There are two what I will call varieties of bioidentical hormones. One is produced by pharmaceutical companies; the other is compounded, or individually made, by a compounding pharmacy. Compounding medications preceded the mass production by big companies by hundreds of years. Examples of the commercially made hormones include the patches, Vivelle dot and Climara (estrogen), and Prometium (progesterone) capsules. The compounded hormones include estradiol, progesterone and testosterone. Whether compounded or commercially-available hormones are better for a particular patient is a decision to be made between her and her care provider. I have many patients on both with excellent results. Purists might argue with defining both forms as bioidentical since they do not both start from a plant base. It is true that compounding is the best way to get hormones individually tailored in whatever dose is required and it can offer a variety of forms: creams/gels, lozenges, sublingual drops. However, the critical factor is the molecule that results, regardless of the process. In each case, the molecule is estradiol, progesterone or testosterone and biochemically identical to a woman's own.

The most recent research on the effects and safety of hormone therapy has focused on the critical aspect of timing, when women start on hormones. Many women will have significant symptoms long before their last period and will need to start replacement then. Others may not need hormones for troubling symptoms but choose to take them for maintaining good health as they age. These women may not start until the last period or reasonably soon thereafter. What the research is showing is that women who start hormones either before their last period or within several years of that time gain the most in long-term health maintenance, especially with regard to the heart, bones, brain, bladder, vagina and colon. For the majority of menopausal women, it can be argued that the benefits far outweigh the risks.

Whether or not to take hormones is an individual decision for every woman. It's not as simple as saying menopause is natural and, therefore, we should be able to brace through it without help. The fact is that in this day and age, we outlive our hormone supply. Not so very long ago, women died in their 40s and 50s as a part of the natural course, so menopause was actually an end of life event. Modern medicine has changed all that, and we now live 30 to 50 years beyond menopause. How can we expect the body to function optimally when deprived of basic ingredients of operation?