Bioidentical hormones come in various forms: creams, gels, patches, sublinguals, capsules, and vaginal applications. Some forms require a prescription and/or a compounding pharmcy and some forms can be purchased over-the-counter or via the Internet. I will tell you what I know about obtaining bioidentical hormones in the section "How do I get bioidentical hormones?"
I have considered trying to include a comprehensive list of hormones indicating which are bioidentical and which are synthetic. I've read similar lists and didn't retain much. Since the purpose of this website is to share what I know personally, I will stick with the hormones that I know and/or have experience with.
This is a good time for me to explain several things before I continue.
Estrogen and progesterone are not the only hormones that decrease or change during perimenopause and menopause. There's DHEA, cortisol, and testosterone to name a few more. And let's not forget about human growth hormone, and thyroid and adrenal gland issues. My point is, while supplementing with bioidentical estrogen and progesterone can help enormously, it will not make you 21 again. If only it were that simple.
You can get a saliva test done to test the levels of all these hormones. Anyone can get one without a prescription, and I have included links for labs to order from in the "Helpful links" section. A saliva test gives a more accurate measure of your hormones than a blood test according to some theories. Mainstream doctors usually use blood tests. Insurance companies may not pay for your saliva test, especially if it is not ordered by a doctor. But if you can cough up the money, it is helpful in finding out where all your hormone levels are. Some labs want you off all supplemental hormones for at least a month before you take the test. Other labs are now starting to let you take the test while you are taking your hormones. I took a saliva test a few years ago. The lab I used required me to go off all hormone supplementation for a month. The test results told me my estrogen levels were normal for a woman my age (yes, that was the problem!) and that I had almost no progesterone (already knew that). But I also learned that my DHEA, cortisol, and testosterone levels were in the high normal range. So all in all, it was worth the money. However, I cannot afford this regularly and operate on how I feel now.
I would also like to explain what a compounding pharmacy is. This is a pharmacy that makes medications, hormones and other medications, to exact dosages specified by a doctor's prescription. Compounding pharmacies are the most common source for bioidentical hormones. You won't find a compounding pharmacist at any drug store chain or Wally World pharmacy. If you have a doctor that is willing, he or she can work with any compounding pharmacy online. Again, check "Helpful Links" for links to compounding pharmacies. You will, however, need a doctor's prescription. I would gladly use a compounding pharmacy if I had the prescription(s).
Over-the-Counter Progesterone Creams
There are dozens, probably hundreds, of over-the counter progesterone creams available online, in health stores, or even in some pharmacy chains. Which ones are good? I have experimented with at least a half dozen brands over the years. Some seemed to work better than others for me. I look for a product with a good base that absorbs well and isn't sticky. I look for a product with the least amount of unnecessary ingredients like fragrance and herbs that I don't want. Afterall, I'm buying progesterone, not black cohosh, chaste berry, or a bunch of Chinese herbs I can't pronounce. And I don't want chemicals I don't understand. Then, of course, there is price.
Here are the my own personal rules for buying a progesterone cream:
- I don't buy wild yam creams. They only contain diosgenin, the precursor to progesterone. While bioidentical progesterone is made from diosgenin, diosogenin does not convert to progesterone in the human body.
- I don't buy a progesterone cream that also contains wild yam extract for the same reason as above.
- The label should say "USP Progesterone." "Natural Progesterone" is a term also used, but I check with the company to be sure they mean "USP Progesterone." If they can't tell me, I don't buy.
- The progesterone cream needs to contain at least 450 to 500mg of progesterone per ounce. For example, if I am buying a 4 oz. tube of progesterone cream and the tube contains 2000mg of progesterone, that's fine.
- I don't buy a progesterone cream in a jar. Every time I open the jar, I am exposing the entire contents to the air and to whatever I am putting into the jar to measure with. I only buy a progesterone cream in a pump or a tube. Tubes seem to work fine and are easier to measure with in my opinion (I may not want the standard dosage in a squirt of cream).
- I don't want a long list of herbs in the ingredients. If I want herbs I will buy herbs.
- I think I get what I pay for. If a compounding pharmacist charges $30.00 and a tested progesterone cream like Pro-Gest costs a minimum of $21.00, how can a company sell a progesterone cream for $10.00? Keep in mind these over-the-counter progesterone creams are not regulated, so I use common sense.
My favorite over-the-counter progesterone creams at this point are Pro-gest and Natpro. Natpro seems more expensive initially because it is purchased in sets of three tubes. However, it contains more progesterone per tube and goes farther than Pro-gest, and it has been my experience that it absorbs better and faster.
Progesterone Gels and Sub-Linguals
Bioidentical progesterone gels and sub-lingual tablets come only from a compounding pharmacy and need a prescription from a doctor. Consequently, I have not been able to try these. The gel is probably easier to use than the cream. I have heard that the sublingual form of progesterone goes into your system too quickly. But, again, I have not been able to use these methods. A compounding pharmacist can sell low dose progesterone cream (like the over-the-counter brands) without a prescription, but he or she cannot sell a low-dosage progesterone gel without a prescription. Go figure.
Prescription Bioidentical Progesterone from Drug Companies
Yes, there are prescription bioidentical progesterone products made by drug companies. The pharmaceutical companies have patented the delivery methods, not the progesterone. I can buy some of these online without a prescription. These progesterone products were created for use with fertility problems and to help women with low progesterone to avoid miscarriages. They are now also being used for BHRT in lower dosages.
- Prometrium is a soft-gel capsule with micronized bioidentical progesterone in a peanut oil base. (Obviously, not for women with peanut allergies.) It is the first progesterone that can be absorbed orally and comes in a variety of dosages. The soft-gels can also be used vaginally to get the progesterone directly to the uterus.
- Microgest is the same thing as Prometrium, but is manufactured in India. I have tried them both and have not noticed any difference except for price. Microgest is cheaper.
- Crinone is a time-released bioidentical progesterone gel made for vaginal use. It is a product created to help prevent miscarriages, but can be used for BHRT in its lower dose form on a twice weekly basis. The drug company patented the time-released delivery. Sounds great, but it isn't. I have tried Crinone. The trouble is, it's not a "gel." When inserted it immediately dries out the vagina. After that I expelled brown globules and small white gritty pellets for days. This is residue from whatever the substances are that make Crinone time-released. It's quite awful and there would be no way a woman could have sex using it, not to mention feeling disgusting from the discharge. It may work, but I give it a thumbs down, especially since it is very expensive.
- There are prescription suppositories for risky pregnancies that I have found online that could be purchased without a presciption. I have not tried these.
- There is no such thing as bioidentical progesterone patch. Any "progesterone" patch with or without estrogen in it contains a synthetic progestin. The patch would have to be much too large if it contained bioidentical progesterone.
There is not just one estrogen. There are three estrogens that naturally occur together in a woman's body: Estrone (E1), estradiol (E2), and estriol (E3). Estradiol is the strongest estrogen and is dominant in non-pregnant women until menopause. Estriol is the primary estrogen during pregnancy, and estrone is the most prevalent estrogen after menopause. A compoundng pharmacist can make a cream or gel containing one, two (bi-est), or all three (tri-est) of these bioidentical estrogens. This requires a prescription from a doctor.
There are some web sites that claim to sell bioidentical estriol in a lotion form without a prescription. It probably contains a very low dose of estriol. I have never tried these estriol products, but maybe they would work.
I can't use a compounding pharmacy to get my estrogen, but there are a few bioidentical estrogen patches, a gel, and some vaginal creams made by drug companies that can be ordered online without a prescription. (More about this in the section "How Do I Get Bioidentical Hormones?"). Here's are the products I know about.
These are all bioidentical estrodial transdermal gels and they all work the same. Their advantages are that I apply them to my skin and they are absorbed transdermally and do have to be metabolized by my liver. Research shows that this lessens side effects like blood clots and strokes. Hormones are not meant to go through the liver, but are naturally released directly into the blood stream. This is what happens with transdermal use. Another advantage is that the dosage can easily be adjusted. Disadvantages include the need to rotate application sites, time used to apply, and the possibility of transfering estradiol to others with skin contact or with trace amounts left on the hands. I have used estradiol gels but have switched to a patch because of its ease of use and steady release of hormones.
Ovestin is a vaginal bioidentical estriol cream. It is used for vaginal atrophy to help rebuild thicker vaginal walls and keep the vagina moist and supple. Estriol is especially good for this. It also reduces recurrent urinary tract infections. It is not supposed to go systemic, but does. I asked a compounding pharmacist if Ovestin applied to skin other than the vagina would absorb, and he said it would. The disadvantages are that it is a little messy used vaginally and transfers estriol during sex.
Estradot and the Vivelle Dot are basically the same product (Estradot is sold in Europe). These are small, flat patches that contain bioidentical estradiol. The estradiol is absorbed through the patented adhesive delivery system. I use Estradot. The advantages are that I only have to apply it to my abdominal area twice a week, and the dosage is easily adjusted by cutting the patch to any size with scissors. I buy the largest dosage, .1 mg. and often cut it to make it .75 mg or .5 mg. I have found I can save the left over portions for future use. Also, the estradiol is contained and cannot be transferred to anyone else. I have never had any irritation from the adhesive and the patch adheres through showering, swimming and perspiration almost without fail.
Estraderm and Climara
These are older versions of the bioidentical estradiol patch and are larger than Estradot/Vivelle. They also are not flat, but instead contain a bubble of estradiol. I have not used these and see no reason to when there is a smaller, better product availble.
These are vaginal bioidentical estradiol tablets used for vaginal atrophy and work like the Ovestin cream. I have not used this product.
DHEA is a hormone made from cholesterol by the adrenal glands. It is touted as being the precursor to all of a woman's major sex hormones and some theories promote it as an anti-aging hormone, a weight-loss product, and a muscle builder. It declines with age and is a controversial subject with no real answers. DHEA can be purchased without a prescription at most drug stores, health stores, or online. It has some nasty side effects if you have too much of it in you body, like facial hair, scalp hair loss, and a deepening voice, since it is closely related to testosterone. I believe it is powerful and to be used with the utmost care. I have tried small amounts of it for a short time. It made my face break out and I decided it wasn't worth the risk. I don't think I need it at this point.
Some women need a small amount of testosterone after menopause or even before, in addition to estrogen and protesterone replacement therapy. This would be something that a saliva test would indicate. There is a new bioidentical testosterone patch for women called Intrinsa. I have not used it, but I have seen the patch, and it is huge. Certainly not discrete and very expensive. I would not use testosterone unless I was sure I really needed it because of the side effects. There are also testosterone gels made for men. Doctors have prescribed these for women, using only a small fraction of the amount of gel a man would use.