Bioidentical Hormone Replacement Therapy for Menopause

It is important to understand that you don't just wake up one day and find yourself in menopause. It is a process that typically occurs over many years. In fact, once you actually reach menopause (defined as one year of no periods) many of the unpleasant symptoms you may be feeling will likely go away.

The menopause transition can be a really confusing time for many women. Likely hormonal imbalances have left you feeling out of sorts. And juggling all of the responsibilities midlife brings your way doesn't give you much time to focus on yourself.

And if you do take the time to talk to your healthcare provider you may be frustrated by their lack of knowledge about treatment options for the management of the menopause and the menopause transition. Feeling awful and overwhelmed can make you vulnerable to misinformation and leave you confused about what you can do to feel better.

Perhaps one of the most confusing topics in the management of menopause and the menopause transition is the controversy surrounding the use of bioidentical hormone replacement therapy.

Two women talking on beach

Most Hormone Replacement Options Are Bioidentical

The symptoms of the menopause transition are caused by the relative age-related changes and overall decreasing amounts of your reproductive hormones, namely estrogen and progesterone. Taking replacement amounts of these hormones will improve your symptoms.

Believe it or not, most pharmacologic hormone replacement options, especially when it comes to the estrogen component, are now "bioidentical." That is, pharmaceutical companies have created synthetic versions of estrogen that are very similar to the estrogen produced by your ovaries. This wasn't always the case as there was a time when the only prescription estrogen replacement available was a conjugated estrogen made from the urine of pregnant mares.

As far as the progesterone component of hormone replacement is concerned there are many synthetic options known as progestins. These synthetic progestins act like the progesterone produced by your ovaries but are not identical. However, there is a bioidentical option to replace your natural progesterone. It is known as a micronized progesterone, and it is a synthetic copy of the same progesterone produced by your ovaries.

Compounded vs. Pharmacologic Hormone Preparations

Confused? Wondering why so many sources promoting bioidentical hormones seem to make them sound different than what you can get from your pharmacy?

The fact is that what they are calling "bioidentical" hormone replacement therapy is really compounded hormone replacement therapy. And since we know that most pharmacologic hormone replacement options are now bioidentical what we are really looking at is compounded hormone replacement versus pharmacologic hormone replacement.

Compounding refers to a specific method of preparing medication. Pharmacists typically can complete additional training to become skilled in pharmaceutical compounding. Compounding allows pharmacists to create specific and individualized formulations of a medication. And in the case of hormone replacement therapy, a compounding pharmacist can create unique hormone formulations.

This is in contrast to the pharmacologic hormone replacement therapy options available from the drug companies. These medications are mass-produced and come in standard and consistent doses.

Both compounded and pharmacologic hormone replacement therapy options require a prescription from your healthcare provider.

The Concern About Compounded Hormone Preparations

It is understandable why the idea of personalized hormone replacement therapy is so attractive. The thought of taking "just the hormones you need" seems to make sense. But the problem is that there isn't any good evidence to support testing and then treating hormone levels.

Most experts agree that this approach to hormone replacement therapy is not appropriate. Instead, most recommend using established doses to prevent disease like osteoporosis or using the lowest dose possible to relieve symptoms.

There is also a general concern about the overall consistency and safety of using compounded hormone replacement preparations. This could lead to you getting too much or too little of the hormones.

Some experts have also voiced concern about the cost of compounded hormone replacement. Many of these options are expensive and not covered by insurance. There is a concern that women may be paying a significant amount of money for something that does not have data to suggest that it is a better or safer option.

Why Your Healthcare Provider Might Not Prescribe Bioidentical Hormones

Again, remember most healthcare providers are prescribing bioidentical hormones as most synthetic hormone replacement options manufactured by drug companies are bioidentical.

Many healthcare providers will not give you a prescription for compounded hormone replacement. The biggest concern for clinicians is the lack of evidence to support the use of compounded hormone replacement. And this goes against their principle of practicing evidence-based medicine.

But, some clinicians will prescribe compounded hormone replacement. But it is important that you understand that there is no evidence to say that it is better or safer than the hormone replacement made by drug companies.

Who Should Consider Compounded Hormone Preparations

It is important to remember that the evidence does not support the concept that compounded hormone replacement is a safer option than pharmacologic hormone replacement therapy. That being said, there are certain women who could benefit from a more customized option.

Compounded hormone replacement may be a good option if you are sensitive to the typical fillers or additives found in the standard pharmacologic options. Or perhaps you are not able to find a standard dose that balances symptom relief and side effects well.

A Word From Verywell

The menopause and the menopause transition are a natural part of aging and don't necessarily require medication. Some women have very mild symptoms while other women have very significant symptoms that disrupt their daily life.

Using hormone replacement therapy to ease the symptoms associated with these changes may be essential to maintaining your quality of life. It is important that you discuss your symptoms with your healthcare provider.

You may need to seek the care of a practitioner who specializes in the management of menopause if you do not feel that your primary healthcare provider can give you adequate information or treatment options.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • American Congress of Obstetricians and Gynecologists (2012). Compounded bioidentical menopausal hormone therapy. Committee Opinion No. 532. Washington, D.C: American College Obstetricians and Gynecologists. 

By Andrea Chisholm, MD
Andrea Chisolm, MD, is a board-certified OB/GYN who has taught at both Tufts University School of Medicine and Harvard Medical School.