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 .
A prospective randomized comparative study of the effects of intranasal and transdermal 17 beta-estradiol on postmenopausal symptoms and vaginal cytology.
CONTEXT Investigating the adverse effects of oral hormone replacement therapy ( HRT ) , the clinical effectiveness of alternative combinations and route of administrations . AIM To compare the effects of intranasal and transdermal 17 beta-estradiol combined with vaginal progesterone on vasomotor symptoms and vaginal cytology . SETTING S AND DESIGN A 12-week , prospect i ve , r and omized comparative study was conducted between July 2005 and September 2006 . MATERIAL S AND METHODS Eighty postmenopausal women aged between 42 - 57 years , who had scores of > or = 1.7 on the menopause rating scale-I ( MRS-I ) items " 1 - 6 " , were r and omly assigned to receive intranasal ( 300 microg/day , n = 40 ) or transdermal ( 50 microg/day , n = 40 ) 17 beta-estradiol continuously . All patients also received a vaginal progesterone gel twice weekly . Vasomotor symptoms were evaluated at weeks 0 , 4 , 8 and 12 . Vaginal maturation index ( VMI ) was evaluated at weeks 0 and 12 of the study . STATISTICAL ANALYSES The Mann-Whitney U and the Wilcoxon tests were used . P < 0.05 was regarded as significant . RESULTS Thirty-two women in the intranasal and 29 women in the transdermal group completed the study . The total score of the MRS , the sum-scores of Factor 1 " HOT FLUSHES " and Factor 2 " PSYCHE " significantly decreased in both groups at week 4 . Factor 3 " ATROPHY " scores significantly decreased only in the transdermal group at week 12 . The VMI showed no changes within and between the two groups at the end of the study . CONCLUSION Intranasal and transdermal 17beta-estradiol combined with vaginal progesterone gel as a continuous HRT caused a similar decrease in vasomotor symptoms but did not have any significant effect on VMI after 12 weeks of treatment in this study population
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 .