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Compounded bioidentical hormones: Help or hype?

A middle-aged woman smiles at the camera.

Though they're often marketed as a safer alternative to standard hormone therapy, they may have extra risks.

More and more women who want relief from menopausal symptoms are turning to compounded hormones, custom mixed by pharmacists. In fact, by some estimates, up to 68% of women using hormones at menopause now take compounded hormones rather than standardized hormones sold by a drug company.

One reason may come down to marketing. Compounded hormones are often promoted as "bioidentical" or "natural." But it's important not to confuse the terms:

  • "Bioidentical" means they are structurally the same as or chemically similar to the hormones in women's bodies. These "natural" hormones come from plant sources, unlike the synthetic hormones in traditional hormone therapy.
  • "Compounded" means the drugs are custom mixed by a pharmacist following a doctor's prescription. This may be done when a woman has an allergy to an ingredient, like peanut oil, in some commercially prepared products. Or it may be done to achieve a lower dose or a certain mix of bioidentical hormones.

Bioidenticals have increased in popularity ever since a large study found that women taking estrogen plus progesterone had a slightly increased risk of breast cancer, heart disease and strokes.

And they're heavily promoted as safer—and even more effective—than standard therapy. But is this true?

There's no scientific proof to support these claims, according to the American College of Obstetricians and Gynecologists and other major medical groups. What's more, compounded bioidentical hormones may actually have extra risks because of how they're made and regulated.

Here's the bottom line about each treatment:

What to know about standard hormone therapy

Standard hormone therapy is well-tested, and it's largely considered safe for women under 60 and within 10 years of menopause. It is approved and regulated by the U.S. Food and Drug Administration (FDA). Products are standardized so ingredients and doses are always the same.

What to know about compounded hormone therapy

Because these products are individually mixed, their content and purity can vary among pharmacies or even batch by batch. The individual hormones used in these products may be FDA-approved. But FDA does not test or approve the final preparation. So there's no guarantee that it will be effective or safe. They may also be more expensive, and insurance plans may not cover the cost.

The take-home if you're considering compounded bioidentical hormones to ease menopause symptoms: Be aware of the hype surrounding them. And have a thorough conversation with your doctor about their risks and benefits.

Additional sources: Hormone Health Network; North American Menopause Society

Reviewed 9/16/2022

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