Bio-identical Hormone Replacement Therapy (BHRT) is the therapeutic use of hormones that are identical to the hormones made naturally by the body. There are many different types but the ones used predominantly include: testosterone, progesterone, estradiol (E2), estriol (E3), DHEA, cortisol, and thyroid. These hormones are typically used to treat symptoms of peri-menopause, menopause, andropause (male menopause), thyroid dysfunction, abnormal uterine bleeding and adrenal fatigue, although other symptoms may be treated as well. The most common symptoms successfully treated with BHRT include hot flashes and vaginal dryness.

Bio-identical hormones can be used and metabolized as our body was designed to do,
potentially minimizing side effects. Compounded bio-identical hormone dosages can be fine-tuned to a patient’s specific needs. Many European studies suggest that bio-identical hormones are safer than synthetic hormones. However, that doesn’t mean that bio-identical hormones are perfect. We also do not have any large scale, double blinded, placebo controlled trials on bio-identical hormone replacement therapy to confirm our opinions.

There is growing use of bio-identical hormones which are made by compounding pharmacists. These drugs are formulated to be identical in molecular structure to the hormone, which is normally present in the body (hence bio-identical HRT). Estrogens are not well absorbed orally and have to be taken either in the form of a cream or a troche (lozenge). This compounded HRT can be tailor-made for the patient according to a symptom profile as well as hormonal testing. The latter can be performed by salivary hormone assay or blood testing.

It however must be understood that there is little in the way of large randomized controlled studies with BHRT. Many medical societies and colleges have released statements that there is unlikely to be any expected difference in the benefits or risks of hormone replacement therapies using bio-identical molecules compared to those using non-bio-identical molecules, and also that compounded hormone products may have additional risks related to compounding. While there is no evidence to support this view, BHRT should be taken with the same precautions as normal HRT. This should include routine breast screening, pap smears and endometrial biopsy should there be any abnormal vaginal bleeding.


Personal history of breast, ovarian, or endometrial cancer and/or a strong family history of breast or ovarian cancer. Close collaboration with an oncologist may be needed in these situations. Unexplained vaginal bleeding may be another contraindication. Women with known heart disease need routine evaluation for their heart problem and annual labs including cholesterol levels.