Bioidentical hormones are precise duplicates of hormones such as estradiol, progesterone and testosterone, in the same way that modern regulated body identical hormones, which I prescribe, are. Bioidentical is often used by clinics as a marketing term purporting the benefits of compounded bioidentical hormones, however, there are concerns about their purity, effectiveness and safety. Progesterone in particular, which is given predominantly to prevent thickening of the womb lining and endometrial cancer in response to oestrogen, when given through the skin, as a cream or gel, may not be absorbed which is of grave concern.
Prescribers of compounded bioidentical hormones are often healthcare professionals (HCPs) who are not experts in the field of menopause medicine and have not been certified by the British Menopause Society or any other postgraduate educational organisation as having appropriate training in this specialty. They tend to charge large sums and offer to personalise your therapy, however, due to the variable nature of our hormones and the fact that most cannot be measured in saliva this is not possible to do with any degree of accuracy and is usually unnecessary.
The management of women with menopause related problems should be underpinned by the principles and guidelines of the British Menopause Society and wherever possible, regulated products, that have been thoroughly tested, should be prescribed. The 2015 NICE NG23 menopause diagnosis and management guideline 1.4.15 stated ‘Explain to women that the efficacy and safety of unregulated compounded bioidentical hormones are unknown.’
Advertising Standards Association (ASA) The ASA ruled in 2017 against the ‘misleading’ promotion of cBHRT when a prescribing dermatherapy cosmetic clinic in Stratford upon Avon was reported. This test case led to a ruling being passed that these clinics and prescribers of cBHRT should not claim greater safety and efficacy as there was no evidence from clinical trials for these products. The ASA also advised that there was insufficient evidence that multiple serum and saliva tests could be used to precisely individualise therapy. The public should be cautious of marketing that can give rise to false securities and should avoid purchasing cBHRT products over the internet.