The difference between regulated BHRT and unregulated compounded BHRT – why we only prescribe body identical BHRT

Why you should choose body identical BHRT
on Thu 6 May


I think it’s fair to say that there has been some confusion over the term “bioidentical” when it comes to describing HRT.


It has been proposed that “body identical BHRT” should be the term used to describe regulated Bioidentical Hormone Replacement Therapy (also written as rBHRT) to distinguish this from Compounded Bioidentical Hormone Replacement Therapy which is written as cBHRT.


This would certainly make life easier for many women struggling to understand how they should be treated for menopause.  Let’s look at the difference


What exactly is rBHRT?

Authorised by regulators such as the MHRA (Medical and Healthcare Regulatory Authority) in the UK rBHRT offers precise duplicates of human hormones which originate in the human ovary as well as the adrenal and thyroid glands.  


Developed by the pharmaceutical industry, these include:

  • Estradiol E2
  • Estriol E3
  • Estrone E1
  • Progesterone
  • Dehydroepiandrosterone
  • testosterone
  • Levothyroxine


Effectively you are topping up your own hormones.


What exactly is cBHRT?

These are compounded hormone treatments made in Compounding Pharmacies and not authorised by the regulatory authorities (MHRA in the UK). 


Because they are marketed as natural supplements, they do not require approval by the MHRA and have not been scientifically evaluated in clinical trials for effectiveness and safety. 


Typically manufactured as vaginal preparations, lozenges and creams they are formulated u as Biest or Triest which relates to particular ratios of E1, E 2 and E3.


There are concerns about these unregulated treatments because:


  • There is a lack of medical evidence about combining E1, 2 and 3
  • Where the dosage is delivered through the skin there is a wide variation in its sufficient absorption to provide endometrial protection
  • They have been developed without regulatory development pathways or controlled randomised trials
  • There are no warnings about potential risks or side effects
  • There are issues around the standardisation of ingredients from one batch to another.


For all these reasons body identical HRT - rBHRT is regarded as having lower associated risks than cBHRT.


What’s more, prescribers often insist on expensive and complex saliva and serum tests. No research has substantiated the need for these and it is not recommended by any menopause societies.


Body identical terms and brands

Estradiol is body identical oestrogen often made from the yam plant


Ultrogestan is body identical progesterone


You may see the term “micronized progesterone” this means its molecular structure is identical to natural progesterone which is produced by your ovaries


Body identical brands include:

  • Evorel
  • Sandrena Gel
  • Oestrogel
  • Estradot patches
  • Elleste Solo patches


These all have particular benefits for individual women which is why working with a qualified menopause professional is really important. Please see this post


If you would like to read the British Menopause Society statement about cBHRT and rBHRT in full you can see this here


I hope you found this helpful. 


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