Bio-identical Hormone Replacement (BHRT)

What does "natural" or "bio-identical" mean?


Natural or bio-identical hormones are the exact same molecular form of the hormones that humans naturally make.  They are made from a natural hormone in sweet potatoes or soybeans that is easily converted to natural human hormones.

Since natural substances, including hormones, cannot be patented, pharmaceutical companies lack financial incentive to fund research and development costs to develop and market natural products.  Unfortunately, pharmaceutical companies control the agenda and fund most scientific research at medical schools in this country.  Therefore the information presented to medical students regarding the treatment of almost all medical conditions is pharmaceutical based.


Although hot flushes are the most recognized symptom of menopause, there are many others that are common such as low libido, "brain fog", dry and thinning vaginal tissue, heart palpitations, weight gain from increased body fat (often abdominal), decreased muscle mass, poor memory, fatigue and thinning hair.  Some women will have few and mild symptoms, while many women will have more severe and life altering symptoms.

For these women, personal and educated decisions must be made regarding the best treatment options for this transitional life event.  Hormone replacement therapy (HRT) is the solution for many women to stop or improve these symptoms and allow a return to a more satisfying lifestyle.

Hormone replacement therapy is given little emphasis in medical school, but what is taught is the use of synthetic hormones or estrogens from other mammals such as horses (Premarin or generic conjugated equine estrogens) and the use of synthetic progesterone-like compounds.  These unnatural hormones are not recognized by the body as natural hormones are, so are not able to be converted by natural enzymes to other natural hormones as body needs determine.

As menopause approaches many hormone levels decline dramatically, including estradiol, progesterone, testosterone, pregnenolone and DHEA.  A balanced approach to hormone replacement includes replacing all of these as needed on an individual basis.  The adrenal hormone cortisol can also be evaluated using saliva testing.  This hormone generally does not decline with age to the degree that other hormones decline, but levels can be abnormal.  These abnormal levels are most commonly triggered by life stressors and can be treated with targeted nutrtional support, but in selected cases cortisol can be supplemented.

The many benefits of progesterone are discussd in John R. Lee, M.D.'s book, Natural Progesterone. Benefits include 1) a decrease in the rate of bone loss seen at menopause due to progesterone's stimulation of the cells that build new bone, 2) action as a mild diuretic as progesterone negates estrogen's effect of causing sodium and fluid retention when used alone, 3) a decrease in the risk of breast cancer by 20-30% as shown in a large ongoing study of menopausal women in France.

Estradiol is the estrogen made by the female ovary.  It is the only estrogen that needs to be replaced as women age. Estradiol is metabolized into estriol and estrone, but there is no benefit to replace these. 

DHEA is the most abundant hormone in the body and is a precursor to many other hormones, including the adrenal hormone cortisol.

Pregnenolone is also a precursor to many hormones and low levels of this have been linked with a decrease in memory.

Testosterone levels in women average about 10% that in men.  It has an important role in maintaining sexual desire and energy as well as strength and integrity of skin, muscle and bone.