Is there a role for compounded bioidentical hormones in menopause treatment?

Bioidentical hormones are hormones that are identical to what is found naturally in the body, and compounded medications are those that are prepared in a pharmacy (as opposed to being commercially manufactured). Compounded bioidentical hormones are often marketed as being a “natural” HRT alternative, but many people don’t realize that some conventional, commercially-manufactured HRT medications also use bioidentical hormones.

Compounded bioidentical hormones can be advantageous for people requiring a unique formulation that is not commercially made, or who are allergic to an ingredient in a commercially-made product.^[1] However, there is little research on the effectiveness or safety of compounded bioidentical hormone therapies.^[2] There are also inherent risks with compounded medications due to variations in compounding methods, ingredients used, and quality control practices between pharmacies. This can increase the risk of bacterial contamination and lead to inconsistencies in drug potency and absorption. For example, one study comparing compounded bioidentical hormone medications prepared by 13 different pharmacies found that the products contained anywhere from 26% less to 31% more of the active ingredient than intended.^[3]

Compared to compounded bioidentical hormones, commercially-made bioidentical hormones should be preferentially used, as they have a substantial evidence base defining their safety and efficacy and are held to higher quality control measures during manufacturing.^[1]