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Bioidentical Hormone Replacement Therapy

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Navigating menopause is no small feat. As women go through premenopause and perimenopause, their levels of estrogen, progesterone, and testosterone begin to drop. This continues through the end of menopause and often leads to unwanted side effects, including:

  • Mood swings
  • Night sweats
  • Hot flashes
  • Vaginal dryness
  • Changes in sex drive
  • Fatigue
  • Weight gain
  • Cognitive difficulties

Some women may find relief from menopausal symptoms through supplements or other natural remedies. However, these solutions may not be enough if hormone levels drop too severely or cause prolonged symptoms.  

Once women have reached post-menopause, their bodies are no longer producing the robust levels of hormones they were during their reproductive years. Women are then at greater risk for certain health issues like cardiovascular disease.

Enter BHRT: bioidentical hormone replacement therapy. BHRT can help restore hormone levels in menopausal and postmenopausal women. For many, menopausal hormone therapy regimens can improve quality of life by reducing the negative side effects that come with decreased hormone levels.

When to Look at Hormone Therapy

While some hormone fluctuations are natural and not necessarily cause for concern, prolonged or extreme hormone imbalances can lead to a number of health risks

Hormones play a crucial role in maintaining physical function and well-being. Estrogen alone is implicated in the proper function of multiple physiological systems, including:

In the event that lifestyle modification like dietary modifications and supplementation don’t work, hormone replacement therapy (HRT) may just be the answer.

What are bioidentical hormones?

Bioidentical hormones differ from the hormones used in traditional HRT by perfectly mimicking the chemical structure of natural hormones produced in the human body. Unlike many synthetic hormones, the hormones used for bioidentical hormone replacement therapy (BHRT) are derived from the estrogen found in plants such as yams and soy. 

Some bioidentical hormones include: 

  • Estrone
  • Estriol
  • 17 beta-estradiol
  • Progestins (micronized progesterone)
  • Testosterone
  • Dehydroepiandrosterone (DHEA)

What is the difference between bioidentical hormones and synthetic hormones? Many professionals consider bioidentical hormones more natural than their synthetic counterparts. The production of bioidentical hormones more closely resembles the process through which hormones are rendered in our own bodies. 

Traditional HRT often includes synthesized hormones or equine estrogens from horse urine. Some common synthetic hormones include:

  • Progestin
  • Premarin (a synthetic blend of equine estrogens)
  • Estradiol acetate

What will bioidentical hormones do for me? Bioidentical hormones can offer a safe, effective, and more natural approach to hormone replacement. 

BHRT can help alleviate some of the health risks associated with hormone imbalance, as well as symptoms that come with menopause. One study even found that BHRT benefitted women with hormonal imbalances caused by breast cancer.

Compounding Bioidentical Hormones

There are two classes of bioidentical hormones, manufactured and compounded. The US Food and Drug Administration (FDA) has approved certain manufactured bioidentical estrogens. These can be produced by pharmaceutical companies, and include:

Compounded bioidentical hormones are hormone cocktails that have been mixed according to a patient’s individual needs. Compounded bioidentical hormones aim to be indistinguishable from natural hormones produced in the body. These formulations must be ordered by a prescribing clinician and then prepared at a compounding pharmacy. 

Compounded bioidentical hormones are not yet FDA-approved, although testing begin in 2018. 

What does BHRT treat?

BHRT can do more than help alleviate symptoms of menopause. There are many potential applications for bioidentical hormones, including:


Doctors and patients may prefer BHRT over traditional HRT because it offers a more natural approach that may come with fewer negative side effects.

A comprehensive review comparing both methods suggested that synthetic hormones may vary in efficacy and safety. The same review found that BHRT may produce lower risks of blood clotting and breast cancer incidence than traditional HRT. 

A 2009 study also found that progesterone was associated with a decreased risk of breast cancer. Synthetic progestins, however, were associated with an increased risk of breast cancer. This study also reported that patients were more satisfied with therapy that included bioidentical hormones than those who were treated only with synthetic hormones. 

Do bioidentical hormones really work? The evidence points towards yes, bioidentical hormones really work. However, all treatments come with potential side effects. Always consult with your doctor or health care provider to make sure a treatment is right for you.

Types of Bioidentical Hormones

Bioidentical hormones come in a variety of forms. The most effective method depends upon each patient’s individual needs. Common types of bioidentical hormones include:

  • Pills or tablets
  • Lotions, gels, or creams
  • Transdermal patches
  • Implanted pellets
  • Vaginal suppositories

Each type of prescription has benefits and drawbacks. Implantable pellets, for example, will deliver steady doses of BHRT over a longer period compared to some other methods. However, because these hormone preparations are inserted and last up to months, it can be difficult to make adjustments for fluctuating hormones.

Your doctor will help determine which method and what compounds may be right for you.

How Providers Determine Dosages

Medical providers will determine BHRT dosages according to each patient’s individual needs. This often includes a thorough biological analysis, including blood, urine, and saliva tests. The hormone levels indicated by these tests will allow the doctor to determine the optimal blend of hormones for the patient.

Physicians will continue to monitor patients’ salivary, blood, and urinary hormone levels throughout treatment. Through this process, medical teams can adjust hormone compounds as necessary.

BHRT Risks

Despite the potential benefits, initiating BHRT may cause some side effects, including:

  • Acne
  • Increased facial hair
  • Mood swings
  • Weight gain
  • Fatigue
  • Bloating
  • Spotting
  • Cramps
  • Breast tenderness

Most of these cases are mild and resolve quickly as patients’ bodies adjust. 

Who should not take bioidentical hormones? Those who have or are at risk of certain medical conditions may want to avoid any type of hormone therapy. Such conditions include:

  • Gallbladder disease
  • Breast cancer*
  • Endometrial cancer
  • Liver disease
  • Vagnal bleeding
  • Blood clots
  • Allergy to any hormone supplements

*Studies that have connected BHRT to reduced risk of breast cancer and breast cancer treatment symptoms have yet to be sufficiently replicated. 

A 2002 study from the WHI also found that prolonged use of traditional HRT including conjugated equine estrogens and progestin may lead to increased risk of heart disease and stroke.  

Have more questions?

Have you been experiencing menopausal symptoms or other signs of hormone imbalance? If so, it may be time to talk to a specialist about BHRT and other treatment options. If you don’t have a trusted health care provider, we welcome you to book a discovery call with our Care Team today. 

We’ll walk you through our practice and our unique approach to hormone balance and overall wellness. If you’re not ready to book a call, feel free to subscribe to our newsletter and follow us on Instagram.


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