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 very similar, they include a range of products which vary widely in terms of safety and effectiveness.
Dr Lucy Wilkinson explains more so you can make the best choice for you based on the evidence and research.
Hormone replacement therapy (HRT) and body identical hormones
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 HRT risks and benefits.
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?
A logical approach is to use HRT products which are identical to the body’s own hormones. The good news is that these are available as regulated and prescribed products, many of which are routinely recommended by doctors for HRT.
These are generally known as body identical HRT, although you may also see them called regulated bioidentical HRT (rBHRT). Yep, it sure is confusing! For the sake of simplicity, we will call these ‘body identical’ in this article.
Body identical HRT may help with:
The majority of oestrogens doctors prescribe for HRT are in fact body identical, using a form of oestrogen called estradiol which is extracted from natural sources (often yams).
If you also take progesterone, the only currently regulated and prescribed bioidentical form is called Utrogestan, also known as ‘micronised progesterone’.
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 hormone replacement therapy
So if body identical HRT (also known as regulated bioidentical 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…
What are the risks of compounded bioidentical HRT?
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.
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 (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 I know if the provider of my 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 here. 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.
HRT prescribed by doctors 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 which guarantee the strength, purity and safety of the product supplied.
Unregulated compounded bioidentical HRT is not recommended. This is because there is not enough evidence to prove that this is either safe or effective.
Only regulated forms of HRT are prescribed on the NHS. Your doctor will be able to recommend the best treatment for you.