You may have heard about bioidentical and body identical hormones for treating your menopause symptoms and feel confused about the differences between them. While these two terms sound similar, they include a range of products which vary in terms of safety and effectiveness. Read on to make the best choice for you based on the evidence and research.
Find what you need quickly
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What is hormone replacement therapy (HRT?)
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What is body identical HRT?
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What are the brands of body identical HRT?
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Is body identical HRT available on the NHS?
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Compounded bioidentical HRT
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What are the risks of compounded bioidentical HRT?
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How do you know if the provider of your HRT is reputable?
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Final word
Start your free online menopause assessment to see if HRT is right for you
What is hormone replacement therapy (HRT)?
HRT is an effective treatment for menopause symptoms including hot flushes, mood changes and sleep problems. However, there is still a lot of confusion and misunderstanding surrounding this treatment. Read more about the HRT debate.
As the symptoms of menopause happen due to decreasing hormone levels, HRT works by replacing oestrogen and progesterone. The debate around body identical and bioidentical hormones happens because of one question, which is the best way to replace these hormones?
What is body identical HRT?
Body identical hormone replacement therapy (body identical HRT) is the recommended treatment for menopause in the UK. In fact, a large proportion of the products already on the market for HRT are already body identical and use a type of oestrogen called estradiol. This is mainly derived from plant sources, including yams.
These products use hormones which are identical to those produced by the body. Using these identical hormones is a logical approach to menopause treatment. Emerging evidence also suggests that some forms of body identical HRT, most notably micronised progesterone, are lower-risk than man-made or synthetic versions.
While they are generally known as body identical HRT, you may also see this kind of HRT referred to as regulated bioidentical HRT (rBHRT), reflecting the fact that they are subject to tight safety and quality control procedures. Yes, it sure is confusing!
For the sake of simplicity, we will call this type of HRT ‘body identical’ throughout this article.
Body identical HRT may help with:
- Sweating and hot flushes
- Itchiness
- Aches and pains
- Restless legs
- Heart palpitations
- Fatigue and poor sleep
- Read more about menopause symptoms in our symptoms library.
What are the brands of body identical HRT?
Body identical oestrogen products currently on the market include:
- Evorel
- Sandrena gel
- Oestrogel
- Estradot patches
- Elleste Solo patches
If you also take progesterone, the only currently regulated and prescribed bioidentical form is called ‘micronised progesterone’, which is available on its own in a product called Utrogestan, or in combination with oestrogen in a tablet called Bijuve.
Other forms of micronised progesterone are available, although they are not currently licensed for use in menopause. However, a doctor with appropriate expertise may recommend one of these in certain circumstances.
Find out more about the different types of HRT.
Is body identical HRT available on the NHS?
Yes, body identical HRT is available on the NHS. However, it cannot be guaranteed that this will be the first type of HRT that will be offered to you. You need to ask for it specifically to ensure that you get it.
In contrast, bioidentical HRT, read on to learn more, is not available on the NHS as it is not regulated.
Quality control for HRT
The important thing to understand is that prescribed forms of HRT – whether they are body identical or not – are subject to quality control tests and are regulated. This means we know where it is produced and exactly what it contains. These products have also been monitored and tested over decades and hundreds of thousands of users have been reviewed. This means that we have a good idea of the risks, benefits and safety profiles of each treatment.
In summary
Body identical hormones are natural, tested and regulated. Your doctor can prescribe you many types of body identical HRT and adapt your dose to help you manage changing symptoms.
Compounded bioidentical HRT
So if body identical HRT is prescribed routinely by doctors, what is compounded bioidentical hormone replacement therapy (cBHRT), also known as bioidentical HRT?
You may have seen compounded bioidentical HRT advertised by clinics and providers who are unregulated or who may not have appropriate training, according to the British Menopause Society (BMS).
These providers test blood or saliva samples with the aim of determining your exact hormone requirements. As there are actually several different types of oestrogen in the body, the idea is to replace these in the most effective ratio possible. The providers then create a bespoke mixture of hormones for the patient on the basis of the test results. These are often given as either lozenges or a cream. This may sound good, but let’s find out why it’s not that simple…
Start your free online menopause assessment to see if HRT is right for you
What are the risks of compounded bioidentical HRT?
The NHS and the British Menopause Society do not recommend compounded bioidentical hormones as it is not clear how safe or effective they are. Here are some of the key reasons why.
Unproven tests
These tests have never been proven through medical research, and are deemed ‘costly’ and ‘unnecessary’ by the BMS. Basing your treatment on one saliva or blood test gives only a brief snapshot of what is happening in your body. Your hormones are fluctuating all the time and the risk is you may be prescribed too much or not enough, which could have consequences for your long-term health.
Unregulated hormones
More worryingly, compounded bioidentical hormones are not regulated and you cannot be sure what they contain. The dose and ingredients could be different from what you are told and there could even be contaminants. Unreliable dosages are particularly risky. Higher levels of oestrogen and progesterone could potentially lead to an increase in the serious risks associated with HRT. Doses lower than stated can potentially lead to poorly treated symptoms and even a risk of endometrial cancer if the dose of progesterone is too low to protect the lining of the womb.
How it’s administered
Another issue is with the route of administration. Many compounded bioidentical HRT products include progesterone which is given transdermally as a cream or gel. This is considered an unreliable way to provide progesterone, which is vitally important in HRT to protect the lining of the womb from abnormal thickening and cancer.
In summary
It’s easy to understand why people feel drawn to these treatments which promise so much – but it is much safer to talk to your own doctor for help with your menopause symptoms. They will take into account many different elements of your medical history before recommending an appropriate way forward. Compounded bioidentical hormone replacement therapy is not recommended as these products are not regulated, there is no evidence they work and it’s unclear if they are safe. Instead, regulated body identical hormones are recommended, which are available from your own doctor on prescription.
How do you know if the provider of your HRT is reputable?
It can sometimes be very tricky to work out who exactly is providing the advice, especially when websites and marketing information look slick and professional. The best place to start is by having a conversation with a doctor registered with the General Medical Council (GMC). The GMC is the regulatory body for doctors in the UK and registration is mandatory. You can search for doctors on the GMC medical register. Your own doctor is a great place to start as they will be able to check your medical records (including your past medical history and family history among others) and advise on the safest form of HRT for you.
Final word
Personalised care is important! It is vital to seek out the best treatment for you, whether that is medication or lifestyle changes. Being informed about your choices is a great first step, and you will find lots of information on the Stella website to get started.
Body identical HRT is the most effective treatment available for menopause symptoms. It is also the most studied treatment available for menopause, meaning that we have lots of information about its effects and safety. When HRT is produced by regulated pharmaceutical companies, there are strict quality control processes in place to guarantee the strength, purity and safety of the product supplied.
Unregulated compounded bioidentical HRT is not currently recommended due to concerns about the safety of the medications provided, the testing processes used to recommend doses and the way in which these hormones are administered.
Only regulated forms of HRT are prescribed on the NHS. Your doctor will be able to recommend the best treatment for you.
Read more about menopause on our blog or in our symptoms library.
- British Journal of General Practice, The dangers of compounded bioidentical HRT
- British Medical Society, Statement on bioidentical HRT (article)
- Hillard, T. et al (2017). Management of the Menopause. ed. London: British Menopause Society, pp. 67, 82-99
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