What is BHRT? | Ask Yvette

Bio-identical v body -identical

I see a lot of menopause groups sharing information about these 2 types of hormone replacement therapies, including under the acronyms BHRT/cBHRT/rBHRT. It’s always encouraging to see pharmaceutical companies developing new products, particularly in this area of health which has been tainted by the risks associated with HRT as well as the controversies surrounding the farming practices involved with pregnant mares’ urine.

So what are BHRTs?

The B in this acronym stands for either “bio-identical” or “body-identical”; however, they can be used interchangeably in some countries which leads to confusion. Hence, we prefer to refer to them as either Compounded HRT or Regulated HRT.

Compounded HRT (called bio-identical HRT in the UK)

This refers to HRT which has been made up, often “to order”, in a clinic or specialist pharmacy. These centres charge for this service based upon blood or saliva tests, the accuracy of which can be questioned if not repeated over a number of weeks (our body’s hormones fluctuate from day to day). The source of the ingredients used in not defined and the final product itself is not regulated. Women could be over dosed or underdosed. We would NOT endorse anyone uses this method of regulating their hormones during the menopause.

In the USA, some bio-identical HRT products are approved by the FDA, essentially because they are regulated..

Regulated HRT (called body identical HRT in the UK)

These are HRT products which have been manufactured according to a specification under strict guidelines, as a result of independent trials (ideally double blind, placebo controlled, multi-centre). These products will be licensed by each country’s Medicine Control Agency, with a unique number which will allow for any adverse events to be reported and the safety of the medication to be monitored over the years. They will only be available on prescription from a licensed doctor.

If medical prescribed HRT is your choice for the menopause, this in the only form of HRT that is of the right quality, backed by the necessary safety and has been independently shown to be effective.

BHRT is becoming the new Buzz Word!

What does concern me is the way that BHRT is being presented to women, both on and offline, particularly in relation to the claims of safety because they are derived from plants.

As with most things, the devil is in the detail and we should all read the small print! A lot of women see the word “safe” and block out everything else including the word “derived”.

The origin of these hormones might be plant based, but:

• What plant(s) are/is being used? Is it one that humans have safely eaten in large quantities for example? Or is it an herb type that is only used in small quantities and not every day or even every week like tarragon or dill? We don’t know if there are any safety issues from people suddenly eating large quantities of certain food groups. As a professor I know once said “there are no poisons, only poisonous doses”. Water in sufficiently large quantities will be toxic.
• The only two plants I have seen mentioned in connection with these types of hormones are Yam and Soy. Soy throws up another concern about whether the seeds used are from GMO sources, in which case the soy crops will have almost certainly have been treated with Glysophate (Roundup).
• Neither Yam or Soy are the same as human Progesterone or Oestrogen respectively. Therefore, they must be synthesised in order to be modified into the human oestrogen/progesterone steroidal hormones.
• I seriously doubt that any manufacturer would identify the nature of their synthesis/modification process(es) and what other ingredients/chemical are added, so we cannot make informed decisions about their long-term safety in the human body.
• Do manufacturers keep using the original plant(s) as their base ingredient or have they chosen to synthesize the plants themselves? If you are using plant sources, you must make sure that your extracts contain the same levels from each harvest, a process called standardisation. Again, I wonder if we will ever know the answer to this question, but almost certainly it will come down to commercial decisions.
• New does not mean safe. I believe that we will not truly know the safety of these hormones for another two or three decades or maybe even more. You only need to look at the side effects listed in the patient leaflets for all the new regulated HRT products; it appears that the manufacturers themselves don’t believe there are many changes from the “old form” HRT.
• A syrup can be natural if it’s been derived from liquidising fruit, a supplement can be natural if it just contains extracts of the fruit or vegetable. But in my opinion calling any product “natural” that have been synthesised is misleading.

For further reading, we suggest:

https://www.netdoctor.co.uk/healthy-living/wellbeing/a28594/bioidentical-hormones-menopause-hrt/

http://www.pms.org.uk/professionals/hormones

https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/