Bioidentical hormones. The term, bioidentical, means that they have exactly the same chemical structure as hormones made by your body. Bioidentical hormones are synthetic, or made in a laboratory. They look exactly like your body’s hormones, but they are man-made. 

Your body cannot tell the difference between a bioidentical hormone product and its own hormones. Proponents of bioidentical hormones believe this makes them safer and better than other forms of synthetic estrogen and natural occurring estrogens. However, there is not enough scientific evidence to support these claims.

Herbal products. Some herbal products claim to be useful for treating the symptoms of menopause. However, the FDA does not regulate herbal products in the same way that it controls over-the-counter and prescription medications.

The FDA regulates herbal products as foods, not drugs. This means that manufacturers do not have to prove that they work or that they are safe. The FDA does not regulate their purity either. Some products have been contaminated with toxic substances.

For your safety, always buy herbal products from a reliable source. Your pharmacist can help you choose a reliable manufacturer. You should also consult your doctor before using herbal products.

Why is hormone replacement therapy used?

Your doctor may recommend hormone replacement therapy (HRT) to treat menopausal symptoms. Menopause symptoms most likely to respond to HRT include:

  • Anxiety and mood swings, which can interfere with your daily life and become debilitating
  • Hot flashes, which are often described as a sudden sensation of warmth, flushing and sweating
  • Night sweats, which are the nighttime version of hot flashes
  • Osteoporosis, or thinning bones, which is a complication of menopause. You may not know you have thinning bones unless your doctor finds it on a screening test.  This can put you at increased risk for fractures.
  • Sleep problems, which include insomnia or sleeplessness
  • Vaginal dryness, which causes burning, irritation, and painful sexual intercourse

Who prescribes hormone replacement therapy?

The following specialists prescribe hormone replacement therapy for menopause:

  • Family medicine doctors provide comprehensive healthcare to adults and children. 
  • Internists provide comprehensive healthcare to adults.
  • Midwives, including certified nurse-midwives (CNMs) and certified midwives (CMs). These types of midwives are healthcare professionals who provide prenatal, labor, and delivery care, and some gynecologic care, including menopause treatments. The ability of a midwife to prescribe hormone replacement therapy varies by state.
  • Obstetricians/gynecologists (Ob/Gyns) specialize in women's health, pregnancy, and labor and delivery.

How is hormone replacement therapy given?

You will take estrogen alone for hormone replacement therapy (HRT) continuously. This means that you take it every day without any breaks. This differs from estrogen combined with progesterone, which you take cyclically to mimic the menstrual cycle.

What are the risks and potential complications of hormone replacement therapy?  

Hormone replacement therapy (HRT) is effective for treating many of the symptoms of menopause. However, it is not right for every woman because there are risks. Some of these risks are serious and even life threatening. Your healthcare provider is best person to guide your treatment decisions based on your circumstances.

The Women’s Health Initiative (WHI) is a major study supported by the National Institutes of Health (NIH). WHI looked at the risks and benefits of HRT. Results from this study generally showed that women should use HRT in the lowest possible dose for the shortest amount of time. Long-term use of HRT was associated with significant risks. 

For estrogen-only replacement therapy, these risks include: 

  • Blood clots, in the form of a deep vein thrombosis (DVT). A blood clot can travel to the lungs and cause a pulmonary embolism (PE).
  • Stroke

For estrogen combined with progesterone replacement therapy, these risks include:&