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 17&bgr;-estradiol gel for the treatment of vasomotor symptoms in postmenopausal women
Objective To determine the efficacy and tolerability of two strengths of percutaneous 17&bgr;-estradiol in a hydroalcoholic gel and placebo in controlling vasomotor symptoms of menopause . Design A total of 221 postmenopausal women were assigned r and omly to treatment with percutaneous 17&bgr;-estradiol gel 1.25 g ( containing 0.75 mg of estradiol ) or 2.5 g ( containing 1.5 mg of estradiol ) or placebo gel applied once daily for 12 weeks . The primary efficacy variable was the mean change from baseline in the frequency of moderate/severe hot flushes . In addition , the mean changes from baseline in the frequency and severity of all hot flushes were assessed . Safety and tolerability were evaluated from endometrial biopsy , adverse events , and laboratory tests . Results A significant reduction ( P < 0.05 ) in the mean frequency of moderate-to-severe hot flushes and mean frequency and severity of all hot flushes was observed with both 17&bgr;-estradiol gel groups compared with placebo . The mean number of moderate-to-severe hot flushes at the end of the study with 17&bgr;-estradiol gel 2.5 g , 17&bgr;-estradiol gel 1.25 g , and placebo gel was 2.0 , 2.8 and 5.2 , respectively . The overall incidence of adverse events was not significantly different among groups , though a higher incidence of estrogen-related adverse events was reported with the 17&bgr;-estradiol gel 2.5-g dose . Conclusions 17&bgr;-estradiol gel was effective and well tolerated for alleviating moderate-to-severe hot flushes in postmenopausal women . Therapy may be initiated with the 1.25-g dose with an increase to the 2.5-g dose if needed
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 .