Three things to know about menopausal hormone therapy (MHT) products
- FDA-approved bioidentical menopausal hormone therapy (MHT) products are available.
- You do not need compounded products to use hormones that are chemically identical to those your body makes (bioidentical hormones).
- Both the type of hormone and how it gets delivered to your body affect effectiveness and side effects.
Understand Terms in the Menopausal Hormone Therapy (MHT) Products Chart
What is an active pharmaceutical ingredient (API)?
The active pharmaceutical ingredient is the part of a medication, a molecule (i.e. type of estrogen or progestogen) that produces the intended symptom relief or health benefit.
What is an excipient?
An excipient can help the active ingredient (API) work by helping with delivery or stabilization. An excipient might be added to enhance coloring or be an input to help manufacturing of the product be easier. Excipients are explained in more detail here.
What does bioidentical mean?
Bioidentical means that a product is made to be chemically identical to the hormone your body naturally produces. However, the ingredients of a bioidentical product, whether in a compounded version or an FDA-approved product, are all manufactured in a lab. None comes directly from nature or is “natural”. The exception is a type of estrogen called conjugated equine estrogen (CEE). CEE comes from a pregnant horse’s urine. So it is, in fact, made in nature. The idea of “natural” menopausal hormone therapy products has long been associated with compounded products but it is a misconception.
What is compounding?
Compounding is the creation of custom products using FDA-approved APIs and mixing them with excipients to tailor a remedy to a specific prescription.
What does route of administration mean?
The route of administration determines how a product gets into your body. There are many estradiol products, see the menopausal hormone therapy (MHT) products chart below, but they have different routes of administration and therefore have different side effect profiles.
- Oral: a product you take by mouth (tablet, capsule or sublingual)
- Transdermal: a product you apply to your skin (cream, patch or gel)
- Vaginal: a product you insert in your vagina (cream, gel, insert/tablet, ring)
Note: Transdermal estrogen has a safer risk profile than oral estrogen with respect to blood clots, stroke, and cholesterol changes because it does not have the effect on the liver that oral estrogen does. This would be especially pertinent for a woman with a personal or family history of these medical issues.1,2
Understand the three (3) types of estrogen
- Estrone (referred to as E1): produced in fat tissue after a women reaches menopause
- Estradiol (referred to as E2): produced by the ovaries during the reproductive years
- Estriol (referred to as E3): produced by the placenta during pregnancy
FAQs
4 Key Aspects to Understand Menopausal Hormone Therapy (MHT) Products:
- Hormone type (an estrogen or progestogen; we do not cover testosterone here)
- Bioidentical vs. Non-bioidentical (sometimes you see the word “synthetic” used to indicate that a product is not bioidentical, but don’t be fooled! Synthetic means a product is made through a chemical process in a lab. All hormone products with the exception of conjugated equine estrogen (CEE) are made in a lab.
- FDA – approved vs. compounded (not FDA – approved)
- Route of administration (how the drug enters your body)
Understanding the subtle but real difference among MHT options is important. We’ve written a three-part blog post to help you do that. You can find those here:
Menopausal Hormone Therapy (MHT) Products Chart
Hormone |
Route of
|
Bioidentical
|
Non-Bioidentical
|
|---|---|---|---|
| Estrogen | Oral | FDA-approved Estrace®, generics (17β-estradiol) Available compounded (not FDA-approved) Estradiol (E2), estriol (E3), biestrogen (E2E3), triestrogen (E1E2E3) |
FDA-approved Premarin® (conjugated equine estrogens, CEE) New (Nov ’25): Generic Premarin (conjugated estrogens, USP) |
| Estrogen | Transdermal (cream, gel, patch) |
FDA-approved Divigel®, EstroGel®, Elestrin® (estradiol topical gel E2) Evamist® (estradiol transdermal spray E2) Alora®, Estraderm®, Minivelle®, Vivelle – dot® (estradiol patch) – twice weekly Climara®, Menostar® (estradiol patch) – weekly Available compounded (not FDA-approved) Estradiol (E2); estriol (E3); bioestrogen (bi-est): 20% E2 and 80% E3; triestrogen (tri-est, triple-est): 10% E1, 10% E2, and 80% E3 |
None |
| Estrogen | Vaginal | FDA-approved Imvexxy®, vaginal insert (17β-estradiol) Vagifem®, vaginal insert (estradiol hemihydrate) Yuvafem®, vaginal insert (estradiol hemihydrate) Estring®, vaginal ring(17β-estradiol) Femring®, vaginal ring (estradiol acetate) Estrace®, vaginal cream (17β-estradiol) Estragyn®, vaginal cream (estrone) |
FDA-approved Premarin® vaginal cream (conjugated estrogens) |
| Progesterone | Oral | FDA-approved Prometrium®, generics (progesterone, USP) Available compounded (not FDA-approved) Progesterone, USP |
None |
| Progesterone | Transdermal (cream, gel) |
Available compounded (not FDA-approved) Progesterone, USP |
None |
| Progesterone | Vaginal | FDA-approved Crinone® (progesterone, USP gel) Endometrin® (progesterone, USP insert) Available compounded (not FDA-approved) progesterone, USP |
None |
| Progestin | Oral | None | FDA-approved Provera® (medroxyprogesterone acetate) Aygestin®, Ortho Micronor®, Camila®, Errin®, Jolivette®, Jencycla®, Nor-QD®, Nor-Be® “Minipill” progestin-only birth control (norethindrone acetate) |
| Combination | Oral | FDA-approved Bijuvia® (estradiol/progesterone) |
FDA-approved Activella®, Lopreeza®, Amabelz®, Mimivey® (estradiol/norethindrone acetate) Angeliq® (estradiol/drospirenone) FemHrt®, Fyavolv®, Jinteli® (norethindrone acetate/ethinyl estradiol) Prempro® (conjugated estrogen/medroxyprogesterone) |
| Combination | Transdermal (patch) | None | FDA-approved ClimaraPro® (estradiol/levonorgestrel) Combipatch® (estradiol/norethindrone acetate) |
Last updated: February 2026
The FDA (the US regulatory body) initiated removal of black box warnings for cardiovascular disease, breast cancer, and dementia from menopausal hormone therapies. Our blog post explains what exactly it means and what it doesn’t mean. The warnings for endometrial cancer when estrogen is used without a progestogen remain.
REFERENCES
1. Is transdermal menopausal hormone therapy a safer option than oral therapy? Bette Liu, Canadian Medical Association Journal, 2013.
2. Risk of Gall Bladder Disease With Hormone Replacement Therapy Patches Lower Than With HRT Pills, Science Daily, 2008