Body identical HRT vs bioidentical HRT: what’s the difference?
Menopause is a natural stage of life that every woman who has periods will go through. It marks the end of the reproductive years as the ovaries stop releasing eggs. However, the hormonal changes during perimenopause and menopause can have a significant impact on your body, your emotions and your everyday life.
Hormone replacement therapy (HRT) is a form of treatment that replaces hormones that decline during menopause and can help manage many menopause symptoms. There are different types of HRT, and two terms that are often confused are body identical HRT and bioidentical HRT.
Although the names sound very similar, they are not the same thing. This guide explains the difference between body identical HRT and compounded bioidentical HRT, and what you need to know when considering HRT.
What is bioidentical HRT?
The term “bioidentical HRT” is often used to describe hormone preparations that are chemically identical to hormones produced naturally by the human body. In the UK, the term is most commonly associated with compounded bioidentical hormones.
These preparations are individually compounded rather than being standardised, licensed medicines. They may be made by specialist pharmacies using hormones derived from plant sources.
Compounded bioidentical HRT is different from licensed HRT. Licensed HRT products have been assessed for their quality, safety and effectiveness and are manufactured to consistent standards.
At Menopause Care, we do not prescribe compounded bioidentical hormones.
What is body identical HRT?
Body identical HRT contains hormones that are chemically identical to those naturally produced by the human body, but importantly, these hormones are contained within licensed medicines.
Licensed body identical HRT products have been assessed by the medicines regulator for their quality, safety and effectiveness. They are manufactured to consistent standards, so the dose and composition of the medicine are controlled.
Body identical HRT may contain oestrogen, progesterone or, in some circumstances, testosterone. Your clinician will consider your symptoms, medical history and individual circumstances when discussing which type of HRT may be appropriate.
Body identical HRT vs bioidentical HRT: what is the difference?
The main difference is regulation and standardisation.
Body identical HRT uses hormones that are chemically identical to those produced naturally by the body, but they are supplied as licensed medicines that have undergone regulatory assessment.
Compounded bioidentical HRT is individually prepared and is not supplied as a standardised, licensed HRT product.
It is therefore important to understand that “bioidentical” does not automatically mean safer, more natural or better suited to you. The term itself does not tell you whether a hormone preparation is licensed or how it has been manufactured.
What are the benefits of licensed body identical HRT?
Licensed HRT can be an effective treatment for many symptoms associated with perimenopause and menopause. Depending on the type of HRT used, treatment may help with symptoms such as:
- Hot flushes and night sweats
- Sleep disturbance
- Vaginal dryness and other genitourinary symptoms
- Menopause-related mood changes
- Joint and muscle symptoms
- Changes to menstrual bleeding during perimenopause
HRT can also have benefits for bone health and can help prevent the bone loss associated with oestrogen deficiency.
The benefits and risks of HRT vary between individuals. Your clinician can help you understand which options may be appropriate for you.
What are the concerns about compounded bioidentical HRT?
Compounded bioidentical hormones are not the same as licensed HRT products. Because they are individually compounded, there can be differences in how preparations are made and in the dose delivered.
Unlike licensed medicines, compounded preparations have not gone through the same regulatory assessment and clinical development process required for licensed medicines.
There is also limited evidence about the long-term safety and effectiveness of many compounded bioidentical hormone preparations.
This is why major menopause organisations and medical regulators distinguish between licensed body identical HRT and compounded bioidentical hormones.
What are the risks of body identical HRT?
Like all medicines, HRT can have side effects and risks. These depend on factors including the type of HRT, the dose, how it is given and your individual medical history.
Possible side effects when starting HRT can include:
- Breast tenderness
- Headaches
- Nausea
- Bloating
- Mood changes
- Vaginal bleeding or spotting
- Skin irritation with patches, gels or sprays
These symptoms often improve as your body adjusts to treatment, but persistent or troublesome side effects should be discussed with your clinician.
There are also longer-term considerations when taking HRT. For example, combined HRT is associated with a small increase in breast cancer risk, while the route of oestrogen administration can affect the risk of blood clots.
Your clinician will discuss the benefits and risks of HRT with you and take your personal circumstances into account.
What types of body identical HRT are available?
Body identical HRT is available in a range of formulations.
Oestrogen can be given in several ways, including:
- Patches
- Gels
- Sprays
- Tablets
- Vaginal preparations
If you have a womb, you will usually also need a progestogen alongside systemic oestrogen to protect the lining of the womb. Body identical progesterone is available as micronised progesterone.
The right type and combination of HRT will depend on your symptoms, whether you have a womb, your medical history and your preferences.
Is body identical HRT available on the NHS?
Yes. Licensed body identical HRT products are available on the NHS and can also be prescribed privately.
The choice of HRT depends on your individual circumstances rather than simply whether a treatment is described as “body identical”.
At Menopause Care, our doctors prescribe licensed HRT products where clinically appropriate. We do not prescribe compounded bioidentical hormones.
Which is right for me?
Choosing HRT is an individual decision. There is no single type of HRT that is right for everyone.
A menopause specialist can help you understand the different options, including the type of hormone, dose, formulation and route of administration, taking into account your symptoms, medical history and personal preferences.
If you would like to discuss whether HRT could be appropriate for you, you can book a consultation with a Menopause Care doctor.
Our specialist menopause doctors and nurses have a wealth of knowledge about menopause symptoms and an in-depth understanding of how body-identical HRT can effectively manage them. If you’d like to discuss your options for HRT treatment, book a consultation with a Menopause Care doctor.
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