Menopause Hormone Therapy (HRT) in St. Louis, MO

Bioidentical hormones in St. Louis: what it means

Behind the label "bioidentical hormone replacement therapy" is a plain idea: a hormone whose structure matches the body's own. Two hormones used in menopause care fit it exactly, estradiol and micronized progesterone. FDA-approved versions of both are sold by prescription at retail pharmacies.

Compounded hormones are a different thing: a pharmacy prepares them for one patient, as a cream, a capsule or a pellet. Compounded drugs are not FDA-approved, so the FDA cannot assure their safety, effectiveness or dose. In the FDA's words, it has no evidence that compounded "bioidentical hormones" are safe and effective. When the National Academies reviewed them in 2020, the evidence was mostly low quality, such as anecdotes and patient reports.

For women in St. Louis, a physician licensed in Missouri can prescribe estradiol (pill, patch, cream or vaginal) and progesterone when they fit your history. There are no pellets. The pharmacy that fills VevaMD prescriptions also compounds, so ask your physician whether yours is an FDA-approved product or compounded. Two options are compounded for certain: testosterone cream for women and Bi-Est are not FDA-approved.

The NPI registry counts 469 OB-GYNs practicing in St. Louis, about 160.0 for every 100,000 residents against 17.8 nationally and above Missouri's 18.5, a higher rate than 99% of the cities VevaMD covers. With about 35,503 women aged 45 to 64 living in St. Louis, that is about 80 for each OB-GYN in the city, before counting any younger patients.

Counting the area around it, 479 OB-GYNs practice in St. Louis or within 10 miles and 627 within 25 miles: 29.5 for every 100,000 of the 2,126,874 people who live within 25 miles, a dense supply. None of this replaces your own OB-GYN or a menopause doctor you trust; VevaMD adds an online route, with a physician licensed in Missouri reviewing your answers from home in St. Louis.

BHRT pellet clinics work differently: they place a hormone pellet under the skin in the office, and compounded pellets are not FDA-approved. The Endocrine Society points to a study that found hormone levels well above the expected range in women using them. ACOG advises FDA-approved hormone therapy over compounded preparations.

Sources: FDA: Menopause · FDA: National Academies study of compounded bioidentical hormones (2020) · Endocrine Society position statement on compounded bioidentical hormones (2019) · ACOG Clinical Consensus No. 6, compounded bioidentical menopausal hormone therapy (2023) · CMS NPPES NPI full file, 2026-10-11