In November 2023, the ACOG will release Clinical Consensus #6, “Compounded Bioidentical Menopausal Hormone Therapy”. We have covered bioidentical hormones in past episodes. However, this ACOG clinical consensus sheds new light on an old topic. Is there ever a role for bioidentical hormone therapy? What about postmenopausal testosterone use? What does the College say about the marketing of these compounded options? And, were you aware that for the first time ever there is now a novel, bioavailable estrogen in a combination oral contraceptive? That same estrogen (E4) is now being considered as another option for bioidentical hormone use. In this episode, we will review this new estrogen, estetrol (E4), answer the questions posed, and provide other high yield facts from the clinical consensus.