HRT Troches for Menopause: What They Are, What the Evidence Shows and What to Ask

By The HRT Index Editorial Team · Editorial research — not medically reviewed · Last updated November 2, 2026 · Last verified November 2, 2026

HRT troches for menopause are compounded lozenges, usually estradiol, progesterone or a hormone mix, that dissolve in your mouth. No troche is FDA-approved, absorption varies from woman to woman, and The Menopause Society, ACOG and the National Academies all favor FDA-approved hormone therapy unless you have a documented reason, such as an ingredient allergy.

The HRT Index is the independent decision resource for online menopause and HRT care — comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated, so women can choose the path that fits their situation before their first consult.

What we actually verified · Last verified November 2026

• What we read: the FDA's consumer page on menopause and its compounding questions and answers; The Menopause Society's 2022 hormone therapy position statement; ACOG's patient FAQ on hormone therapy and the abstract of its 2023 Clinical Consensus on compounded bioidentical hormones; the National Academies of Sciences, Engineering, and Medicine (NASEM) 2020 report on compounded bioidentical hormone therapy (its highlights, recommendations and chapters on dosage forms, absorption and safety); the Australasian Menopause Society's information sheet and fact sheet on compounded hormones; the FDA labels for Prometrium (micronized progesterone), Bijuva (estradiol and progesterone) and Depo-Testosterone; the FDA's February 2026 announcement on hormone therapy label changes; the 2019 Global Consensus Position Statement on testosterone for women and a March 2025 VA clinical summary on testosterone for women; a 2003 study of hormone troches in postmenopausal women; a 1997 study of under-the-tongue estradiol; and a 2007 report of three endometrial cancers in women using compounded hormones, mostly as troches. Every source is listed at the bottom with the date we read it.
• What we did not do: we did not test any troche, examine anyone, check anyone's hormone levels or speak with a clinician or pharmacist for this page. We did not verify current prices for compounded troches, so we don't quote any. This is editorial research, not medical review, and not advice for your situation.
• Commercial interest: The HRT Index may earn a commission from some providers featured through The HRT Index's Find My HRT Path tool. No provider paid for this page, and no provider reviewed it. See our affiliate disclosure.
• Verification Standard: we judge online menopause care on five pillars, in this order: clinical legitimacy, care quality, medication fit, price transparency and access. Our methodology explains how.

Jump to: Quick answer · What a troche is · FDA status · How troches are absorbed · Progesterone troches and your uterus · What experts say · When compounding may fit · Troches vs FDA-approved options · Biest and testosterone troches · Safety · Cost and insurance · Already using troches? · Questions to ask · Online care · FAQ · Sources

HRT troches for menopause: the quick answer for your situation

A troche can deliver hormones, but you're trading a regulated, labeled product for a custom one whose strength and absorption haven't been tested the way FDA-approved products are. The table below sums up what the sources on this page say. It's a starting point for a talk with your clinician, not a decision.

Bottom line for most women: troches are a compounded, custom-made route. The main expert groups we read favor FDA-approved hormone therapy and reserve compounding for documented needs. The biggest risk to ask about is whether a progesterone troche is enough to protect your uterus.

The right online menopause care isn't the same for every woman — it depends on your symptoms, what you've already tried, your age, your state and your health history. Some situations belong with an in-person clinician first. Use The HRT Index's Find My HRT Path tool to explore a featured care option for your situation — and to flag when online care isn't the right starting point — before your first consult.

Find My HRT Path is free, takes about 60 seconds and doesn't ask for your email. It asks five quick questions about your symptoms, what you've already tried, your age, your state and your health history. It isn't an eligibility test, a diagnosis or a prescription decision, and it won't choose a hormone or a route like troches for you.

What is an HRT troche?

An HRT troche (pronounced "TRO-key") is a small lozenge made by a compounding pharmacy that you hold in your mouth until it dissolves. The hormones are meant to pass through the lining of the mouth into your bloodstream. Troches for menopause usually contain estradiol, progesterone or a mix of hormones, sometimes with testosterone or DHEA.

A few terms you'll see:

• Compounded: made to order by a pharmacist from a prescription, rather than manufactured as a finished, FDA-approved product. ACOG's patient FAQ puts it simply: "A compounded drug is made by a compounding pharmacist using a health care professional's prescription."
• Bioidentical: a hormone with the same chemical structure as the one your body makes. This word describes the molecule, not the product's approval. The Menopause Society notes that "the term bioidentical hormone therapy (similar to endogenous) can be misleading because there are both government-approved and compounded bioidentical hormone therapies." Estradiol and micronized progesterone are bioidentical and are available in FDA-approved products. See FDA-approved bioidentical hormones.
• Buccal and sublingual: buccal means absorbed through the inside of the cheek; sublingual means absorbed under the tongue. The 2003 troche study below used the buccal (cheek) route.
• Biest and triest: compounded estrogen blends. Biest usually means estradiol plus estriol; triest adds estrone.

What's inside varies by prescription. In the published research we read, the troches were multi-hormone mixes. In one 2003 study, each troche contained estradiol (0.5 mg), progesterone (200 mg), testosterone (2.0 mg) and DHEA (10 mg). In a 2007 case report, one woman's troche contained estradiol 1.75 mg, progesterone 300 mg, testosterone 4.5 mg and DHEA 5 mg. Those are examples from research, not typical or recommended doses.

The National Academies' 2020 report compared dosage forms side by side. Under oral FDA-approved bioidentical products it lists only capsules and tablets. "Troche and mini troche" appear only in the compounded column, alongside buccal tablets, soft linguets and sublingual drops. The same chapter counts "at least 13 different cBHT progesterone dosage forms," including a lozenge, compared with four FDA-approved progesterone dosage forms.

Are HRT troches FDA-approved?

No. HRT troches are compounded, and the FDA says plainly that "compounded drugs are not FDA-approved. This means that FDA does not verify the safety, effectiveness or quality of compounded drugs before they are marketed." The hormones inside a troche may be the same molecules found in approved products, but the finished troche has not been reviewed.

What the FDA tells women directly, on its menopause page:

• "FDA recommends that women use hormone therapies that are FDA-approved. FDA-approved hormone therapies are evaluated for safety and effectiveness."
• "Many marketed products that are called 'bioidentical hormones' are compounded drugs, which are not FDA-approved. FDA does not have evidence that compounded 'bioidentical hormones' are safe and effective, or safer or more effective than FDA-approved hormone therapy."
• On estriol, an ingredient in biest and triest: "There are no FDA-approved drugs containing estriol."

That matters in three practical ways:

1. No standard label. FDA-approved hormone products come with prescribing information that spells out risks, warnings and dosing. The Menopause Society lists "lack of a label outlining risks" among its safety concerns about compounded hormones.
2. No proof the dose is consistent. ACOG's patient FAQ says customized compounded hormones "vary in strength and purity. That means you can take too little or too much of a hormone without knowing it."
3. "Same ingredient" isn't "same product." A troche containing estradiol is not an FDA-approved estradiol product, even though the molecule is the same. How much reaches your blood depends on the formulation, and that's what hasn't been tested. Read more in is bioidentical HRT FDA-approved? and compounded vs FDA-approved HRT.

Compounding isn't illegal or always wrong. The FDA notes that clinicians sometimes use compounded drugs "when an FDA-approved drug is not medically appropriate," and that "in these situations, compounding can serve an important patient need." The question is whether you have that kind of need.

How troches are absorbed, and why the dose is hard to predict

Hormones from a troche are absorbed through the lining of the mouth quickly, which can produce a fast peak in blood levels followed by a drop. Small studies show the hormones do get in, but they also show large differences between women, and no large trial has tested troches for safety or for how well they treat hot flashes.

What the research shows:

What that can mean in daily life:

• Peaks and dips. A fast rise and fall is the opposite of what a patch, gel or spray is designed to deliver. Some women may notice symptoms returning between doses. A symptom diary helps your clinician judge whether the route is working.
• Testing doesn't fix the uncertainty. Troches are often paired with saliva or urine testing. The Menopause Society says using serum, saliva or urine hormone testing to guide hormone therapy dosing "is considered unreliable because of differences in hormone pharmacokinetics and absorption, diurnal variation, and interindividual and intraindividual variability." Its key point: "Salivary and urine hormone testing to determine dosing are unreliable and not recommended. Serum hormone testing is rarely needed." Our DUTCH test review covers this in detail.
• Batch-to-batch variation. NASEM recommended that the core menopause hormones, including estradiol and progesterone, be reviewed as candidates for the FDA's Difficult to Compound List, citing "the lack of bioavailability data and product-to-product variability as a result of drug formulation differences, stability, and quality control."

The observational studies of compounded hormones that NASEM reviewed, including some that used under-the-tongue products, reported symptom improvements, but the committee flagged problems such as "the absence of randomization and use of participant-specific dosing regimens with no control group for comparison." In other words, they can't show troches work as well as, or as safely as, approved therapy.

Progesterone troches and your uterus: the risk to ask about first

If you have a uterus and use estrogen, you need enough progestogen (progesterone or a progestin) to protect the uterine lining from overgrowth and cancer. FDA-approved micronized progesterone capsules have been tested for this job. Compounded progesterone troches have not, and medical societies and case reports have raised concerns that they may not reliably protect the lining.

Why it matters: The Menopause Society says "chronic unopposed endometrial exposure to estrogen increases the risk for endometrial hyperplasia or cancer," and that "women with an intact uterus using systemic ET should receive adequate progestogen" (unless they take a specific combination of conjugated estrogens with bazedoxifene). The word "adequate" carries the weight. The statement adds that progestogen dosing that provides endometrial safety depends "on the potency of the progestogen" and varies "with the estrogen dose."

What the sources say about troches specifically:

• The Australasian Menopause Society says compounded progesterone delivery "both by transdermal and troche route, have been reported to be inadequate for endometrial protection when administered in combination with oestrogen, leading to endometrial cancer." It adds: "delivery of progesterone in sufficient therapeutic doses is the important issue, and neither troche nor transdermal therapy does this reliably."
• A 2007 case report in the Medical Journal of Australia described three women who developed endometrial cancer after using compounded "bioidentical" hormones. All three had used troches; one had earlier used a compounded progesterone cream as well. The authors wrote that the cases "raise the possibility that the oestrogen component of the troche was significantly absorbed but the dose of progesterone was inadequate." Three cases can't prove cause, and one author disclosed consulting for drug companies, but the report is why many clinicians ask about uterine protection first.
• The 2003 troche study measured blood levels only. It didn't check whether the uterine lining was protected.

What an approved option looks like: the Prometrium label lists use "in the prevention of endometrial hyperplasia in nonhysterectomized postmenopausal women who are receiving conjugated estrogens tablets," taken as "a single daily dose at bedtime." Bijuva, an FDA-approved capsule with estradiol and progesterone together, is indicated "in a woman with a uterus for the treatment of moderate to severe vasomotor symptoms due to menopause." Your clinician decides which progestogen, dose and schedule fit you.

Unexpected bleeding on any hormone therapy needs to be checked. In the 2007 report, the women's cancers came to light after abnormal bleeding. If you've had a hysterectomy, this particular risk doesn't apply to you.

See do you need progesterone if you have a uterus?, HRT and endometrial cancer risk, progesterone for menopause and HRT after hysterectomy.

What The Menopause Society, ACOG, the FDA and NASEM say about compounded troches

Every major source we read reaches the same conclusion: FDA-approved hormone therapy is preferred, and compounded hormones, including troches, should be reserved for specific documented needs. None of them bans compounding outright.

The Menopause Society's list of safety concerns is worth reading in full: "minimal government regulation and monitoring, overdosing and underdosing, presence of impurities and lack of sterility, lack of scientific efficacy and safety data, and lack of a label outlining risks."

How common is compounded hormone therapy? NASEM's report highlights estimate that compounded hormone formulations "account for an estimated 26 to 33 million prescriptions and cost upwards of $2 billion annually." Those figures cover all compounded hormones, not just troches.

When could a compounded troche reasonably be considered?

Expert guidance leaves a narrow door open: an allergy to an ingredient in an FDA-approved product, or a documented need for a dose or form that approved products don't offer. Preference alone, a "natural" label or a saliva test result isn't enough, according to The Menopause Society and NASEM.

The Menopause Society's wording: "Prescribers should only consider compounded hormone therapy if women cannot tolerate a government-approved therapy for reasons such as allergies to ingredients in a government-approved hormone therapy formulation or for a dose or formulation not currently available in government-approved therapies." It adds that prescribers "should document the medical indication for a compounded bioidentical hormone over government-approved therapies."

A real-world example: the Prometrium label says the capsules "contain peanut oil and is contraindicated in patients allergic to peanuts." A woman with a peanut allergy and a uterus may need a different progesterone source. That's the kind of situation where compounding can come up. Even then, it's fair to ask whether a non-peanut FDA-approved progestogen would work, and whether the compounded form has to be a troche rather than another form.

If compounding is chosen, NASEM recommends that:

• the dose should generally not exceed the strength of FDA-approved products;
• prescribers and pharmacists "should clearly explain the limited evidence-based information" and "inform patients that compounded preparations are not FDA-approved";
• use should come with "documentation of shared decision making and rigorous monitoring for long-term risks."

NASEM also recommended that compounding pharmacies give patients a standardized insert listing all ingredients and noting that the preparation "has not been FDA-approved," and that compounded estrogen and testosterone carry boxed warnings like approved products. Those are recommendations, not current requirements everywhere, so ask your pharmacy for a written ingredient and strength list.

Self-check before you agree to troches. If you answer "no" to all of these, ask your clinician why an FDA-approved option isn't the first step:

• Do I have a documented allergy to an ingredient in the approved products I'd otherwise use?
• Have I tried approved options (pill, patch, gel, spray or ring) and had a specific problem a troche would solve?
• Has my clinician explained, in writing, why a troche is medically needed for me?

HRT troches vs FDA-approved hormone options

FDA-approved estradiol and progesterone come in several forms, and many are the same bioidentical hormones found in troches. The table compares a compounded troche with the approved options, using the FDA labels, The Menopause Society's 2022 statement and ACOG's guidance.

The Menopause Society's 2022 statement lists the systemic routes for hot flashes: "systemic estrogens can be prescribed as oral drugs; transdermal patches, sprays, and gels; or as vaginal rings." Troches aren't among them. If what draws you to troches is wanting "bioidentical" hormones, FDA-approved estradiol plus micronized progesterone gives you bioidentical hormones in tested products. If it's avoiding a daily pill, a patch or ring may cover that.

Read more in types of HRT, HRT injections for menopause and are hormone pellets safe?, which cover other less common routes.

Biest troches and testosterone troches

Biest troches contain estriol, which isn't in any FDA-approved product in the US, and testosterone troches put a hormone with no FDA-approved product for women into a compounded form that the leading testosterone guidance advises against. Both add uncertainty on top of the troche route itself.

Biest and triest. The FDA says it "does not have evidence that drugs containing estriol are safe and effective, or are 'safer forms of estrogen.'" Estriol is often marketed as a gentler estrogen, but that claim isn't supported by the FDA. If a biest troche contains estradiol, the estradiol part still stimulates the uterine lining, so the progestogen question above still applies. See biest vs estradiol and biest cream for menopause.

Testosterone. The 2019 Global Consensus Position Statement on testosterone for women says: "Compounded 'bioidentical' testosterone therapy cannot be recommended for the treatment of HSDD because of the lack of evidence for efficacy and safety, unless an authorized equivalent preparation is not available," and "the panel recommended against the use of compounded testosterone." Its only evidence-based use for testosterone in women is low sexual desire that causes distress (hypoactive sexual desire disorder, or HSDD), and it says oral testosterone "is associated with adverse lipid profiles" and "is not recommended." A March 2025 VA clinical summary states: "There are no FDA approved testosterone products indicated for use in women in the U.S." Testosterone is a Schedule III controlled substance in the US (the Depo-Testosterone label is marked CIII) and needs a prescription. See testosterone therapy without injections, is compounded testosterone safe for women? and is there an FDA-approved testosterone for women?.

DHEA. DHEA often appears in multi-hormone troches. NASEM included DHEA among the hormones it reviewed and found insufficient evidence for compounded hormone use overall. The Menopause Society notes that vaginal DHEA has been "FDA approved for treatment of moderate to severe dyspareunia" (painful sex) due to menopause. That's a vaginal product for a vaginal symptom, not a troche.

Safety: who shouldn't use hormone troches

A troche doesn't sidestep the usual reasons estrogen or progesterone may not be safe. The difference is that a compounded troche may come without the FDA label that lists those risks, so you need to ask about them directly.

The Prometrium label, for example, lists these contraindications for progesterone: allergy to its ingredients (including peanut oil), "abnormal genital bleeding of unknown etiology," "known, suspected, or history of breast cancer," active or past blood clots in the legs or lungs, stroke or heart attack, and liver disease, among others. Estrogen products carry similar lists. Our guides to who should not take HRT and HRT contraindications cover them in detail.

Labels are changing. In February 2026 the FDA announced label changes for several menopausal hormone therapy products that removed some boxed warning statements, and the current Bijuva label notes that its boxed warning was removed in February 2026. Compounded troches don't have FDA labels, so these changes don't tell you anything about a troche. Our FDA HRT label change tracker follows which approved products have changed.

Watch for these and get prompt care:

• Unexpected or heavy vaginal bleeding, especially if you have a uterus
• Pain, swelling or redness in one leg, sudden shortness of breath or chest pain
• Sudden severe headache, vision or speech changes, or weakness on one side
• A new breast lump

Call 911 for signs of a stroke, heart attack or a blood clot in the lungs. See also HRT side effects and is compounded HRT safe?.

What do HRT troches cost, and does insurance cover them?

We didn't verify current prices for compounded troches, so we don't quote any. Prices depend on the pharmacy, the hormones and the strengths in your prescription, and compounded products are often cash-pay. Many FDA-approved estrogen and progesterone products have generic versions that insurance plans may cover.

An unknown cost isn't zero, so a total missing any of these pieces is incomplete. See bioidentical hormone therapy cost, does insurance cover compounded hormones?, cheapest progesterone without insurance and estradiol cost without insurance.

Already using HRT troches? What to do next

If troches are working for you, there's no need to panic, and you shouldn't stop or change them on your own. Any change is best planned with your prescriber. What you can do is check a few things with your prescriber so you know your uterus is protected and you understand what you're taking.

1. Get the exact ingredient list. Ask the pharmacy for every hormone and its strength in milligrams.
2. Ask about your uterus. If you have one and your troche contains estrogen, ask how you know the progesterone dose is protecting the lining, and what monitoring your clinician recommends. The authors of the 2007 case report suggested endometrial surveillance for women who continue compounded hormones after counseling.
3. Report bleeding. Tell your clinician about any spotting or bleeding that wasn't expected.
4. Ask about an approved alternative. Ask whether FDA-approved estradiol and micronized progesterone, or a combination capsule, would fit you, and how a switch would be managed.
5. Keep a symptom diary. Note hot flashes, sleep and mood through the day, which helps show whether levels dip between doses.

See compounded HRT safety and how to get bioidentical hormones online.

Questions to ask your clinician about HRT troches for menopause

Bring these to your appointment, and talk with your clinician about how they apply to you:

1. Why are you recommending a troche instead of an FDA-approved pill, patch, gel, spray or ring?
2. Is there a documented medical reason, such as an allergy, that rules out approved products for me?
3. Exactly which hormones and how many milligrams of each are in my troche?
4. I have a uterus. How do we know the progesterone in this troche protects my uterine lining? Would FDA-approved micronized progesterone be better?
5. What monitoring will I have, and what should I do if I have bleeding?
6. Are you basing my dose on saliva or urine tests? The Menopause Society says those aren't reliable for dosing.
7. Does my troche contain testosterone, DHEA or estriol, and why?
8. Do you or your practice have a financial relationship with the compounding pharmacy? (NASEM recommended that such conflicts be disclosed to patients.)
9. What will this cost each month, including tests and visits, and would insurance cover an approved alternative?
10. How will we decide whether to continue, lower or stop treatment?

Can online menopause care help if you're considering troches?

Online menopause care can help you compare hormone options and find an FDA-approved route that fits, which many women can use at home. Some services lead with compounded products, so it's worth checking what a service offers before you sign up. Here's how our five pillars apply:

• Clinical legitimacy: a licensed clinician should take a full history, including your uterus status, allergies and clot, heart and cancer history, before prescribing.
• Care quality: look for a service that explains FDA-approved options first and tells you why if it suggests a compounded product.
• Medication fit: the service should offer FDA-approved estradiol in several forms, micronized progesterone if you have a uterus, vaginal estrogen and nonhormonal options. Be cautious if a service leads with troches, pellets or saliva testing.
• Price transparency: you should know what visits, medication, tests and refills cost before you start.
• Access: check that the service operates in your state and can arrange any monitoring you need.

See is online HRT safe?, best FDA-approved HRT providers online and nonhormonal options if hormones aren't right for you.

If you're weighing troches against approved options and aren't sure what kind of care fits, start here.

Frequently asked questions

Are HRT troches for menopause FDA-approved?

No. Troches are compounded by a pharmacy for each prescription, and the FDA says compounded drugs are not FDA-approved. The hormones in them, like estradiol and progesterone, are also available in FDA-approved products.

Do hormone troches work for hot flashes?

Small studies show hormones from troches are absorbed, but no large controlled trial has tested troches for hot flashes. The National Academies found insufficient evidence to support compounded hormone therapy overall. By contrast, The Menopause Society reports that estrogen therapy, with or without a progestogen, reduced weekly hot flash frequency by 75% compared with placebo in trials.

Are progesterone troches enough to protect my uterus?

That hasn't been shown. The Australasian Menopause Society says neither troche nor transdermal progesterone delivers protective doses reliably, and a 2007 report described endometrial cancers in women using compounded troches. FDA-approved micronized progesterone is labeled to prevent endometrial hyperplasia.

Are bioidentical troches safer than regular HRT?

There's no evidence they are. ACOG says there is "no scientific evidence that compounded hormones are safer or more effective than standard hormone therapy," and the FDA says the same about compounded "bioidentical hormones." FDA-approved bioidentical estradiol and progesterone are available.

What's the difference between a troche and a sublingual tablet?

Both dissolve in the mouth. A troche is a lozenge held against the cheek or under the tongue, and a sublingual tablet goes under the tongue. In hormone therapy, both are typically compounded. No FDA-approved menopause hormone product we found comes as a troche.

Can a saliva test tell me the right troche dose?

No. The Menopause Society says salivary and urine hormone testing to set dosing is unreliable and not recommended, and that serum testing is rarely needed. It recommends "the appropriate, often lowest, effective dose" of estrogen consistent with your treatment goals.

Is a testosterone troche OK for women?

It isn't recommended. No US testosterone product is approved for women, and the 2019 Global Consensus recommended against compounded testosterone. For low sexual desire that causes distress, it says off-label use of an approved male formulation is reasonable if levels stay in the physiologic female range.

When might my clinician prescribe a troche?

The Menopause Society and NASEM say compounded hormones could be considered for a documented allergy to an ingredient in an approved product, or a needed dose or form that isn't available. Preference alone isn't enough.

Can Find My HRT Path tell me if troches are right for me?

No. Find My HRT Path asks about your symptoms, what you've tried, your age, your state and your health history to suggest a care option. It doesn't choose a hormone, a route or a dose. A clinician who knows your history does that.

The bottom line

HRT troches for menopause are compounded lozenges that dissolve in your mouth. They aren't FDA-approved, their strength and absorption can vary, and the main expert groups, including The Menopause Society, ACOG, the FDA and the National Academies, favor FDA-approved hormone therapy unless you have a documented reason like an ingredient allergy. The biggest question is uterine protection: if you have a uterus, a progesterone troche hasn't been shown to protect the lining the way FDA-approved micronized progesterone does. If you've been offered troches, ask why, ask what's in them, and ask what approved options would give you the same bioidentical hormones.

If you're still sorting out which hormones, which route and which kind of care fit, Find My HRT Path can point you to a starting option and flag when in-person care should come first.

Related reading

• Compounded vs FDA-approved HRT
• Is bioidentical HRT FDA-approved?
• FDA-approved bioidentical hormones
• Bioidentical hormone therapy cost
• Do you need progesterone if you have a uterus?
• HRT and endometrial cancer risk
• Biest vs estradiol
• Types of HRT

Sources

All sources were read on November 2, 2026.

1. US Food and Drug Administration. Menopause (Women's Health Topics). Content current as of December 14, 2023. https://www.fda.gov/consumers/womens-health-topics/menopause
2. US Food and Drug Administration. Compounding and the FDA: Questions and Answers. Content current as of September 16, 2025. https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers
3. The 2022 hormone therapy position statement of The North American Menopause Society (The Menopause Society). Menopause, 2022;29(7):767–794. https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf
4. American College of Obstetricians and Gynecologists. Hormone therapy for menopause (FAQ517). Last updated October 2021, last reviewed February 2024. https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause
5. American College of Obstetricians and Gynecologists. Compounded bioidentical menopausal hormone therapy. Clinical Consensus Number 6, November 2023, reaffirmed 2026 (abstract). https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/11/compounded-bioidentical-menopausal-hormone-therapy
6. National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Report Highlights, July 2020. https://nap.nationalacademies.org/resource/25791/cBHT Consensus Study Report Highlights.pdf
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8. National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy (2020), Chapter 5: Compounded Bioidentical Hormone Preparations. https://nap.nationalacademies.org/read/25791/chapter/7
9. National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy (2020), Chapter 6: Bioavailability of Compounded Bioidentical Hormone Therapy Preparations. https://nap.nationalacademies.org/read/25791/chapter/8
10. National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy (2020), Chapter 7: The Safety and Effectiveness of Compounded Bioidentical Hormone Therapy. https://nap.nationalacademies.org/read/25791/chapter/9
11. Australasian Menopause Society. Bioidentical custom compounded hormone therapy (information sheet). https://hub.menopause.org.au/Play?pId=677e7630-9fc8-40c4-9ba9-66d4c015ed93
12. Australasian Menopause Society. Bioidentical hormone therapy (fact sheet). https://www.menopause.org.au/health-info/fact-sheets/bioidentical-hormone-therapy
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16. Prometrium (progesterone, USP) capsules prescribing information, Acertis Pharmaceuticals, label dated July 23, 2026. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1cf237ff-c4f8-4faa-a7aa-77599c856889
17. Bijuva (estradiol and progesterone) capsules prescribing information, Mayne Pharma, label dated September 29, 2026. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=59eadb88-c9f3-4871-b176-7ddd98faf9bc
18. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the use of testosterone therapy for women. Journal of Clinical Endocrinology & Metabolism, 2019;104(10):4660–4666. https://pmc.ncbi.nlm.nih.gov/articles/PMC6821450/
19. US Food and Drug Administration. FDA approves labeling changes to menopausal hormone therapy products. Press announcement, February 12, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-labeling-changes-menopausal-hormone-therapy-products
20. Depo-Testosterone (testosterone cypionate injection, USP, CIII) prescribing information, Pharmacia & Upjohn, label dated August 20, 2026. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cfbb53d4-b868-4a28-8436-f9112eb01c39
21. VA Pharmacy Benefits Management Services and National Formulary Committee. Transdermal testosterone (off-label) for hypoactive sexual desire disorder in postmenopausal females: summary guidance. March 2025. https://www.va.gov/formularyadvisor/DOC_PDF/CRE_Testosterone_HSDD_Clinical_Summary_Mar_2025.pdf

This page is for education only and is not medical advice. It doesn't replace an examination, diagnosis or treatment plan from a clinician who knows your health history. Don't start, stop or change any hormone treatment without talking with your clinician. If you have chest pain, sudden shortness of breath, sudden severe headache, vision or speech changes, or a painful swollen leg, call 911.