You may be hesitant to try hormone replacement therapy after hearing the scary stories about how it can cause more problems than it fixes. However, research shows that hormones are safe and effective for many patients.

BHRT treats both men and women with hormonal imbalance symptoms like hot flashes/night sweats or low libido. This is typically done with bioidentical hormones.

How Bioidentical Hormones Are Made

Bioidentical hormones are custom-made by pharmacies based on a healthcare provider’s prescription. The hormones are made to match your physical body’s needs and are available in many forms, including pills, creams, gels, and vaginal suppositories.

They are derived from plant-based sources like wild yams and soybeans but must undergo significant processing before being approved by the FDA to be sold as hormones. Bioidentical hormones have the same chemical structure as the natural hormones produced in your body and are less likely to cause side effects than conventional hormones.

However, when people talk about BHRT, they refer to compounded bioidentical hormones, not FDA-approved bioidentical hormone products. Unlike the FDA-approved bio-identical hormone replacement Silver Springs, compounded bioidentical hormones have not been evaluated for safety and quality and vary in strength from pharmacy to pharmacy. Because of this, experts don’t recommend them.

Natural Hormones

While bioidentical may sound more natural, the FDA and medical specialty groups have confirmed that hormones marketed as “bioidentical” or “natural” aren’t safer or more effective than those used in traditional hormone therapy products. Bioidentical hormones can be made from extracts of plants or animals, such as conjugated equine estrogens (CEE)(Premarin), oral contraceptive pills, and medroxyprogesterone (Provera). They also can be synthetically manufactured in a lab.

Bioidentical hormones are available in various forms, including tablets, creams and gels, injections, and pellets. At Dermatology Realm, we prescribe a combination of bioidentical hormones compounded by a local pharmacist and delivered via a pellet placed under the skin. The pellets provide a more even release of the hormones. Your doctor will conduct a saliva test or blood work to monitor hormone levels and to determine whether you need to increase or decrease the dosage. You must pay out of pocket, as insurance does not cover these hormones.

Prescription Bioidentical Hormones

The bioidentical hormones are made from plant steroid extracts such as soy and wild yams, but the final products look and act much like the hormones your body produces. They can come in several forms, such as pills, creams, and gels.

Doctors talking about bioidentical hormones usually mean FDA-approved products — such as estradiol (Estrace, Vivelle, Climara) and progesterone (Prometrium). Bioidentical hormones also can be prepared in a compounding pharmacy based on a provider’s prescription. These compounded hormones aren’t FDA-approved, so their effectiveness and safety haven’t been tested.

Most experts believe that, if used properly, these hormones are safe and effective for treating menopause symptoms. These include hot flashes, vaginal dryness and loss of libido, insomnia, and depression. The key to successful treatment is a balanced regimen that includes lifestyle changes, such as exercise and dietary supplements, which can help reduce side effects. It is essential to discuss your options with an experienced practitioner.

Compounding Bioidentical Hormones

Some people use a compounded bioidentical hormone product, a mixture of hormones made in a pharmacy according to a health care practitioner’s prescription. They may be prepared as pills, creams, gels, or injections. Each person’s physical body has unique needs, so a healthcare practitioner will evaluate a patient and prescribe appropriate dosages and strengths of bioidentical hormone preparations to achieve hormonal balance.

Many people use bioidentical hormone replacement therapy to ease the symptoms of perimenopause, menopause, and andropause. These include hot flashes, vaginal dryness, mood swings, and loss of libido. Hormones can also protect against osteoporosis, cardiovascular disease, and dementia.

Unlike traditional hormone replacement therapies that contain synthetic estrogens, such as Premarin, which is made from the urine of pregnant horses, bioidentical hormones have the same molecular structure as the hormones your body produces. However, the Women’s Health Initiative study 2002 results raised concerns about long-term hormone therapy for women because it can increase the risk of breast cancer, blood clots, heart disease, and brittle bones.