When women hear the term bioidentical hormone therapy (bHRT), it’s often assumed to mean compounded hormones or “natural plant hormones.” In reality, the safest, most effective, and most clinically studied forms of bHRT are regulated prescription products, not custom compounds or over-the-counter supplements.
Understanding the difference matters for both symptom relief and long-term safety.
What Does “Bioidentical” Actually Mean?
Bioidentical hormones are chemically identical to the hormones your body produces, primarily:
- Estradiol (E2)
- Progesterone
“Bioidentical” refers to molecular structure, not source. Whether a hormone originates from plants or a lab is irrelevant once it has been chemically modified. What matters is:
- Accuracy of dosing
- Absorption and metabolism
- Safety data
- Regulatory oversight
Evidence-Based bHRT Options (Preferred)
1. Micronized Progesterone (Prometrium® or generic)
What it is
- Oral micronized progesterone
- Identical to ovarian progesterone
Why it’s preferred
- Improves sleep quality and sleep onset
- Supports mood and anxiety regulation
- Converts to calming neurosteroids (e.g., allopregnanolone)
- Protects the uterine lining when estrogen is used
- Has a more favorable breast safety profile than synthetic progestogens
Why Prometrium is better than compounded progesterone creams
- Standardized dosing
- Predictable absorption
- Pharmaceutical-grade purity
- Extensively studied in large populations
2. Transdermal Estradiol Patches (Estradot®, Climara®, etc.)
What it is
- Bioidentical estradiol delivered through the skin
Why it’s preferred
- Avoids first-pass liver metabolism which is more protective for preventing blood clots
- Lower impact on clotting factors and triglycerides
- Stable blood levels
- Reduced risk of venous thromboembolism compared to oral estrogen
Ideal for
- Hot flashes
- Night sweats
- Mood instability
- Migraine-prone women
- Perimenopause and menopause
Why patches beat compounded estrogen creams
- Accurate, consistent dosing
- No batch-to-batch variability
- Proven safety and efficacy data
3. Transdermal Estradiol Gel (EstroGel®)
What it is
- Bioidentical estradiol in gel form applied to the skin
Why it’s preferred
- Flexible dosing
- Rapid absorption
- Bypasses the liver
- Useful for women sensitive to patches or adhesives
Advantages over compounded gels
- Known absorption rates
- Regulated manufacturing
- Consistent estradiol delivery
4. Vaginal Estrogen (Vagifem®, Estragyn®, Estring®)
What it is
- Low-dose bioidentical estrogen applied locally
Why it’s preferred
- Effectively treats vaginal dryness, pain with intercourse, recurrent UTIs
- Minimal systemic absorption
- Does not significantly increase systemic estrogen levels
- Safe for long-term use in most women
Why it’s superior to compounded vaginal hormones
- Ultra-low dosing precision
- Proven safety data
- Reduced risk of over- or under-treatment
Why Regulated bHRT Is Safer Than Compounded Hormones
Compounded hormones are often marketed as “custom,” “natural,” or “safer,” but this is misleading.
Concerns with compounded bHRT
- No requirement for large-scale safety trials
- Variable dosing and absorption
- Batch-to-batch inconsistency
- Limited quality control
- Hormone levels may be unpredictable or supraphysiologic
Major medical societies, including endocrine and menopause organizations, consistently recommend FDA/Health-Canada-approved bioidentical hormones over compounded products unless there is a true medical necessity.
The Problem With “Natural” or “Plant Hormones”
Wild Yam and “Progesterone Creams”
Wild yam is frequently marketed as a natural source of progesterone. This is biochemically incorrect.
Important facts
- Wild yam contains diosgenin
- The human body cannot convert diosgenin into progesterone
- Conversion requires laboratory chemical processes
- Over-the-counter wild yam products do not raise progesterone levels
- There is no reliable clinical evidence showing hormonal effects in humans
Any perceived benefit is likely due to placebo, non-hormonal effects, or coincidental symptom changes.
Why This Matters
Relying on products that do not measurably change hormone levels can:
- Delay effective treatment
- Worsen sleep and mood symptoms
- Leave the uterine lining unprotected if estrogen is used and can lead to endometrial hyperplasia
- Create a false sense of hormonal support
The Takeaway
Not all bHRT is created equal.
Evidence-based, regulated bioidentical hormones like Prometrium, Estradot, EstroGel, and Vagifem offer:
- Proven symptom relief
- Predictable dosing
- Better safety data
- Lower risk profiles compared to oral synthetic hormones and compounded products
Women deserve clear, honest information so they can make informed decisions, not marketing-driven ones.
Educational Disclaimer
This information is for educational purposes only and is not intended to diagnose, treat, or replace individualized medical advice. Hormone therapy should always be discussed with a qualified healthcare provider.
Looking for bHRT Support?
I work with women throughout all hormonal phases of life, including the transition through menopause and beyond. If you would like support in bio-identical hormone replacement therapy for perimenopause or post menopause I would be happy to help.
