Bioidentical Hormone Replacement Therapy: Insiders' Guide

6 minute read

By: Alloy Staff|Last updated: January 18, 2024|Medically reviewed by: Corinne Menn
Female research scientist in lab examining vial. AW565

Bioidentical Hormone Replacement Therapy: Insiders' Guide

Hormonal imbalances related to perimenopause and menopause can drastically impact your everyday quality of life. Bioidentical hormone replacement therapy (BHRT), also commonly referred to as menopausal hormone therapy, is a method of treatment that can help reduce symptoms such as mood swings, hot flashes, and night sweats. But what is it?

With so much misinformation out there, pursuing hormone therapy can seem daunting or scary, leading you to miss out on real solutions for your symptoms. In this article, we’ll investigate what bioidentical hormones are, what they treat, and possible side effects so that you can have an informed discussion with your healthcare provider.

At Alloy, we use the latest research to offer menopausal hormone therapy (MHT), also called hormone replacement therapy (HRT), that can change lives. If you want to receive HRT to combat your menopausal symptoms, get your relief plan from Alloy today!

What Are Bioidentical Hormones?

Hormones are chemicals produced by your endocrine glands that serve as messengers, telling particular functions of your body how and when to work. During menopause, your body goes through major hormonal changes as your ovaries stop producing as many hormones. That’s where menopausal hormone therapy can be helpful. 

Bioidentical hormones are hormones that contain the same molecular structure as the hormones made by your body.

Vital hormones that bioidentical hormone therapy can replenish include:

  • Estrogen

  • Progesterone

Bioidentical hormones can be created by a pharmaceutical company or a compounding pharmacy, and differ from the conjugated estrogen formulas used in older forms of hormone replacement therapy. At Alloy, we only use FDA-approved bioidentical estradiol and micronized progesterone that are standardized and available at regular pharmacies.

Bioidentical vs. Synthetic Hormones 

While both bioidentical and synthetic hormones are made in a lab, the raw ingredients used are different. Both can be useful solutions, but bioidentical hormones often have far better results with fewer risks of negative side effects.

Symptoms BHRT Treats

Hormones can impact several important bodily processes, including metabolism, reproduction, growth, and sexual function. Perimenopausal or menopausal symptoms can take a toll on your day-to-day life, which is why hormone therapy may be helpful. 

Bioidentical hormone therapy can treat the following symptoms:

  • Mood swings

  • Hot flashes

  • Vaginal dryness

  • Night sweats

  • Lack of energy

  • Memory loss

  • Sleep problems

  • Decreased interest in sex 

If you experience any of the above symptoms, bioidentical hormone therapy could be a helpful solution to resolve these issues.

Types of Bioidentical Hormone Replacement Therapy

Bioidentical hormone replacement therapy comes in several different forms. The one that’s best for you will depend on the advice of your healthcare provider, as you may need to try more than one form before you identify the one that works best for you. 


One option for BHRT is Estradiol in pill form, taken once a day, at .5 mg, 1 mg or 2 mg, depending on your healthcare provider’s recommendation. This form is often recommended for people experiencing symptoms of menopause, including hot flashes, mood swings, and sleep issues. 

If you do not smoke, have no blood pressure or clotting problems, or have no history of heart or liver disease, this could be a good option. As with all forms of estrogen, if you have a uterus, you will also need to take progesterone to protect your uterine lining.


The Estradiol Patch can be a helpful option during perimenopause or menopause. This can be a more convenient option, as you only have to change the patch twice a week instead of taking a pill every day. The patch is also recommended for women who smoke, are overweight, experience hypertension or migraines, or have a family history of stroke or heart disease.  


BHRT gels are transdermal like the estradiol patch, which means they’re absorbed through the skin. Gels can help with hot flashes, night sweats, mood changes, and vaginal symptoms, and your healthcare provider will recommend the best treatment option for your symptoms.  

Vaginal Creams

Estradiol Vaginal Cream treats symptoms like vaginal dryness, itching, burning, painful sex, and frequent UTIs. This option is only for those experiencing genitourinary symptoms due to menopause. 

Vaginal creams contain a small dose of estrogen and are applied topically for the relief of the immediate area, and are not used to treat systemic symptoms such as hot flashes or night sweats. 

You insert the cream into the vagina with an applicator and  apply it externally to the vulva. The recommended use is every other day at first, and less frequently after the first few months. 

How Soon Does BHRT Start to Work?

Most women will start to feel better within a few days, much better in a week or two, and generally reach maximum symptomatic relief for any given dose and formulation within 4-6 weeks. 

It may take some time to identify the best dose for you and your symptoms. That said, some people experience relief from their symptoms as early as two days after they begin treatment. 

Bioidentical Hormone Replacement Therapy ​​Contraindications

People who have a history of or who experience the following should consult their healthcare provider:

  • Breast cancer

  • Porphyria

  • Severe active liver disease

  • Undiagnosed vaginal bleeding

Transdermal estradiol in patch or gel form has not been shown to increase these risks just as bioidentical estradiol and progesterone have not been shown to increase breast cancer risk. 

The latest data suggests that synthetic progestins may slightly increase the risk of breast cancer. At Alloy, we prescribe micronized bioidentical progesterone as the first line option for BHRT for those who need to take  progesterone. 

Bioidentical progesterone has never been shown to cause an increase in breast cancer risk.  Your healthcare provider will discuss your full medical history with you before recommending any kind of hormone replacement therapy. 

Possible BHRT Side Effects

While most side effects are minimal and subside after a few months, there are some possible side effects you should know about. 

You may experience the following:

  • Nausea

  • Bloating or weight gain

  • Mood swings

  • Breakthrough bleeding

  • Breast tenderness

  • Cramps

  • Headaches

Your healthcare provider will likely recommend regular symptom evaluations to monitor your progress. That said, if you experience side effects that worsen or persist for a long period of time, contact your healthcare provider immediately. 

Common Myths About Bioidentical Hormone Replacement Therapy

Estrogen Causes Cancer

One of the myths out there is that estrogen is dangerous and can cause cancer. However, the reality is that current data indicates estrogen does not cause breast cancer. The preponderance of evidence suggests that using FDA-approved BHRT does not increase your risk of breast cancer over your baseline risk. 

In fact, in the WHI study, women only taking estrogen had a 30% decreased incidence of breast cancer.

BHRT Can Delay Menopause

Unfortunately, BHRT cannot delay menopause. BHRT can help you manage menopause symptoms, which can make aging more pleasant. With the right hormones, you can enjoy the privilege of aging without the uncomfortable side effects. 

You Shouldn’t Start Bioidentical Hormone Replacement Therapy Too Young

In fact, starting BHRT earlier can have meaningful benefits, especially if you’re experiencing severe perimenopausal symptoms. Some studies show that there’s a critical window wherein if you begin BHRT earlier, you’re more likely to have more positive results, reducing symptoms and possibly avoiding further health complications that crop up with age.

You Can Be on BHRT For Too Long

You can continue BHRT for as long as you and your doctor are happy with the results. Your healthcare provider will continue to monitor your symptoms and any side effects to determine the best dose, formulation and duration of therapy.  

Herbs and Vitamins Are Safer Than Hormone Treatments

While certain herbs and vitamins may help alleviate some perimenopausal and menopausal symptoms, the lack of regulation around their distribution and raw ingredients can make it difficult to find the proper dose and formulation. 

With FDA-approved BHRT, your healthcare provider can recommend an exact dose and formulation backed by evidence-based guidelines to treat your current symptoms. 

Pellets and Shots Are Good Forms of Bioidentical Hormone Replacement Therapy

Pellet therapy and shots can actually be more harmful than helpful. In pellet therapy, hormones are inserted under the skin in pellet form to continuously release hormones over time. This kind of hormone therapy is not approved by the FDA and can combine multiple hormones using unapproved combinations or formulations.

Those using pellets have reported as many as six times the number of side effects compared to other forms, including breakouts, mood swings, increased anxiety, weight gain, and changes in hair pattern. Some people even experienced unusual uterine bleeding and, in extreme cases, needed a hysterectomy. 

Additionally, if you are using a pellet and you need to change your dose, your doctor will need to surgically remove the pellet. If your dose isn’t working for you, you would need multiple removals, which is invasive and can have risks of its own, including infection. 

Estradiol injections or shots have similar risks with increased side effects. If your healthcare provider recommends pellets or shots, find another doctor and seek other options in order to protect yourself and your health. 

Get Bioidentical Hormone Replacement Therapy From Alloy Today

Understanding your bioidentical hormone replacement therapy options can feel overwhelming, but it doesn’t have to be. At Alloy, our products are backed by the latest scientific evidence and guidelines and are all FDA-approved hormone therapies.

We only offer FDA-approved bioidentical hormones, and we’ll demystify the types available so that you can get the best products for your menopausal symptoms. Learn more about our hormone replacement therapies and solutions to get one step closer to relief. 

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