Estrogens
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Certain forms of old-fashioned/traditional HRT are derived from horses’ urine (specifically, the urine of pregnant mares). These types of HRT are known as conjugated equine estrogens (CEEs).

However, plant-based HRT (derived primarily from yams) is widely available and in many places, such as the UK, is prescribed first line. This plant-based form of estrogen is termed estradiol and is “body-identical” (or regulated bio-identical), meaning that it has the same molecular structure as the oestradiol we produce in our bodies pre-menopause.

Transdermal (plant-based) oestradiol (e.g. gels and patches) is suitable for vegans. Oestradiol implants/pellets are also vegan-friendly. The vast majority of HRT tablets are not suitable for vegans as they tend to contain lactose and/or gelatine (constituents do vary between countries, however, so this is always worth checking). 

Progestogens

In vegan patients who require progestogencover (e.g. in those who have not had a hysterectomy), the levonorgestrel intrauterine system (e.g. the Mirena-IUS)  would be a suitable choice.

For vaginal/vulval symptoms Intrarosa (prasterone) pessaries are vegan friendly.

Premarin is not suitable for vegans as it is extracted from the urine of pregnant mares. 

Accreditation: Dr Hannah Short. PMS & Menopause Specialist. IAPMD Surgical Menopause Advisory Committee.

Visit www.iapmd.org/surgery for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.