There are many ways to take bioidentical hormones. Here we cover some of the more common options available in the UK.
What should your doctor consider before deciding the dosage form?
One of the considerations is the ‘first pass’ effect, which happens when medication is swallowed either directly or through saliva. The ‘first pass’ describes the process of medication being filtered out of the body by the liver and gut. As a result, higher doses of medication may be required to achieve a particular effect. Another consideration is how long the hormones take to work. And finally, hormones are lipophilic, which means they pass through your mucosa easily to reach your bloodstream.
Oestradiol, oestriol, progesterone, pregnenolone, melatonin and DHEA are suitable to take in any dosage form. Testosterone is not suitable for oral administration due to its slow clearance in the liver, which may cause toxicity over time.
The main dosage forms of hormones are:
Oral, using capsules, suspensions or rapid dissolve tablets
Easy to take, however, the ‘first pass’ effect is strong. Only about 10% of the medication ends up being bio-available, that is, available for the body to use. The metabolites produced from the ‘first pass’ can be useful, such as allopregnanolone from progesterone, which aids sleep.
Sublingual, using oral drops or rapid dissolve tablets or Intrabuccal, using lozenges (troches)
Absorbed quickly, the hormones rapidly disintegrate and as a result, blood levels rise and fall rapidly over the first six hours. This suggests that the medication can be taken twice daily.
Sublingual hormones are held under the tongue until absorbed, whereas intrabuccal hormones are held between the cheek and gum until dissolved. In either case, about 50% of the hormones are swallowed with the rest being absorbed through the musoca under the tongue or in the cheek and gum.
Topical, using creams and gels
Easy to adjust the dosage and easy to administer, with no ‘first pass’ effect. Appropriate base creams will deliver the majority of the hormones directly into the bloodstream without retaining much in the skin layers. It is recommended to apply topical hormones on non-fatty areas of the body with thin skin as their lipophilic nature means they may create a reservoir in fatty tissue. May be used daily or twice-daily.
Vaginal or Rectal, using pessaries or suppositories
Good absorption with a localised effect, rather than systemic. Rapid onset, hence twice-daily usage may be beneficial.