A patient sent me the following blog asking my opinion, so I thought I would write a blog to address this for everyone who may have similar questions or queries. The blog in question is by the well-respected Dr Heather Currie, read it here.
Dr Currie is an experienced doctor and also runs a site called Menopause Matters. She’s an active member of the British Menopause Society too. A lot of what has been written in this blog I definitely agree with but I do have a slightly different view point on a couple of points.
I do agree that the term bio-identical refers to the structure of the hormones used, and does not mean custom made all compounded. Dr Currie says that there are bio-identical hormone preparations available that are licensed, such as Estrogel, Oestradiol tablets, Utrogestan , and this is true. Where ever possible I would prefer to use these medications as my first choice.
However, one of my main problems when prescribing for women is due to testosterone. I find testosterone to be a very important hormone for women. It is important for libido, motivation, muscle mass, preventing osteoporosis, focus and concentration and memory.
At present, no drug company makes a testosterone dosage for a woman. There are testosterone preparations available but they are in doses that are made for men, such as 50mg a day, where commonly I would prescribe 1mg a day for women. I know certain doctors tell women to “guesstimate” the dose when they give them a preparation made for men, but this isn’t something that I feel comfortable with, so I get my testosterone manufactured in a low dose for women.
Other medications can be manufactured in special doses when needed. For example, if a patient needs specific forms, strengths, or a medication that needs to be change from a tablet form to a liquid form or intravenous form, I use a pharmacy that does this for 250 hospitals in the UK. They are not a compounding pharmacy but rather a specials manufacturing pharmacy that can make special doses of medication when needed. They have a strict quality assurance process that tests the medications and quality.
Sometimes a patient will have a negative effect due to the medication that has been prescribed, and therefore I might want to have a lower dose made for them to see if this suits their body better. This is another reason for having hormones manufactured for a patient, as is that it may be their choice or for financial reasons.
I do ask my patients to have blood testing of their hormones done from time to time. I have this done at a specific time after they’ve used the hormones, to make sure the levels are not getting too high which might excessively stimulate breast, ovarian, and endometrial tissue. If this is the case I can lower the dosage, and if the patient is having side-effects it is also useful for me to take a blood test to see exactly why this is happening. I also advise my patients to have a pelvic ultrasound scan yearly and regular breast screening and smears. This is because I do not want the hormones to cause overstimulation in these areas.
For me, the two most important aspects is not doing harm and being of service to the patients I see and listening to their needs. I try and provide them with options so I can help their symptoms and give them a say in how they are treated. For me, one size doesn’t always fit all. I am also aware that some women feel fantastic on conventional HRT and I have no problem with that either. The key is to look at the person in front of me, listen to them, and treat them holistically, taking into account their preferences and lifestyle.