Pharmaceuticals Estrace® (oral tablets), Estring® (ring) and Vagifem® (tablet) contain estradiol-17β, but are not part of the bioidentical hormone therapy.

The hormones taken by mouth are absorbed through the digestive tract and then transported to the liver, before being released into the body. In fact, almost 90% of the dose taken by mouth remains in the liver – this is called the “first pass liver effect”. In other words, only 10% of the dose taken circulates in the body to exert the expected beneficial effects.

Administration through the skin (timbres et gels) allows the body to directly absorb almost 100% of hormones. There is therefore no loss during passage through the liver or overactivation of liver enzymes. THE’hormone therapy applied to the skin is therefore better tolerated on the digestive level.

La bioidentical progesterone taken by mouth, however, has an advantage for women in menopause who suffer from insomnia: when passing through the liver, metabolites are produced and these have beneficial effects on sleep.

Some pharmacists prepare creams based onbioidentical hormones. These preparatory pharmacists, very few in Quebec, do not manufacture hormones as such: they obtain them in powder form and incorporate them into creams, according to the quantities prescribed by doctors. These creams, which are also called masterful preparations, would however be weakly absorbed by the body.

The Régie de l’assurance maladie du Québec (RAMQ) does not reimburse bioidentical hormonal products, because she considers them to be exceptional drugs. On the other hand, the drug insurance program covers several treatments ofclassic hormone therapy. Note that some private insurance plans reimburse bioidentical hormone therapy treatments, including magistral preparations.

Notes. Since the 1^er March 2010, the RAMQ withdrew Premarin® and Premplus® products from the list of reimbursed drugs, due to a very significant increase in their price. The College of Physicians suggests that its members replace them with the following, which are reimbursed:

– estrogens: CES®, Estrace® and Ogen®.

– progestins: medroxyprogesterone (generic drugs).

Treatments reimbursed by the RAMQ cost $ 10 to $ 20 per month. Bioidentical hormone therapy is significantly more expensive, for example, $ 60 and more per month for a treatment including progesterone and a transdermal estradiol patch. In any case, the higher the dosage, the more the price increases.