Bioidentical Hormones

“Bioidentical hormones are hormones
from plant sources that are chemically similar
or identical to hormones produced in the human body”.1

Umbrella
What may the Bioidentical Hormones Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Bioequivalent Hormone Therapy
  • Bioidentical Hormone Medications
  • Bioidentical Hormone Replacement Therapy (BHRT)
  • Bioidentical Hormone Therapy (BHT)
  • Bioidentical Hormones
  • Bioidenticals
  • Custom-Compounded Bioidentical Hormone Therapy (C-CHT)
  • Custom-Made Bioidentical Hormones
  • Custom-Mixed Bioidentical Hormones
  • Hormone Therapy Alternatives
  • Natural Hormone Therapies
  • Pharmacy Compounded Hormones
  • ‘Compounded’ Bioidentical Hormone Replacement Therapy (cBHRT)
  • ‘Regulated’ Bioidentical Hormone Replacement Therapy (rBHRT)

Bioidentical Hormones

What are bioidentical hormones?

DotS the definition of bioidentical hormones may vary. On page one in Menopausal Hormone Therapy the European Menopause and Andropause Society’s definition is:

“‘Bioidentical hormones’ is a term used to describe plant-derived preparations (like approved MHT drugs) modified to be structurally identical to human hormones such as estradiol and progesterone”.2

Bioidentical Hormone Therapy

What is bioidentical hormone therapy?

DotS the definition of bioidentical hormone therapy may vary. In Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. I’ve heard about something called bioidentical hormones. What are they? the North American Menopause Society’s (NAMS) definition is:

“The term bioidentical hormone therapy began as a marketing term for custom-compounded hormones. But it is taken to mean hormones that have the same chemical and molecular structure as hormones that are produced in the body”.3

Body-Identical Hormone Therapy

What is body-identical hormone therapy?

DotS the definition of body-identical hormone therapy may vary. In Bioidentical Custom Compounded Hormone Therapy the Australasian Menopause Society’s (AMS) definition is:

“…‘body-identical’ hormone therapy refers to pharmaceutical products that have the same chemical structure as those produced in the human body”.4

Drug Compounding

What is drug compounding?

DotS the definition of drug compounding may vary. In Compounding and the FDA: Questions and Answers – What Is Compounding? the FDA elaborate on:

“Drug compounding is often regarded as the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient. Compounding includes the combining of two or more drugs. Compounded drugs are not FDA-approved”.5

Compounded Bioidentical Hormones

What are compounded bioidentical hormones?

DotS the definition of compounded bioidentical hormones may vary. In Complementary and Herbal Therapies for Hot Flushes: Compounded Bioidentical Menopausal Hormone Therapy the AMS note:

“Compounded “bioidentical” hormones contain hormonal preparations which are aimed at correcting “hormonal imbalances” which may occur at menopause. However, there is no evidence to support the effectiveness or safety of these products”.6

In Compounding and the FDA: Questions and Answers – Are Compounded Drugs Approved By FDA? the FDA elaborate on:

“Compounded drugs are not FDA-approved. This means that FDA does not verify the safety or effectiveness of compounded drugs. Consumers and health professionals rely on the drug approval process for verification of safety, effectiveness, and quality. Compounded drugs also lack an FDA finding of manufacturing quality before such drugs are marketed”.7

Natural or Not

Are bioidentical hormones natural?

In Bioidentical Hormones: Are They Safer? Are bioidentical or natural hormones safer and more effective than hormones used in traditional hormone therapy for menopause symptoms? the (United States) Mayo Clinic author explains:

“The term “natural” means the hormones in the product come from plant or animal sources. They’re not made in a lab. But many of these products still need to be commercially processed to become bioidentical”.8

In Bioidentical Custom Compounded Hormone Therapy the AMS explain:

“It is important to realise that no hormone used in any preparation of pharmaceutical grade menopausal hormone therapy (MHT) or compounded “bioidentical therapy” is ‘natural’. They are all synthesised in the laboratory from some precursor by enzymatic manipulation”.9

In Menopause Management Options: Pharmacy-Compounded Hormones (Bioidentical Hormones) the (Australian) Jean Hailes for Women’s Health (JH) note:

“Some doctors prescribe pharmacy-compounded hormones, which are also known as ‘bioidentical’ hormones. These are mixtures of different hormones made up in compounding pharmacies. The hormones are promoted as ‘natural’ and ‘exactly like our own’, which is not true.

Pharmacy-compounded preparations can contain oestrogens, progesterone and sometimes other hormones such as testosterone. The preparations are made into capsules, creams, gels, drops (applied to the tongue), lozenges or troches (soft square-shaped tablets) that are sucked inside the cheek.

All hormone therapies are manufactured synthetically. Hormones are only natural when they are in the human body”.10

Safe or Not

Are bioidentical hormones safe?

In Bioidentical Hormones: Risks and Benefits – What Are the Risks of Bioidentical Hormones?, published 15 May 2022, the (United States) Cleveland Clinic elaborate on:

“Many healthcare providers who use bioidentical hormones claim they are safer than traditional hormone therapy treatments. But there have been no large research studies of bioidentical hormones to show evidence of this”.11

On page 771 in The 2022 Hormone Therapy Position Statement of The North American Menopause Society, published July 2022, and endorsed by multiply organizations, the NAMS explain:

“There is a dearth of safety and efficacy data with little or no high-quality pharmacokinetic data to provide evidence of safety and efficacy of compounded bioidentical hormone therapy and insufficient evidence to support overall clinical use of compounded bioidentical hormone therapy for treatment of menopause symptoms. Compounded bioidentical hormone therapy presents safety concerns, such as minimal government regulation and monitoring, overdosing and underdosing, presence of impurities and lack of sterility, lack of scientific efficacy and safety data, and lack of a label outlining risks”.12

Testing or Not

Is serum, saliva or urine hormone testing necessary?

On page 771 in The 2022 Hormone Therapy Position Statement of The North American Menopause Society, published July 2022, and endorsed by multiply organizations, the NAMS note:

“Compounded bioidentical hormone therapy has been prescribed or dosed on the basis of serum, salivary, or urine hormone testing; however, the use of such testing to guide hormone therapy dosing is considered unreliable because of differences in hormone pharmacokinetics and absorption, diurnal variation, and interindividual and intraindividual variability”.13

Government Approved

Are government approved bioidentical hormones available?

Yes. In Bioidentical Hormone Therapy: Custom Compounded versus Government Approved published in 2020, the NAMS elaborate on:

“If you prefer to treat your bothersome menopause symptoms with hormones that are chemically identical to those you produced naturally before menopause, ask your healthcare provider to prescribe estradiol and progesterone products that are scientifically tested and government approved. Estradiol is available as an oral tablet, skin patch, topical gel, topical spray, and vaginal ring. Low doses of estradiol used in the vagina (to treat vaginal dryness and painful intercourse but not hot flashes) are available as a vaginal tablet, cream, and ring. Progesterone is available as an oral capsule (see table below for product names)”.14

On page 771 in The 2022 Hormone Therapy Position Statement of The North American Menopause Society, published July 2022, and endorsed by multiply organizations, the NAMS also note:

“The term bioidentical hormone therapy (similar to endogenous) can be misleading because there are both government-approved and compounded bioidentical hormone therapies. Government approved (in the United States, FDA-approved) bioidentical hormones include estradiol, estrone, and MP, which are regulated and monitored for purity and efficacy. These are dispensed with package inserts containing extensive product information (based on RCTs) and may include black-box warnings for AEs. In contrast, compounded bioidentical hormone therapies are prepared by a compounding pharmacist using a provider’s prescription. These therapies may combine multiple hormones (estradiol, estrone, estriol, DHEA, testosterone, progesterone) and use untested, unapproved combinations or formulations or are administered in nonstandard or untested routes such as subdermal implants, pellets, or troches”.15

In Hormone Replacement Therapy (HRT) Alternatives: Bioidentical or “Natural” Hormones the (United Kingdom) NHS include:

“Many standard HRT hormones are made from natural sources, but unlike bioidentical hormones, they’re closely regulated and have been well researched to ensure they’re as effective and safe as possible”.16

In Menopause Management Options: Pharmacy-Compounded Hormones (Bioidentical Hormones) the JH include:

“Note: in Australia, doctors can prescribe conventional menopause hormone therapies (MHT) that are identical to those hormones made in your body. These products have been thoroughly tested for safety and effectiveness”.17

Recommended or Not

Do menopause societies, women’s health organizations and other organization, recommend the use of compounded hormone therapy?

On page four in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published online 10 June 2022, one of the recommendations is:

  • “The use of compounded bioidentical hormone replacement therapies is not recommended given the issues related to their purity, potency and safety. The potential benefits of bioidentical hormone therapy can be achieved using conventionally licensed products available through NHS prescribing without having to resort to compounded varieties from specialist pharmacies”.18

In Menopause Management Options: Pharmacy-Compounded Hormones (Bioidentical Hormones) the JH note:

“We do not recommend the use of pharmacy-compounded menopause hormone therapy”.19

Health Care Provider

What if I choose to use bioidentical hormones?

If you choose to use bioidentical hormones it may be in your best interest to also choose to tell your health care providers you are doing this. The JH caution:

“It’s important to have a face-to-face meeting with your health practitioner to discuss the risks and benefits of different treatments for menopause”.20

Health Topics A-Z

Where may I find Health Topics related to Bioidentical Hormones?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

Where may I find Links related to Bioidentical Hormones?

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Links

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New or Updated

  1. 20 Years of Data Lead To Changes In Perceptions, Usage of Menopausal HT
  2. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT): 7. Myth – Compounded Bioidentical Hormone Therapy Is Safer Than Conventional MHT
  3. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  4. Bioidentical Custom Compounded Hormone Therapy
  5. Bioidentical HRT [British Menopause Society Consensus Statement]
  6. Bioidentical Hormone TherapyBioidentical Hormone Therapy
  7. Bioidentical Hormones
  8. Bioidentical Hormones
  9. Bioidentical Hormones Explained – A British Menopause Society Video
  10. Bioidentical Hormones – Ask Dr Jean
  11. Bioidentical Hormones: Are They Safer?
  12. Complementary Medicine Options for Menopausal Symptoms
  13. Complementary/Alternative Therapies for Menopausal Women
  14. Compounded Bioidentical Hormone Therapy
  15. Compounded Bioidentical Hormone Therapy [Video]
  16. Compounding Interests: The Risks of Bioidentical Hormones
  17. Compounding and the FDA: Questions and Answers
  18. Custom-Compounded Bioidentical HT for Menopause Symptoms May Yield ‘Abnormally High’ Hormone Levels
  19. Deciding About Hormone Therapy
  20. Deciding About Hormone Therapy Use
  21. Despite Effectiveness Women Remain Skeptical of Hormones At Menopause—What’s the Problem?
  22. Dr Gail Busby – I Forgot To Ask the Doctor – Episode 9 The Menopause
  23. Endocrine Society Encourages Clinicians To Avoid Prescribing Compounded Hormones
  24. Find A Menopause Practitioner [United States and Other]
  25. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  26. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  27. Follicle-Stimulating Hormone (FSH) Levels Test
  28. HRT and Alternatives
  29. HRT: Summary
  30. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  31. Hot Flashes
  32. Hot Flashes
  33. Hot Flashes: What Can I Do? [+ Video: What Are the Signs and Symptoms of Menopause?]
  34. How To Find Relief for Hot Flashes At Night
  35. Index To Drug-Specific Information [United States]
  36. Is It Really ‘FDA Approved?’ FDA Doesn’t Approve Compounded Drugs
  37. Joint Position Statement by the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  38. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
  39. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms [+ Video: Talking Menopause With Your GP]
  40. Lifestyle and Behaviour Changes for Menopausal Symptoms
  41. Lifestyle and Behavioural Modifications for Menopausal Symptoms
  42. Looking At HRT In Perspective
  43. Luteinizing Hormone (LH) Levels Test
  44. Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option!
  45. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video]
  46. Mayo Clinic Minute: Lifestyle Changes To Manage Menopause Symptoms [+ Video]
  47. Menopause
  48. Menopause
  49. Menopause
  50. Menopause
  51. Menopause & Herbs
  52. Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. I’ve heard about something called bioidentical hormones. What are they?
  53. Menopause FAQs: Hot Flashes
  54. Menopause Management Options: Pharmacy-Compounded Hormones
  55. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Bioidentical Hormones
  56. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Symptom Tracker
  57. Menopause Patient Information [Videos] 3. The Risks & Benefits of HRT
  58. Menopause Patient Information [Videos] 4. The Different Types of HRT
  59. Menopause Preparedness Toolkit Video Series: Treating Vasomotor Symptoms of Menopause
  60. Menopause Symptoms and Relief
  61. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  62. Menopause Treatment: Bioidentical Hormones
  63. Menopause Treatments: What Works, What Doesn’t
  64. Menopause What Are the Symptoms?
  65. Menopause: Diagnosis & Treatment
  66. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause – Treatment for Menopausal Symptoms [NICE Guideline]
  67. Menopause: Medicines To Help You
  68. Menopause: Menopause – Hormone Treatments
  69. NAMS Applauds NASEM Efforts on Compounded Bioidentical Hormone Therapy
  70. National Academies of Science, Engineering, and Medicine (NASEM) Study on the Clinical Utility of Treating Patients With Compounded “Bioidentical” Hormone Therapy
  71. National Center for Complementary and Integrative Health: 4 Things To Know About Menopausal Symptoms and Complementary Health Practices
  72. National Center for Complementary and Integrative Health: Herbs At A Glance
  73. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  74. National Center for Complementary and Integrative Health: Know the Science: How Medications and Supplements Can Interact
  75. National Center for Complementary and Integrative Health: Menopausal Symptoms: In Depth: What the Science Says About Complementary Health Approaches for Menopausal Symptoms – Other Complementary Approaches: Bioidentical Hormones
  76. National Center for Complementary and Integrative Health: Natural Doesn’t Necessarily Mean Safer, or Better
  77. Natural Remedies To Help Manage Perimenopause Symptoms
  78. Natural Therapies & Supplements
  79. Neither Natural Nor Safe: Compounded Bioidentical Hormones Need Better Evidence
  80. Non-Estrogen Treatments for Menopausal Symptoms
  81. Office of Dietary Supplements: Black Cohosh
  82. Office of Dietary Supplements: Dietary Supplement Fact Sheets
  83. Optimising the Menopause Transition: Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  84. Safety and Efficacy of Compounded Bioidentical Hormone Therapy (cBHT) In Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
  85. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use (2020)
  86. The Issue With Bioidentical Hormones — Free Health Article
  87. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement
  88. Tips To Help Manage Menopause Symptoms
  89. Using Natural Therapies In the Menopause Transition – Webinar
  90. Vaginal Dryness Alternative Treatments
  91. Video Series-2020: What You Need to Know About Bioidentical Hormone Therapy
  92. Video Series-2021: Treatment Options for Vaginal Dryness and Urinary Issues
  93. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  94. Video Series-2022: New Treatment Options for Menopause Symptoms Are Around the Corner
  95. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  96. Videos and Podcasts: Interviews and Podcasts – Interviews: New Hormonal Tests To Diagnose or Even Predict the Menopause?
  97. What Everyone Should Know About Menopause Symptoms

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Menopause Management Options: Pharmacy-Compounded Hormones (Bioidentical Hormones). Last Updated: 08 September 2022 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 23 January 2023
  2. Menopausal Hormone Therapy. 2022:1. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/05/Menopausal-hormone-therapy.pdf Accessed: 23 January 2023
  3. Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. I’ve heard about something called bioidentical hormones. What are they? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 23 January 2023
  4. Bioidentical Custom Compounded Hormone Therapy. Content Updated: May 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/212-bioidentical-hormones-for-menopausal-symptoms Accessed: 23 January 2023
  5. Compounding and the FDA: Questions and Answers – What Is Compounding? Content Current As of: 29 June 2022. Food and Drug Administration https://www.fda.gov/drugs/guidancecomplianceregulatoryinformation/pharmacycompounding/ucm339764.htm Accessed: 23 January 2023
  6. Complementary and Herbal Therapies for Hot Flushes: Compounded Bioidentical Menopausal Hormone Therapy. Content Updated: January 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/734-complementary-and-herbal-therapies-for-hot-flushes Accessed: 23 January 2023
  7. Compounding and the FDA: Questions and Answers – What Is Compounding? Content Current As of: 29 June 2022. Food and Drug Administration https://www.fda.gov/drugs/guidancecomplianceregulatoryinformation/pharmacycompounding/ucm339764.htm Accessed: 23 January 2023
  8. Burnett, T. Bioidentical Hormones: Are They Safer? 07 December 2022. https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/bioidentical-hormones/faq-20058460 Accessed: 23 January 2023
  9. Bioidentical Custom Compounded Hormone Therapy. Content Updated: May 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/212-bioidentical-hormones-for-menopausal-symptoms Accessed: 23 January 2023
  10. Menopause Management Options: Pharmacy-Compounded Hormones (Bioidentical Hormones). Last Updated: 08 September 2022 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 23 January 2023
  11. Bioidentical Hormones: Risks and Benefits – What Are the Risks of Bioidentical Hormones? 15 May 2022. Cleveland Clinic https://my.clevelandclinic.org/health/articles/15660-bioidentical-hormones Accessed: 23 January 2023
  12. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. July 2022:771. North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 23 January 2023
  13. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. July 2022:771. North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 23 January 2023
  14. Menopausal Symptoms: In Depth: What the Science Says About Complementary Approaches for Menopause Symptoms – Other Complementary Approaches: Bioidentical Hormones. Last Updated: May 2017. National Center for Complementary and Integrative Health https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth Accessed: 23 January 2023
  15. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. July 2022:771. North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 23 January 2023
  16. Hormone Replacement Therapy (HRT) Alternatives: Bioidentical or “Natural” Hormones. Page Last Reviewed: 09 September 2019. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/alternatives/ Accessed: 23 January 2023
  17. Menopause Management Options: Pharmacy-Compounded Hormones (Bioidentical Hormones). Last Updated: 08 September 2022 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 23 January 2023
  18. Hamoda et al. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First published 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 23 January 2023
  19. Menopause Management Options: Pharmacy-Compounded Hormones (Bioidentical Hormones). Last Updated: 08 September 2022 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 23 January 2023
  20. Menopause Management Options: Pharmacy-Compounded Hormones (Bioidentical Hormones). Last Updated: 08 September 2022 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 23 January 2023
Topic Last Updated: 23 January 2023 – Topic Last Reviewed: 23 January 2023

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