Functional hormone therapy aims for optimal hormone balance across the whole hormone circle (steroid hormone pathway). It aims not just to replace estrogen. For example, it takes into account the benefits of progesterone not just in protecting the lining of the womb but also the role of progesterone on the brain and mood (calming and anxiety relieving). It also aims to achieve optimal levels of testosterone and looks at optimising stress, by acknowledging the influence of cortisol on disrupting hormone balance.

My focus is holistic and, to achieve it, I spend time with my patients understanding both their medical and emotional symptoms.  We take stock of current diet and lifestyle habits and we agree on a plan that includes food and self-care interventions.

We assess all the hormones in the pathway and aim to achieve balance. Sometimes we can do this using available licensed estradiol and progesterone preparations and I will certainly discuss this first.

Other times, when those are not tolerated or adjusted doses or more fine tuning is required, I may prescribe dose-adjusted compound bio-identical hormones; Compound pharmacies are regulated by the General Pharmaceutical Council and are often used by hospitals to make smaller doses for people with special circumstances. The use of compound hormones requires more monitoring for hormone levels as well as additional safety checks like a pelvic ultrasound.

Personalised medicine often recognises that the “one-size fits all” approach does not work for everyone and I think it is important to have the knowledge to make our own decisions when it comes to our own health.

The duration of treatment is highly individual and dependent on your personal situation.

It used to be general advice for HRT that you should not be on it for more than 5 years or not after the age of 60, but this has also changed and it is currently recommended that you can continue hormone replacement for as long as the benefits outweigh the risk. Regular reviews are recommended at least yearly. Your treatment plan will be tailored to your needs in consultation with your doctor.

Hormone replacement therapy (HRT) is often prescribed to women during perimenopause (the time from first symptoms to up to several years beyond the last period) and menopause (starting one year after the last period) for symptoms of hot flushes, vaginal dryness, loss of libido, depression, irritability or PMS-like symptoms, bone loss and osteoporosis or its prevention, and cardiovascular disease. HRT is currently approved only for hot flushes and osteoporosis.

Using hormone therapy for other symptoms or problems is considered “off-label” use, and the burden is on the physician to be sure that there is adequate science to support the use in a given situation.

 

Bio-identical hormones are hormones with the same exact structure that your body naturally makes. When hormone levels are brought back to “normal” for your age, there is much evidence that your overall health benefits. The risk of osteoporosis and fractures decreases. HRT is the most effective treatment for hot flushes. There may be other long-term beneficial effects of treatment. If your (female sex) hormones are already normal, adding additional hormone to address symptoms is not beneficial and may increase your risk of diseases like cancer or problems like blood clotting.

In the case of the hormones we use, the word ‘natural’ is used to refer to the structure of the hormone molecules, which are produced from natural plant sources. This chemical structure is 100% the same as that of the naturally occurring hormones produced by your glands. This means their effects are more consistent with the normal biochemistry of your body than those of synthetic hormones.

Bio-identical Hormones (BHRT) are hormones with the same structure that the body makes naturally. When hormones become imbalanced, there are many physical and emotional symptoms.

HRT

Conventional HRT is defined as estrogen replacement therapy, licensed for the management of hot flushes (vasomotor symptoms) and used in the management of osteoporosis.

However, hormone deficiency impacts our mood and brain functioning and psychological complaints largely outweigh hot flushes in the patients I see.

Conventional HRT means estrogen replacement therapy, which may indeed use the human-like estradiol

As estrogens increase the lining of the womb, giving them alone has been shown to cause endometrial cancer (cancer of the lining of the womb). Therefore, if you have a uterus, in order to protect it, you will be recommended a progestin/progestogen – a synthetic progesterone-like drug. Progestins have been shown to have a slightly higher risk of breast cancer.

More recently, natural progesterone has been recognised as safer and better tolerated and is increasingly being prescribed to protect the lining of the womb by most menopause specialists.

Therefore, there are now licensed hormones that are identical with the ones we naturally produce (bio-identical/body-identical), which come in a variety of doses (for estradiol) and one licensed natural progesterone in a fixed dose capsule of 100mg.

These medications containing human-like hormones are essentially licensed bio/body identical hormones that have been through a process of clinical trials and are now approved and have thankfully become the preferred method of menopause treatment in most menopause centres for the past few years. But this has not always been so.

Bio-identical hormones have however existed for a long time (natural progesterone was first made in 1947!). As there were no licensed alternatives for a long time, they were made in compounding pharmacies. Their use is sometimes criticised as they are not made by a pharmaceutical company and they have not undergone ‘rigorous clinical trials’. However, they have been used for 3-4 decades, at a time when conventional guidelines advocated equine estrogens and synthetic progestins, which have since been shown to increase risks of breast cancer, stroke, hypertension and have now thankfully been largely abandoned in favour of human-like hormone use.

In some ways, conventional medicine has now caught up with the BHRT way of practice, acknowledging that transdermal estradiol is safer than oral estradiol and natural progesterone (micronised oral progesterone tablets) are safer and better tolerated than their synthetic counterparts- the progestins.

The fact that a medication is licensed does not always mean it is 100% safe and indeed the licensed equine estrogens used previously on a large scale have now been largely discontinued.  The use of human-identical hormone therapy has now gained almost universal recognition as being the safest way forward using available licensed products.

Bio-identical hormones are derived from diosgenin, which is sourced from Mexican yams and then converted into human hormones. They need to be prescribed by a doctor and bespoke prescriptions are designed for each individual patient. The treatments are then compounded under strict guidelines by a specialist pharmacy. Bio-identical hormone therapy (BHRT) is usually administered in the form of creams, lozenges or capsules.

Tests for a hormone assessment are used in conjunction with symptoms to allow for a better assessment of hormonal issues and to inform treatment.

Currently, hormone testing is not required for prescribing conventional HRT, which defined as oestrogen replacement therapy, and is licensed for use once periods have become very infrequent or stopped altogether. This is because oestrogen levels have most likely declined and replacing them may be based on taking a history and discussing risks and benefits.

However, in hormone balance therapy, only hormones that are low or sub-optimal are being replaced.

Studies show that we transition differently into menopause.

The SWAN (study of women across the nation) measured urinary hormone during the menopause transition over a decade in women not using hormone therapies.

his study demonstrated for the first time that not all midlife women experienced one pattern of Estradiol/ estrogen decline over the menopause transition, but rather we all do it slightly differently.

(SWAN, Study of Women’s Health Across the Nation. MENOPAUSE AND WOMEN’S MIDLIFE HEALTH Menopause, Vol. 26, No. 10, 2019 12)

“Among 31.5% of SWAN women, estradiol levels rose around 5.5 years before the LMP (last menstrual period) with a steep decline almost 1 year before the LMP”

“A similar rise of estradiol was observed among 13.1% of SWAN women, but with a slow decline over 2 years after the LMP”

Some women however had a continuous downward slope- slow decline of estradiol over time.

So, sometimes oestrogen levels can be sky high, other times they can fall significantly

Progesterone levels are the first levels to drop very early on, often in our forties

Testosterone levels vary among women and one cannot predict their levels without testing.

This is why we recommend testing for hormone levels.

It can be hard to predict which pattern will you follow, that’s why we may recommend hormone testing for most women in earlier stages of peri-menopause.

As many women have very high estrogen levels in peri-menopause, we do not recommend giving additional estrogen if the levels are very high already.

If the periods have already stopped or are just very few and far between (less than 3 per year) testing may not be required as estradiol levels have now most likely dropped. However, other hormone levels such as testosterone are helpful to measure and testing can be beneficial.

We test hormones via a blood test and sometimes a urine test.

Blood hormone test is an indicator of circulating hormones in the blood- what is readily available.

Urine hormone tests look at hormone metabolites, and helps understand how hormones are stored or eliminated alongside with other useful markers (neurotransmitters/ vitamins/ stress hormones). They are particularly useful if you are worried about breast cancer (have a significant family history) or have a past history of endometriosis, PCOS or if fatigue and brain fog are significant or maybe you have already tried HRT and not found it fully helpful.

HORMONE TESTING OPTIONS

Dried Urine testing for Comprehensive Hormones (DUTCH) – includes all sex hormones and their metabolites, cortisol/adrenal stress profile, and some neurotransmitter markers; this is a home testing kit £255- results take 4-6 weeks

Blood testing for Sex Hormone Profile (day 21 cycle) £195

(FSH, estradiol, progesterone, total and free testosterone, DHEA sulphate, vitamin D) £195 via The Doctors Laboratory 76 Wimpole Street; results available in 7-10 days

Thyroid hormones profile TSH, free T3 and free T4 £97 (including thyroid auto-antibodies £127)

Advanced health check (homocysteine, liver function, kidney function, blood count, ferritin, iron, B12) £250

Other testing for sexual health profiles also available- please enquire via contact form

No, New Model Medicine (NMM) is a private, self-pay clinic and we don’t currently work with insurance companies.

Yes, By Law a prescription is valid for 6 months from the date on the prescription, unless the medicine prescribed contains controlled drugs (i.e. DHEA or TESTOSTERONE). A prescription for the controlled drugs is valid for 28 days from the date on the prescription.

The expiry date for compounded medication is 12 months for transdermal creams, 6 months for capsules, lozenges, hair tonics and facial creams. If there is a different expiry date due to medication ingredients, the expiry date will be issued on the medication. Always check the expiry date in case it differs.

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New Model Medicine (NMM ) is registered with the Care Quality Commission (CQC) and achieved this status on 12 August 2021.