premique Cycle 10, etc. and they were very popular in Ireland too. Horse Oestrogen or Equine Oestrogen as it is called, is really effective at controlling menopause symptoms but can be quite strong and some women experience unwanted side effects while using it. Furthermore, many women didn’t like the idea of using a hormone that involved animal cruelty.
There are many other forms of HRT available around the world that do not involve horses!
Many alternative types of HRT are manufactured by several pharmaceutical companies that offer hormone medicines derived from plant sources which mimic the molecules of human oestrogen and progestagen – no horses nappies involved! These are often referred to at “body-identical”, “bio-identical” or “nature-identical”, often referred to as BHRT. We have had those products available to us in Ireland for many years but in the USA, the Food & Drug Administration (FDA) have been very reluctant to approve them and American women have been at a terrible disadvantage. Unlike their European counterparts, American women couldn’t get non-horse HRT from their doctors and this wasn’t acceptable to many.
Background on Compounded HRT popularity
This gap in the market in the U.S. prompted the rise of private laboratories which started manufacturing what they termed “bio-similar” or “compounded bio-identical HRT”. That is hormone derived from plant sources and not horses urine. These HRT chemicals are made in private, compounding labs and marketed as “natural products” - so as to avoid FDA regulation. They often work very well as they frequently contain much stronger hormone content than what we offer in prescription HRT.
Compounded bio-identical HRT is not recommended by any reputable or peer reviewed medical source. These are hormone containing pellets or creams or pessaries that are produced in private laboratories. They are not subjected to the same quality standardisation as conventional HRT that you buy with a prescription from the pharmacy and there is no guarantee that their stated doses are accurate. They can often be significantly more expensive to buy than prescription HRT too. So why do women use them?? Compounded HRT products do not necessarily meet safety standards and can also be quite expensive with some women paying over 100 euro/month for their HRT.
In Europe, Australia and many other developed countries, the pharmaceutical industry has been making a wide range of bio identical HRT choices, so we don’t need unregulated, potentially unsafe products.
The NICE, the British Menopause Society and many other respected educational sources only recommend pharmaceutical HRT. Pharmaceutical HRT is only available on a GP prescription, it is often plant sourced and “bio- identical” but this HRT is made in factories where the process meets standards for purity & safety. Standard, prescription HRT is also covered by the medical card but even for private patients, the cost is rarely more than 20-30 euro /month.