Are bioidentical or natural hormones safer and more effective than hormones used in traditional hormone therapy for menopause symptoms?
Answer From Tatnai Burnett, M.D.
No, they aren't. The hormones marketed as "bioidentical" and "natural" aren't safer than hormones used in traditional hormone therapy. And there's no proof that they work any better at easing menopause symptoms, including hot flashes and vaginal dryness. What's more, some bioidentical hormone medicines are custom mixed, and they can vary greatly in quality.
The term "bioidentical" means the hormones in the medicine are chemically the same as those the body makes. In fact, the hormones in bioidentical medicines may not be any different from those in traditional hormone therapy. In the United States, many hormone therapy medicines approved by the Food and Drug Administration (FDA) and prescribed by healthcare professionals have bioidentical hormones in them.
The term "natural" means the hormones in the medicine come from plant sources. They're not created in a lab right from the beginning. But many of these substances still need to be processed by a commercial lab to become bioidentical.
Traditional hormone treatments also sometimes use natural hormones. For example, some FDA-approved medicines come from plants. These medicines include some brands of estradiol (Estrace, Alora, others). Estradiol has the hormone estrogen. These medicines also include a form of the hormone progesterone sold under the name Prometrium.
Some bioidentical hormones are made in pharmacies that custom mix medicines. These are called compounding pharmacies. Compounding pharmacies aim to tailor medicines to a customer's needs.
Marketers of compounded bioidentical hormones claim their products have some advantages over traditional hormone therapy:
- They're made in doses and forms that differ from those in FDA-approved medicines. For many medicines that come in mixes that aren't standard, you need to go through a compounding pharmacy. But medicines from compounding pharmacies aren't subject to the same thorough quality standards that typical commercial hormone treatments have to meet. So the dose and purity of a compounded bioidentical hormone medicine may vary from batch to batch.
- They're custom-made for you, based on a test of your saliva to assess your unique hormonal needs. But the hormone levels in saliva don't reflect the levels in blood or correspond to menopause symptoms.
Overall, research has not shown that compounded bioidentical hormones offer benefits over common commercially made medicines. Ask your healthcare professional to talk with you about all the risks of a compounded version before you try one.
With
Tatnai Burnett, M.D.
Show References
- Menopause: Medicines to help you. U.S. Food and Drug Administration. https://www.fda.gov/consumers/free-publications-women/menopause-medicines-help-you. Accessed June 19, 2024.
- Martin KA, et al. Treatment of menopausal symptoms with hormone therapy. https://www.uptodate.com/contents/search. Accessed June 19, 2024.
- Compounded bioidentical hormone therapy. Endocrine Society. https://www.endocrine.org/advocacy/position-statements/compounded-bioidentical-hormone-therapy. Accessed June 19, 2024.
- Menopausal symptoms: In depth. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth. Accessed June 19, 2024.
- American College of Obstetricians and Gynecologists. Clinical Consensus No. 6: Compounded bioidentical menopausal hormone therapy. Obstetrics & Gynecology. 2023; doi:10.1097/AOG.0000000000005395.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 141: Management of menopausal symptoms. Obstetrics & Gynecology. 2014; doi:10.1097/01.AOG.0000441353.20693.78. Reaffirmed 2024.
- AskMayoExpert. Bioidentical hormones. Mayo Clinic; 2023.
- Burnett TL (expert opinion). Mayo Clinic. July 2, 2024.
Original article: https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/bioidentical-hormones/faq-20058460