Understanding BHRT and Estrogen

Bioidentical hormone replacement therapy (BHRT) is a type of hrt therapy for menopause that uses lab-created hormones derived from plant sources. These hormones are chemically identical to those produced by the human body, which means they can interact with hormone receptors in a similar way.

Estrogen is one of the primary hormones that can be included in BHRT for low estrogen in women. Its levels naturally decline during menopause, which can contribute to a range of symptoms. In some cases, healthcare providers may consider low estrogen treatment options — hormonal or non-hormonal — to help manage these changes.

It’s important to note that not all products marketed as “bioidentical” are regulated in the same way. Commercially available bioidentical hormones must meet strict quality and safety standards, while compounded bioidentical formulations — prepared individually in some pharmacies — are not subject to the same oversight and can vary in consistency.

What is Estrogen and Why Does It Matter?

Estrogen is a steroid hormone mainly produced by the ovaries before menopause. It plays a role in reproductive health, bone density, and various body systems. As women transition into menopause, estrogen levels drop significantly, sometimes leading to symptoms such as hot flashes, mood changes, and changes in genitourinary health.

Because these experiences vary greatly between individuals, there is no one-size-fits-all approach. For some, hrt therapy for menopause that includes estrogen may be considered as part of a personalized plan. The decision should always be based on age, health history, and the balance of potential benefits and risks.

Estrogen as a Component of BHRT

In BHRT, estrogen can be prescribed in different forms. The three most common bioidentical estrogens are:

• Estrone (E1)
• 17β-Estradiol (E2)
• Estriol (E3)

Some forms, like E1 and E2, have been studied extensively and are available in approved formulations. E3 is used in certain countries but is not approved in all regions.

Research suggests that estrogen, when used as part of a broader plan, may support symptom management for low estrogen in women, including vasomotor changes, bone health considerations, and genitourinary changes. However, the effectiveness and safety can depend on the timing of initiation, the type of formulation, and the individual’s medical profile.

Possible Benefits and Considerations

Some studies have explored potential benefits of estrogen therapy, including:

• Bone health support – Estrogen may help slow bone loss after menopause.
• Mood and well-being – Some individuals report improvements in mood and quality of life.
• Genitourinary support – Estrogen may help with vaginal dryness and urinary tract health.
• Cognitive function – Research is ongoing into estrogen’s effects on brain health.

These potential benefits must be weighed against possible risks, such as blood clots, stroke, or certain cancers, depending on personal and family medical history. This is why any low estrogen treatment plan should be made in consultation with a qualified healthcare provider.

Should You Consider Estrogen in BHRT?

If you are experiencing symptoms related to low estrogen in women — such as hot flashes, sleep changes, or vaginal discomfort — a healthcare provider can assess whether hormonal or non-hormonal therapies are appropriate. Estrogen therapy is not suitable for everyone, especially for individuals with certain health conditions or risk factors.

FAQ

Q: Will my doctor prescribe bioidentical hormones right away?
Not necessarily. The choice of treatment — whether bioidentical or another type — depends on your health needs and medical history. Regulatory bodies do not treat “bioidentical” as a separate category, but approved bioidentical products are held to the same safety and quality standards as other prescription hormones.

Q: What is the difference between bioidentical hormones and compounded bioidentical hormones?
Approved bioidentical hormones undergo rigorous testing for safety, efficacy, and consistency. Compounded versions, prepared by some pharmacies, do not have the same regulatory oversight, meaning quality and dosing may vary.

Q: Which test is better for checking hormone levels: saliva or serum?
Serum (blood) testing is generally more standardized and reliable than saliva testing, although both have limitations. Your healthcare provider may use a combination of tests and clinical evaluation to guide treatment decisions.

Q: Can high estrogen levels occur during low estrogen treatment?
In some cases, estrogen levels may temporarily increase when starting therapy. Your healthcare provider may adjust your treatment or explore other options to maintain a healthy balance.