‘Algorithms do not always match human complexity’ – interview

FemTech World meets Dr Ghazala Aziz-Scott, specialist in integrative women’s health and bioidentical hormone balancing for the Marion Gluck Clinic, to discuss the potential of bioidentical hormones and the future of femtech.

How can bioidentical hormones treat menopause and women’s hormones related issues?

Bioidentical Hormone Replacement Therapy (BHRT) has an identical molecular structure to the naturally occurring hormones which are produced in the body. BHRT uses bioidentical hormones to treat hormonal conditions. It is most used to treat symptoms of peri menopause, menopause, pre-menstrual syndrome (PMS), depression, endometriosis and thyroid dysfunction. 

BHRT can be compounded into a personalised dosage and in different application methods, creating a better solution, with less side effects, for many women. With BHRT, shortages are rarely faced as individual prescriptions are made in the compounding pharmacy.

BHRT is prescribed in personalised dosages, based on thorough testing, and produced to order. This means that the pharmacy (which must meet industry standards for purity of Active Pharmaceutical Ingredients and Good Manufacturing Practice) is able to prepare custom doses and application methods to address the individual needs of a patient.

What difference can BHRT make compared to HRT (Hormone replacement therapy)?

Synthetic HRTs made from estrogens are derived from horse urine or synthetic oral estrogens and are still available on the NHS and are not the optimal choices – the British Menopause Society recognises that bioidentical HRT is the gold standard form of HRT which is derived from plant sterols such as beta sitosterol and diosgenin from Mexican yams. 

Bioidentical and body identical hormones are the same thing but body identical refers to the regulated standard dose treatments available on the NHS and bioidentical refers to the personalised HRT from a compounding pharmacy.

Although body identical and bioidentical hormones are made with similar ‘ingredients’ there are differences between the two, including the manufacturing process, dosage, delivery, and which hormones are available in terms of estradiol, progesterone, DHEA, and testosterone. For example, body identical progesterone is only available as utrogestan which is an oral capsule rather than a cream. The availability of suitable testosterone preparations for women is also limited.

Body identical hormones are produced by large pharmaceutical companies in regulated, set doses and application methods, and while this one-size-fits-all approach works for some patients, the dosage and application of body identical hormones cannot be altered to cater to those with more specific needs.

What do you see in the future of therapies for menopause and other hormones related issues?

There needs to be continued research on the long-term benefits of bioidentical HRT treatments including the role of testosterone and DHEA, and there needs to be greater awareness of the risks of using synthetic HRTs as there is plenty of research evidence to show that they are not the best forms of treatment. 

Personalised care is also important to assess each woman’s individual situation, especially when it comes to hormonal imbalances. Health can be optimised and we can use advanced scientific testing to look at nutrigenomics which demonstrates how individual nutrients can impact the genes coding for hormone synthesis and metabolism, so for example it can give us clues as to why a women may not tolerate HRT that well and what other approaches might be more beneficial.

DUTCH testing takes dried urine samples to assess an individual woman’s estrogen metabolism while on HRT and if she has a tendency to produce the more toxic metabolites of estrogen which can increase the risk of estrogen dependent cancers, so we can make more informed decisions about treatment.

Drugs are also being developed to help hot flushes that are non- hormonal which act on NK3 receptors in the brain and may have therapeutic benefits for women who cannot take HRT for example with recent breast cancer.

Stem cell therapy is also being researched where intraovarian injections may reverse premature ovarian failure in younger women.

What do you think it’s missing in the femtech industry?

Femtech refers to technology specifically focused on women’s health needs and this is a growing industry from apps assisting women in managing their menstrual cycle and reproductive health such as Clue, to apps to manage symptoms of the menopause and new treatments for female health conditions such as endometriosis. There needs to be much greater education and awareness of these tools as they can help break taboos about women’s health and also meet the needs of underserved populations such as those on a low income or minority groups.

Women’s research has historically been underfunded and not prioritised and this is now being recognised widely, including at governmental level and in the education of doctors. Increased investment in femtech can be part of this revolution.

The term femtech must also be inclusive of transgender and non- binary communities who may have the same biology as a cisgender woman but do not identify as a woman or female.

We must remember, however, the importance of connection with an empathetic practitioner who understands the issues in the context of each woman as algorithms can assist but do not always match human complexity.