Medically Reviewed by Dr. Tashiya Mirando, MD, Written by Grace Oh, Licensed Menopause Champion and Integrative Nutrition Health Coach
Hormones play a vital role in regulating many of our body’s functions, from metabolism to mood. But when hormone levels fluctuate—particularly during life stages like menopause—many people turn to menopause hormone therapy to alleviate symptoms. One term you may have encountered in this context is bioidentical hormones. What exactly are they, and how do they differ from traditional hormone replacement therapies? Let’s break down the science and address some common misconceptions.
What Are Bioidentical Hormones?
Bioidentical hormones are compounds designed to mimic the molecular structure of the hormones naturally produced by the human body. These include hormones like estrogen, progesterone, and testosterone. The term “bioidentical” refers to their chemical similarity to the hormones our bodies create.
However, in practice, the term is often used to describe hormones prepared by compounding pharmacies. These pharmacies customise hormone formulations based on individual needs, often marketing them as a “natural” or “safer” alternative to traditional menopause hormone therapy.
It’s worth noting that some traditional hormone therapies already use bioidentical hormones. For example, estradiol 17-beta (a form of estrogen) and micronized progesterone (a form of progesterone) are bioidentical hormones that are FDA-approved and widely used in conventional menopause hormone therapy.
Are Bioidentical Hormones Safer?
One of the most common claims about bioidentical hormones is that they are safer than traditional hormone therapies. However, this claim isn’t supported by scientific evidence. Research shows that bioidentical hormones carry similar risks and benefits as their pharmaceutical counterparts. In fact, they may even pose additional risks.
Here’s why:
- Lack of Regulation: Unlike FDA-approved hormone therapies, compounded bioidentical hormones are not subject to rigorous government oversight. This means their dosage, purity, and safety are not guaranteed.
- Unreliable Testing: Some providers use salivary or urine tests to measure hormone levels and customise treatments. However, these tests are widely regarded as unreliable for determining appropriate hormone dosages and are actively discouraged by medical professionals. Blood tests (serum hormone testing) are more accurate but are rarely necessary for most menopause hormone therapy decisions.
Major medical organizations, including the Australasian Menopause Society and the British Menopause Society, caution against the use of unregulated bioidentical hormones. They emphasise that the risks associated with these products—such as incorrect dosing or contamination—outweigh any perceived benefits.
The Risks of Unregulated Menopause Hormone Therapy
While bioidentical hormones may sound appealing, especially when marketed as “natural,” it’s important to understand the potential risks:
- Inconsistent Dosages: Compounded hormones may not deliver the precise dose needed, leading to ineffective treatment or unintended side effects.
- Purity Concerns: Without regulatory oversight, there’s no guarantee that these products are free from contaminants.
- Lack of Safety Data: Unlike FDA-approved hormone therapies, compounded bioidentical hormones haven’t undergone rigorous clinical trials to confirm their safety and efficacy.
When considering menopause hormone therapy, prioritising regulated, evidence-based treatments is essential to ensure both safety and effectiveness.
What Do Experts Recommend?
Leading menopause and menopause hormone therapy organizations advise against using unlicensed bioidentical hormones. Instead, they recommend FDA-approved hormone therapies, which have been thoroughly tested and monitored for safety. These products often include bioidentical hormones like estradiol and micronized progesterone, but they come with the assurance of quality and consistency.
If you’re considering MHT, it’s essential to consult a healthcare provider who specializes in this area. They can help you weigh the benefits and risks based on your individual health profile and guide you toward evidence-based treatments.
Key Takeaways
- Bioidentical hormones are designed to mimic the hormones your body naturally produces.
- Some traditional hormone therapies already use bioidentical hormones, such as estradiol and micronized progesterone.
- Compounded bioidentical hormones are not regulated and may pose additional risks due to inconsistent dosages and lack of safety testing.
- Major medical organisations recommend using FDA-approved hormone therapies over unregulated bioidentical products.
Final Thoughts
Bioidentical menopause hormone therapy can sound appealing, but it is crucial to separate marketing claims from scientific evidence. While these hormones are formulated to match those naturally produced by our bodies, they come with the same basic benefits and risks as conventional hormone therapies. Moreover, compounded bioidentical hormones may be riskier if they are not subject to regulatory oversight.
If you are considering MHT, speak with a licensed medical professional who can offer guidance tailored to your individual needs. By understanding the distinctions between regulated and unregulated products—and recognising the challenges of salivary or urinary testing—you can make an informed decision that best supports your health.
References
1. Grainger, S. (n.d.-a). Bioidentical Hormone Therapy – Australasian Menopause Society. https://www.menopause.org.au/health-info/fact-sheets/bioidentical-hormone-therapy
2. North American Menopause Society, Menopause Practice, Clinician’s Guide, 6th edition. https://menopause.org/professional-resources/menopause-practice-textbook
3. British Menopause Society. (2023a). BMS Consensus Statement. https://thebms.org.uk/wp-content/uploads/2024/04/01-BMS-ConsensusStatement-Bioidentical-HRT-MARCH2024-A.pdf
4. The Menopause Society. (2024b, November 15). Menopause Topics: Hormone therapy | The Menopause Society. https://menopause.org/patient-education/menopause-topics/hormone-therapy