Bioidentical hormones

What 'bioidentical' does and doesn't tell you

The word is often used as if it meant 'natural' or 'safer.' It doesn't. Bioidentical hormones are made in a lab, usually from plant starting materials, and a hormone that's identical to yours carries the same kinds of benefits and risks as the hormone itself.

What matters more is the product: the dose, the route (pill, patch, gel, cream, vaginal insert), whether it's FDA-approved, and whether it's paired with what you need, such as a progestogen if you have a uterus.

FDA-approved bioidentical options

Many bioidentical hormones are available as FDA-approved prescriptions you can fill at a regular pharmacy. Examples The Menopause Society lists include:

• Estradiol as pills, skin patches, gels, sprays and vaginal products.
• Oral micronized progesterone.
• A combined oral estradiol and progesterone capsule.
• Transdermal testosterone (approved for men).
• Vaginal prasterone (DHEA) for painful sex after menopause.

Compounded bioidentical hormones

Compounded bioidentical hormone therapy (often shortened to cBHT) is mixed by a pharmacy to a custom formula. It is not FDA-approved, and its safety and effectiveness haven't been tested in randomized trials. A 2020 report from the National Academies found no well-designed evidence that compounded products are safer or work better than approved ones, called their widespread use a public health concern, and recommended limiting them to people with an allergy to an ingredient in an approved product or a need for a dose form that isn't commercially available.

Specific worries include inconsistent dosing, lack of the standard warnings that come with approved products, and, with implanted pellets, hormone levels that run well above normal for long periods. The Menopause Society also says saliva hormone tests, sometimes used to 'customize' compounded doses, haven't been proven accurate or reliable.

How HealifyMD approaches it

Hormone therapy at HealifyMD starts with an individual risk discussion with a licensed clinician, covering blood clots, stroke and breast cancer. Some products in the plan are compounded, and the treatment pages say so. You can ask your clinician whether an FDA-approved bioidentical product would meet your needs instead.

Whatever form you use, the basics of safe hormone therapy are the same: the lowest dose that controls your symptoms, a progestogen if you have a uterus and take systemic estrogen, prompt reporting of unexpected bleeding, and a regular review of whether the treatment still makes sense for you.