Questions from The 1/6/23 Mandurah Menopause Talk- Estrogen pellets

COMPOUNDED BIOIDENTICAL HORMONES (Estrogen Pellets, Troches, Creams)

Q. Hi, I am a 57 yr old woman with a total hysterectomy at age 50. I am currently on 100mg of testosterone and 50mg of estrogen through insertion in the groin. The medicines are 2 small pellets smaller than a pea. I have this treatment every 5 months. Do you endorse this treatment?

A. Pellets are compounded bio-identical hormones. They are considered unsafe and are not endorsed by the world menopause society, the Australasian menopause society or any of the major menopause societies in developed countries.

The terms bioidentical hormone therapy and body identical hormone therapy can be confusing and misleading. To eliminate confusion, bioidentical HRT is the unlicensed compounded HRT and the Body is identical is the TGA-approved HRT. Body-identical HRT is regulated and monitored for purity and efficacy, it is prescription-only and is dispensed with package inserts containing extensive product information.

In Australia, government-approved body identical HRT includes Estrogel, Prometrium, Sandrena gel, Vagifem, Ovestin, and different types of patches. Some estrogen tablets are bio-identical, however, estrogen taken by mouth as a tablet has a risk of blood clots in the lungs, DVT, heart attacks and stroke.

A cautionary tale regarding patches. If your HRT patch needs a sticky tape to keep it in place or appears significantly wrinkled it is not effective, take it off and apply a new one. Generally speaking, smaller patches that need changing twice a week are more effective than larger patches that need changing once a week. I must say that I'm not a great fan of patches, because when I review women after 3 months of HRT, women on gel alone are usually doing so much better than women on patches alone. However, patches are great if you are unable to apply estrogen gel yourself, if you keep forgetting or if you prefer a patch. Patches work very well for older women (70th, 80th decade etc). I also use patches in combination with gel as "top-up therapy" for women on high doses of estrogen. Remember, Estrogen doses are not "a one size fits all affair". Just like women on insulin hormone or thyroid hormone don't use a standard fixed dose. It is considered perfectly safe to be on as a high dose of estrogen as you need to control your symptoms. But remember, if you have your womb intact (no hysterectomy), if you have estrogen, you have to have progesterone. Progesterone opposes the growth of the lining of the womb without which there's a small risk of cancer of the lining of the womb.

Remember, compounded bioidentical hormone therapies are prepared by a compounding pharmacist using a health care provider’s prescription. These therapies may combine multiple hormones (estradiol, estrone, estriol, DHEA, testosterone, progesterone) and use untested, unapproved combinations or formulations or are administered in nonstandard or untested routes such as subdermal implants, pellets, or troches.

Choose safe, choose licensed, choose well-researched HRT; TGA approved HRT.

More Q&A for the Mandurah menopause talk to come, Keep a look out for an answer to your question!

Dr Purity Carr is a GP and Menopause Doctor i

Harvey, Western Australia