Hormone therapy is everywhere right now, but if you’ve heard terms like HRT and BHRT, it can be hard to know what they actually mean.
Are they the same thing? Is one safer? Is one more natural?
In this guide, I’ll break down the real difference between traditional hormone replacement therapy and bioidentical hormone replacement therapy so you can better understand which option might be right for your symptoms, your goals, and your long-term health.
At The Gajer Practice, you can learn more about bioidentical hormone replacement therapy and how hormone care may be personalized around your symptoms, health history, and needs.
For more hormone health guidance, watch our YouTube playlist.
What Is HRT?
HRT simply stands for hormone replacement therapy.
HRT is a medical treatment used to replace hormones that have become depleted or changed over time.
For women going through perimenopause or menopause, hormone therapy can help with symptoms such as hot flashes, mood changes, sleep problems, and other symptoms related to the menopause transition.
Hormone replacement therapy isn’t only used for women.
Men go through hormonal changes as well, and hormone replacement may be used when testosterone levels decline and treatment is medically appropriate.
What Is BHRT?
BHRT stands for bioidentical hormone replacement therapy.
Bioidentical means that the hormones have the same chemical structure as hormones your body naturally produces.
BHRT may include estrogen, progesterone, testosterone, or other hormones, depending on an individual’s needs.
Some bioidentical hormone products are FDA-approved.
Others, including certain testosterone formulations used for women, may be compounded for individual patients.
What Are the Key Differences Between BHRT and HRT?
BHRT is really a subset of hormone replacement therapy where bioidentical hormones are used.
HRT is the broader category and can include both bioidentical hormones and other hormone formulations.
Decades ago, many women were treated with older hormone formulations. When results from the Women’s Health Initiative came out, hormone therapy use dropped sharply because of concerns about breast cancer, cardiovascular events, and other health risks.
Since then, the conversation has become much more nuanced.
Researchers and clinicians have looked more closely at which hormones are being used, how they’re administered, when treatment begins, and the individual patient’s health history.
If you want to go deeper into the difference between synthetic and bioidentical hormones, those differences in formulation are an important part of the conversation.
Is BHRT Safer Than HRT?
BHRT can sound like it would automatically be safer than HRT, but the answer is more complicated.
BHRT itself is a type of HRT.
The safety of hormone therapy depends on the specific hormone, dose, route of administration, timing, medical history, and whether the medication is FDA-approved or compounded.
Older hormone regimens included conjugated equine estrogens and synthetic progestins, and research following the Women’s Health Initiative has led to a better understanding of how treatment timing and formulation can affect risks and benefits.
Research on bioidentical hormones continues to evolve.
There are FDA-approved hormone therapies that are bioidentical. Compounded bioidentical hormones, however, aren’t automatically safer or more effective simply because they’re described as bioidentical.
So, the safest option is really the one that you come up with with a physician who knows your medical history, your personal circumstances, and can guide you toward therapy that’s appropriate for you.
What Are the Benefits of BHRT?
Women experience menopause symptoms very differently, and there can be a wide range of symptoms during the menopause transition.
Hormone therapy can help relieve symptoms related to changing hormone levels.
That can include hot flashes, night sweats, trouble sleeping, low energy, and other symptoms women may experience during perimenopause and menopause.
Some women also notice changes in body composition or find that managing their weight becomes more difficult.
Hormone therapy can also have longer-term benefits in appropriate patients.
Estrogen therapy can help reduce bone loss and the risk of osteoporosis and fractures.
Certain estrogen treatments can also help with vaginal and urinary symptoms associated with menopause.
The potential benefits and risks beyond symptom relief depend heavily on the individual patient, the type of hormone therapy, and when treatment is started. Hormone therapy isn’t prescribed solely to prevent heart attacks, strokes, or dementia.
Who Should Avoid Hormone Therapy?
Again, this is something every person needs to discuss with their doctor.
Women with active or prior hormone-sensitive breast cancer may need to avoid certain forms of systemic hormone therapy or consider other options.
Women with a BRCA mutation or other elevated cancer risks also need an individualized discussion about which forms of hormone therapy, if any, are appropriate.
Your history of blood clots, cardiovascular disease, liver disease, unexplained vaginal bleeding, medications, and other health factors can matter too.
Timing also makes a difference.
Starting systemic hormone therapy more than about 10 years after menopause can have a different risk-benefit profile than starting closer to the menopause transition.
That doesn’t mean there are no options available later in life.
The important thing is to get screened, review your health history, and work with a physician who’s knowledgeable in hormone therapy and can help you make that decision.
What Does Hormone Treatment Cost?
Luckily, hormone treatment for women has become much more accessible.
Estradiol patches, which are a commonly used form of estrogen, are available as generics and can be relatively inexpensive depending on your pharmacy and insurance coverage.
Bioidentical progesterone is also widely available.
Compounded testosterone can sometimes be more expensive because there currently isn’t an FDA-approved testosterone product specifically indicated for women.
Overall, costs can often be managed reasonably, but the amount you actually pay will depend on the medications you’re prescribed, whether they’re compounded, your pharmacy, and your insurance benefits.
FDA-approved estradiol and progesterone may be covered by insurance, while compounded medications often have different coverage rules.
How Do You Know If BHRT Is for You?
If you’re having symptoms of perimenopause or menopause where your energy has changed, you’re getting hot flashes, you’re not sleeping as well, or your weight has become more difficult to manage, that’s a good reason to look further into whether hormone therapy could be appropriate for you.
Your doctor can review your symptoms, menstrual history, medical history, medications, risk factors, and goals.
Depending on your situation, lab testing may also be part of that evaluation.
The goal is to understand what’s happening with your hormones and determine whether you may be a candidate for BHRT.
