Bioidentical or body-identical hormones are estradiol and progesterone that are molecularly identical to human hormones. Most (not all) modern menopause hormone therapy is bioidentical. Keep reading for a list of brands.
The difference between “bioidentical” and “body-identical” is that body-identical is the preferred conventional term and bioidentical the term traditionally applied to customised hormone formulas dispensed by a compounding chemist, back in the day when compounding was the only way to obtain hormones identical to the body’s own hormones.
Today, bioidentical products are available from any doctor and pharmacy and are widely
regarded as safer than non-bioidentical hormone therapy.
Bioidentical is safer than other kinds of hormone therapy
Bioidentical hormones have fewer side effects than contraceptive drugs or older types of hormone therapy such as conjugated horse estrogens (Premarin®), which were popular in the 1990s.
Did you know? Premarin is an old-style estrogen drug that contains about 30 different hormones, including androgens, many of which are not body identical. The two main active ingredients are estrone sulfate and equilin sulfate, the second found only in horses. Together, the whole compound is referred to as conjugated equine estrogens and is extracted from pregnant mares’ urine.
Modern estrogen therapy is usually bioidentical estradiol and transdermal (absorbed through the
skin) which allows it to directly enter the bloodstream and not form dangerous blood-clotting factors in the liver. The safest type of estrogen is, therefore, an estradiol patch (Estradot® or
Climara®), gel (Sandrena® or Estrogel®), or vaginal estrogen.
Bioidentical progesterone does not have the mood side effects or breast cancer risk of progestins. In fact, according to Professor Prior, progesterone may even help to reduce the risk of breast cancer. Oral micronized progesterone is also safe for heart disease because it does not carry a clotting risk. Bioidentical progesterone is available as oral micronized progesterone capsules (brands Prometrium® and Utrogestan®). All other brands of “progesterone” are actually progestins (not progesterone), and that includes the tablets Primolut® and Provera, and the patch Estalis®.
Which hormone therapy products are bioidentical?
List of bioidentical versus non-bioidentical hormone therapy
|Angeliq||Bioidentical estradiol + progestin drospirenone|
|Kliovance or Kliogest||Bioidentical estradiol + progestin norethisterone|
|Femoston||Bioidentical estradiol + progestin dydrogesterone|
|Estalis||Bioidentical estradiol + progestin norethisterone|
|Climara Pro patch||Bioidentical estradiol + progestin levonorgestrel|
|Evorel Conti patch||Bioidentical estradiol + progestin norethisterone|
|Livial or Xyvion||Tibolone|
|Provera||Progestin medroxyprogesterone acetate|
|Mirena IUD||Progestin levonorgestrel|
|Estrofem tablet||Bioidentical estradiol|
|Progynova tablet||Estradiol valerate that converts to bioidentical estradiol|
|Trisequens tablet||Bioidentical estradiol + progestin norethisterone|
|Climara patch||Bioidentical estradiol|
|Estradot patch||Bioidentical estradiol|
|Estraderm patch||Bioidentical estradiol|
|Vivelle patch||Bioidentical estradiol|
|Estrogel gel||Bioidentical estradiol|
|Sandrena gel||Bioidentical estradiol|
|Lenzetto spray||Bioidentical estradiol|
|Prometrium capsule||Bioidentical progesterone|
|Utrogestan capsule||Bioidentical progesterone|
|Famenita capsule||Bioidentical progesterone|
|Teva capsule||Bioidentical progesterone|
|Endometrin||Bioidentical progesterone (vaginal)|
|Crinone||Bioidentical progesterone (vaginal)|
|Bijuva capsule||Bioidentical estradiol (oral) + bioidentical progesterone|
Estrogen versus progesterone therapy for menopause and perimenopause
Transdermal bioidentical estradiol can be helpful the hot flushes and mood disturbance of menopause. It’s safest when combined with bioidentical progesterone.
Under current guidelines, the only officially recognised use of oral micronised progesterone is as the progesterone part of hormone therapy – in other words, estrogen plus progesterone, and, even then, only if you have a uterus. As I discuss in Hormone Repair Manual, progesterone can also be used on its own (without estrogen) for perimenopausal symptoms such as night sweats, heart palpitations, sleep issues, migraines, mood problems, heavy periods. Even without a uterus, progesterone is beneficial for mood and breasts.
👉🏽 Tip: Perimenopause or “second puberty” are the two to ten years before periods actually stop. Symptoms include heavy periods, insomnia, anxiety, and night sweats, and are the result of losing progesterone, not estrogen.
Progesterone-alone has a few advantages over estrogen:
- It’s better for sleep and migraines.
- It’s safer for breasts.
- It’s easier to stop because it’s not addictive like estrogen.
👉 Tip: There’s no progesterone in any type of hormonal birth control.
Progesterone can also make periods lighter and is a good alternative to progestin drugs such as the pill and the hormonal IUD. Read For healthcare providers: managing menorrhagia without surgery.
For more information about the benefits of progesterone, read:
And the following articles by endocrinology professor Jerilynn Prior: