Understanding Hormone Therapy: HRT vs. BHRT

Conversations about hormone therapy can feel overwhelming. There’s a lot of information out there, and just as many opinions. But the truth is simple: hormones shift as we age, and those changes can affect how we feel, think and function every day. Both Hormone Replacement Therapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT) aim to ease those symptoms and support long-term health; the key is understanding how they differ and what might be right for you.

Hormonal decline affects people of all genders and often begins in the early thirties. Low or imbalanced hormones can contribute to hot flashes, fatigue, weight gain, mood changes, low libido, sleep disruption, poor exercise tolerance and changes in concentration. For some, the shift is subtle; for others, it disrupts daily life.

HRT vs. BHRT: What’s the Difference?

Both HRT and BHRT replace hormones that the body no longer produces in adequate levels, but they’re made differently:

Hormone Replacement Therapy (HRT)

Traditional HRT uses synthetic or modified hormones, often derived from plant or animal sources. They’re designed to act like human hormones and are FDA-regulated, which means dosing and quality are standardized.

Bioidentical Hormone Replacement Therapy (BHRT)

BHRT uses hormones with the same molecular structure as the ones your body produces. Many BHRT products come from plant-based sources and can be customized by compounding pharmacies, offering more individualized dosing. Because compounded BHRT is tailored, it’s not regulated by the FDA in the same way, and the quality may vary between pharmacies.

The goal of both approaches is the same: to relieve symptoms and restore hormonal balance. The best choice depends on your health history, your symptoms and your preferences.

Benefits of Hormone Therapy

Many people find significant relief with either HRT or BHRT. Benefits may include:

• Reduced hot flashes, night sweats and vaginal discomfort

• Improved sleep, mood and concentration

• Increased libido and energy

• Support for muscle mass and exercise tolerance

• Prevention of bone loss related to low estrogen

• Potential reduction in certain health risks (such as colon cancer with some forms of HRT)

• Support for testosterone-related concerns in men, including heart and bone health

Hormones are powerful, but when used thoughtfully and monitored closely, they can make a meaningful difference.

Risks to Be Aware Of

HRT Risks

• Slightly increased risk of breast cancer with long-term estrogen-progestin therapy

• Higher likelihood of blood clots (DVT, pulmonary embolism)

• Possible increased stroke risk in older women

• Increased risk of gallbladder disease

BHRT Risks

• Custom-compounded BHRT is not FDA-regulated, so quality can vary

• Less long-term research compared to traditional HRT

• Can be more expensive due to customization

  
  

These risks don’t apply to everyone. That’s why individual evaluation matters. Your age, symptoms, medical history and lifestyle all influence what’s safe and appropriate.

Natural Alternatives to Try First

Some clients prefer to start with lifestyle changes before beginning hormone therapy. Helpful strategies include:

• Diet adjustments: more fruits and vegetables, less sugar, alcohol, caffeine and spicy foods (all common hot-flash triggers)

• Regular exercise: supports blood sugar, mood and energy

• Stress management: stress can amplify hot flashes and sleep disruption

• Alternative therapies: acupuncture, biofeedback and hypnosis may provide relief for some

These approaches can help on their own or work alongside hormone therapy for better overall balance.

Choosing What’s Right for You

There’s no one-size-fits-all answer. Both HRT and BHRT can be safe and effective when used appropriately, but they’re not right for everyone. The best approach considers:

• Your symptoms

• Personal and family medical history

• Age and health conditions

• Goals and expectations

• Cost and insurance coverage

A healthcare provider with experience in women’s health and hormone management can help you weigh the benefits and risks so you feel confident in your decision.

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