Menopause Hormone Therapy (HRT) in Richmond, VA

Bioidentical hormones in Richmond: what it means

Behind the label "bioidentical hormone replacement therapy" is a plain idea: a hormone whose structure matches the body's own. Estradiol and micronized progesterone are both bioidentical: their structure matches the hormones the ovaries make. Neither has to be compounded: FDA-approved estradiol comes as pills, patches, gels, sprays, vaginal creams and rings, and progesterone as capsules.

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.

Through VevaMD, a physician licensed in Virginia decides whether hormone therapy fits you and, if so, the form: an estradiol pill, patch, cream or vaginal cream, with progesterone if you have a uterus. Pellets are not part of it. Because the dispensing pharmacy also compounds, you can ask whether your estradiol or progesterone is an FDA-approved product. Two options are compounded for certain: testosterone cream for women and Bi-Est are not FDA-approved.

The NPI registry counts 180 OB-GYNs practicing in Richmond, about 79.1 for every 100,000 residents against 17.8 nationally and above Virginia's 18.1, a higher rate than 94% of the cities VevaMD covers. With about 26,169 women aged 45 to 64 living in Richmond, that is about 150 for each OB-GYN in the city, before counting any younger patients.

Counting the area around it, 220 OB-GYNs practice in Richmond or within 10 miles and 283 within 25 miles: 23.7 for every 100,000 of the 1,193,929 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 Virginia reviewing your answers from home in Richmond.

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