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Are You on an Updated, Gold-Standard HRT Regime?

Ladies beware. I'm seeing a lot of women in France settle for an outdated HRT regime without realising it. Why does it matter? It means you are taking a higher health risk. With some synthetic progesterones, the risk is less than others, but still, when the most updated version of HRT is actually available in France, why take the risk?


WHAT IS THE GOLD STANDARD OF HRT?



The newest, and seen as safest, form of HRT is what's called 'body identical' HRT in places like the UK and America. (Note that I am not talking about 'bioidenticals', an unregulated HRT regime that is only really recommended if you like emptying your pockets, more on bioidenticals and my experience with such practitioners is in my book).


But note 'body identical HRT' is not said in France. Using this term will just lead to a blank stare. To understand how to let your doctor know you want body identicals, you need to understand the difference between synthetic and body identical HRT.


SYNTHETIC VS BODY IDENTICAL HRT

I get into this in detail in my book, but briefly, it's the progesterone part of a HRT regime that is synthetic or body identical.


Old forms of progesterone, called 'progestins', aren't even really progesterone at all. Simply put, they couldn't figure out how to get the molecules of progesterone small enough our bodes would accept them, so they made these medications that instead trick your body into thinking it's come across progesterone. So that your body then produces the same results that it would if it actually had been given progesterone.


But now scientists figured out how to mimic the 'recipe' of the progesterone naturally in our bodies in a way that the body can process, with molecules that are small because they are 'micronised'. This is the new 'body identical' progesterone, generally derived from wild yams and soybeans.


So if you want body identical HRT in France, along with your oestrogen patches or gel (both are body identical, the same 'recipe' as the oestrogen in your body) you need to ask for micronised progesterone, in French, 'progesterone micronisée'. The main brand is Utrogestan, and the main 'generics' you will generally find yourself being prescribed are Estima, Progestan, and Biogaran.

ARE SYNTHETICS DANGEROUS?


It depends on the synthetic progestin we are talking about. Some are deemed safer than others. But in general, synthetics are the ones that are connected to a risk of breast cancer, body identicals less so. For example, a large-scale data review concluded that, "progesterone was associated with lower breast cancer risk compared to synthetic progestins when each is given in combination with oestrogen".


And synthetics also tend to be more likely to cause unwanted side effects. In fact micronised progesterone has meant those with health complications like fibroids, liver issues, or migraines can now in some cases access HRT.


The one synthetic that seems safer than the other has been around since the 1950s and is called dydrogesterone. I see it prescribed a lot in France, where the main mark is called "Duphaston'. A 2020 review paper on HRT suggests that, "micronised progesterone and dydrogesterone appear to be the safest options, with lower associated cardiovascular, thromboembolic, and breast cancer risks compared with other progestogens." (But note that this paper was from the advisory board of a big Pharma company that produces both micronised progesterone and a patch containing dydrogesterone!)


Do be careful and check your medications, as I've seen women been prescribed synthetics here that are seen as dangerous enough there are alerts against them. The European Commission put out a statement against chlormadinone (LUTERAN and generics) or nomegestrol (LUTENYL and generics), connecting them to the growth of brain tumours. And still it seems they are handed out.


IF I AM ON A SYNTHETIC SHOULD I CHANGE OVER?


It's up to you. I admit that personally, I would, particularly if I was on any other synthetic than dydrogesterone. But some women prefer to stick with the medication they are on despite the higher risks. They are happy with how they feel. They aren't experiencing side effects, their medication seems to work for them. And I am not a doctor, nor am I here to tell any women what to do with her body.


And there is truth in the fact that body identicals are newer on the market. So things like Duphaston are more tried and tested. Although body identicals have been around enough the research is solid, and they really are outperforming synthetics in all research to date.


So if you are already on HRT, up to you. But if you are not yet on HRT, why not start immediately with body identical HRT?





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