Bioidentical hormones are structures that mimic those of human steroid hormones. These substances are derived from plant oils through a chemical conversion process to the plant. The products are a match in structure and function of endogenous hormones in the human body and are made available for professional compounding.
Menopause is a permanent cessation of menstruation resulting from loss of ovarian function. A patient may be classified as menopausal if it has been at least 12 months since their last menstrual cycle. During menopause, there are significant changes in hormone levels which can result in symptoms that negatively affect a woman’s quality of life. Such symptoms include hot flashes, night sweats, and sleep disturbances.
Bioidentical hormone replacement therapy (BHRT) aims to restore balance between hormone levels and can alleviate the symptoms of menopause.
The hormone levels affected during the menopausal period are those of estrogen, progesterone, and testosterone. When the ovaries fail, overall estrogen levels fall. Likewise, after age 35 years, progesterone levels decline as the ovaries begin to deteriorate and continue to fall after menopause. Testosterone gradually declines with age as well as its precursor DHEA, particularly in patients who are stressed.
The goal of BHRT is to regainthe balance of these endogenous hormones utilizing the compounded substances which mimic them. Each of these hormone deficiencies affect specific symptoms that the bioidentical hormones target to treat.
Estrogen: hot flashes, night sweats, decreased libido, vaginal dryness, vaginal atrophy, irritability
Progesterone: PMS, mood swings, insomnia, foggy thinking
Testosterone/DHEA: decreased libido, decreased metabolism, low energy
Important factors to consider whether a woman is a candidate for BHRT include medical history, current medications, hysterectomy status, and assessment of hydration and stress level. Labs are used to guide target symptoms to treat since they can indicate which imbalances exist. To detect hormone deficiencies, a saliva test is utilized to measures the unbound hormones through saliva capillaries. This is the preferred method as it is easily collected and correlates with serum levels.
As opposed to commercially available HRT, compounded BHRT allows patient-specific needs to be met with various combinations that can be individually determined in a range of available dosage forms. Dosage forms include capsules, vaginal creams, suppositories, sprays, topical gels, transdermal gels, troches, and RDTs. This can be beneficial for women who may not tolerate FDA approved products or the ingredients contained in them.
References
https://www.healthline.com/health/bioidentical-hormone-replacement-therapy#hrt-vs-bhrt
Evans, J. R. (2022, December 12). Bioidentical hormone replacement therapy. Healthline. https://www.healthline.com/health/bioidentical-hormone-replacement-therapy#hrt-vs-bhrt
https://pmc.ncbi.nlm.nih.gov/articles/PMC3127562
Files, J. A., Ko, M. G., & Pruthi, S. (2011). Bioidentical hormone therapy. Mayo Clinic proceedings, 86(7), 673–680. https://doi.org/10.4065/mcp.2010.0714
Is bio-identical hormone therapy fact or fairy tale?
Francisco, Laura. Nurse Practitioner; Seattle Vol. 28, Iss. 7, (Jul 2003): 39-44, table of contents.
This Post Was Written By:
Alexia Komitopoulos, PharmD Candidate 2025
