Menopause Hormone Therapy (HRT) in Winston-Salem, NC

Bioidentical hormones in Winston-Salem: what it means

"Bioidentical" is a word compounding pharmacies often use in marketing, but what it describes is real: a hormone built like the body's own. Estradiol and micronized progesterone are both bioidentical: their structure matches the hormones the ovaries make. Both come in FDA-approved prescription forms, from estradiol pills, patches, gels and vaginal forms to progesterone capsules.

"BHRT" often means compounded hormones, a cream, a blend such as Bi-Est or a pellet that a pharmacy mixes for one prescription. Compounded drugs are not FDA-approved, so the FDA cannot assure their safety, effectiveness or dose. The FDA says it has no evidence that compounded "bioidentical hormones" are safe and effective, or more effective than FDA-approved hormone therapy. When the National Academies reviewed them in 2020, the evidence was mostly low quality, such as anecdotes and patient reports.

Winston-Salem is a center for OB-GYN care: the federal NPI registry lists 134 OB-GYNs with a primary practice address in the city, 53.4 per 100,000 residents, 3.0 times the US rate of 17.8 and above North Carolina's 18.9. That is more per resident than 87% of the 924 cities VevaMD covers. That is about 240 women aged 45 to 64 for each OB-GYN in the city, a ratio rather than a count of open appointments.

Within 25 miles of Winston-Salem there are 231 OB-GYNs for 952,645 residents (24.2 per 100,000), well above the national rate; 136 are in the city or within 10 miles. None of this replaces your own OB-GYN or a menopause doctor you trust; VevaMD adds an online route, with a physician licensed in North Carolina reviewing your answers from home in Winston-Salem.

For women in Winston-Salem, a physician licensed in North Carolina can prescribe estradiol (pill, patch, cream or vaginal) and progesterone when they fit your history. VevaMD does not offer pellets. The pharmacy that fills VevaMD prescriptions also compounds, so ask your physician whether yours is an FDA-approved product or compounded. Testosterone cream for women and Bi-Est are compounded and not FDA-approved.

Then there are pellets, implanted under the skin at a clinic; compounded pellets are not FDA-approved. The Endocrine Society cites blood levels well above the expected range in women using compounded pellets. ACOG recommends FDA-approved menopause hormone therapy over compounded hormones.

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