Hormonal Imbalance – The Root Cause

Women in their mid-forties to fifties may experience changes such as mood fluctuations, disrupted sleep, hot flashes, bone fragility, weight changes, vaginal dryness, and feelings of anxiety or fatigue. These symptoms are part of the natural menopausal process, diagnosed after 12 months without menstruation.

Globally, over 6 million women enter menopause each year — a number expected to rise as populations age.

Estrogen and progesterone play roles in bone health, cardiovascular function, mood regulation, and cognitive function. Their decline during menopause can lead to symptoms lasting several years.

Some women manage well with lifestyle adjustments such as exercise, balanced nutrition, stress reduction, and adequate sleep. Others may experience more severe symptoms and explore medical treatments, including hrt therapy or non-hormonal approaches.

HRT: Replenishing the Body’s Hormone Reserves

Traditional HRT uses hormones sourced from plants or animals, chemically altered to be similar — but not identical — to human hormones. One well-known example is conjugated equine estrogens (CEE), derived from pregnant mares.

HRT has been extensively studied, particularly in large-scale clinical trials like the Women’s Health Initiative. The goal is to supplement declining hormone levels, with the hrt dosage, timing, and delivery method tailored to the individual’s needs when possible.

What is BHRT?

Bioidentical hormone replacement therapy uses plant-derived hormones that are chemically identical to the body’s own. Examples include estradiol (E2), estrone (E1), and progesterone. These are available in approved formulations that meet regulatory safety and quality standards.

In some cases, pharmacies prepare compounded bioidentical hormones (CBHT) by mixing hormones in specific ratios. However, compounded products are not regulated to the same degree as approved medications, meaning their quality and hrt dosage consistency can vary.

For an overview of BHRT, visit our guide to Bioidentical Hormone Replacement Therapy.

HRT and BHRT: Potential Benefits

While experiences vary, research suggests that both bioidentical hormone replacement therapy and HRT can offer benefits when appropriately prescribed and monitored:

Benefits of HRT

• May help manage hot flashes, night sweats, and mood changes in some individuals.
• Can support bone density and reduce osteoporosis risk in women under 60.
• May have positive effects on cholesterol balance when initiated early in menopause.

Benefits of BHRT

• Offers an option for those seeking hormones chemically identical to human hormones.
• Some research indicates benefits in bone, cardiovascular, and genitourinary health.
• When used at an appropriate hrt dosage, BHRT may have safety profiles comparable to traditional HRT for certain patients.

It’s important to note that the benefits of BHRT and HRT must be weighed against potential risks, and neither is universally suitable.

HRT and BHRT: Possible Risks

Potential risks depend on factors such as age, health status, family history, hrt dosage, and duration of therapy.

HRT Risks

• May increase the risk of certain cardiovascular events or cancers in some individuals.
• Not all side effects are predictable — monitoring is essential.

BHRT Risks

• Side effects can be similar to traditional HRT.
• Limited large-scale research compared to traditional HRT.
• Compounded BHRT products may have variable quality and dosing accuracy.

Final Considerations

When comparing bioidentical hormone replacement therapy vs HRT, the choice should be individualized. Both approaches can be effective for some women, but both carry risks.

Healthcare providers will consider age, menopause stage, health history, and treatment goals when recommending an option — and may also suggest lifestyle or non-hormonal strategies.

The Bottom Line

Menopause is a natural life stage, not an illness, but for some women, symptoms can significantly impact quality of life. Both HRT and BHRT can be part of a short-term, carefully monitored plan to manage symptoms — but neither is a cure for menopause.