Defining bioidentical hormones for menopause-related symptoms

Main Article Content

Anne M. Whelan
Tannis M. Jurgens
Melanie Trinacty


Hormone Replacement Therapy, Menopause, Dissent and Disputes


In the last decade, the use of bioidentical hormones (BHs) to treat menopause-related symptoms has become increasingly popular. However, the many different definitions of BHs have led to a great deal of confusion often making it difficult for health care providers to discuss this area with patients.

Objective: The purpose of this paper was to produce a concise definition of bioidentical hormones, based on a review of the literature.

Methods: Searches, using systematic review methodology, were conducted from inception to June 2010 in PubMed, EMBASE, IPA, The Journal of International Compounding and the Internet to identify definitions of bioidentical hormones. There were no restrictions on type, date or language of publication. Included papers/website included those that contained a definition of BHs. Definitions were extracted, similarities and differences summarized, and these were then examined to produce a concise definition.

Results: Sixty-three definitions were found. Based on the analysis of similarities and differences, the following definition, comprised of three components (term being defined; category to which term belongs; distinctive characteristics of term) was produced: “Bioidentical hormones are chemical substances that are identical in molecular structure to human hormones.”

Conclusions: This definition clearly and concisely explains the meaning of BHs which should lead to a common understanding of the term and limit confusion among health care providers, the general public and the scientific community.



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1. Somers S. Ageless: The Naked Truth About Bioidentical Hormones. 1st ed. New York: Crown Publishing Group; 2006.

2. Rosenthal MS. Ethical problems with bioidentical hormone therapy. Int J Impot Res. 2008;20(1):45-52.

3. Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American menopause society. Menopause. 2010;17(2):242-255.

4. The Endocrine Society Position Statement: Bioidentical Hormones [Internet]. Endocrine Society [cited 2010 June 22]. Available from:

5. ACOG Committee Opinion #322: Compounded bioidentical hormones. Obstet Gynecol. 2005;106(5 Pt 1):1139-1140.

6. Shepherd JE, Bopp J. Pharmacy-based care for perimenopausal and postmenopausal women. J Am Pharm Assoc. (Wash) 2002;42(5):700,711-712.

7. Allen LV. Interview on HRT: Christiane Northrup. Int J Pharm Compd. 1998;2(1):12-17.

8. Boothby LA, Doering PL, Kipersztok S. Bioidentical hormone therapy: a review. Menopause. 2004;11(3):356-367.

9. Peterson G, Aslani P, Williams KA. How do consumers search for and appraise information on medicines on the Internet? A qualitative study using focus groups. J Med Internet Res. 2003;5(4):33.

10. Eysenbach G, Kohler C. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. BMJ. 2002;324(7337):573-577.

11. Pepper M, Driscoll D. Writing Definitions [Internet]. Purdue Online Writing Lab [cited 2010 Jul 9]. Available from:

12. Well E. Bioidentical hormones. Adv Nurse Pract. 2009;17(9):37-41.

13. Chervenak J. Bioidentical hormones for maturing women. Maturitas. 2009;64(2):86-89.

14. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009;121(1):73-85.

15. Sites CK. Bioidentical hormones for menopausal therapy. Womens Health (Lond). 2008;4(2):163-171.

16. Schaefer T. Patient information: bioidentical hormone therapy. Could it be right for you? Adv Nurse Pract. 2008;16(9):27.

17. Hansen K. Bioidentical hormones: panacea for menopausal hormonal therapy or bio-beware? S D Med. 2008;61(7):244-245.

18. Boothby LA, Doering PL. Bioidentical hormone therapy: a panacea that lacks supportive evidence. Curr Opin Obstet Gynecol. 2008;20(4):400-407.

19. Patsner B. Pharmacy compounding of bioidentical hormone replacement therapy (BHRT): a proposed new approach to justify FDA regulation of these prescription drugs. Food Drug Law J. 2008;63(2):459-491.

20. Cirigliano M. Bioidentical hormone therapy: a review of the evidence. J Womens Health. (Larchmt) 2007;16(5):600-631.

21. Fugh-Berman A, Bythrow J. Bioidentical hormones for menopausal hormone therapy: variation on a theme. J Gen Intern Med. 2007;22(7):1030-1034.

22. Moskowitz D. A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks. Altern Med Rev. 2006;11(3):208-223.

23. Campbell S. Bioidentical hormones. Achieving the perfect fit. Adv Nurse Pract. 2006;14(2):25,29,30.

24. MacLennan AH, Sturdee DW. The 'bioidentical/bioequivalent' hormone scam. Climacteric. 2006;9(1):1-3.

25. McKee J, Warber SL. Integrative therapies for menopause. South Med J. 2005;98(3):319-326.

26. Weisenbach TM. Bioidentical hormone therapy for menopausal and perimenopausal patients. Adv Nurse Pract. 2004;12(8):77-80.

27. Romero M. Bioidentical hormone replacement therapy. Customizing care for perimenopausal and menopausal women. Adv Nurse Pract. 2002;10(11):47-52.

28. Walker CR. Bioidentical hormone replacement therapy. A natural option for perimenopause and beyond. Adv Nurse Pract. 2001;9(5):39,42,45.

29. Collins D. Bioidentical hormone therapy. An overview of benefits and prescribing guidance. Adv Nurse Pract. 2008;16(5):41-46, 68.

30. What are bioidentical hormones? Natural. Bioidentical. Compounded. Confusion about these terms is only adding to the confusion over hormone therapy. Harv Womens Health Watch. 2006;13(12):1-3.

31. Mahmud K. Natural hormone therapy for menopause. Gynecol Endocrinol. 2010;26(2):81-85.

32. Burrell BA. The replacement of the replacement in menopause: hormone therapy, controversies, truth and risk. Nurs Inq. 2009;16(3):212-222.

33. Kuehn BM. FDA warns claims for pharmacy-made "bio-identical" hormones are misleading. JAMA. 2008;299(5):512.

34. Ribot C, Tremollieres F. Hormone replacement therapy in postmenopausal women: all the treatments are not the same. Gynecol Obstet Fertil. 2007;35(5):388-397.

35. Curcio JJ, Wollner DA, Schmidt JW, Kim LS. Is Bio-Identical Hormone Replacement Therapy Safer than Traditional Hormone Replacement Therapy?: A Critical Appraisal of Cardiovascular Risks in Menopausal Women. Treat Endocrinol. 2006;5(6):367-374.

36. Wright JV. Bio-identical steroid hormone replacement: selected observations from 23 years of clinical and laboratory practice. Ann N Y Acad Sci. 2005;1057:506-524.

37. Francisco L. Is bio-identical hormone therapy fact or fairy tale? Nurse Pract. 2003;28(7 Pt 1):39,44.

38. Watt PJ, Hughes RB, Rettew LB, Adams R. A holistic programmatic approach to natural hormone replacement. Fam Community Health. 2003;26(1):53-63.

39. Panay N, Fenton A. Bioidentical hormones: What is all the hype about. Climacteric. 2010;13(1):1-3.

40. Menopause medicine: The bottom line on bioidentical hormone therapy. Geriatrics. 2008;63(9):28-29.

41. Collins JJ, Ahlgrimm M. Hormone therapy it's time for a second opinion. Int J Pharm Compd. 2008;12(2):122-127.

42. Hays B. Solving the puzzle of hormone replacement. Altern Ther Health Med. 2007;13(3):50-57.

43. Altman AM. Bioidentical hormones: What's fact and what's fable? Sex Reprod Menopause. 2007;5(1):13-16.

44. Benda W. Bioidentical hormones set the current political stage. Integr Med. 2006;5(5):58-61.

45. Schmidt JW, Wollner D, Curcio J, Riedlinger J, Kim LS. Hormone replacement therapy in menopausal women: Past problems and future possibilities. Gynecol Endocrinol. 2006;22(10):564-577.

46. Taylor M. "Bioidentical" estrogens: Hope or hype? Sex Reprod Menopause. 2005;3(2):68-71.

47. Bioidentical hormones. The bottom line on compounded hormones. Mayo Clin Womens Healthsource. 2005;9(9):1-2.

48. Koumis T, Nathan JP, Rosenberg JM. What is bioidentical HRT and is there evidence to support its use? Drug Topics. 2005;149(9).

49. DeGarmo R. Defending bioidentical hormones [4]. Drug Topics. 2005;149(6).

50. Page K, Brownie S, Wohlmuth H. Natural management options for menopause. Integr Med. 2005;4(1):20-28.

51. Hu FS, ReedKane D, Draugalis JR. Patient satisfaction with pharmacist intervention and consultation in hormone replacement therapy: An update. Int J Pharm Compd. 2006;10(3):187-192.

52. Vigesaa KA, Downhour NP, Chui, Cappellini L, McCallian DJ. Efficacy and tolerability of compounded bioidentical hormone replacement therapy. Int J Pharm Compd. 2004;8(4):313-319.

53. Wepfer ST. Science behind bioidentical hormone replacement therapy. Part 1. Indian Journal of Natural Products. 2001;5(6):462-464.

54. ReedKane D. Natural hormone replacement therapy: what it is and what consumers really want. Indian Journal of Natural Products. 2001;5(5):332-333.

55. Lorentzen J. Hormone Replacement Therapy: Part 1 - The Evolution of Hormone Treatment. Int J Pharm Compd. 2001;5(5):336-338.

56. Vail J. "Natural" or "bioidentical" hormone replacement: What makes the difference? An interview with Christopher B. Cutter, MD. Int J Pharm Compd. 2003;7(1):24-26.

57. Price DL. Common acronyms used by health professionals who prescribe or prepare hormone replacement therapy. Int J Pharm Compd. 2007;11(4):288-291.

58. Allen LV. The politics of hormone replacement therapy. Int J Pharm Compd. 2007;11(4):278-281.

59. Stephenson K, Jones W, Stephenson DMM. The role of drug promotion in the prescription of hormone replacement therapy in the United States. Int J Pharm Compd. 2006;10(3):175-184.

60. Reed-Kane D. Patient handout: Hormone replacement therapy. Int J Pharm Compd. 2003;7(5):339.

61. Goodrum J. Estriol: Women's choice vs. a manufacturer's greed. Int J Pharm Compd. 2008;12(4):286-292.

62. Definition:bioidentical hormones [Internet]. Google [cited 2010 June 23]. Available from:

63. Pettle A. Bio-Identicals [Internet]. Ruth Pettle Wellness Centre [cited 2010 June 23]. Available from:

64. Bioidentical hormone replacement therapy [Internet]. Wikipedia [cited 2010 June 23]. Available from:

65. Kaye M. Bioidentical hormones: Are they safe? - The hormone conundrum [Internet]. More magazine [cited 2010 June 23]. Available from:

66. Bioidentical Therapy [Internet]. Westcoast Womens Clinic [cited 2010 June 23]. Available from:

67. The Alternative that Isn’t: Bioidentical Hormones [Internet]. Science-Based Pharmacy [cited 2010 June 23]. Available from:

68. Pick M. Bioidentical hormones come of age — Hormone Replacement Therapy [Internet]. Women to Women [cited 2010 June 23]. Available from:

69. Hormone [Internet]. Dorland's Illustrated Medical Dictionary [cited 2010 Jul 21]. Available from:

70. Endogenous [Internet]. Dorland's Illustrated Medical Dictionary [cited 2010 Jul 21]. Available from:

71. Barkhouse S, Boyd R, Burford N, Doucette A, Grundy K, Guy R. Concepts in Chemistry: Structure and Reactivity. 1st ed. Halifax, Nova Scotia: Dalhousie Printing Centre; 2006.

72. Adams C, Cannell S. Women's beliefs about "natural" hormones and natural hormone replacement therapy. Menopause. 2001;8(6):433-440.

73. Chang AA, Heskett KM, Davidson TM. Searching the literature using medical subject headings versus text word with PubMed. Laryngoscope. 2006;116(2):336-340.

74. Jenuwine ES, Floyd JA. Comparison of Medical Subject Headings and text-word searches in MEDLINE to retrieve studies on sleep in healthy individuals. J Med Libr Assoc. 2004;92(3):349-353.

75. Top Search Providers for August 2009 [Internet]. Search Engine Watch (SEW) [cited 2010 June 24]. Available from: