Combined estrogen and progesterone HRT pill accepted for use in Scotland

One-a-day Bijuve capsule is the first body identical combined estrogen and progesterone treatment of its kind to be accepted by the Scottish Medicine Consortium.

A one-a-day combined estrogen and progesterone HRT pill has been accepted for use by post-menopausal women in Scotland.

The Bijuve oral capsule is the first HRT treatment to contain body identical estrogen and progesterone, offering alternative for women who may prefer to take their HRT in tablet form (see Q&A below).

Bijuve was accepted by the Scottish Medicine Consortium (SMC), which decides on which medicines are acceptable for use by NHS Scotland.

The SMC considers clinical and health economic evidence, as well as evidence submitted by patient groups, to decide whether a medicine provides value for money.

Bijuve has been licensed for use in the UK since 2021, yet it is only available in a handful of areas.

Theramex, the women’s health company which developed the treatment, said this was in part due to COVID-19 backlogs in approvals but also “yet another symptom of the lack of prioritisation of women’s health issues”.

“We hope that timely adoption of Bijuve onto local Scottish formularies is prioritised so women have access to more treatment choices,” added Theramex UK general manager Tina Blackhouse.

Currently Bijuve is only available on 13 formularies in England and Northern Ireland. Formularies are lists of medicines approved for use by local medicines committees.

Commenting on the announcement, Menopause Specialist and balance founder Dr Louise Newson said: “This really is a great move in the right direction for more women to receive HRT.

“This is a cost effective a safe choice of HRT which still is not widely available to women.

“I really hope that other areas in England will allow clinicians to prescribe Bijuve to more women.”

What is Bijuve?

Bujuve is a soft gel capsule containing 1mg of estradiol and 100mg of body identical progesterone.

Designed to be taken daily, it is an option for some women who may prefer to take HRT in tablet form.

What does ‘body identical’ actually mean?

The type of HRT prescribed by the NHS and many private clinics is known as body identical HRT.

This also includes estrogen you take through the skin in a patch, gel or spray, and micronised progesterone, known under the brand name Utrogestan in the UK.

Body identical HRT is derived from the yam plant and has the same molecular structure as the hormones you produce naturally from your ovaries. This type of HRT is heavily regulated and thoroughly tested and researched.

If you still have a womb (uterus), it is important that a progesterone or progestogen is prescribed alongside the estrogen for your HRT, in order to keep your womb lining thin and healthy.

Many women opt to have a Mirena coil to receive progestogen. While this is not classed as body identical, it is a very safe and effective type of progestogen and is shown to have the least side effects or risk compared to other types.

Some types of older HRT contain a mixture of different types of estrogens and could not be described as body identical, but these are rarely prescribed by doctors these days.

Although Bijuve is an oral type of HRT, it does not appear to be associated with an increased risk of clot, unlike other types of oral HRT.

Is body identical HRT the same as bioidentical HRT?

No. Some private clinics are using what are called ‘compounded bioidentical’ hormones. Compounded bioidentical hormones are not regulated and are not subject to any quality controls. The hormones are custom made in order to prescribe them in combination doses or preparations that are not routinely available. They are neither licensed nor regulated and are not recommended.