Part 1: Bioidentical Hormone Therapy vs Conventional Hormone Therapy

Are all hormones created equally? Simply put, no.

It is our opinion that there are some hormones used in hormone replacement therapy that are better than others. That starts with the type of hormone molecules that are used, either bioidentical or not-bioidentical, with our preference being bioidentical.


Both Bioidentical Hormone Therapy (BHT) and Conventional Hormone Therapy (CHT) fall under the general umbrella of Hormone Replacement Therapy (HRT). The difference is how closely the hormone molecules used mirrors our own body's hormones. Bioidentical hormones are molecularly very similar to the hormones that our bodies naturally produce. Conventional hormones are mostly synthetically made or derived from biological sources such as horse urine and less-closely resemble our body’s own.


Does this matter? Absolutely, each tiny change in structure changes how that molecule interacts within our body. Therefore, each type of hormone molecule has different benefits (efficacy) and risks (side effects) associated with it.


Bioidentical Estrogens include:

  • Estrone 

  • Estradiol 

  • Estriol

  • 17-Beta estradiol

  • Estradiol acetate

  • Estradiol hemihydrate


Estrogens used in CHT, that are not bioidentical:

  • Esterified estrogens

  • Conjugated estrogens

  • Conjugated equine estrogens


Bioidentical Progesterone includes:

  • Progesterone (or micronized progesterone)


Progesterone-like compounds used in CHT, that are not bioidentical:

  • Medroxyprogesterone acetate

  • Norethindrone acetate

  • Levonogestrel


(If you are on a non-compounded HRT product and are wondering if it is bioidentical, click here to find out. HRT made by compounding pharmacies are almost always bioidentical)


The Most Well Known Hormone Replacement Therapy Study, The WHI Study

The most extensive and well-known study done on HRT safety was completed between 1993 and 2002 and is called The Women’s Health Initiative Study, commonly referred to as the WHI study. The WHI was one of the most far-reaching clinical trials of post-menopausal women's health ever undertaken in the US. As part of this project there was a subset of women (approximately 30,000 women) who were part of the HRT trial. The trial was stopped in 2002 as the women who were on HRT were found to be at a greater risk of heart disease, stroke, blood clots, and breast cancer. This is why hormone replacement therapy got a bad reputation. Of course, these are very serious risks. But here is where there is an important thing to note - None of the hormones used in the WHI study were bioidentical.


Estrogen used in WHI was conjugated equine estrogens (CEE) made from pregnant mare urine and the progesterone used was a synthetically made progesterone, medroxyprogesterone acetate. Women were either on estrogen alone (in the case of women who had previously had a hysterectomy) or were on a combination of both the estrogen and progesterone.


So the question is, can we really apply what we learned from the WHI to bioidentical hormones? We think no. Different molecules, different risks, and different benefits. This is NOT to say that bioidentical hormones come with no risks. But the question is in this day and age is how do we proceed into the future? Are we confined to accepting a sentence of vaginal atrophy, night sweats, decreased vigor for life and other quality of life-limiting symptoms of hormonal deficiency or hormonal imbalance?  Our goal at Remedy is to help women feel their best and use hormones safely. After all, women nowadays are now living almost half their life in their perimenopause/postmenopause state!

Please stay tuned for Part 2 of our 3 Part series next week: Estrogen and Progesterone, the Cornerstones of HRT. Where we will be breaking down more specifics on estrogen and progesterone including a deeper dive into both the safety profiles of both of these hormones as well as the relief they can provide. 


By April Segal, PharmD, BCPS, APh

Remedy Pharmacist + Founder