Menopausal Hormone Therapy (MHT) Products Chart

Three things to know about menopausal hormone therapy (MHT) products

You do not need a compounded product to use hormones that are chemically identical to those your body makes (sometimes these are referred to as bioidentical).
There are many FDA-approved menopausal hormone therapy (MHT) products that are chemically identical to those your body makes.
Both the kind of hormone (i.e., estrogen, progesterone) and how it gets delivered to your body (i.e., orally/pill, through the skin/patch) affect its effectiveness and possible side effects.

*** To understand what having FDA approval can assure you about a menopausal hormone therapy product, we highly encourage you to read this post.

Jump to the MHT Products Chart

Why we use

MHT = Menopausal hormone therapy and
not HRT = Hormone replacement therapy: hormones aren’t being replaced to the levels they were, they are being added at much lower doses
nor HT = Insulin and thyroid are also hormone therapies, so we use the M to distinguish menopausal related products.

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 is a term used to indicate that a product is made to be chemically identical to the hormone your body 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 drug gets into your body. There are estradiol products with varied routes of administration, see the menopausal hormone therapy (MHT) products chart below. The route of administration impacts how the drug gets processed in the body which can lead to different effects and side effects.

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: Unlike estrogen pills, estrogen absorbed through the skin (e.g. like patches or creams) bypasses the liver. This appears to lowers the risk of blood clots and has less effect on blood fats such as triglycerides but there have not yet been randomized clinical trials head-to-head to proves this.

Understand the three (3) types of estrogen

Estrone (referred to as E1): produced in fat tissue. It’s the predominant estrogen after menopause.

Estradiol (referred to as E2): produced by the ovaries during the reproductive years — during which it’s the predominant estrogen.

Estriol (referred to as E3): produced by the placenta during pregnancy — and is the dominant estrogen during pregnancy.

FAQs

What is the difference between progestin and progesterone?

What is compounding? Is it safe?

4 Key Aspects to Understand Menopausal Hormone Therapy (MHT) Products:

Hormone type (an estrogen or progestogen; we do not cover testosterone here)
Structurally identical vs. structurally different
- you may see “bio-identical” or “body-identical” used to describe a product in which the hormone is structurally the same as the one your body makes.
- sometimes you see the word “synthetic” used to indicate that a product is not the same structurally, 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 and in essences “synthetic” or “synthesized”.
FDA – approved vs. compounded (not FDA – approved)
Route of administration (how the drug enters your body)