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 .
Low-Dose Estradiol Spray to Treat Vasomotor Symptoms: A Randomized Controlled Trial
OBJECTIVE : To investigate the safety and efficacy of a transdermal estradiol ( E2 ) spray in women with postmenopausal vasomotor symptoms . METHOD : A r and omized , double-blind , placebo-controlled , multicenter , parallel-group clinical trial was conducted . Postmenopausal women ( N=454 ) with at least eight moderate-to-severe hot flushes per day applied daily , one , two , or three E2 ( 90 microliter spray contains 1.53 mg E2 ) or matching placebo sprays .  The primary efficacy endpoints were mean change from baseline in frequency and severity of moderate-to-severe hot flushes at weeks 4 and 12 . RESULTS : All three E2 groups showed a significant decrease in hot flushes at weeks 4 and 12 compared with their placebo groups ( P<.010 ) . The mean change in frequency at week 12 was eight fewer flushes per day for women in the E2 groups and between four and six fewer flushes for women in the placebo groups . Women in the three- and two-E2 spray groups demonstrated significant ( P<.050 ) reductions in severity score at weeks 4 and 12 ; women in the one-spray group showed significant reductions at week 5 . At week 12 , the majority ( 74–85 % ) of women on E2 showed at least a 50 % hot flush frequency reduction as compared with 46 % in the placebo group . The systemic E2 delivery rates at week 12 were approximately 0.021 mg/d , 0.029 mg/d , and 0.040 mg/d for the one- , two- , and three-spray doses , respectively . Common adverse events were similar to those previously reported with other transdermal products . Treatment-related application site reaction rate was similar to placebo ( 1.3 % compared with 1.8 % ) . CONCLUSION : The three dose levels of E2 spray achieved efficacy at 0.021–0.040 mg/d delivery rates . The spray is a well-tolerated , new , convenient method of delivering low-dose E2 transdermally . Clinical Trial Registration : Clinical Trials.gov , www . clinical trials.gov , NCT00122200 LEVEL OF EVIDENCE :
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 .