This article is part of WHA’s new perimenopause and menopause series.

Bioidentical hormone replacement therapy (BHRT) has gained significant attention as more people seek “natural” alternatives for managing menopause symptoms.

However, confusion persists around what “bioidentical” and “natural” mean and how they differ from traditional hormone therapies. Here’s the thing: bioidentical is really just a marketing term for menopause hormone therapy (MHT)—formerly known as hormone replacement therapy. And all hormone therapies are inherently synthetic, not natural. Confused yet?

Clearing up these misconceptions is essential to making informed decisions about managing your menopause symptoms, so you can find the solution that works best for you. Let’s unpack it all.

The hormone replacement therapy terminology you need to know

It’s important to define key terms that are often (incorrectly) used interchangeably or redundantly in the menopause conversation.

Menopause hormone therapy

MHT is more modern terminology for hormone replacement therapy for menopause. They are the same thing. MRT/HRT is a treatment that replenishes hormones to alleviate symptoms of perimenopause and menopause.

Conventional hormone therapy / traditional hormone replacement therapy

These terms don’t mean much because people are actually referring to menopause hormone therapy. One could argue these terms refer to treatments from 40 years ago, but that’s typically not how they’re used in articles or conversations.

Common confusion – These terms are mistakenly used to describe MHT/HRT, leading many to believe that they represent outdated treatments, while bioidentical hormones are seen as the new treatment. Something like “bioidentical hormone therapy vs. traditional hormone therapy” is a common framing, but what medical professionals talk about in 2024 is all bioidentical hormone therapy.

Bioidentical hormones

Bioidentical hormones are lab-made (synthetic) hormones chemically identical to those naturally produced by the human body. They are the most common form of treatment for the symptoms of perimenopause and menopause as part of MHT prescribed by physicians and other healthcare practitioners.

Common confusion – People may misidentify bioidentical hormones as “natural” and assume it is a distinct form of hormone therapy, rather than the standard hormone therapy option. It is not bioidentical vs conventional or natural vs standard. It is all the same type of hormone therapy.

Synthetic hormones

Synthetic hormones are lab-created hormones (such as bioidentical hormones) designed to mimic natural hormones, often used in MHT.

Common confusion – People may assume synthetic hormones are harmful, but they are FDA-regulated, checked for safety and quality and commonly used in hormone therapy.

Natural hormones

Natural hormones are only those produced by the body’s endocrine system, responsible for regulating various biological processes.

Common confusion – People misidentify bioidentical hormones as a “natural” hormone therapy, but the only true natural hormones are those produced by your body. Bioidentical does not mean natural.

Compounded hormones

Compounded hormones are custom-made hormone medications prepared by pharmacists, perhaps using bioidentical ingredients in the mixture, but are not regulated in the same way as standard hormone therapies.

Common confusion – People may think that bioidentical hormones are supposed to be compounded, but compounding does not equal bioidentical. A good example of a compounded medication is All Purpose Nipple Ointment (APNO), often used to help with sore nipples during chestfeeding to cover all possible causes.

A brief evolution of hormone therapies for menopause

About 40 years ago, bioidentical hormones were not available, and hormone therapy often involved much higher doses. Many past research studies on hormone therapy focused on historical methods using conjugated equine estrogen and medroxyprogesterone, which are not bioidentical.

[Cue the confusion over the term ‘conventional hormone therapy!]

Today, FDA-approved hormone therapy is bioidentical and often comes in forms other than oral estrogen. These hormones are prescribed in lower doses, making them safer and lower risk compared to years past.

The different types of bioidentical hormones

Bioidentical hormone treatment options are tailored to individual needs. These hormones, which are chemically identical to those naturally produced by the body, come in various forms, including:

  • Pills
  • Creams
  • Patches
  • Gels
  • Vaginal rings

Commonly, people start menopause hormone therapy with a bioidentical estrogen patch and a bioidentical micronized progesterone oral capsule. When selecting the most appropriate form of bioidentical hormone therapy, you and your provider will take into account your individual symptoms, health history and lifestyle factors. There is no maximum duration for HRT use.

What is the safest hormone replacement therapy?

Hopefully, we’ve cleared up some of the confusion surrounding menopause hormone therapy terminology. Notably, the only truly natural hormones are those produced by the body, and bioidentical hormones—which are synthetic but chemically similar to our body’s hormones—are the primary type of hormone therapy and are regulated and effective.

So if a patient asks whether bioidentical hormones are better, my follow-up might be: compared to what? Bioidentical hormones are the standard. But if we’re comparing them to compounded therapies, that’s a different conversation. It’s important to understand the key differences between FDA-approved bioidentical hormones and nonregulated compounded therapies.

Bioidentical hormones

FDA-approved bioidentical hormone therapy treatments undergo rigorous testing for safety, efficacy and quality, ensuring that patients receive a standardized product with reliable effects. These medications are produced in facilities that meet strict regulatory standards.

Compounded hormones

Compounded therapies are made specifically for individual patients and aren’t subject to the same stringent regulations, as they’re mixed onsite at pharmacies. This lack of oversight can lead to variations in potency, purity and safety, potentially increasing the risk of side effects or ineffective treatment.

While compounded therapies have their place—such as vaginal estrogen, which can be compounded to address skin side effects—they’re generally not recommended for whole-body hormone treatments, especially for managing menopause symptoms.

Naturopaths or functional medicine practitioners may recommend compounded treatments, believing them to be more “natural.” While it’s essential to choose a provider you trust, remember that FDA-approved options are available, safe and proven effective.

Managing menopause symptoms naturally

The menopause transition is a natural phase of life that everyone with ovaries will experience, though some may face more severe symptoms than others.

Menopause hormone therapy (MHT) doesn’t replace essential practices that support well-being—like regular exercise, nutritious eating, quality sleep and making time for joy. Instead, it complements them. Together, these lifestyle habits and MHT offer effective ways to manage symptoms.

If hormone therapy is not right for you, there are other options. Make an appointment with menopause care provider to start that discussion.