If you’re thinking about hormone therapy for perimenopause or menopause, you’ve probably run into a lot of confusing terms — bioidentical, compounded, FDA-approved, oral, transdermal. Here’s what they actually mean, plus a quick look at the three hormones used in therapy today, so you can walk into your next appointment feeling informed, not overwhelmed.

The Three Hormones Used in MHT

• Estrogen — the most effective treatment for hot flashes, night sweats, and vaginal dryness. Estrogen may also have long term health benefits when used at right time, right patient and right dose.  It comes as a pill, patch, gel, spray, or ring. If you still have a uterus, estrogen is always paired with a progestogen to protect the uterine lining.

• Progestogens — protect the uterus when you’re taking estrogen and someone with a uterus is on systemic estrogen. Options include micronized progesterone (a body-identical, FDA-approved capsule) or synthetic progestins. Your provider will help pick the one that fits your health history.

• Testosterone — not FDA-approved for women in the U.S., but some providers prescribe it off-label (usually as a compounded cream) for low libido that hasn’t improved with other treatments. This is a more individualized conversation.

Bioidentical vs. Compounded vs. FDA-Approved: What’s the Difference?

• Bioidentical means the hormone is chemically identical to what your body makes. This is about chemistry, not where the product comes from.

• FDA-approved means the product has been tested by the FDA for safety, purity, and consistent dosing. Many FDA-approved products — like standard estradiol patches, gels, and micronized progesterone — are already bioidentical.

• Compounded means a pharmacy custom-mixes the product for you, often at a specific dose or combination. Compounded hormones can also be bioidentical, but they are not FDA-tested for purity or dose consistency, so quality can vary by pharmacy.

In short: “bioidentical” and “FDA-approved” aren’t opposites — most people can get a bioidentical hormone in an FDA-approved form. Compounding is usually reserved for situations where a standard dose or combination doesn’t fit your needs.

Oral vs. Transdermal: Does Route Matter?

Yes — how you take estrogen changes its risk profile. Oral (pill) estrogen passes through your liver first, which is linked to a slightly higher risk of blood clots and stroke compared to transdermal (patch, gel, or spray) estrogen, which is absorbed through the skin and bypasses that first pass through the liver. Many providers favor transdermal options for people with certain risk factors, but the right choice depends on your personal and family health history.

Other Options Worth Knowing About

Hormone therapy isn’t the only path. Non-hormonal prescriptions (like certain antidepressants, gabapentin, or the newer medication fezolinetant), cognitive behavioral therapy, and vaginal moisturizers or low-dose local estrogen for dryness are all legitimate options — especially if MHT isn’t right for you. We’ll cover these in more detail in a future post.

Not sure which option is right for you? At Coastal Well Woman, we take the time to understand your medical history and your goals, so together we can find the safest, most effective option to meet your needs and improve your quality of life. Schedule a visit to start the conversation.