Hormone Replacement Therapy (HRT) and Menopausal Hormone Therapy (MHT) are interchangeable terms used to describe the medical approach of administering hormones to alleviate symptoms associated with menopause.
This treatment strategy aims to replenish the declining levels of hormones that occur naturally during the menopausal transition.
Body-identical or bioidentical hormone therapy represents a specific category within HRT/MHT. These hormones are meticulously designed to be chemically indistinguishable from those naturally produced by the human body.
By closely mimicking the molecular structure of endogenous hormones, these treatments offer an effective means of managing menopausal symptoms while potentially providing a more physiologically aligned approach to hormone replacement.
The spectrum of body-identical hormones encompasses several key components:
Oestradiol:
This primary form of estrogen is available in various formulations to suit individual preferences and medical requirements. Options include transdermal patches for consistent hormone delivery through the skin, gels for topical application, and tablets for oral administration. It’s made from plants, mostly yams.
Micronised progesterone:
Marketed under the brand name Utrogestan, these tablets contain micro-ionised progesterone that has been extracted from plants. They offer flexibility in administration, as they can be taken orally or used vaginally, depending on the specific treatment plan.
Testosterone:
While not as commonly prescribed as oestrogen and progesterone, testosterone therapy may be considered for some women experiencing low libido. AndroFeme Cream is a female-specific topical formulation of testosterone, though it's important to note that this particular product is not subsidised, which may affect its accessibility for some patients.
Body-identical hormones are accessible through two primary channels: as prescription medicines or as compounded formulations. Understanding the distinction between these two sources is crucial for both healthcare providers and patients:
Prescription medicines:
These undergo rigorous regulatory oversight and standardised manufacturing processes. This stringent approach ensures consistent hormone dosages and preparation methods across batches, resulting in predictable and uniform therapeutic effects. The reliability of prescription medicines provides confidence in treatment outcomes and facilitates more precise management of menopausal symptoms.
Compounded medicines:
In contrast, compounded hormones are prepared in specialised pharmacies, often tailored to individual patient needs. While this customisation can be beneficial in certain cases, the production process for compounded medicines is subject to less stringent regulatory controls. Consequently, there's a potential for more significant dose variations between batches, which may impact treatment consistency and efficacy.
It's important to acknowledge that not all hormone therapies fall under the category of body-identical treatments. Several oral non-body-identical options remain available and widely used in menopausal hormone therapy:
Ovestin:
This preparation contains estriol, a form of oestrogen that is generally considered weaker than estradiol.
Premarin:
Derived from a pregnant mare's urine, this medication contains conjugated equine estrogens. While effective, its non-human source distinguishes it from body-identical options.
Kligest and Kliovance:
These combination products contain estradiol paired with norethisterone, a synthetic progestogen. They offer the convenience of combined hormone therapy in a single preparation.
Trisequens:
This cyclical regimen mimics the natural hormonal fluctuations of the menstrual cycle by providing estradiol and a cyclical progestogen component.
Oral contraceptive tablets:
In some cases, particularly for women in the perimenopausal phase, oral contraceptives may be prescribed to manage symptoms and provide contraception.
Mirena coil:
While primarily used for contraception, this intrauterine device releases a local progestogen and can be beneficial in managing certain menopausal symptoms, particularly heavy menstrual bleeding during the perimenopausal transition.
It's crucial to exercise caution regarding over-the-counter products marketed for menopausal symptom relief. These preparations often lack the rigorous regulatory oversight applied to prescription medications. Consequently, their precise composition, potency, and mechanisms of action may be unclear or inconsistent.