Hormones are chemicals made by different organs, glands, and tissues in your body. They’re an important part of your body’s messenger system. These chemicals send signals to almost every part of your body. They control things such as your mood, sex drive, how your body uses energy, and even how well you sleep.
If your hormones are out of balance or your body can’t make enough, your doctor could suggest bioidentical hormone replacement therapy (BHRT).
Bioidentical hormones are man-made. They’re designed so your body uses them in the same way it does your own hormones. Bioidentical hormones can be very helpful for people who have hormonal imbalance or who might not make enough hormones naturally.
What Are Bioidentical Hormones?
“Bioidentical hormones are made from plant and animal products to match those hormones that your body makes naturally,” says Sherry Ross, MD, a board-certified OB/GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, CA.
They’re designed so your body uses them in the same way. That’s why they’re sometimes called bioidentical or body-identical hormones.
Why you take bioidentical hormones
The most common types of these hormones are:
- Estrogen
- Progesterone
- Testosterone
Your doctor could prescribe BHRT if you have:
- Perimenopause
- Menopause
- Low testosterone
These conditions can cause a lot of side effects that affect your daily life. For instance, once you stop having regular periods, you can have:
- Hot flashes
- Night sweats
- Brain fog
- Mood swings
- Weight gain
- Low energy levels
- Memory loss
- Trouble sleeping
- Vaginal dryness that can make sex painful
- Lower interest in sex
Men with low testosterone often have:
- Low sex drive
- Problems getting an erect (hard) penis
- Depression
- Fatigue (feeling tired even after resting)
- Thinning armpit and pubic hair
Bioidentical hormones vs. synthetic
Hormone replacement therapy (HRT) is a general term. It’s what doctors call it when you take hormones to replace the ones your body no longer makes.
Bioidenticals are a type of HRT.
Many traditional HRT treatments that doctors prescribe are made with bioidentical hormones.
Are bioidenticals FDA-approved?
There are two types of bioidentical hormones. The difference is important to know.
Some kinds are made by drug manufacturers and are FDA-approved.
Others are custom-made. These are called compounded bioidenticals and are not FDA-approved.
Are bioidenticals right for you?
If your doctor thinks you could benefit from a type of hormone therapy, they’ll consider:
- Your medical history
- Blood test results that show your current hormone levels
- Symptoms you’re having
- Your personal preferences (for instance, if you’d prefer a patch you wear for a few days or a daily pill to swallow)
Timing plays a part, too. For instance, “I always tell patients that bioidentical hormone replacement therapy, or any hormone replacement therapy, is most effective when started shortly after the beginning of menopause,” says G. Thomas Ruiz, MD, a board-certified OB/GYN and lead OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.
Commonly prescribed bioidentical hormones
Different types include:
- Estrogen (estradiol, estrone, estriol)
- Progesterone
- Testosterone
- Dehydroepiandrosterone (DHEA)
Compounded Bioidentical Hormones
If you use compounded bioidentical hormones, custom amounts of manufactured hormones are mixed together for you. A doctor prescribes specific kinds and doses, then they’re combined by a pharmacist at a special compounding pharmacy. Some products might be given the FDA stamp of approval but the final blends usually are not. More research is needed on the safety of compounded bioidentical hormones.
How you take compounded bioidenticals
These hormones come in a lot of forms, including:
- Pills
- Lozenges
- Creams
- Implants (also called pellets)
- Injectables
- Suppositories
How do you figure out your dosage of compounded bioidentical hormones?
The recommended dosage range for bioidentical hormones depends on the specific hormone. Dosages for oral estrogen range from 0.5 milligram or less to 1 milligram or more. For oral progesterone, a dose of under 100 milligrams is low, while more than 200 milligrams is high.
So, how do doctors figure out the type and amount of hormones to give you? For compounded bioidenticals, they often rely on a test of your saliva (spit).
This raises concerns for many experts. That’s because the hormone levels in your spit aren’t the same as the hormones in your blood. And they don’t reflect the symptoms you’re having.
There are other issues with this custom type of BHRT.
“Compounded bioidentical hormones…have not been tested in medical trials in the same way as traditional hormone replacement therapy and are not FDA approved,” Ross says. “They’re marketed as being ‘more natural, safer, and better’ for the body, but there are no medical studies to support these claims.”
While compounded bioidentical hormones are made from plant products (such as soy and yams) and animal products, “they still need chemicals to become active in your body,” Ross says. “It is important to understand that bioidentical hormones are not proven to be any safer or have less side effects than traditional hormone replacement therapy.”
But because compounded bioidentical hormones don’t have to follow FDA guidelines, there’s also no way to make sure each dose you get will be the same. The strength could vary, so could the ingredients. With this type of HRT, it’s hard to know for sure if what you’re taking is safe or useful.
The American College of Obstetricians and Gynecologists suggests taking FDA-approved hormones instead of compounded BHRT.
How long do bioidentical hormones take to work?
“Hormonal treatment always requires an adjustment period,” says Victoria Finn, MD, a board-certified endocrinologist in New York. “It takes time to restart hormonal receptors, correct imbalances with other hormones, and achieve a steady blood hormone concentration. This process can take a week to two weeks, or even longer, before you start feeling better.”
Some people don’t see a big difference for a few months.
Benefits of Bioidentical Hormone Replacement Therapy (BHRT)
People take replacement hormones for different reasons. Often, it’s because of menopause. Your periods usually stop for good when you’re in your 40s or 50s.
This is a natural phase of life. But replacing the hormones you no longer make with doctor-prescribed bioidentical hormone replacement therapy can lower the symptoms and help you have a better quality of life.
“Everything in a woman’s body has tissues that work better in the presence of estrogen, whether it be their bones, skin, bladder, or vagina,” Ruiz says. “In the absence of working estrogen, a bioidentical hormone maintains as close to normal body function as possible.”
BHRT can:
- Lower brain fog
- Make it easier to sleep
- Lessen night sweats
- Ease mood swings and irritability
- Improve vaginal dryness
- Lower the urgent feeling that you need to pee
- Help strengthen your bones
- Lower your risk of heart disease
- Lower your risk of diabetes
Another benefit of bioidentical hormones is that “they can be absorbed in the bloodstream directly via cream, ointment, or patch applied to the skin,” Ruiz says.
That can be simpler than taking hormones by mouth.
“For pills to be activated, they have to be swallowed, survive processing in the stomach, get absorbed into the bloodstream through the intestine, and then be made into the active hormone by your liver,” Ruiz says.
Risks of Bioidentical Hormone Replacement Therapy (BHRT)
In 2002, researchers of a large study claimed that there were no long-term benefits of taking HRT after menopause. They also said it could raise the risk of serious health issues such as heart disease and breast cancer.
“Because of that, millions of women stopped taking their hormones,” Ruiz says, “and [the researchers] gave the impression that the only reason to take hormones was if you had disruptive menopausal symptoms like hot flashes and the inability to sleep.”
More research has since found that guidance to be flawed. The health risks of HRT for women younger than 60 or who have been out of menopause for less than 10 years is actually small.
For instance, most studies show that HRT doesn’t raise your risk of breast cancer until you’ve been on it for more than five years. Even then, it’s less than 1 in 1,000.
Like with any HRT, bioidentical hormone replacement therapy can still raise your risk of:
- Uterine cancer. This can happen if you still have your uterus and only take estrogen and not progestin.
- Heart disease. For those who begin taking hormones 10 years after menopause, doctors have found this risk.
- Blood clots
- Stroke
- Gallbladder disease
As with any medication, talk to your doctor about the risks you could have if you start bioidentical hormone replacement therapy. You can also ask what steps you can take to avoid them.
Bioidentical Hormone Replacement Therapy Side Effects
Not everybody has side effects when they start taking BHRT. If you do, they usually get better as your body gets used to your new hormone levels.
Based on the type of bioidentical hormones you take, you could have:
- Mood changes
- Blurry eyesight
- Itchy skin or skin rashes
- Increased facial hair
- Tiredness
- Bloating
- Spotting
- Cramps
- Acne
- Headaches
- Tender breasts
Pharmacies that compound bioidentical hormones don’t have to report side effects to the FDA. Because of that, it’s hard to predict the symptoms these custom-made treatments may cause.
When to call your doctor
Always let your doctor know if a new symptom concerns you, interferes with your daily life, or gets worse instead of better.
They might suggest changing the type or dose of your bioidentical hormones.
Before you start BHRT, ask your doctor what side effects to expect.
Weight gain as a side effect of bioidentical hormone therapy
You might have heard that hormone therapy can cause you to gain weight, but research doesn’t back this up. Weight gain is common as you get older and go through menopause.
Who shouldn’t take bioidentical hormones
Your doctor may caution you against any hormone replacement therapy if you’ve had or are at risk for:
- Abnormal vaginal bleeding
- Breast cancer
- Ovarian cancer
- Uterine cancer
- Blood clots
- Heart disease
- Stroke
- Liver disease
- Gallbladder disease
Hormones also aren’t suggested if you’re pregnant.
Whether to start bioidentical hormones is a personal choice and one that you and your doctor can make together. To choose the right type for you, they’ll need to take into account things such as your health, medical history, and symptoms.
Once you start bioidentical HRT, it’s important to follow up with your doctor.
“Regular checkups as advised by your provider are essential to adjust your treatment and monitor for any possible side effects,” Finn says.
Takeaways
Bioidentical hormones are a type of hormone replacement therapy. Although they’re manufactured, they’re very close to the hormones that your body makes naturally. The FDA has approved some types of bioidentical hormones to treat conditions such as menopause. But if you get a compounded version, which is custom-made, it’s unclear how safe it is or how well it will work.
Bioidentical Hormone Replacement Therapy FAQs
What is in bioidentical hormone replacement therapy?
These are synthetic hormones that are a lot like the ones you have naturally in your body. They’re made from plants.
There are two types.
Some prescribed bioidentical hormones are made by drug manufacturers and tested by the FDA. They’re a lot like traditional HRT.
Compounded bioidentical hormones are custom-made treatments. They’re often advertised as having “natural” ingredients. That can be misleading, as they’re still processed in a lab. Because compounded bioidenticals aren’t regulated by the FDA, their safety and dosage aren’t guaranteed.
Which is better, HRT or bioidentical?
Bioidentical hormones are a form of HRT. When it comes to which type of bioidentical hormone therapy is better, many doctors urge caution when using compounded types. That’s because they haven’t been studied a lot. They also don’t have to follow the rules put in place by the FDA. So, there can be lack of clarity on which hormones you’re really taking and their strength.
Who is not a candidate for bioidentical hormones?
Your doctor may ask you to avoid bioidentical hormones if you’ve had, or are at risk for, a health issue such as:
- Breast cancer
- Stroke
- Heart disease
- Blood clotting disorder
If so, talk to your doctor about what other treatment options you have to ease your symptoms.
