A Word About “Bioidentical Hormones

Bioidentical hormones are sometimes called “natural” hormones—even though they are synthesized in a laboratory— because they are identical to the hormones that women make in their bodies. (Conventional hormone therapy uses estrogens or progestins that differ slightly from the hormones made in the body. Likewise, hormones purified from natural sources are not necessarily bioidentical.)

There are two types of bioidentical hormone products:

Pharmaceutical products. These are compounds that have been approved by the U.S. Food and Drug Admini- stration (FDA). Their quality and safety is regulated so it is the same product every time. These products (particularly estradiol) are available as pills, patches, gels, and vaginal inserts.

Custom-made products. When many people think of bioidentical hormones, they think of custom- made products. These are made in a compounding pharmacy (a pharmacy that mixes medications according to a doctor’s specifications). Often these contain varying amounts of two or three types of estrogen. Although some ingredients are approved by the FDA, the compounds (the final product that is created after all the individual ingredients are combined) are not. And because these compounds are not regulated by the FDA, they can be of low quality and the dosage can change with each batch.

Both types can be taken by mouth (pills), through the vagina (creams, rings) or through the skin (patch, gel, injection). Because the quality of custom- made products can vary, it is probably safer to use pharmaceutical products. This way you’ll know exactly what you’re getting and how much.

How do you know what is the best bioidentical hormone for you?

Are bioidentical hormones safer to use than other forms of hormone therapy?

To date there is no scientific proof to show that bioidentical hormones, whether prepared by a compounding pharmacy or pharmaceutical company, are safer to use than other forms of hormone replacement. All forms of HT may have potential risks, whether compound- ed or pharmaceutical, bioidentical or not.

The lack of FDA oversight of compounded hormones means that the dose you get may not be the same from refill to refill. For consistent safety and dose, it is best to take FDA-approved hormone preparations, whether they are bioidentical or synthetic.