Bioidentical hormone replacement therapy (HRT) is an approach, which provides the same hormones found in a human female.  Bioidentical HRT can be found in pharmaceutical products ( Vivelle, Climara, Alora, Estragel, Estrasorb, Divigel, Evamist, Estrace, Prometrium ) and in custom formulas made by a compounding pharmacist.

Bioidentical HRT can also be made by compounding pharmacists who mix up various oral and topical preparations in their stores using techniques they learned in pharmacy school. Having been a pharmacist before medical school I feel especially qualified to discuss this issue.  However, pharmaceutical companies must meet stricter standards for quality control and efficacy.  Therefore pharmaceutical bioidentical hormones should be the first therapy of choice over compounded ones. Compared to other progesterone preparations, topical compounded progesterone has the poorest absorption and should not be used. Progesterone reduces a woman’s risk of uterine cancer. Uterine cancer has been reported from inadequate dosing of topical progesterone in women receiving estrogen preparations.

Physicians need to measure estradiol blood levels to verify effectiveness of the products and to ensure adequacy of dosage. Transdermal hormone preparations is the medical term for products applied topically to the skin as patches, gels or creams.  Topical hormone products have fewer side effects than oral products because they do not cause the liver to produce harmful byproducts.


It’s important to emphasize that ALL published studies on bioidentical HRT utilized pharmaceutical and NOT compounded bioidentical HRT. An important 2008 observational study, published in the European Heart Journal showed that in 698,098 Danish women followed for five years, women on combined oral estrogen plus oral synthetic progestin had a 35% increased risk of heart attacks while women on topical pharmaceutical gel or patch estradiol, with or without progesterone, had a 38% decreased risk of heart attacks.  Women on oral estrogen alone had no increase or decrease risk showing NO benefit compared to women taking no HRT.

There is a French study in 3175 women using transdermal estradiol and oral progesterone for 8.9 years which found no increased incidence of breast cancer.  More such studies need to be done including studies of preparations made by compounded pharmacists. However, for the time being, it seems prudent to choose the natural hormones, estradiol and progesterone, over Prempro and Premarin


This is a confusing time for women in relation to hormone replacement therapy. On the one hand they have the option of taking hormones to relieve the symptoms of menopause but, on the other hand, they are faced with conflicting data on the safety of taking hormone replacement (HRT).  It is important to stand back, look at the real facts and use a little common sense. All of us know that the mass media often tends to sensationalize the news to grab your attention and make it more interesting. The decision to take HRT is too important to be made on the basis of a few sound bytes. Rather it requires careful discussion with your physician, who can inform you on the pros and cons of estrogen replacement in your particular circumstances.  Knowledge is power. Use it to arm yourself with the data you need to make an informed decision.  Because safety is a paramount issue, the fallback position should be to provide hormones that mimic Mother Nature.

“Outliving Your Ovaries” is written by Endocrinologist Dr. Marina Johnson, Medical Director of The Institute of Endocrinology and Preventive Medicine. Dr. Johnson, a pharmacist and a physician, describes a wide body of research showing that pharmaceutical topical bioidentical hormones are safer than the most commonly prescribed hormones.   Dr. Johnson was recently an invited speaker at the Cleveland HeartLab presenting the extensive research in her approach to treating menopause. To obtain a copy of this latest book with all of the technical “peer-reviewed” research and explanations – Click Here

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