What is bioidentical HRT?
Two different things share the name. Body identical HRT is licensed and you can get it from your GP. Compounded bioidentical hormones haven’t been tested in proper trials. One question tells them apart.
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What is bioidentical HRT?
Bioidentical hormones are exact copies of the ones your body makes. But the British Menopause Society (BMS), the UK’s menopause experts, says the word is often used as a marketing term by clinics.
So experts split it in two. Hormones made by drug companies and approved by the UK medicines regulator (MHRA) are called body identical. Hormones mixed by specialist pharmacies are called compounded.
| Body identical (regulated) | Compounded bioidentical | |
|---|---|---|
| Made by | Drug companies, approved by the MHRA | Specialist pharmacies, outside the usual MHRA checks |
| Comes as | Gel, spray, patches, tablets or capsules | Creams, lozenges or vaginal products |
| Tested in trials | Yes, through the full medicine approval process | Not tested against a dummy treatment or standard HRT |
| What UK guidance says | BMS: prescribe regulated products wherever possible | NICE: safety and benefit unknown. BMS: not recommended. |
Sources: BMS; NICE NG23; NHS Tayside
That one question is: is this a licensed medicine?
The BMS says regulated products should be prescribed wherever possible. So ask the clinic or a pharmacist before you pay.
Which HRT is body identical?
Body identical HRT is ordinary licensed HRT, not a special type. Your GP can prescribe it.
| Hormone | Body identical? | Comes as |
|---|---|---|
| Estradiol (a form of oestrogen) | Yes | Gel, spray, patches or tablets |
| Micronised progesterone, such as Utrogestan | Yes | Capsules you swallow |
| Estradiol with progesterone, such as Bijuve | Yes | One capsule with both hormones |
| Progestogens, such as norethisterone | No, man-made versions | Tablets, patches or the hormonal coil |
| Conjugated oestrogen, such as Premarin | No, it comes from horses | Tablets |
Sources: NHS Tayside; NHS: Utrogestan; Women’s Health Concern; NHS: treatment
Still have your womb? You need progesterone or a progestogen with your oestrogen. Oestrogen alone can thicken the womb lining, which slightly raises the risk of womb cancer.
Testosterone isn’t licensed for menopause, but a specialist can prescribe it, usually for low sex drive after menopause when HRT alone hasn’t helped. See testosterone for women.
Is compounded bioidentical HRT safe?
Nobody knows. NICE says the efficacy and safety of unregulated hormone products are unknown. Efficacy means how well they work.
If you still have your womb, the biggest worry is its lining. Progesterone in a cream or gel is absorbed unevenly. So it may not protect your womb lining, and over time that may raise the risk of womb cancer.
Clinics often sell saliva or repeat blood tests to tailor a dose. The BMS says this testing isn’t backed by research or guidance. For the tests that do help, see HRT blood tests.
In 2017 the advertising watchdog (ASA) ruled that clinics shouldn’t claim compounded hormones are safer or work better than licensed HRT.
Before you pay for bioidentical hormones
- Ask the clinic or a pharmacist if it is a licensed medicine.
- Still have your womb? Check how your progesterone protects it. A cream may not.
- Don’t pay for saliva tests to tailor a dose. Guidance doesn’t recommend them.
- Already using a compounded product? Ask your GP about licensed options.
Is body identical HRT safer than other HRT?
It may be, but it isn’t proven. The BMS compares micronised progesterone with some man-made progestogens. It says it may carry a lower clot risk when taken with oestrogen tablets, and a lower short-term breast cancer risk.
But it says those differences need confirming in bigger studies. NICE says there’s not enough evidence to tell if the breast cancer risk differs.
How you take oestrogen matters for clots. The NHS says patches, sprays and gels don’t raise the risk of blood clots. Tablets can, but the risk is still very low.
Higher clot risk, or a BMI over 30? NICE says to consider HRT through the skin. Ask your GP if a patch, gel or spray suits you.
More on HRT risks and side effects.
How do I get body identical HRT on the NHS?
Getting body identical HRT from your GP
- 1
Talk to your GP
NICE says offer HRT for hot flushes and night sweats.
- 2
Pick your oestrogen
Estradiol as a gel, spray, patch or tablet.
- 3
Protect your womb
Add progesterone or a progestogen if you still have a womb.
- 4
Review at 3 months
NICE says check how it's working after 3 months.
Sources: NICE NG23; NHS: types of HRT; NHS: Utrogestan
Want micronised progesterone? Ask your GP about it by name. It’s a licensed medicine, available on prescription.
Side effects? The NHS suggests carrying on for at least 3 months if you can. Never stop or change a prescribed medicine without your prescriber.
Can’t take HRT, or don’t want to? See natural alternatives to HRT.
When to speak to a GP
Book an appointment if:
- You’re thinking about HRT, or you’re on it and worried about the risks.
- You have any bleeding from your vagina after menopause, even a small amount or only once.
- You still have irregular bleeding more than 6 months after starting HRT.
- Your side effects are severe or last longer than 3 months.
Using a compounded product now? Take it with you, so your GP can talk through licensed options.