What are bioidentical hormones for menopause?

As a woman nears menopause, changes in her hormone levels can often affect her health and her lifestyle. There are options to address these issues, including bioidentical hormones. These are medicines that are made from plant-based derivatives, and they have a chemical structure that is exactly the same as what your body makes. Because these medications are engineered to specifically match each woman's natural hormones, they're without many of the side effects caused by traditional hormone replacement therapy (HRT). They can make women feel better within a few months.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Bioidentical hormones are sometimes used by women as a type of menopause hormone therapy (MHT) for the symptoms of menopause. These agents are creating a bit of a stir because enterprising marketers of bioidentical hormone replacement therapy (BHRT) claim these drugs are safer then traditional hormone therapies. Because this therapy contains natural or plant-based forms of estrogen, progesterone and some weaker hormones called estriol (which is not approved by the Food and Drug Administration (FDA) for any use and has not been shown to be either safe or effective), some believe they are safer to take. Here is where the confusion comes in. BHRT is obtained at a compounding pharmacy. Compounding pharmacists prepare customized pharmaceuticals for patients receiving prescriptions from their doctors because they need special formulas due to an allergy to certain ingredients for instance. And these compounded products contain pharmaceutical grade ingredients. But this is not the same as the products compounded without a prescription. 

Bioidentical hormone therapy is a loosely defined term and women should be wary of those dispensing it as a safer form of hormone treatment or as a treatment for other health conditions. The saliva test used to determine the dose the pharmacist compounds has not been proven to be useful because a woman's hormone levels fluctuate widely over the course of the day and week and can be affected by diet, among other factors.

Patricia Geraghty, NP
Women's Health

Bioidentical hormone therapy is a loosely defined term, started mostly as a marketing ploy. It has come to mean the form of estrogen and progesterone most similar to the forms made by the human body. Many women choose these hormones from compounding pharmacies. Although there is a place for compounded medications when the patient has allergies to some of the ingredients or a dosage is not available otherwise, compounded products do not have the safety net of FDA approval. Be cautious if someone is promoting compounded bioidentical hormones as safer or more effective. These claims are not supported by evidence. If a woman is seeking to use formulations that can be considered bioidentical she can use FDA regulated products with estradiol and with micronized progesterone.

Stacy Wiegman, PharmD
Pharmacy Specialist

Bioidentical hormone therapy involves using hormones that are chemically identical to ones your body produces. The hormones are derived from plants and can be customized to meet your unique hormonal needs.

Use caution when considering  bioidentical hormone therapy because products from customized sources or compounded formulas have less rigorous quality standards than drugs that are regulated by the Food and Drug Administration (FDA). Bioidentical hormones such as estradiol and micronized progesterone are available from FDA approved sources. Also, there is little scientific data that bioidentical hormone therapy is better than regular hormone therapy.

Talk to your doctor or pharmacist about the advantages and disadvantages of bioidentical hormone therapy.

Some hormones used in menopausal hormone therapy are called "bioidentical," meaning they are chemically, i.e., molecularly, identical to the substance as it occurs in your body. These hormones, however, don't come from your body (or another woman's body). Most bioidentical estrogens and progesterone come from soy (estrogen) or yams (progesterone).

They are also not "natural," or in their natural state, when you take them. To create a hormone women can use, the plant or animal-based hormones are synthesized, or processed, through a several-step process in a laboratory.

While all hormonal supplements, including bioidenticals, are made in a laboratory, the difference between a bioidentical hormone and a synthetic hormone is that the synthetic hormone is a patented molecular compound created in the laboratory to mimic the action of naturally occurring hormones and mass produced. Prempro, for instance, is a combination of two synthetic hormones.

Synthetic and bioidentical hormones work in the same way: by binding in a kind of lock-and-key process to special proteins on cell surfaces called receptors. Once a hormone—whether synthetic or bioidentical—locks onto these receptors, the messages from that hormone can be transferred to the cell.

There are two main types of bioidentical hormones: those that are FDA-approved and commercially available with a prescription, such as Estrace, Climara, Vivelle, EstroGel, Divigel and Estrasorb, and those that are produced on an individual basis for women, in compounding pharmacies.

Bioidentical hormones, which are essentially plant-derived estrogens that have been chemically modified to mirror a woman's natural hormones, are increasingly being used as alternatives to brand-name prescription hormones to treat menopause symptoms. They are often compounded at pharmacies according to a clinician's prescription. However, despite advertising claims, there is no medical evidence that they are any more or less beneficial—or risky—than the drug-company hormones. Moreover, unlike the pharmaceutical versions, the bioidenticals haven't undergone the scrutiny and clinical testing required for approval by the Food and Drug Administration (FDA).

Bioidentical hormones can and do treat symptoms of menopause safely and effectively in the hands of an experienced and caring physician.

Bioidentical or human identical hormones are prescription medications and are available in FDA approved preparations or individually compounded preparations. They are not alternative medications.

The scientific data on bioidenticals is large and deep. In the conventional medical domain the term bioidentical has caused much confusion and controversy leading to much unnecessary suffering.

When referring to bioidentical hormones we mean estradiol, progesterone and testosterone, all available in FDA-apporved formulations and used for more than 5 decades in both US and Europe.

Symtpoms of menopause include hot flashes, night sweats, insomnia, weight gain, depression, irritability, loss of libido and many others. Bioidentical or human identical hormones successfully treat theses symptoms and provide relief for women thus improving quality of life and allowing women to continue as contributors to society.

Bioidentical hormones are not alternative therapies and should be the first line of therapy for symptoms of menopause along with thyroid when indicated.

Bioidentical hormones are manmade hormones that are just the same as the hormones the body makes. There are several products with hormones like this that are on the market and are well-tested. But this term is most often used to mean drugs that are custom-made from a doctor's order. These custom-made products are also known as bioidentical hormone replacement therapy (BHRT). Despite product claims, there is no proof that BHRT products are better or safer than MHT drugs approved by the Food and Drug Administration (FDA). BHRT also can be expensive as many insurance and prescription programs do not pay for these drugs because they are viewed as experimental.

This answer is based on source information from the National Women's Health Information Center.

Continue Learning about Menopause

All About Perimenopause
All About Perimenopause
Between mood swings and weight fluctuations, perimenopause can make you feel like a teenager again—and not necessarily in a good way. Hormonal changes...
Read More
How are antidepressants used to treat hot flashes?
Dr. Celeste Robb-NicholsonDr. Celeste Robb-Nicholson
Prescription antidepressants can do double duty in menopause, relieving both depression and hot flas...
More Answers
8 Signs and Symptoms of Menopause
8 Signs and Symptoms of Menopause8 Signs and Symptoms of Menopause8 Signs and Symptoms of Menopause8 Signs and Symptoms of Menopause
What Causes Hot Flashes?
What Causes Hot Flashes?

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.