Menopausal hormone therapy (MHT) is the gold standard for treating menopause-related symptoms. Symptoms include low libido, weakening muscle mass, insomnia, hot flashes, vaginal dryness, cardiovascular aging, brain health, and bone loss. However new research highlights a significant problem—many women do not properly absorb standard estrogen therapies. Poor absorption leads to inadequate hormone blood levels and ineffective relief. Compounded and bioidentical estrogen formulations offer a necessary alternative.
The Problem: Poor Absorption of Standard Estrogen Formulas
Early research presumed the average women would respond predictably to transdermal estrogen in the form of patches, gels, or sprays. However, the study by Glynne et al. in Menopause—demonstrates that at least 25% of women do not adequately absorb estradiol from these common formulations. A substantial number of women may be using MHT without achieving the necessary estrogen levels for symptom relief.
Poor absorption of estrogen is not simply a matter of incorrect patch or gel application. Even when applied correctly, factors such as genetics, gut microbiome composition, skin characteristics, and metabolism influence how much estrogen reaches the bloodstream. “Poor hormone absorbers,” consistently fail to achieve the recommended serum estradiol levels needed to relieve symptoms and prevent bone loss.
The Consequences of Insufficient Estrogen Absorption
Standard guidelines recommend serum estradiol levels should reach at least 60 pg/L to alleviate menopausal symptoms (Rabe et al., 2021). In poor absorbers, estrogen levels remain below this threshold, rendering treatment ineffective. With BioTE therapy we look at levels of estradiol, but monitor the SHBG and FSH for the most effective free circulating hormone.
Even worse, without monitoring hormone blood levels the problem goes undetected. Women using standard MHT might assume they are receiving an adequate dose, while in reality, their body is not absorbing enough estrogen to provide benefits. This can lead to persistent symptoms, worsening osteoporosis, and increased cardiovascular risk despite adherence to prescribed therapy.
Why Compounded and Bioidentical Estrogen is a Solution
For women who fall into this category, compounded and bioidentical estrogen formulations offer a personalized solution. Unlike mass-produced patches or gels that deliver a one-size-fits-all approach, compounded estrogen can be tailored to a woman’s unique absorption ability, metabolic rate, and symptom profile.
Key advantages of compounded and bioidentical estrogen include:
- Custom Dosing – Higher or alternative doses can be formulated based on individual absorption levels, ensuring that each woman reaches a therapeutically effective estradiol concentration.
- Alternative Delivery Methods – Some women who don’t absorb transdermal estrogen well may respond better to sublingual, intravaginal, implanted pellets or oral micronized estrogen formulations.
- Improved Symptom Relief – By tailoring hormone therapy to each woman’s needs, symptoms like hot flashes, insomnia, and vaginal dryness can be more effectively treated.
- Potentially Safer Adjustments – Standardized MHT formulations may not always allow for fine-tuning. Compounded estrogen offers a way to increase absorption without unnecessarily increasing exposure to higher-than-needed systemic estrogen levels.
- Testosterone – By tailoring hormone therapy to each woman’s needs, symptoms like hot flashes, insomnia, and vaginal dryness can be more effectively treated. Testosterone metabolism contributes to estrogen levels.
Identifying Who Needs Personalized Estrogen Therapy
Not every woman requires a customized approach, we advise consideration of all alternatives. And, for those who do not respond to standard MHT, a tailored solution is essential. The recent study in Menopause suggests identifying poor absorbers through routine serum estradiol monitoring could be key to ensuring that every woman receives effective treatment (Glynne et al., 2024).
If you’re using estrogen therapy but still experiencing menopausal symptoms, you might be one of the many women who cannot properly absorb standard transdermal formulations. Talk to your healthcare provider about testing your serum estradiol levels and exploring alternative options like compounded bioidentical hormone therapy.
As more research emerges, it is becoming clear that one-size-fits-all hormone therapy does not work for everyone. Fortunately, personalized, bioidentical, and compounded formulations provide a safe and effective path forward for those who need it.
References
- Glynne, et al. (2024). “Poor Absorption of Transdermal Estrogen in Menopausal Hormone Therapy: A Growing Concern.” Menopause, 31(2), 102-110.
