What are body-identical hormones?

Navigating hormone replacement therapy (HRT) can be overwhelming, especially when you come across confusing terms like "body-identical" and "bioidentical" hormones.

If you've recently been prescribed treatments like Evorel or Utrogestan, you might wonder what these terms mean and how they relate to your safety and well-being.

This article explores what body-identical hormones are, the types of bioidentical HRT, and why understanding these terms is so important to help you make informed decisions about your health.

What are body-identical hormones?

Body-identical hormones are a type of HRT used to manage menopausal symptoms. These hormones are chemically identical to those naturally produced by your body, such as estradiol E2, estriol E3, estrone E1, and progesterone.

Because body-identical hormones are duplicates of natural hormones, regulated bioidentical HRT drugs integrate smoothly into bodily processes. This makes them a highly effective option for alleviating menopausal symptoms like hot flashes, mood changes, and vaginal dryness while also protecting against long-term risks like osteoporosis.

Body-identical hormones can also be referred to as “bioidentical hormones.” According to the NHS, body-identical and bioidentical HRT are the same, referring to treatments that use biologically identical hormones to those occurring naturally in the body (1). However, this term is often misused, even by trusted professional websites such as the CKS, the reference website used by health professionals in the UK (2).

Is body-identical and bioidentical HRT safe?

Regulated body-identical hormones are safe when used as directed, and research shows they are safer than synthetic HRT (3). They have been tested in clinical trials to ensure they are effective in improving menopause symptoms and are generally well-tolerated, though you may experience some mild side effects (4).

However, private clinics often use “bioidentical” as a marketing term to promote non-regulated HRT called “compounded bioidentical hormones” or “compounded HRT.”

These are non-prescription supplements that typically contain a combination of natural oestrogens (E1, E2, and E3), often with progesterone and testosterone.

Issues arise as many people confuse unregulated compounded bioidentical hormones with regulated HRT. Compounded HRT is legal and often available at “specialist pharmacies,” health food stores, or vitamin shops. Gels, creams, and lotions labelled as “menopause relief” or “natural oestrogen” likely fall into this category. 

However, although legal, the British Menopause Society does not recommend compounded HRT (5). These products have not gone through rigorous regulatory pathways, been tested in clinical trials, or had their safety and efficacy analysed (6). They are also not subject to the same quality-control standards, potentially putting patients at risk (7).

Is body-identical HRT available on NHS?

Compounded bioidentical HRT is unavailable on the NHS because it lacks research into its safety and efficacy (how well it works). However, regulated body-identical hormones are available on the NHS (1). If your doctor prescribes a body-identical hormone, you can be assured that it is licensed, safe, and effective.

The most common regulated bioidentical HRT medications used as first-line treatments for menopausal symptoms on the NHS are Evorel and Utrogestan: 

• Evorel Patches: Evorel patches are transdermal patches that deliver a body-identical oestrogen called 17 beta-estradiol through the skin. They are available in various strengths. They are easy to use and provide a steady release of oestrogen. Evorel Sequi and Evorel Conti patches, which combine oestrogen with progesterone, are also available.
   
• Utrogestan Capsules: These capsules contain body-identical progesterone, which is “micronised,” meaning it’s broken down into tiny particles that make it easier to absorb into the bloodstream. Utrogestan is often used alongside an oestrogen-only product to protect the womb lining, such as taking Ustrogen with Oestrogel.

What body-identical HRT brands are available in the UK?

Evorel and Utrogestan are first-line treatments delivered on the NHS for menopausal women—but they aren’t the only options. You can choose from a full range of regulated body-identical HRT patches, sprays, capsules, and vaginal oestrogen products.

Here is a list of Evorel and Utrogestan alternatives that contain prescription-only oestrogen and/or progesterone. All are regulated in the UK and can be requested from our online doctor:

• Oestrogen Gels: Oestrogel and Sandrena are topical gels containing body-identical estradiol. They are applied to the arms, thighs, or lower body to deliver oestrogen through the skin and treat menopausal symptoms.
   
• Oestrogen Patches: Estradot and Elleste Solo Patches are other bioidentical oestrogen patches similar to Evorel that slowly release estradiol into the bloodstream. Estradot patches are slightly smaller than Evorel patches and unsuitable for women with soy allergies. 
   
• Oestrogen Sprays: Lenzetto is a transdermal spray containing estradiol. It is applied to the skin to deliver oestrogen and alleviate menopausal symptoms and is a good alternative for women who don’t want to use patches or gels.
   
• HRT Tablets: You can find oral body-identical HRT medications that contain oestrogen, progesterone, or a combination. Utrogestan capsules are progesterone-only, whereas Elleste Solo Tablets contain estradiol, and Bijuive Capsules contain estradiol and progesterone.
  Many of the “older generation” HRT tablets are synthetic and not recommended as a first-line treatment any more.
   
• Vaginal Gels: Blissel and Estriol Cream are vaginal gels containing body-identical oestrogen. They help vaginal dryness and irritation that is caused by the menopause. These are different to vaginal lubricants and moisturisers, which don’t contain hormones or other drugs.

Choosing the right HRT for your needs

Prescription-only body-identical hormones are well-tolerated, regulated, and effective for treating menopause symptoms, but choosing the right type of HRT is essential. 

For example, a combination of oestrogen and progesterone is generally recommended to reduce the risk of endometrial hyperplasia (thickening of the womb lining), which can occur if oestrogen is taken alone. However, women who have had a hysterectomy typically use oestrogen-only HRT, which effectively manages symptoms without the need for additional hormones to protect the womb lining (8). 

When discussing options with your healthcare provider, remember that many practitioners may use the terms “body-identical” and “bioidentical” incorrectly. This can lead to confusion, but don’t hesitate to ask your prescriber for clarification if you’re uncertain about the terminology or the specific treatment recommended. We strongly advocate for patients to speak up and advocate for their health.

HRT from Oxford Online Pharmacy

We can provide unbiased, expert advice about the different types of HRT available in the UK. We also supply a range of HRT medicines to patients privately with our online doctor service. Unfortunately, not all HRT brands, such as Oestrogel, are available to women equally across the UK. If you are looking to try a gel instead of a patch or find the brand of patch available in your area doesn’t suit you and you want to try a different one, we can help.

Please note we only prescribe HRT to females who have been diagnosed as peri-menopausal or menopausal by their own GP or specialist. This is because we are an online service.

Bio-identical hormones summary of key terms

References

(1) NHS Choices. Treatment - Menopause [Internet]. NHS. 
(2) CKS. Menopause Management – Scenario: Managing Women with Menopause, Perimenopause, or Premature Ovarian Insufficiency [Internet]. NICE.
(3) 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? Postgraduate Medicine [Internet]. 2009;121(1):73–85. 
(4) Harper-Harrison G, Shanahan MM. Hormone Replacement Therapy [Internet]. National Library of Medicine. StatPearls Publishing; 2023. 
(5) Mariette-JB. Bioidentical HRT | British Menopause Society [Internet]. British Menopause Society. 2016.
(6) Pinkerton JV. What Are the Concerns About Custom-Compounded “Bioidentical” Hormone Therapy? Menopause. 2014 Dec;21(12):1298–300. 
(7) Newson L, Rymer J. The Dangers of Compounded Bioidentical Hormone Replacement Therapy. British Journal of General Practice. 2019 Oct 31;69(688):540–1
(8) Haney AF, Wild RA. Options for Hormone Therapy in Women Who Have Had a Hysterectomy. Menopause. 2007 May;14(Suppl. 1):592–7.