Body Identical HRT (regulated Bio Identical HRT/ BHRT)

Body Identical Hormone Replacement Therapy (HRT).

As we age our ovaries produce less oestrogen and testosterone.

Symptoms women suffer during the menopause are due to oestrogen (and sometimes testosterone) deficiency. 

We have oestrogen receptors throughout the body.

This is why the menopause can cause symptoms in practically every organ system.

Replacing the hormone oestrogen reduces these symptoms.

HRT is a hormone REPLACEMENT therapy. It is not a ‘drug’.

The aim is to replace the hormones that your body once produced.

The hormones I use and describe here are ‘Body-Identical’.

This means they are the same as the ones naturally occurring in the body.

These are the safest to use and have the lowest risk of side effects.

(These are different from the compounded Bio-identical hormones which are not regulated and not recommended by the British Menopause Society) 

  • Oestrogen Replacement

Is safest when taken through the skin (rather than via mouth). This is known as the trans-dermal route

It is prescribed in either a PATCH, SPRAY or GEL form.

They all deliver the same hormone. .

It is patent preference (and availability of product as there have been shortages in the UK) which dictates what to use.

The gel comes either in a pump dispenser Estrogel or a small disposable sachet Sandrena .

Gel is applied daily onto the skin of the leg, arm, buttock or tummy and it is allowed to dry for absorption.

The patch is a small , sticky transparent ‘plaster’ that is applied to the skin and then changed every three days.

There are a number of different patches. Currently many are unavailable (see another fact sheet).

Most contain only oestrogen. (Some contain both oestrogen and progesterone).

Symptoms can take anywhere between a few days and a few months to improve on HRT. You can experience side effects in the first few months but these mostly settle with time. The gel and patches are usually available on the NHS via your GP

  • Progesterone

In women with a uterus, (ie those who have not had a hysterectomy), it is important to use a progesterone when giving oestrogen HRT.

Oestrogen stimulates the lining of the womb (endometrium) to thicken.

If it thickens by too much, there is a risk of eventually developing into a cancer.

Taking progesterone keeps this at bay.

I most commonly use either Utrogestan , or the Mirena coil to deliver progesterone.

A coil, once fitted ,can be forgotten about for 5 years but some women do not like the thought of it.

A woman has to remember to take the Utrogestan.

Utrogestan is the safest progesterone with fewest side effects,

It is normally taken by mouth.

If opting for Utrogestan there are two different methods to taking it. Continuous and cyclical.

Women in the peri-menopause are normally prescribed progesterone in a cyclical way.

They take progesterone  on days 17-28 of their cycle and then have a bleed.

Women who are post menopausal take the progesterone every day in a continuous regime.

Taking the progesterone at night can help with sleep.

  • Testosterone

Testosterone is a male AND a female hormone.

It is produced in the ovaries (and adrenal glands) and ovarian production declines at menopause.

Low testosterone can cause a lack of Joie de vivre, less strength and energy, low mood, poor libido, loss of sexual

function and musculoskeletal aches and pains.

Like oestrogen, it can also be replaced.

Typically, I normally wait to see if menopausal symptoms resolve following oestrogen replacement first.

If symptoms remain I would discuss the use of testosterone.

Used at female doses it should not cause any masculine side effects.

The only product currently available in the UK designed for female use is only available on private prescription.

It is imported from Australia and called Androfeme.

Taking HRT is a personal choice based on patient preference,

medical and family history.

No two women are the same and every woman needs a

holistic plan tailored to her own individual needs.

– Dr Naomi Potter, GP and Menopause Specialist

Dr. Naomi Potter

I am a GP with specialist interest in Menopause care. I have worked in the NHS for 16 years and as a GP with specialist interest in menopause and women's health for 9 years.

I run menopause clinics based from my clinic in New Malden, but now via video link to women from all over the London, the South East and the UK

Dr. Naomi Potter

GP & Specialist Doctor
in Menopause Care