Subgroup analysesSubgroup analyses by dose of BHT suggested that higher doses of BHT may be associated with more effectiveness but also higher risk of adverse effects .
There was low to moderate quality evidence that BHT in various forms and doses is more effective than placebo for treating moderate to severe menopausal hot flushes .
There was some evidence to suggest that higher doses of BHT are associated with greater effectiveness but also with higher risk of adverse effects .
No data are yet available about the safety of BHT with regard to long-term outcomes such as heart attack , stroke and breast cancer .
BACKGROUND Various hormone therapies ( HT ) are available to treat  menopausal vasomotor symptoms .
Bioidentical hormones are chemically identical to those produced by the human body , and several types are well-tested and available on prescription .
Many women have opted for bioidentical hormone therapy ( BHT ) on the assumption that it is safer than other forms of HT .
We evaluated the evidence .
OBJECTIVES To determine the effectiveness and safety of bioidentical hormones compared to placebo or non-bioidentical hormones for the relief of vasomotor symptoms .
Percutaneous estradiol gel with an intrauterine levonorgestrel releasing device or natural progesterone in hormone replacement therapy.
OBJECTIVE To evaluate the bleeding patterns and clinical compliance associated with postmenopausal amenorrhea-inducing forms of hormone replacement therapy using either percutaneous estradiol-gel and a levonorgestrel-releasing intrauterine device or an oral/vaginal natural progesterone . METHODS Sixty postmenopausal women with an intact uterus were followed over 12 months in this open , non-r and omised , parallel group study . All patients continuously received a gel containing 1.5 mg of estradiol daily . The women were divided into three groups on the basis of progestin administration . Twenty women ( group I ) had a levonorgestrel-releasing device ( LNG-IUD ) inserted at the beginning of the study . Twenty-one women ( group II ) received oral natural micronised progesterone ( oral P ) 100 mg daily during 25 calendar days each month , and 19 women ( group III ) used vaginal natural micronised progesterone ( vaginal P ) 100 - 200 mg daily during 25 calendar days each month ( higher dose if spotting occurred ) . Clinic visits were at 0 , 3 , 6 and 12 months . Bleeding patterns were recorded by the patient in a diary and clinical compliance was evaluated at control visits during the treatment . Symptoms were recorded using a modified Kuppermann index . The serum estradiol concentration was determined at the 0 , 6 and 12 month control visits . RESULTS 80 % ( n = 16 ) of the patients in the LNG-IUD group , 67 % ( n = 14 ) in the oral P group II and 53 % ( n = 10 ) in the vaginal P group were without bleeding at 12 months . Spotting was common during the first 3 months . Symptom relief was good in each group . The LNG-IUD did not cause any serious side-effects . Compliance was good for LNG-IUD and oral progesterone but not for vaginal progesterone . CONCLUSIONS Percutaneous estradiol-gel associated with LNG-IUD is an appropriate method of hormone replacement therapy . The combination of oral natural progesterone with estradiol-gel is also useful , although bleeding episodes complicated the treatment in one third of the patients . The vaginal administration of natural progesterone was impractical due to bleeding disorders
Subgroup analysesSubgroup analyses by dose of BHT suggested that higher doses of BHT may be associated with more effectiveness but also higher risk of adverse effects .
There was low to moderate quality evidence that BHT in various forms and doses is more effective than placebo for treating moderate to severe menopausal hot flushes .
There was some evidence to suggest that higher doses of BHT are associated with greater effectiveness but also with higher risk of adverse effects .
No data are yet available about the safety of BHT with regard to long-term outcomes such as heart attack , stroke and breast cancer .
BACKGROUND Various hormone therapies ( HT ) are available to treat  menopausal vasomotor symptoms .
Bioidentical hormones are chemically identical to those produced by the human body , and several types are well-tested and available on prescription .
Many women have opted for bioidentical hormone therapy ( BHT ) on the assumption that it is safer than other forms of HT .
We evaluated the evidence .
OBJECTIVES To determine the effectiveness and safety of bioidentical hormones compared to placebo or non-bioidentical hormones for the relief of vasomotor symptoms .