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OVERVIEW OF BIO-IDENTICAL HORMONE REPLACEMENT THERAPY

Introduction
According to the North American Menopause Society, there are approximately 4,900 women
entering menopause everyday, with a total of over 40 million menopausal women in the United
States. It was estimated that 15 to 38 percents of these menopausal or post-menopausal women
were on Hormone Replacement Therapy (HRT) of conventional or synthetic hormones, such as
Premarin or Prempro. That was over 8 million women taking synthetic hormones daily1.
However, criticism of the use of conventional HRT has increased among gynecologists, and
patients often refuse that treatment because they fear the side effects of therapy, such as breast
cancer, coronary heart disease, and venous thromboembolism. As a result, more women are
interested and willing to take Bio-identical Hormone Replacement Therapy (BHRT) instead of
conventional HRT.
What’s BHRT?
BHRT is also referred to as “natural” HRT and “human-identical” HRT in the literature.
It’s not human in origin but is IDENTICAL in organic structure and function to human
hormones. Bio-identical hormones are derived from a plant oil called diosgenin, which has a
very similar chemical structure to our endogenous cholesterol. Diosgenin is extracted from
soybeans and wildyams, and then is chemically altered in a lab to exactly match human
endogenous hormones2.
The Food and Drug Administration (FDA) considers bio-identical hormones to be natural
regardless of their source, and as a result they cannot be patented.
Goals of BHRT3:
• To alleviate the symptoms caused by the natural decrease in production of hormones by the
• Replace the hormones to the extent that positive benefits are realized.
• Bring the body back to hormonal balance.
• Imitate the body’s natural processes as much as is possible.

BHRT can be compounded to replace deficient hormones in amounts individualized to the
unique needs of each woman. Commonly compounded BHRT formulations include various
combinations of estrone (E1), estradiol (E2), estriol (E3), progesterone, dehydroepiandrosterone
(DHEA), and testosterone. These hormones can be formulated into oral sustained-release
capsules, transdermal creams or gels, buccal troches, sublingual drops and vaginal suppositories
or creams1. The followings are examples of compounded BHRT formulations (Table 1).
Table 1. Examples of Compounded BHRT Formulations
E3 (80%)/E2 (10%)/E1 (10%), 1.25 mg-2.5 mg daily Premenopause (days 14-28 of cycle): 100 mg daily What are the functions of BHRT?
The benefits of bio-identical HRT include: minimizing symptoms of menopause, prevention of
osteoporosis, improved lipid profiles, reduced risk of heart disease, reduced risk of endometrial
and breast cancer, and prevention of Alzheimer’s disease.
What’s Conventional/Synthetic HRT?
Synthetic hormone is a chemical substitution, not a true hormone, which only MIMICS some
hormonal functions. Side chains are added to the natural substance to create a synthetic product,
which is patented by a manufacturer. Since these hormones have different chemical structure,
they act differently and produce substantially different side effects than BHRT.
Table 2 shows a short list of commercially available Conventional HRT4.
Table 2. Examples of Conventional HRT
Generic and Dosage form
Sources of active ingredients
Conjugated estrogens
Esterified estrogens (estrone, equilin)
Micronized estradiol
Estropipate
Conjugated estrogens/
Medroxyprogesterone acetate
Estradiol/
Norethindrone acetate
Medroxyprogesterone acetate
Norethindrone acetate
Conventional HRT’s are only available as fixed doses of hormones. They cannot change to meet
individual’s hormone need.
Please contact Costa Mesa Compounding Pharmacy for more information or questions on
prescribing a BHRT. Our pharmacists are specially trained and assisted by the Professional
Compounding Centers of America (PCCA) to work closely with you to prescribe every
individualized formulation to meet the unique needs of your clients.
Reference
1. www.communitydrug.com 2. Walker C. Close-up on Complementary Care: Bioidentical Hormone Replacement Therapy A Natural Option for Perimenopause and Beyond. Advance for Nurse Practitioners. May 2001; pg 1-5 3. Allen L. Compounding for Hormone Replacement Therapy. Secundum Artem Current & Practical Compounding Information for the Pharmacist. 8:1-5 4. Reed-Kane D. Natural Hormone Replacement Therapy: What it is and what consumers really want. IJPC. 2001 Sep-Oct;5(5):332-335

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