Understanding Bio-identical Hormones: Are They the Right Choice for You?

As more women seek treatment for menopause symptoms, the conversation around bio-identical hormones has become increasingly popular. You’ve likely heard the term, but what exactly are bio-identical hormones? Are they better or safer than traditional hormone therapy? And how do you know if they’re right for you?

Let's break down what bio-identical hormones are, explore the science behind their use, discuss the opinion of The Menopause Society (formerly NAMS) on this treatment option, and talk about my view on bio-identicals and what I do with patients in my practice.

What Are Bio-identical Hormones?

Bio-identical hormones are hormones that are chemically identical to those naturally produced by your body. This means that, at a molecular level, bioidentical hormones match the hormones your body makes, such as estrogen, progesterone, and testosterone.

The term “bioidentical” refers to the structure of the hormone, not its source. These hormones can be derived from plant sources, such as yams or soy, and are then processed in a lab to create hormones that your body recognizes and processes in the same way as the hormones you naturally produce.

The most common bioidentical hormones used in menopause treatments include:

Estrogen: The bioidentical form of estrogen is 17-beta estradiol.

Progesterone: The bioidentical form of progesterone is micronized progesterone, commonly known by the brand name Prometrium.

Testosterone

DHEA

Are Bio-identical Hormones Safer or Better Than Other Hormones?

Many women are drawn to bio-identical hormones because they believe they are “natural” and therefore safer. However, it’s important to understand that "bioidentical" doesn’t necessarily mean "safer" or "better” as there are different types of bioidenticals, some which are safer than others.

There are two main categories of bio-identical hormones:

1. FDA-approved bio-identical hormones: These are rigorously tested for safety and effectiveness and are available by prescription in standard doses and forms. Many of these medications are covered by insurance or drug plans.

2. Custom-compounded bio-identical hormones: These are made by compounding pharmacies and tailored to an individual’s specific needs. However, compounded hormones are not FDA-approved and are not held to the same standards for testing, quality, or safety as FDA-approved hormones.

In my practice, I prefer to start with FDA-approved bioidentical hormones as a first line of treatment because they closely replicate the body’s natural hormone patterns and have been thoroughly tested for safety and efficacy.

Bio-identical Hormone Formulations: What Are Your Options?

Bio-identical hormones are available in a variety of formulations. You can get them in different forms, depending on what works best for your lifestyle and symptoms:

Pills: Oral tablets are an easy option but may not be as effective for vaginal symptoms.

Patches: Transdermal patches deliver hormones through the skin and are often preferred for their lower risk of side effects, such as blood clots.

Gels or creams: These are applied directly to the skin and absorbed into the bloodstream. They offer flexibility but require consistent daily application.

Vaginal creams, rings, or tablets: These are used for treating vaginal symptoms like dryness or discomfort during sex. They deliver localized estrogen without affecting the rest of the body.

Injections or pellets: These are less common for bio-identical hormone therapy, and I do not use these methods in my practice. Pellets are inserted under the skin but are often discouraged due to the difficulty in adjusting doses if side effects occur.

To Compound or Not: Should You Choose Compounded Bio-identical Hormones?

The idea of having hormones customized for your body’s exact needs can be appealing. However, there are some key considerations to keep in mind when deciding between FDA-approved and custom-compounded bio-identical hormones.

FDA-Approved Bio-identical Hormones:

Rigorously tested for safety and efficacy.

Have standardized doses to ensure consistency in treatment.

Available in many forms (patches, gels, pills, etc.).

Covered by most drug plans.

Backed by scientific research and approved by regulatory agencies.

Custom-Compounded Bioidentical Hormones:

Made by compounding pharmacies and customized for each patient.

Not FDA-approved, meaning they do not undergo the same level of testing.

Lack quality control and standardization, which may result in inconsistent dosing.

Often marketed as “natural” or safer, but there is no strong evidence to support this.

In some cases, custom-compounded bio-identical hormones may be necessary—especially for women who need non-standard doses or have allergies to certain ingredients. In those instances, I work with a reputable compounding pharmacy to ensure the highest quality. However, I only recommend compounded hormones when specific needs cannot be met by FDA-approved options.

The Menopause Society’s Opinion on Bioidentical Hormones

The Menopause Society supports the use of FDA-approved bio-identical hormones as part of hormone therapy for menopausal women. These hormones are seen as safe and effective when used appropriately under the guidance of a healthcare provider.

However, The Menopause Society is cautious about the use of custom-compounded bio-identical hormones. Because these hormones are not FDA-approved and lack rigorous testing, there is concern about their safety, consistency, and effectiveness. The society recommends using FDA-approved bio-identical hormones over compounded versions whenever possible.

Are Bioidentical Hormones Right for You?

If you’re considering bio-identical hormone therapy, it’s important to have a detailed conversation with your healthcare provider. While bioidentical hormones can be an effective treatment for menopause symptoms like hot flashes, mood swings, and vaginal dryness, the key is to choose the safest, most effective option based on your individual needs.

For most women, FDA-approved bioidentical hormones are a great choice. They offer the benefits of being biologically identical to your body’s hormones, with the added assurance of safety and quality control. In some cases, custom-compounded hormones may be necessary, but this option should only be considered when standard therapies aren’t suitable.

Final Thoughts

Bio-identical hormones can play an important role in menopause hormone therapy, but it’s important to separate fact from fiction. While bioidentical hormones are a valuable option for many women, they are not inherently safer just because they are labeled “natural.” The best approach is to work closely with your healthcare provider to find the right treatment for you, whether that’s FDA-approved bioidentical hormones, synthetic hormones, or compounded hormones in specific situations. There are many women who prefer synthetic hormones and tolerate them better, and I’m open to using those as well—at the end of the day each woman is unique and so is the hormone therapy plan I put them on.

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