Many women are, quite understandably, leery of taking hormone replacement therapy (HRT), ever since the flap in July 2002 when results from the Women's Health Initiative study were reported. The study found statistically significant increases in rates of breast cancer, coronary heart disease, strokes and pulmonary emboli. Now HRT is usually limited to short-term use of combinations of progestins and equine estrogens that have been approved by the FDA.

A problem has arisen recently with the more widespread use of so-called bio-identical hormone replacement therapy (BHRT). These products are made by compounding pharmacists, who mix the ingredients themselves and sell them, often making exaggerated claims of effectiveness. Sellers of bio-identicals often claim that these "all-natural" pills, creams, lotions, and gels are without the risks of synthetic FDA-approved drugs for menopausal HRT . In fact, they often contain estriol, a weak form of estrogen; FDA has not approved any drug containing estriol.

Some of the marketing claims for BHRT drugs are wildly exaggerated, without any evidence of clinical trials to support them: "A natural, safer alternative to dangerous prescription drugs"; "Can slim you down by reducing hormonal imbalances"; "Prevents Alzheimer's disease and senility". This led the FDA to issue letters to 7 compounding pharmacies stating that their claims about the effectiveness of their BHRT drugs are "unsupported by medical evidence and are considered false and misleading".

If you are using, or considering using, BHRT, I urge you to consult your family doctor or gynecologist, who can give you appropriate advice and a reliable prescription.