What you’ll learn
We’ll cover what bioidentical hormones actually are, how BHRT works, and how to figure out if it’s the right fit for you.
Menopause symptoms have been messing with your life for long enough, and now you need something that works. And fast. But not so fast that you’d try the first thing you see without knowing it’s safe. You’ve probably seen bioidentical hormones marketed as a more natural option because they come from plants. However, like other hormones, they often go through processing in a laboratory to make them work similarly to the hormones your body naturally produces.
Bioidentical hormone replacement therapy (BHRT) relieves symptoms for many women and comes with similar risks and trade-offs as other types of menopause hormone therapy (MHT). That’s not a reason to rule it out, but a reason to see how it works before you decide what’s the best fit for you. Learning more about the different options available to you can help you have an informed conversation with your doctor and choose what’s right for you.
What is bioidentical hormone replacement therapy (BHRT)?
Bioidentical hormone replacement therapy (BHRT) is a type of menopause hormone therapy (MHT). “Bioidentical means the structure matches the estrogen your body naturally makes,” explains Dr. Sheryl Ross (Dr. Sherry), Chief Medical Officer of Women’s Health at QuickMD.
But bioidentical doesn’t automatically mean compounded, even though the two terms get used interchangeably. “Remember, bioidentical does not mean compounded,” she adds. BHRT comes in two main forms: FDA-approved products and compounded preparations.
The FDA-approved BHRT versions:
- Are manufactured by regulated pharmaceutical companies
- Have standardized dosing
- Go through routine testing for safety and quality
Compounded BHRT versions:
- Are custom-mixed by a pharmacy based on your specific prescription
- Allow for more flexibility in dosing and combinations
- Do not go through FDA quality testing
- Have less oversight on consistency, purity, and dose accuracy
Research has not shown that compounded BHRT offers any benefits over commercially made medicines. Compounded hormones are not any safer than FDA-approved medications.
What are bioidentical hormones made from?
Most bioidentical hormones start as compounds extracted from soy or wild yams. That might sound more like a supplement, but the finished product is a prescription‑grade medication. Those plant compounds go through a chemical process in a lab that transforms them into hormones molecularly identical to the estrogen, progesterone, or testosterone your ovaries or adrenal glands would produce.
When are bioidentical hormones prescribed?
When hormone levels drop enough to cause symptoms that disrupt your day or keep you up at night, BHRT can bring them back into balance. Doctors may prescribe BHRT for:
- Perimenopause and menopause: Manage symptoms like hot flashes, night sweats, vaginal dryness, mood swings, and sleepless nights.
- Early menopause: If you go through menopause early (before 45) or have your ovaries removed, BHRT can help with symptoms and protect bone and heart health.
- Low testosterone: Helps with fatigue that sleep doesn’t fix, low sex drive, losing muscle mass, or a mood that just stays flat.
- Bone health: Estrogen‑based BHRT can help slow bone loss, reduce fracture risk, and prevent or manage osteoporosis.
How does bioidentical hormone replacement therapy work?
Your body relies on hormones like estrogen, progesterone, and testosterone to regulate functions such as body temperature, mood, sleep, bone renewal, and sex drive. They move through the bloodstream and lock into specific receptors that trigger these processes to run the way they should. When hormone production slows down, you feel it.
BHRT restores these hormones using an exact molecular match, so they bind to the same receptors and signal the body to restore normal functioning. This restoration helps relieve hot flashes, mood swings, vaginal dryness, low energy, and low sex drive. It also helps protect bones and may support heart health for some women if started before age 60 and within 10 years of menopause.
Types of bioidentical hormones
BHRT comes in several forms. The right one depends on which hormone you need, your symptoms, your medical history, and which fits most easily into your routine.
Hormone pellets
Pellets are tiny implants placed just under the skin, usually near the hip, during a quick in-office procedure. They release a steady dose of hormones over the course of 3 to 6 months.
Why consider pellets: Long‑lasting, steady hormone levels without daily dosing or frequent visits with your doctor.
Tablets and oral capsules
Tablets and capsules are taken daily to relieve symptoms like hot flashes, night sweats, and mood swings. They’re processed through the liver first, which can reduce how much hormone your body absorbs. Oral estrogen may also increase the risk of blood clots when compared to non-oral forms of BHRT.
Why consider tablets and oral capsules: Easy to take and often the cheapest option.
Gels and creams
Gels and creams are applied to the skin, usually on the inner arm or thigh, and absorb directly into the bloodstream. They give you more control over your daily dose, but they need to be applied at the same time each day. You’ll also want to keep the area covered or dry before contact with partners, kids, or pets, since the hormone can transfer through skin-to-skin touch.
Why consider gels and creams: Good option if you cannot swallow pills or have medical issues that make blood clots a concern.
Patches
Patches stick to the skin and deliver a steady stream of hormones that pass through the skin into the bloodstream. They’re changed once or twice a week, depending on which hormone you need.
Why consider patches: Consistent hormone levels with minimal daily effort and without the same clot‑related risk increase seen with oral estrogen.
Vaginal rings
Soft, flexible rings placed in the vagina that release a low dose of estrogen to treat vaginal dryness, painful sex, and sometimes bladder symptoms. These rings are typically replaced every 90 days.
Why consider vaginal rings: Good option if you need mostly local treatment for vaginal or urinary symptoms, since very little hormone reaches the rest of the body.
Vaginal suppositories
There are no FDA-approved BHRT suppositories, so these are compounded by a pharmacy. They’re inserted vaginally to treat dryness, irritation, bladder issues, and discomfort during sex.
Why consider vaginal suppositories: Easy to use and may help prevent frequent urinary tract infections (UTIs).
Injections
Hormone injections are given on a weekly or monthly schedule. Levels can fluctuate more between doses compared to pellets or patches, so timing and frequency will matter.
Why consider injections: If you prefer scheduled injections and want to avoid implants, patches, or daily topical products.
What are the benefits of bioidentical hormones?
Bioidentical hormones can help ease common menopause symptoms by restoring the hormones your body is making less of. With BHRT, many women start to feel better and more comfortable in their own skin. Specific results depend on which hormones you’re replacing, but patients often report:
- Fewer hot flashes and night sweats
- Less vaginal dryness and more pleasurable sex
- More refreshing, consistent sleep
- Steadier moods and less irritability
- Improved focus and lasting energy
- Stronger sex drive
Many women tell me they feel like someone turned the lights back on in their brain and body, they no longer feel possessed, and start to feel more like themselves.
How to get bioidentical hormones
BHRT is a prescription treatment, so the process starts with a licensed doctor who can evaluate whether it’s a good fit for your symptoms and health history.
1. Talk to a licensed doctor
You’ll tell your doctor which symptoms you’ve been experiencing, how long it’s been happening, and what’s bothering you most. That conversation shapes what treatment looks like for you.
2. Find out if BHRT is right for you
Your doctor will look at your medical history, current medications, and any risk factors that could affect treatment. They may also order bloodwork to get a clear picture of where your hormone levels stand. Most healthy women who start BHRT before age 60 and within 10 years of menopause will see more benefits than risks.
3. Get your prescription
If BHRT makes sense for you, your doctor will write a prescription based on what your body needs. Depending on the BHRT type and formulation, you’ll fill it at either a standard pharmacy or a compounding pharmacy.
4. Start BHRT treatment
Once you have your medication, your doctor will walk you through exactly how to use it, how often, and what to expect in the first few weeks as your body adjusts.
5. Monitor and adjust as needed
Over the following weeks and months, your doctor will check in on how you’re responding to the BHRT. Keep track of your symptoms and share that info with your provider. They will adjust your dose or delivery method if something isn’t working the way it should.
Start your BHRT journey with QuickMD
When menopause wears you down, and nothing seems to take the edge off, we can help. As Dr. Sherry puts it, “If symptoms are affecting your sleep, mood, memory, daily comfort, relationships, sexual function, or ability to get up in the morning, that’s enough reason to explore treatment options.”
At QuickMD, our doctors can talk through what you’ve been dealing with over a quick telemedicine visit.
Frequently asked questions about bioidentical hormones
Does insurance cover bioidentical hormones?
Most insurance plans cover FDA-approved bioidentical hormones like pills, patches, and gels. Custom compounded versions are a different story and usually aren’t covered. Call your insurance provider to find out what your specific plan includes.
Do bioidentical hormones help you lose weight?
Bioidentical hormones aren’t a weight loss treatment. However, some women notice modest changes once their sleep, energy, and mood start improving, which can make it easier to stay active and eat well.
Will bioidentical hormones cause weight gain?
Bioidentical hormones aren’t a weight loss treatment. But according to Dr. Sherry, estradiol can support metabolic health by helping your body handle glucose more efficiently, which can reduce central weight gain and help stabilize appetite and energy levels. Some women also notice modest changes once their sleep and energy improve, which makes it easier to stay active and eat well.
Are bioidentical hormones safe?
FDA‑approved bioidentical hormone products are generally considered safe for most women when used at the lowest effective dose for the shortest amount of time needed. Dr. Sherry adds, “Bioidentical progesterone has a strong safety profile and is commonly used for years as part of hormone therapy.” Compounded versions don’t go through the same FDA testing or quality controls, so there’s less certainty about consistency, purity, and dosing accuracy.
