If you’re dealing with hot flashes, night sweats, insomnia, mood changes, vaginal dryness, weight changes, or low libido, it’s normal to wonder whether hormone therapy is the “next step”—and whether it’s safe.

Bioidentical hormone therapy (often shortened to BHRT) can be a safe and effective option for many people in perimenopause and menopause. The key is that it’s not one-size-fits-all. Safety and results depend on your symptoms, your health history, and how therapy is prescribed and monitored.

What Is BHRT, Exactly?

“Bioidentical” simply means the hormone’s molecular structure matches what the human body makes. In a clinical setting, BHRT most often refers to but not limited too:

• Estradiol (a form of estrogen)
• Micronized progesterone (a form of progesterone)

These can be used as part of hormone replacement therapy (HRT). Some people use “BHRT” and “HRT” interchangeably, but the most important point is this: what matters most is the right hormone, the right form, the right dose, and the right patient.

How Do I Know If I’m A Candidate?

You may want to consider BHRT if:

• Your symptoms are clearly affecting quality of life (sleep, mood, daily function, relationships, work)
• You’ve entered perimenopause or menopause and symptoms are persistent
• You want a treatment approach that is personalized and regularly monitored

People most commonly consider BHRT for symptoms like:

• Hot flashes and night sweats
• Insomnia or disrupted sleep
• Mood changes, irritability, or anxiety
• Vaginal dryness or painful sex
• Weight changes and shifts in body composition
• Low libido or reduced vitality

What Makes BHRT “Safest And Most Effective”?

BHRT tends to be safest and most effective when it is:

Personalized To Your Physiology

Your needs are shaped by your symptoms, cycle status (perimenopause vs menopause), and overall health—especially thyroid patterns, blood sugar/insulin balance, stress physiology, and sleep quality.

Started Within The Evidence-Based Treatment Window

There is an evidence-based “window” where hormone therapy is commonly considered most favorable for symptom relief and overall risk/benefit balance. A menopause-trained clinician can help determine whether you’re in that window based on your age, time since menopause, symptoms, and risk factors.

Prescribed In Bioidentical Forms

Many menopause-informed clinicians prefer bioidentical forms such as estradiol and micronized progesterone when clinically appropriate.

Monitored Regularly

BHRT should not be “set it and forget it.” Monitoring matters because your needs can change over time. Follow-up typically includes symptom tracking, dose adjustments, and periodic check-ins based on your health history and response.

Is Hormone Therapy Safe?

For many women, BHRT can be safe—especially when individualized and prescribed thoughtfully. But “safe” depends on the full picture, including:

• Age and stage (perimenopause vs menopause)
• Metabolic health (including insulin patterns and weight trends)
• Cardiovascular risk factors
• Personal and family history (including hormone-sensitive cancers)
• How your body metabolizes hormones
• The specific type, dose, and route used

This is why it’s so important to work with a clinician trained in menopause care who evaluates symptoms, patterns, age, and physiology—not labs alone—and who can personalize the treatment plan.

What About Blood Tests For Decision-Making?

Hormone labs can be part of the conversation, but they’re not the whole story.

In perimenopause especially, estrogen and other hormones can fluctuate significantly, so tests may not match how you feel. A menopause-informed clinician will use labs as supporting information, not as the only deciding factor.

Does Everyone Need Progesterone?

If you still have a uterus and you use estrogen therapy, progesterone is often included to support uterine safety. The exact plan depends on your anatomy, symptoms, and medical history—and should be guided by a trained clinician.

What About Testosterone Therapy?

Testosterone therapy may be appropriate when clinically indicated—especially for:

• Low libido
• Reduced vitality
• Fatigue that doesn’t match your usual baseline
• Decreased muscle mass or strength over time

Like estrogen and progesterone, testosterone should be personalized and monitored. It isn’t automatically “right for everyone,” but it can be helpful for the right patient, used for the right reason, in the right way.

What If I’m Not Ready For BHRT—Or I’m Not A Good Candidate?

Some people aren’t ready, and some have medical reasons to avoid or delay hormone therapy. Even if BHRT isn’t the best fit right now, you still have meaningful options.

A menopause-informed plan can include addressing the “big drivers” that affect symptom intensity and resilience during midlife—like sleep quality, stress load, thyroid patterns, insulin/blood sugar balance, and foundational nutrition. For many people, improving these pieces can change how they feel dramatically, whether or not they choose hormone therapy.

Science Section (Selected References)

• The Menopause Society (NAMS): 2022 Hormone Therapy Position Statement
• American Heart Association Scientific Statement (2023): Rethinking Menopausal Hormone Therapy
• ACOG Clinical Consensus (2023): Compounded “Bioidentical” Menopausal Hormone Therapy
• ISSWSH Clinical Practice Guideline (2021): Systemic Testosterone Therapy In Women (Evidence-Based Use For HSDD; Dosing/Monitoring)

How Peace And Calm Health Functional Medicine Can Help

At Peace and Calm Health Functional Medicine in Lakewood, CO, the focus is a whole-person, menopause-informed approach that looks at your symptoms in context—especially thyroid health, insulin/blood sugar patterns, nutrition, sleep, and stress physiology.

If you’re wondering whether BHRT is right for you (or whether it’s safe in your situation), Peace and Calm can help you:

• Clarify whether you’re in perimenopause or menopause based on symptoms, patterns, and physiology
• Identify factors that commonly worsen symptoms (like thyroid or metabolic imbalance)
• Build a personalized plan to support how you feel day-to-day
• Understand BHRT considerations so you can make an informed decision with a menopause-trained prescribing clinician

To explore next steps, book a Clarity Call here:
https://www.drjenniferhorton.com/work-with-me

You can learn more about wellness programs here:
https://www.drjenniferhorton.com/wellness-programs

Medically reviewed by Dr. Jennifer Horton, DO, ABFM, IFMCP

This content is for educational purposes and does not substitute personalized medical advice.