1/18/24, 8:27 PM Bioidentical Hormone Replacement Therapy: A Guide

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SEXUAL HEALTH REPRODUCTIVE HEALTH ISSUES

What Is Bioidentical Hormone

Replacement Therapy?
By Brandi Jones, MSN-ED RN-BC Published on August 17, 2022

Medically reviewed by Ana Maria Kausel, MD

Table of Contents

What Is BHRT?

Bioidentical Hormones

Treatments

Traditional vs. Bioidentical

Benefits

VIEW ALL

Hormones are chemicals made by the endocrine system. They direct

functions in multiple systems of the body. When they are imbalanced, it
can affect your weight, mood, energy levels, libido, fertility, and more.

Hormone replacement therapy (HRT) is the use of artificial hormones to

balance hormone levels and decrease symptoms. Bioidentical hormone
replacement therapy (BHRT) is one version of this kind of treatment.

This article reviews what bioidentical hormones are, what BHRT treats,
how it differs from other forms of HRT, its benefits and risks, and how to
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take it.
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Anne Rippy / Getty Images

What Is Bioidentical Hormone Replacement

Therapy?
Hormones control sexual health, mood, body temperature, growth,
immunity (ability to fight infection), and more. Bioidentical hormone
replacement therapy is a type of treatment used to reduce symptoms
related to hormone imbalances.

What Are Bioidentical Hormones?

Bioidentical hormones are synthetic (artificial) versions of the hormones
already made in the endocrine system. They are chemically and
structurally identical to human hormones. [1]

Bioidentical hormones are often confused with “natural” hormone

therapy. "Natural hormones" is the term used to describe those extracted

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from plants such as yams and soybeans. [2]

Are Bioidentical Hormones Natural?

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While parts of bioidentical hormones may be derived from natural
sources, they are not considered natural because they are made in a
lab. [3]

What Can BHRT Treat?

BHRT can help with problems related to imbalanced hormones, such as: [1]

Mood swings
Fatigue
Difficulty concentrating
Menopausal symptoms
Decreased bone density (osteoporosis) after menopause
Infertility (problems conceiving a baby)
Decreased libido (interest in sex)
Temperature dysregulation

BHRT is also an important treatment for those who are transgender and
are transitioning.

Related: Estrogen Treatment for Transgender Women and Transfeminine

People

Compounded Bioidentical Hormones vs. Standard BHRT

Standard BHRT is often confused with compounded bioidentical hormone
replacement therapy (cBHRT). The following are the primary distinctions
between standard BHRT and cBHRT: [4] [3]

Standard BHRT is commercially available, prepackaged, standardized

doses of bioidentical hormones approved by the Food and Drug
Administration (FDA).
Compounded BHRT involves custom compounded recipes mixed in a
pharmacy. [5] Formulas usually include a mixture of standard BHRT and

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nonhormonal ingredients; cBHRT is not FDA approved.

How to Take BHRT

BHRT comes in various forms and routes, including: [6]
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Oral capsules, tablets, or pills
Vaginal capsules
Lozenges
Oils (oral)
Topical (on the skin) creams, gels, solutions, or sprays
Transdermal (through the skin) patches
Suppositories (vaginal and rectal)
Enemas
Under-the-tongue pills, tablets, or drops (sublingual)
Nasal sprays
Under-the-skin implanted pellets
Injections (shot)

Dosages and amounts vary based on the formulation and route of

medication. It’s important to follow the prescriber's directions to get the
most benefit from BHRT.

Transdermal HRT
There is strong scientific evidence that transdermal estrogen (a patch
placed on the skin) decreases many risks associated with taking oral
hormone therapy. The absorption is better, and it is less likely to
cause side effects such as nausea. [7]

Traditional HRT vs. BHRT

The goal of hormone replacement therapy is to replace low levels of
hormones. While levels may not be completely restored, treatment is
usually enough to resolve symptoms. Differences between HRT and BHRT
are:

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Traditional HRT refers to synthetic hormones made in the lab. They are
FDA-approved medications that come in standard, prepackaged doses.
BHRT uses synthetic hormones that are the most identical to those in the
body. They come in standard, commonly used doses that are approved by
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the FDA. [1] The chemical structure of the hormones used in BHRT is often
the same or similar as those used in traditional therapy. [4] [3]

Benefits of BHRT
New studies have found that the benefits of HRT outweigh the risks for
younger women or those in the early stages of menopause. [7] BHRT has
become a popular form of HRT over the last couple of decades. The
perceived benefits of BHRT include: [8] [4] [1]

Safety: Many healthcare providers and patients remain concerned about

using HRT. Some feel BHRT is a safer alternative to traditional HRT.
Customization: cBHRT can be mixed with standard BHRT to create a
personalized dose based on your hormone levels, symptoms, and
preference and is especially beneficial for those who are allergic to
ingredients in standard BHRT or need a dose that is not available
otherwise.
They are exact duplicates: Bioidentical hormones are the most identical to
those made in the body.

How Common Is Compounded BHRT?

An estimated 1 million to 2.5 million women in the United States use
cBHRT for menopausal symptoms. [8]

Side Effects and Risks of BHRT

The side effects of BHRT vary depending on the type of hormone
replacement used. Examples of side effects include: [6]

Acne
Dyslipidemia (high cholesterol or triglycerides)
Mood swings
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Hair loss
Breast tenderness
Weight gain
Fatigue
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Bloating
Increased facial hair
Itching in areas where topical medications are applied

As with any systemic (throughout the body) estrogen therapy, there is a

slight risk of blood clots, breast cancer, and gallbladder disease. There is
also a small risk of stroke and heart attack, especially for women over age
60. [9]

For those who still have a uterus, there is also an increased risk for
endometrial cancer. [10]

Is Compounded BHRT Safer or More Effective?

While many people believe that cBHRT is safer or more effective than
traditional HRT, this may not be true. According to the Endocrine
Society, there is little to no scientific evidence to support these claims.
[4]

There is concern that cBHRT does not have the FDA oversight needed
to: [3]

Adequately test for safety and quality

Ensure doses are consistent
Regulate effectiveness
Enforce labeling and packaging regulations (which can lead to allergic
reactions and incorrect or incomplete information)

Summary
Bioidentical hormones are synthetic (artificial) hormones often confused
with natural hormones derived from plants. Standard BHRT is tested,
approved, and regulated by the FDA, while cBHRT is not. Many people
prefer BHRT because of its perceived safety and because it can be

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customized. However, no scientific evidence shows they are safer or more

effective than traditional HRT.
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A Word From Verywell
Experiencing disruptions with your hormones can cause frustrating
symptoms that interfere with your daily life. There are multiple options to
help you combat these symptoms, including bioidentical hormone
replacement therapy. Talk with your healthcare provider so they can help
you decide on the best plan for your health and well-being.

FREQUENTLY ASKED QUESTIONS

Is bioidentical hormone therapy safer and more

effective than traditional hormone therapy?
No, according to the FDA and the Endocrine Society, research has
not shown that bioidentical hormones are safer or more effective
than traditional hormones. [10] [4]

Does bioidentical hormone replacement therapy

(BHRT) really work?
Standard BHRT that has been studied, approved, and regulated
by the FDA is effective. However, compound bioidentical
hormone therapy (cBHRT) is not FDA tested or approved. In
addition, cBHRT dosages vary and there is insufficient evidence
to know if they work correctly. [3]

How long can you stay on bioidentical hormones?

How long you stay on bioidentical hormones varies based on the
kind of hormone and your unique situation. For example, risk of
adverse effects from systemic estrogen increases with age,
especially for women over age 60, and with extended use (longer
than 10 years). If your treatment stops working, you have severe
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side effects, or your risk increases, your healthcare provider may

instruct you to discontinue hormone therapy. [4] [11]
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11 Sources

By Brandi Jones, MSN-ED RN-BC

Brandi is a nurse and the owner of Brandi Jones LLC. She specializes
in health and wellness writing including blogs, articles, and
education.

See Our Editorial Process

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