The Difference Between Bioidentical Hormone Replacement Therapy (BHRT) and Hormone Replacement Therapy

Hormones are essential chemicals in the body that regulate vital functions, from growth and metabolism to reproductive health. As we age, levels of certain hormones naturally decline, affecting energy, mood, and overall health. This decline can be more pronounced during peri and post menopause  often leading to symptoms like fatigue, mood swings, and osteoporosis. Hormone Replacement Therapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT) are treatments designed to replenish declining hormone levels, though each approach differs in formulation, origin, and impact on the body. This article explores these differences to help you make an informed choice.

What is Hormone Replacement Therapy (HRT)?

Hormone Replacement Therapy (HRT) traditionally involved synthetic hormones designed to supplement declining estrogen (really estradiol) and progesterone, particularly in post menopausal women. Estrogen and progestin are common hormones prescribed in HRT, where estrogen serves as a synthetic substitute for estradiol and progestin for progesterone. The synthetic nature of these hormones means that they do not perfectly mimic the chemical structure of hormones naturally produced by the human body. Instead, they’re developed in laboratories to stimulate similar responses.

Synthetic estrogen, often derived from sources like pregnant horse urine (as in Premarin), and synthetic progestin (such as Provera), are frequently used because they can be patented and mass-produced by pharmaceutical companies. These drugs aim to relieve symptoms associated with menopause, including hot flashes, mood swings, and increased bone loss. However, because synthetic hormones are not identical to human hormones, they can sometimes produce side effects, such as bloating, mood changes, blood clots and, in some cases, an increased risk of breast and uterine cancer.

Pharmaceutical companies are now also offering bioidentical hormones but when the hormones come from these companies they will contain more inactive ingredients, such as fillers and dyes. A lot of patients react to these inactive ingredients. The doses of bioidentical hormones from a pharmaceutical company will also be in much lower, specific doses not allowing for individual tailoring of doses or optimal route of administration.

What is Bioidentical Hormone Replacement Therapy (BHRT)?

Bioidentical Hormone Replacement Therapy (BHRT) is based on hormones derived from natural sources, like yams and soy, and processed to have a molecular structure identical to human hormones. Because of this identical structure, the body recognizes and metabolizes bioidentical hormones as if they were naturally produced, which can lead to a more seamless integration into the body’s biological processes.

Compounding pharmacies often process bioidentical hormones into customized prescriptions tailored to individual needs, enabling a more personalized approach to hormone therapy. BHRT is increasingly chosen for its perceived advantages in safety and effectiveness, particularly as it aligns more closely with the body's natural processes. Many individuals find that they experience fewer side effects with BHRT, potentially avoiding issues like mood swings, bloating, and other discomforts sometimes linked to synthetic hormones.

1. Source and Composition: 

  • HRT: Synthetic hormones created in laboratories, often derived from animal sources or artificial compounds.  Limited offering of bioidentical hormones, often with fillers and dyes that cause side effects.

  • BHRT: Natural, plant-derived hormones chemically identical to those produced by the human body.

2. Processing and Patenting:

  • HRT: Synthetic hormones can be patented, making them highly profitable for pharmaceutical companies.  Bioidenticals cannot be patented.  Bioidenticals approved by the FDA are limited in number, indication for which they can be used, doses available, and often contain fillers and dyes.

  • BHRT: As natural hormones are not patentable, major pharmaceutical companies have less financial incentive to promote them. They are typically compounded in specialized pharmacies.

3. Side Effects:

  • HRT: Some individuals report side effects like bloating, bleeding, blood clots and increased cancer risk, particularly for breast and uterine cancers.

  • BHRT: Because these hormones are identical to natural human hormones, they are often better tolerated and linked to fewer side effects.

4. Availability and Prescribing Practices:

  • HRT: Widely available and often covered by insurance, making it a convenient option for many patients.

  • BHRT: Not as commonly prescribed, as many physicians are more familiar with synthetic hormone options and may have limited training in BHRT. Health insurance may not cover BHRT, making access more challenging.

Key Differences Between HRT and BHRT

Why Some Doctors Don’t Prescribe Bioidentical Hormones

Many doctors are more familiar with synthetic hormones because of the influence of pharmaceutical companies and the training they receive, which often focuses on patentable products. Additionally, insurance companies usually only cover the limited FDA approved bioidentical hormone therapy.  Insurance companies do not like to cover BHRT as it is often produced by compounding pharmacies and doesn’t come under a specific brand name. As a result, unless a physician has pursued additional training in BHRT, they may not be aware of its benefits or available options and only aware of pharmaceutical company products.

Should You Consider Hormone Replacement Therapy?

Deciding between HRT and BHRT is a personal choice that depends on factors like health history, risk tolerance, and lifestyle preferences. Some choose hormone therapy to manage menopause symptoms, reduce the risk of osteoporosis, and improve their overall well-being. For those wary of synthetic hormones, BHRT offers a natural alternative that aligns more closely with the body’s natural processes. The risks of untreated hormone decline can be significant, with potential impacts on heart health, bone density, and cognitive function.

Many patients find BHRT appealing because it may offer similar benefits to synthetic HRT but with a lower risk of adverse effects. However, consulting with a knowledgeable healthcare provider is crucial to discuss risks, benefits, and individualized options.