Your body’s hormones control most of your basic bodily functions. They serve as an internal communication system between cells throughout the body.
They coordinate everything from digestion and growth to your appetite, immune function, mood, and libido. So, when your hormones are out of balance, even slightly, it can have a big impact on your health and well-being.
Often, when people’s hormones drop or become unbalanced, they turn to hormone replacement therapies to ease symptoms. Hormone replacement therapy is also used in some types of gender affirming care.
Bioidentical hormone replacement therapy (BHRT) has gotten a lot of attention in recent years. It promises a “natural” form of hormone therapy. But what exactly is BHRT, and how’s it different from other hormone replacement therapies?
Read on to learn all you need to know about BHRT, its benefits and risks, and whether it may be right for you.
BHRT can be used to boost low hormone levels. It’s most frequently used to ease symptoms of perimenopause and menopause. It may also be used to improve symptoms of cancer treatment or to treat conditions such as:
- insulin resistance
- adrenal and thyroid disorders
Bioidentical hormones are lab-produced hormones derived from plants. They are chemically identical to those the human body produces. Estrogen, progesterone, and testosterone are among those most commonly replicated and used in treatment. Bioidentical hormones come in various forms, including:
Some bioidentical hormones are made by drug companies. Others, known as compounded bioidentical hormones, are custom made by a pharmacy, according to a doctor’s orders.
This process is known as compounding. Compounding typically involves ingredients being combined or altered to meet the needs of an individual.
The U.S. Food and Drug Administration (FDA) has approved some forms of manufactured bioidentical hormones, including bioidentical estriol (a weak form of estrogen) and progesterone. However, the FDA hasn’t approved any custom-compounded bioidentical hormones.
Compounded bioidentical hormones are manufactured and sold without FDA oversight for safety, quality, or purity. This makes it hard to know what exactly you’re getting if you purchase compounded bioidentical hormones. Many medical organizations have taken a stand against the marketing and use of unapproved bioidentical hormones.
Compounded bioidentical hormones are often touted as being safer and more effective than synthetic hormones. But the FDA and most doctors will caution that those claims haven’t been proven in reputable studies, and that these hormones may even be potentially dangerous in some cases.
Bioidentical hormones are different from those used in traditional hormone replacement therapy (HRT) in that they’re identical chemically to those our bodies produce naturally and are made from plants.
The hormones used in traditional HRT are made from the urine of pregnant horses and other non-bioidentical hormones.
Supporters of bioidentical hormones claim their products are safer because they are “natural” and identical in makeup to the hormones the body produces naturally.
But most experts believe the risks of BHRT and HRT are similar. Compounded bioidentical hormones may carry even more risks. There’s no credible evidence that BHRT is more effective than HRT.
BHRT is most often used by people experiencing a reduction in hormone levels due to perimenopause or menopause. It’s used to increase the levels of the hormones that have dropped and improve moderate to severe menopause symptoms, including:
- hot flashes
- night sweats
- mood changes
- memory problems
- weight gain
- sleep issues
- reduced interest in sex or pain during sex
In addition to helping with symptoms, hormone replacement therapy may also reduce your risk for diabetes, tooth loss, and cataracts. Anecdotally, some believe that it can help improve skin thickness, hydration, and elasticity, and even reduce wrinkles.
While the FDA has approved some bioidentical hormone products, it hasn’t approved any compounded bioidentical hormones. This means that compounded bioidentical hormones are not regulated for safety or effectiveness.
The National Academies of Sciences, Engineering, and Medicine recommend that compounded bioidentical hormones should only be used in very specific circumstances, such as an allergy to FDA-approved hormone products.
There are claims that bioidentical hormones are safer and more effective than traditional HRT because they’re identical in structure to those produced in the body. But these claims have not been confirmed by large-scale, reputable studies.
Research has shown that certain types of hormone replacement therapy may increase the risk for conditions such as:
- blood clots
- gallbladder disease
- heart disease
- breast cancer
Hormone replacement therapy for menopause symptoms is not usually recommended for people who have experienced breast cancer. This is because it appears to
Hormone replacement therapies can also cause side effects, particularly in the beginning as your body adjusts to the hormones. The possible side effects may be different depending on the type of hormone therapy you’re taking, so it’s best to ask your doctor what to expect. Some common side effects may include:
Some people cannot take BHRT or any form of hormone replacement. The risks and potential for side effects may vary depending on your health history. Discuss the pros and cons with your doctor before using any hormone replacement therapy.
BHRT comes in a variety of forms including:
- implanted pellets
Talk to your doctor about which form may be best for you and your lifestyle. You’ll likely need to be monitored regularly once you begin BHRT to evaluate your body’s response.
However, the FDA cautions against monitoring hormone levels via blood and saliva tests. These only tell you your hormone levels at a moment in time and can vary widely throughout the day.
The FDA recommends that if you do choose any form of hormone therapy that you use the lowest dose that produces results. The FDA also says you should use it for the shortest length of time possible.
BHRT may be an option for some people who have symptoms associated with hormone levels that are low or otherwise unbalanced.
However, not all BHRT products are FDA-approved. The American College of Obstetrics and Gynecology recommends using FDA-approved hormone therapies instead of compounded BHRT. Currently, there’s no evidence that compounded BHRT is superior to other forms of hormone replacement.
Along with potential benefits, there are side effects and risks associated with BHRT and with hormone replacement therapies in general. It’s important to discuss these with your doctor.
In addition, certain health conditions can increase your risk for serious side effects with hormone replacement. Your doctor can help you determine whether hormone replacement therapy is an option for you.
If you do decide to use BHRT, you should use the lowest dose that proves effective, and follow up with your doctor regularly about whether to continue hormone therapy.