In short
Bioidentical means a hormone with the same molecular structure as the one your body makes. By that definition, the standard treatment used here is already bioidentical: 17-beta oestradiol and micronised progesterone. In marketing, the word usually means something else: custom-compounded multi-hormone mixtures, creams, pellets or troches, with doses adjusted by serial hormone testing. Those are what the Endocrine Society, the Menopause Society and the American College of Obstetricians and Gynecologists advise against. There are no randomised trials of their efficacy or safety, and their contents, dose, quality and sterility are not subject to regulatory oversight. They are not prescribed here. Regulated body-identical hormones are.
Treatment Overview
What does bioidentical actually mean?
Technically, a bioidentical hormone is one with the same molecular structure as a hormone the body produces, such as 17-beta oestradiol.
Oestradiol is preferred over conjugated equine oestrogens precisely because it is structurally identical to the main oestrogen the ovary secretes. Micronised progesterone is preferred over synthetic progestins for the same reason. Both are licensed, regulated products available on prescription.
So a woman on a transdermal oestradiol patch with micronised progesterone is already taking body-identical hormones. That is worth knowing before paying for something described as an alternative to it.
Why is the word confusing?
Because the technical meaning and the marketing meaning are not the same thing, and the marketing meaning is the one most women encounter first.
| Regulated body-identical | Custom-compounded “bioidentical” | |
|---|---|---|
| What it is | 17-beta oestradiol and micronised progesterone, licensed products | Multi-hormone mixtures made up per patient: oestradiol, oestrone, oestriol, progesterone, testosterone, DHEA |
| Form | Patch, gel, tablet, vaginal insert or ring | Creams, gels, sublingual tablets, suppositories, troches, implanted pellets |
| Dose setting | By symptoms and tolerance | By serial hormone testing, often saliva |
| Regulatory oversight | Yes, including package inserts and standard warnings | No. Contents, dose, quality and sterility are not overseen |
| Trial evidence | Extensive | No randomised trials of efficacy or safety |
Both are derived from plant sources and modified to match human hormones. The raw material is not the difference. The oversight is.
What is actually wrong with compounded hormones?
Four things, set out in the 2016 Endocrine Society scientific statement and echoed by the Menopause Society and the American College of Obstetricians and Gynecologists.
- There is no rationale for them. Approved oestrogen and progestogen formulations exist in every country, so a non-approved product is not filling a gap.
- There are no randomised trials showing either efficacy or safety for treating menopausal symptoms.
- Contents and dose are not overseen. In one study of compounded products, potency ranged from 67.5 to 268 percent of what the label stated.
- They carry no package insert and none of the standard warnings that every approved oestrogen must provide.
Absorption is also unpredictable. One pharmacokinetic study of a commonly used compounded combination oestrogen preparation found highly variable absorption, with blood oestradiol and oestrone lower than expected compared with an equivalent dose of a commercially available transdermal patch.
There is a further concern about endometrial protection. Endometrial cancer rates in the United States were stable from 1992 to 2002 and then rose by about 2.5 percent a year, with a 10 percent increase between 2006 and 2012, over the same period in which compounded hormone use grew and approved combination products declined. That is an association across populations rather than proof of cause, and other risk factors were constant or falling, which is why it is taken seriously rather than dismissed.
Why is saliva hormone testing not used?
Because the dose of hormone therapy is set by whether your symptoms are controlled and whether you tolerate it, not by a hormone level, and saliva testing has no evidence base for guiding treatment.
Serial hormone monitoring with dose adjustment is a defining feature of compounded programmes rather than a feature of good practice. It gives the impression of precision, produces numbers that change between samples, and leads to dose changes that are not driven by how the woman feels.
The same applies to blood oestradiol levels in standard practice: routine levels are not used to steer ordinary hormone therapy either.
What about implanted pellets?
Implanted hormone pellets are not prescribed here, for the same reasons as other compounded preparations plus one of their own.
A pellet cannot be removed easily once inserted. If the dose turns out to be too high, if side effects appear, or if a new contraindication emerges, there is no way to stop treatment quickly. Every other route can be stopped the same day.
Compounded pellet formulations also sit outside regulatory oversight of contents, dose and sterility, and because they are implanted, sterility is not a theoretical concern.
What is prescribed instead?
Regulated 17-beta oestradiol, usually as a patch or gel, with micronised progesterone if you still have a womb.
That regimen is body-identical in the technical sense, licensed, dose-consistent, comes with a package insert, and is the combination that current guidance prefers. Where dryness is the main problem, low-dose vaginal oestrogen is used locally instead.
A patch or gel through the skin is the usual first choice, with micronised progesterone alongside it if you still have a womb. The preparations compared.
One more point on testosterone and DHEA, which are often part of compounded mixtures: routine androgen therapy is not suggested for postmenopausal women. Approved testosterone products for women exist in some countries and not in others, and endogenous androgen levels do not predict sexual function in women.
How is a switch from compounded hormones handled?
Carefully, and not by stopping abruptly at the first appointment.
The first task is establishing what you have actually been taking: which hormones, at what stated dose, in what form, for how long, and whether a progestogen was included in a dose adequate to protect the womb lining. That last point is the one that most often needs attention first.
From there the switch is to an equivalent regulated preparation, with the expectation that symptoms may shift for a few weeks while the absorption profile changes. A review follows at three months.
If you have been using a compounded oestrogen without adequate progestogen cover and you still have a womb, that is assessed on its own terms, including any bleeding history, before the new regimen starts.
Bioidentical hormones in Dubai and the UAE
What you will encounter here
Compounded bioidentical programmes, pellets and saliva-guided dosing are marketed widely in Dubai, often alongside language about natural hormones and personalised dosing.
Worth separating: the hormones in regulated products are also derived from plant sources and are also identical to human hormones. Natural and compounded are not the same word, and neither implies safer. The Endocrine Society statement makes exactly this point, that the popularity of compounded products grew after the early Women’s Health Initiative reports even as later data showed regulated hormone therapy to be safe in younger menopausal women.
Three questions are worth asking anywhere you are offered this: is the product licensed and does it come with a package insert, is the dose set by my symptoms or by a hormone test, and if I want to stop next week, can I.
What regulated means here
Oestrogen and progesterone preparations are prescription medicines in the UAE, in the regulated categories of the classification maintained by Dubai Health Authority Drug Control.
A licensed product carries a known dose, a package insert with the standard warnings, and a manufacturer accountable for its contents. That is the practical difference from a preparation mixed to order, and it is the reason the switch is worth the disruption for women who are currently on a compounded regimen.
Treatment is reviewed once a year, and stopping is planned rather than abrupt. What the yearly review covers.
Regulated body-identical estradiol in practice: HRT patches and oestrogen gel.
Who Is a Good Candidate?
- Women considering a bioidentical hormone programme who want to know what the word actually means before paying for one.
- Women currently on compounded hormones who want to switch to a regulated preparation.
- Women with an implanted pellet who want the situation reviewed and a plan for what comes next.
- Women who have been told regulated hormone therapy is synthetic and want that checked.
- A request for a compounded prescription, a pellet, or dosing guided by saliva testing: not offered.
- A personal history of breast cancer, coronary heart disease, a previous clot or stroke, or active liver disease: these rule out systemic oestrogen whatever the preparation.
- Unexplained vaginal bleeding, particularly on a compounded regimen without adequate progestogen cover: investigated first.
What Happens During the Consultation
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1
What you are actually taking
Which hormones, at what stated dose, in what form, for how long, from where, and whether a progestogen was included in a dose adequate to protect the womb lining.
-
2
What it has done so far
Symptom response, side effects, bleeding history, and any hormone testing that was used to steer the dose. Blood pressure, weight and breast screening status.
-
3
The equivalent regulated regimen
Which licensed preparation matches what you need, whether a progestogen is required, and what to expect while the absorption profile changes.
-
4
The switch, with a review date
A written plan for the changeover, what may shift in the first weeks, what counts as a reason to call, and a review at three months.
Program Structure & Follow-Up
What happens after a switch
The first three months are about settling on the regulated dose:
- Weeks 1 to 4: symptoms may shift as absorption changes. This is expected rather than a sign the switch failed.
- Weeks 4 to 12: the dose is adjusted by symptoms, and any bleeding pattern establishes itself.
- At three months: full review of symptoms, dose, bleeding, blood pressure and tolerance.
Contact between appointments runs through the membership programmes.
Why endometrial protection is checked first
Because unopposed oestrogen thickens the womb lining, and hyperplasia has been seen after as little as six months.
Compounded regimens vary in whether a progestogen is included and at what dose, and the dose is what matters, not merely its presence. Where the cover has been inadequate and there is a womb, any bleeding history is assessed before the new regimen starts.
Benefits, Limits & Safety
What this page is not saying
It is not saying that women on compounded hormones feel no better. Many do.
The objection is that the improvement cannot be attributed to the specific product, that the dose delivered is not reliably known, and that the same benefit is available from a preparation whose contents, dose and warnings are accountable. Placebo itself reduces hot flushes by 20 to 50 percent in trials, which is why regulated evidence matters.
Is licensed hormone therapy synthetic?
The oestradiol and micronised progesterone used here are structurally identical to human hormones, made from plant sources in the same way as compounded preparations.
Conjugated equine oestrogens are a different product and are not the preferred choice. Older synthetic progestins such as medroxyprogesterone acetate are also not the first choice, and were the ones associated with the coronary and breast findings in the Women’s Health Initiative.
When should you contact a doctor?
Contact a doctor on any hormone preparation for bleeding that does not fit, or signs of a clot:
- Bleeding after a spell of none, heavy or prolonged bleeding, or bleeding after sex.
- Sudden breathlessness or chest pain, or pain and swelling in a calf.
- A new breast lump or nipple change.
- Symptoms suggesting too high a dose on a pellet, such as marked acne, hair growth or voice change, which cannot be reversed by stopping.
In the UAE, call 998 for an ambulance in an emergency.
A history of breast cancer, coronary heart disease, a previous clot or stroke, or active liver disease changes the answer. Who is and is not a candidate.
What the evidence shows
Regulated 17-beta oestradiol and micronised progesterone are body-identical, licensed and extensively studied. Custom-compounded preparations have no randomised trials of efficacy or safety, and measured potency has ranged from 67.5 to 268 percent of label.
How dose is set
By symptom control and tolerance, with a review at three months after any switch and then yearly. Not by saliva testing, and not by routine blood hormone levels.
What is not offered
Custom-compounded hormone mixtures, implanted pellets, saliva-guided dosing, and routine testosterone or DHEA for postmenopausal women.
Cost & Program Investment
What a switch involves depends on what you are currently taking and which regulated preparation replaces it, so no single figure is given here. The consultation sets out the full cost, including the review, before anything is prescribed. Ongoing care runs through the membership programmes.
Frequently Asked Questions
No. Body-identical hormones are exactly what is prescribed here: 17-beta oestradiol and micronised progesterone. The objection is to custom-compounded multi-hormone mixtures, which have no randomised trials of efficacy or safety and whose contents, dose, quality and sterility are not subject to regulatory oversight.
The oestradiol and micronised progesterone used here are structurally identical to human hormones, and are made from plant sources in the same way as compounded preparations. Conjugated equine oestrogens and older synthetic progestins are different products and are not the preferred choice.
Many women do feel better on them, but the improvement cannot be attributed to the specific product and the dose actually delivered is not reliably known. In one study, potency of compounded products ranged from 67.5 to 268 percent of label. A regulated preparation gives the same benefit with a known dose and standard warnings.
It is not used. The dose of hormone therapy is set by whether symptoms are controlled and whether you tolerate it, not by a hormone level. Serial hormone monitoring with dose adjustment is a defining feature of compounded programmes rather than a feature of good practice.
No. Beyond the general objections to compounded preparations, a pellet cannot be removed easily once inserted, so if the dose is too high or a side effect or new contraindication appears, treatment cannot be stopped quickly. Every other route can be stopped the same day.
The Endocrine Society, in a 2016 scientific statement, the Menopause Society, and the American College of Obstetricians and Gynecologists have all issued statements advising against custom-compounded hormone therapy.
There is an association at population level rather than proof. Endometrial cancer rates in the United States were stable from 1992 to 2002, then rose about 2.5 percent a year with a 10 percent increase between 2006 and 2012, over the same period in which compounded use grew and approved combination products declined, while other risk factors were constant or falling.
Not here. Where you are already on one, the work is to establish what you are taking, whether your womb lining has been adequately protected, and how to move to an equivalent regulated preparation, rather than to continue the same arrangement.
Routine androgen therapy is not suggested for postmenopausal women. Endogenous androgen levels do not predict sexual function in women, and approved testosterone products for women exist in some countries and not in others.
For oestrogen, the skin route avoids the first pass through the liver. Oral oestrogen raises the risk of clots and stroke; transdermal oestrogen showed no excess clot risk in observational data, including in women with a clotting tendency or a high BMI. Both relieve hot flushes equally well.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Compounded Bioidentical Hormones in Endocrinology Practice: An Endocrine Society Scientific Statement
- The 2022 hormone therapy position statement of The North American Menopause Society
- Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline
- Risks and benefits of estrogen plus progestin in healthy postmenopausal women (Women's Health Initiative)
- Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials
- Drug Control
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.