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Understanding Hormone Replacement Therapy (HRT) in Singapore: Types, Myths & Realities

This article has been medically reviewed by Dr June Sheren (MBBS, MMed, MSc Performing Arts Medicine) and Dr Nav Uppal (MBBCh, MRCGP, DRCOG), Medical Advisors at Surety.


Navigating menopause can be overwhelming, especially when it comes to understanding your options for hormone replacement therapy (HRT). One of the most common areas of confusion lies in the different types of HRT, particularly the term “bioidentical.”


Hand reaches towards red and yellow flowers arranged on a gray background with scattered rose petals, creating a calm floral scene.

This article breaks it down simply and clearly for women in Singapore who want to make informed decisions about their midlife health.


What Is HRT, and When Might You Consider It?

Hormone Replacement Therapy is used to alleviate menopause-related symptoms such as:

  • Hot flushes and night sweats

  • Mood changes and sleep disturbances

  • Vaginal dryness and low libido

  • Increased risk of osteoporosis

 

You do not have to start HRT just because you're experiencing menopause. A consultation with a doctor can help you understand your options, assess your risk factors, and decide whether HRT is suitable for you.

Understanding the Types of HRT

At a glance: Key differences between HRT options
At a glance: Key differences between HRT options

Standard (Regulated) HRT

This includes synthetic or bioidentical hormones that are:

  • Government-regulated (HSA-approved in Singapore)

  • Produced by pharmaceutical companies with strict quality controls

  • Available in standardised doses (oral, transdermal patches, gels, etc.)


Bioidentical simply means the hormone has the same molecular structure as the hormones naturally produced by your body. Many approved HRT products in Singapore contain bioidentical estradiol or progesterone, such as Estrofem, Estradot, or Utrogestan.


These are not the same as compounded therapies (more on this below).

 

What About Compounded BHRT?

This is where much of the confusion arises.


Compounded BHRT refers to:

  • Custom-mixed hormone preparations made by a compounding pharmacy

  • Often advertised as “natural” or “personalised”

  • Not regulated by Singapore's HSA or any major international health authority


Some clinics in Singapore offer cBHRT via creams, pellets, or lozenges. While it may sound appealing, patients should be aware:

Risks of Compounded BHRT:

  • Not tested for consistency, potency, or safety

  • Higher potential for incorrect dosing

  • Not supported by most professional menopause or endocrinology societies due to lack of evidence and regulation


The Australasian Menopause Society and international bodies recommend regulated, approved HRT products over cBHRT, even when the latter is labelled “bioidentical.”


Why Some Women Still Consider BHRT

Many women are drawn to BHRT because:

  • It is perceived as more “natural”

  • It can be tailored to symptoms

  • There's a belief that it's safer than synthetic options


But remember, not all BHRT is equal:

  • FDA/HSA-approved bioidentical hormones (like Utrogestan) are safe and effective.

  • Compounded BHRT lacks standardisation and has not been proven to be safer or more effective.

 

Common Myths About HRT: Debunked!

Myth 1: “HRT causes weight gain.”

Feet standing on a digital scale in a bright room. The background is blurred, and the floor is light-colored tile. Mood is neutral.

Truth: Weight changes are often due to aging, lifestyle, and metabolism shifts, not HRT itself. There's no solid evidence linking regulated HRT to weight gain.

 

Myth 2: “Bioidentical hormones are always safer.”

The word "Safety" is highlighted in green marker on a printed page. Nearby text is slightly blurred. Focus on the importance of safety.

Truth: Regulated, prescription-based body-identical HRT has been proven safe and effective for many women. However, "bioidentical" doesn't automatically mean better or safer especially when referring to compounded, unregulated formulations. It’s important to consult your doctor to find the right fit. The key difference is whether the product is regulated and tested.

 

Myth 3: “HRT causes breast cancer.”

Close-up of three people wearing pink shirts with pink ribbons, symbolizing breast cancer awareness. Plain pink background.

Truth: The risk depends on the individual's health history, the type of HRT, when it's started, and how long it's used. Estrogen-only HRT is not associated with increased breast cancer risk. Combined HRT (estrogen + progestogen) may slightly increase the risk with longer-term use. Women should discuss the benefits and risks with their doctor to make an informed decision.

 

Side Effects of HRT

Like any treatment, HRT may cause:

  • Breast tenderness

  • Headaches or bloating

  • Mood swings (especially from progesterone)

  • Spotting or breakthrough bleeding


Switching formulations or adjusting dosages can help minimise side effects.


Alternatives to HRT

If HRT isn’t suitable, some non-hormonal options include:

  • Lifestyle changes (exercise, stress reduction, sleep hygiene)

  • Plant-based supplements (e.g., soy isoflavones, black cohosh)

  • Traditional Chinese Medicine or acupuncture

  • Cognitive behavioural therapy (CBT) for hot flushes or mood


Note: More research is needed to confirm the long-term effectiveness of these alternatives.


Final Thoughts

The most important takeaway: There are safe, regulated, body-identical HRT options available in Singapore, prescribed by qualified healthcare professionals.  If you're experiencing menopausal symptoms that are affecting your quality of life, speak with your doctor about whether HRT is right for you.


Bioidentical ≠ Compounded. Know the difference. Ask questions. And choose what's right for you.

 

Every woman’s journey through menopause is different, there’s no one-size-fits-all solution, but there is support, science, and guidance to help you thrive through it.

 

Need guidance or support?

Reach out to us at contact@suretysg.com and we’ll connect you with the right doctors, professionals, and resources to support your midlife journey.

 


 References

Australasian Menopause Society. (2020). Information sheet: Compounded bioidentical hormone therapy (cBHT). https://www.menopause.org.au/images/factsheets/AMS_Compounded_Bioidentical_HT.pdf

HealthHub Singapore. (n.d.). Cyclic estrogen-progestogen hormone replacement therapy (HRT). https://www.healthhub.sg/a-z/medications/hrt-cyclic-estrogen-progestogen

SingHealth. (n.d.). Hormone replacement therapy (HRT). https://www.singhealth.com.sg/patient-care/medicine/hormone-replacement-therapy

Verywell Health. (2023). Hormone replacement therapy: What to know. https://www.verywellhealth.com/hormone-replacement-therapy-5271199

My Menopause Centre. (2022). HRT myths – “I’ll grow a beard” and other HRT myths busted. https://www.mymenopausecentre.com/blog/hrt-myths-ill-grow-a-beard-and-other-hrt-myths-busted/

UT Southwestern Medical Center. (n.d.). Menopause myths: What to know about hormone therapy and heart health. https://utswmed.org/medblog/menopause-myths/

Wikipedia contributors. (2023). Bioidentical hormone replacement therapy. In Wikipedia, The Free Encyclopedia. https://en.wikipedia.org/wiki/Bioidentical_hormone_replacement_therapy

SG Essentials. (n.d.). Hormone therapy (BioTE® pellets). https://sgessentialssd.com/hormone/

Wellness & Gynaecology Centre by Dr. Julinda Lee. (n.d.). Services for women. https://agemanagement.com.sg/our-services/services-for-women/

 

 

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