Bioidentical hormones: Are they safer?

No, they aren't. According to the Food and Drug Administration (FDA) and several medical specialty groups, bioidentical hormones may be riskier than standard hormone therapy, and there's no evidence they're any more effective.

Bioidentical hormones have become popular in recent years, partly because of celebrity endorsements and partly in reaction to reports of increased health risks with standard hormone therapy. The term "bioidentical" means the hormones in the product are chemically identical to those your body produces. In fact, they are — but so are the hormones used in many FDA-approved hormone replacement products.

Marketers of bioidentical hormones say their products have these advantages over standard hormone therapy:

• They're derived from plant chemicals, not synthesized in a laboratory. Some FDA-approved products (Estrace, Climara patch and Vivelle-Dot patch, and Prometrium natural progesterone) are also derived from plants.
• They're produced in doses and forms that differ from those in FDA-approved products. Some bioidentical hormone products are available without a prescription, but most require a prescription. Also, for many nonstandard combinations, you need to go through a compounding pharmacy. Compounding pharmacies specialize in making medications customized for individual needs, such as inability to swallow solids or allergy to a binding agent in a tablet. However, products from compounding pharmacies have not been subject to the same rigorous quality assurance standards that standard commercially available hormonal preparations have to meet.
• They're custom made for you, based on a test of your saliva to assess your unique hormonal needs. Unfortunately, however, the hormone levels in your saliva don't reflect the levels in your blood or correspond to menopause symptoms.

Some women may benefit from nonstandard doses and forms of hormones in bioidentical hormone preparations, but there is almost no scientific support for an advantage of these compounds over common commercially produced preparations.