I remember a beloved youtuber in a video showing how to apply certain makeup and suddenly saying, “I am having a hot flash.” As her well made-up face got drenched in sweat, all I was thinking was, “But she said that she takes hormones (HRT).”

Many women suffer a lot of symptoms during perimenopause, menopause and post-menopause. Some of the symptoms are, depression, hot flashes, weight gain, sleep problems, vaginal dryness, vaginal atrophy, etc. Most of these symptoms are caused by hormonal imbalance.

Hormone replacement therapy

If you go to your doctor with those symptoms, normally you will get one of these treatments: hormone replacement therapy (HRT) or bioidentical hormone replacement therapy (BHRT).

What is better: HRT or bioidentical hormones?

There is no one answer in conventional medicine. The doctor recommends what he or she thinks is the best treatment for every patient depending on the severity of the symptoms and the overall health condition and risks. So there is no one better than the other for every person.

What is HRT?

HRT is hormone replacement therapy. The treatment replaces some of the estrogens and progesterone that we lose during perimenopause, menopause and post menopause to try to balance our hormones. The hormones used in this treatment are synthetic drugs, and some of them are made using animal hormones.

The advantage of this treatment is precision, because they are created in a lab, it can be personalized and the amounts of the active ingredients are exact. They can also be more potent.

HRT has many drawbacks and health risks and it is not the best treatment for many women, including women with higher breast cancer risk. As you may have read, HRT increases the risks of heart disease, stroke, blood clots and breast cancer. There are also indications that it does not protect against osteoporosis, heart disease, and dementia, as some in the medical community believe.

Pretty scary drugs, if you ask me. As a functional medicine consultant, I think this treatment should be used only when absolutely necessary. I disagree with the medical advice that it is recommended to people with moderate menopausal symptoms. In extreme cases, I think it can be used to stabilize the hormones while a healthy lifestyle and natural techniques are followed. Ideally this should be a temporary solution.

bio identical hormone replacement therapy

What is BHRT?

BHRT is bioidentical hormone replacement therapy. Same as before but using plant based hormones. There are creams, pellets, pills and other forms to deliver these hormones.

The plant based hormones are identical on a molecular level to those created by our bodies. The fact that they are plant based may make it appears as if they are safe, but according to the FDA, bio-identical hormone replacement therapy has not been studied long enough and it may not be safer than the synthetic versions.

Some studies indicate that they are safer, but we do not have enough data. Some doctors express that BHRT is not as precise as conventional HRT.

Alternatives to HRT or BHRT

Many women can get great relief from perimenopausal and menopausal symptoms with just lifestyle changes. Besides a healthy lifestyle, there are also many natural treatments using supplements, herbs and natural techniques that offer relief. Ideally HRT and BHRT should be the last resort or a temporary resource.

We are more than hormones

In functional medicine we believe that the hormonal imbalances addressed with HRT and BHRT are normally caused by deeper health issues affecting vital organs such as the liver and adrenal glands.

Most natural health practitioners will not only try to balance the hormones, they will also try to determine what organs are causing the imbalance, and will try to solve the root cause of the problem. Usually a natural or functional medicine practitioner looks at the person as a whole and not only the illness or symptoms.

Many menopausal symptoms can be caused by emotional reasons or too much stress. In addition to treatment, most natural practitioners will recommend many lifestyle changes, most regular doctors will also recommend some changes but with less emphasis.

HRT and BHRT work faster than natural treatments and lifestyle changes. But they will never beat a healthy lifestyle and actually solving the health problems that are causing the menopause related symptoms.

Other risks of HRT and BHRT

As previously said, when our hormones are imbalanced there are causes that need attention. If we only take hormones, we are not addressing those underlying issues and without treatment probably they may get worse.

Another aspect is that hormonal replacement, just as in the case of that youtuber I mentioned earlier, may not eliminate all the symptoms. In some cases HRT and BHRT only improve the severity of the symptoms. Some women will need to try different protocols to reach an ideal state and more often than not, it may not be reached. HRT and BHRT, just like contraceptives, can have side effects such as facial hair growth, acne etc.


Although HRT and BHRT have many risks, if a woman’s quality of life is severely affected, these treatments can offer a bridge while trying to improve general health and embracing a healthier lifestyle. Long term a drug or supplement is never a good substitute for a healthy lifestyle.

A word of caution

If you take hormones, do not discontinue them without consulting with your doctor. There is a safe way to do it and it must be followed.

13 Comments on Should you take HRT or bioidentical hormones during menopause and perimenopause

    • Thanks Tammy. Your mindset is very important, put in your head that you will be fine and you probably will or will only require some supplements.

  1. Great article. Yes, it seems pretty scary to take the drugs. I didn’t have that many problems but I remember my mom having horrendous migraines and also blackouts at the time. Adrenal glands being depleted are a huge factor so when I found Dioscorea villosa I was very happy that it helped.

    • Yes Katherine, depleted adrenals are a bif part of the problem, overcharged liver is the other. I did not know about Dioscorea villosa, interesting.

  2. What a great article. I am so huge about living a natural life! They are so many wonderful ways to help where the addition of chemicals can totally be avoided.
    Nowadays seeing a naturopath is my answer. The holistic approach is what suits me and my family the best

    • Natural is always better. When it comes to hormones it is even more important to be careful.

  3. Great info, well laid out and easy to understand. I haven’t had to worry about this yet, but I’d definitely want to go the more natural route.

    • You are very young Gabe. I think with your healthy lifestyle you probably will not face any of these issues, most of them are preventable.

  4. It’s so important for women to have this information…especially before they reach these life milestones. Thank you for writing such an informed article. I work with women who are nearing menopause or are in menopause and this is information I can share with them as we move forward!

  5. Very informative article! I really appreciate the breakdown of benefits as well as side effects that can have a very harmful impact.

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