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Our position statement on the use of bioidentical (body identical) hormone treatments to improve symptoms and health risks of perimenopause, menopause and hormonal changes in women of all ages
Newson Clinic is the largest provider of women’s hormone health services in the UK, undertaking more than 150,000 consultations to date for perimenopause, menopause, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), PCOS/PMOS and postnatal depression.
Hormone changes can dramatically affect day-to-day life of women, and we offer treatments to reduce unnecessary suffering and improve future health.
Newson Clinic is proud to be rated as ‘Outstanding’ by the Care Quality Commission, the independent regulator of health and adult social care in England.
In addition to providing care and treatment, we undertake a large amount of research and Dr Louise Newson and her research team publish extensively in academic journals and also present their data at national and international conferences.
Most women have symptoms due to hormonal changes that are impacting their daily lives and their future health. Prescribing the right dose and type of hormone treatments relieves symptoms, and also improves future health.
This position statement outlines our approach to the prescribing of bioidentical hormone treatments.
There are other interventions that are important for women, especially with respect to their lifestyle.
Perimenopause is when women have symptoms due to hormonal changes and their periods have not stopped. Perimenopause can start at any age and often lasts for a decade or more until menopause.
Menopause is defined as 12 months after a woman’s last menstrual period. Menopause lasts forever, as regardless of symptoms, the low hormone levels lead to health risks in women who are not prescribed hormone treatments.
Menopause usually occurs between the ages of 45-55, but it can happen at any age. Menopause can also happen following surgery to remove the ovaries or uterus, as a result of cancer treatments, genetics or for unknown reasons.
Symptoms associated with fluctuating and low hormones in perimenopause and menopause include:
Women with low hormone levels have an increased future risk of many diseases, including:
PMS, PMDD, PCOS/PMOS and postnatal depression (PND) are usually caused by hormonal changes and can lead to the same symptoms as perimenopause and menopause.
Symptoms associated with low hormones can have a profound impact on women’s relationships and professional lives, both personally and at work. Hormone treatments can significantly improve these symptoms and improve future health.
Hormones are chemicals that coordinate the various functions of the body: they carry messages through the blood stream to achieve a state of balance, and are essential for life and good health.
Bioidentical hormones are hormones that are manufactured so they are identical to the hormones produced in the body. Older types of manufactured hormones (often known as synthetic hormones) are structurally different to natural hormones, and are associated with both risks and side effects.
In contrast, bioidentical hormones have the same effects on the body as natural hormones, and are not associated with the risks of synthetic hormones.
The three key hormones affected by these conditions are:
When levels of these three key hormones fluctuate and fall, it can lead to symptoms, and also long-term health risks as a result of the body being deficient in these hormones.
The aim of bioidentical hormone treatments is to return levels of estradiol, progesterone, and testosterone to within the normal range in a healthy person to improve both symptoms and future health. The correct dose of hormone treatments is guided by symptom improvement and where appropriate, checking hormone levels in the blood.
Hormone treatments aim to restore hormone levels to ‘physiological’ or normal range. It is not about raising hormone levels higher than the body would ordinarily have.
Estradiol is the most beneficial form of the hormone estrogen.
Synthetic estrogens (used in older types of HRT) slightly increase the risk of endometrial (womb) cancer occurring. To reduce this risk, a type of progesterone is prescribed, as progesterone helps to protect the lining of the womb.
Bioidentical estradiol (that is, estradiol which has been manufactured to have the same molecular structure as estradiol produced in the body) has not been shown to be associated with a risk of endometrial cancer.
Estradiol is available in a number of formulations, including gels and skin patches. This type of treatment is known as transdermal estradiol, as it is absorbed through the skin and enters the bloodstream.
It is important to differentiate between the dose that is administered through the skin and the level of estradiol delivered to the blood. It is the level of estradiol in the blood that is important in achieving symptomatic relief.
The optimal blood estradiol concentration for relief of symptoms and prevention of bone loss has been shown to be 220-550 pmol/L.6
Some women may need higher doses of estradiol above the licensed dose to achieve recommended blood levels to have relief from symptoms.
In 2025, Newson Clinic’s research team published the largest real-world study ever conducted on transdermal estradiol absorption involving 1,508 perimenopausal and postmenopausal women. This research found that one in four of women (25%) using the highest licensed dose of estradiol had subtherapeutic levels of estradiol (<200pmol/l), with patch users being more likely to have low levels.7
Other research has shown up to tenfold differences in estradiol levels in the blood between women using exactly the same dose of the same product.8
At Newson Clinic we advocate optimising the dose of bioidentical estradiol to achieve control of symptoms and improve future health by achieving adequate blood estradiol levels.
At Newson Clinic, we regularly measure blood estradiol levels to ensure they are within the recommended range.
In addition to protecting the lining of the womb from the effects of estrogen, progesterone treatment also:
Micronised progesterone is a bioidentical form of progesterone.
While estradiol has not been shown to be associated with a risk of endometrial cancer, progesterone is prescribed with estradiol to reduce womb thickening and bleeding.
At Newson Clinic we prescribe micronised progesterone, progesterone by pessaries and suppositories (Cylogest) and progesterone cream. All these preparations are bioidentical. We usually avoid the use of synthetic progesterone (known as progestogens) due to their increased risk of blood clots, heart attack, stroke and cancer.
We often prescribe a standard dose of progesterone even when we increase the dose of estradiol to improve absorption to achieve recommended blood levels. Dosing of progesterone is individualised and not dependent on the dose of estradiol or testosterone prescribed.
We do this because the standard dose of progesterone is usually sufficient to provide womb protection for estradiol levels in the recommended range.
We do not usually measure progesterone levels, because they are not an accurate reflection of levels in the body.
In 2025 Newson Clinic’s research team published a study which looked at endometrial (lining of the womb) thickness and outcome in 235 women who had experienced bleeding while taking hormone treatments of estradiol and progesterone. This study found the thickness of the lining of the womb in women with unexpected bleeding on hormone treatments was not linked to the dose of either their estradiol or progesterone. Importantly, there were no cases of endometrial hyperplasia or cancer in this study.9
Levels of testosterone often decline in women in their 30s and continue to decline.
Testosterone is prescribed as bioidentical testosterone via transdermal gels or cream.
Improvements can take a few months, with maximum benefits within three to six–months. In addition to the proven benefits to libido, many studies have shown testosterone can also improve mood.10-14
Nearly all our patients report having low libido and following testosterone treatment often report, in addition to improvements in libido, improvements in mood, energy, motivation and sleep.15
Side effects of testosterone treatment are uncommon, especially if the testosterone blood level is kept within the normal range for women, and any side effects are usually reversible.
At Newson Clinic, we routinely measure testosterone blood levels in our patients.
References:
Balance is a free hormone-health app, founded by Dr Louise Newson, that helps you track symptoms, spot patterns, learn from evidence-based content and prepare for your healthcare appointments.
Winton House, Church Street, Stratford Upon Avon CV37 6HB
Balance is a free hormone-health app, founded by Dr Louise Newson, that helps you track symptoms, spot patterns, learn from evidence-based content and prepare for your healthcare appointments.
Winton House, Church Street, Stratford Upon Avon CV37 6HB
