Updated : 16-10-2025; Author : David Bauder, Owner & PA-C Weight Loss and Vitality www.weightlossandvitality.com
Bioidentical Hormones for Women Over 40: What You Need to Know
If you’re struggling with menopause, be it hot flashes or mood disturbances, you may be considering options for treatment.
Read this article completely to get a clear insight into Biodentical Hormones for women
Bioidentical hormone therapy, or BHT, is a popular option amongst perimenopausal and menopausal women who are seeing relief from uncomfortable symptoms associated with this time of their life.
BHT can not only provide symptom relief but also lead to long-term wellness and potential prevention of age-related diseases.
However, risks involved with therapy require careful medical supervision. Let’s discuss all you need to know before starting BHT.
What are Bioidentical Hormones?
Bioidentical hormones are synthetic hormones intended to replicate the hormones naturally produced by your body.
Bioidentical hormones are typically used in conditions such as perimenopause and menopause.
To really understand bioidentical hormones, it is important to first know about hormones. The endocrine glands produce hormones, which act as chemical messengers throughout the body.
Hormones communicate what things should execute what functions to keep things running smoothly.
When hormones become out of balance, things may not run as smoothly. Thus, you may exhibit physical or emotional symptoms that can disrupt your day-to-day functioning.
Hormone replacement therapy can help to restore balance to your hormones, helping you to feel better.
Bioidentical hormones are synthetic hormones, meaning scientists derive them from plants. The most frequently used bioidentical hormones include estrogen, testosterone, and progesterone.
The Food and Drug Administration (FDA) has approved a couple of types of bioidentical hormones that are available via a prescription from a healthcare provider. Other bioidentical hormones are not FDA approved, particularly compounded forms of bioidentical hormones.
Many consider compounded bioidentical hormones to be a natural, safer, and more effective therapy versus conventional hormone therapy.
However, there is currently no evidence to substantiate this notion (1). There are some inherent risks associated with BHT, which will be discussed later in the article.
That said, compounded BHT can offer more tailored dosing options such as 50/50, 60/50 or 80/20 estradiol-to estriol formulations.
This may provide superior tissue-specific benefits and improved tolerability for certain women.
These combinations are not available in commercial FDA-approved products and can be particularly helpful in managing women and minimising estrogen-sensitive risks.
It is also worth mentioning that the 2002 Women’s Health Initiative (WHI) study, which initially cast widespread doubt on hormone therapy, was later criticised for its design flaws, including the use of synthetic progestins and enrolling women years past menopause.
This study’s failure continues to cloud the public’s perception of hormone use despite new research showing the important distinctions between types of hormones used.
Why Women Over 40 Should Consider BHT
As aforementioned, one of the more popular uses of bioidentical hormones is in the context of menopause and perimenopause.
Menopause refers to the period of time in a woman’s life when they stops getting their period and thus is no longer fertile.
Menopause occurs when someone has not had a period for 12 months. Women typically reach menopause between the ages of 45 to 55 (2).
Perimenopause refers to the period of time before menopause. During this time, a woman’s period may look different in terms of frequency and duration.
Cycles may become shorter or longer, and flow can become lighter or heavier. Women may also miss cycles (3).
Aside from changes to menstruation, perimenopause and menopause can cause uncomfortable symptoms.
These are the result of the changes to hormones during this time, including estrogen and progesterone. Symptoms can include things like:
1. Hot flashes.
These are episodes of sudden warmth in the face, chest, and neck. This warmth can cause excessive sweating, specifically at night.
2. Difficulty sleeping.
Women can also experience sleeping trouble as a result of hormone changes. As such, one may experience fatigue and memory issues during the day.
3. Mood changes.
Perimenopause and menopause are often associated with emotions such as anxiety, irritability, and feelings of moodiness.
4. Bladder problems.
This can include loss of bladder control or urinary tract infections (UTIs).
5. Vaginal dryness.
This can complicate sexual intercourse, leading to pain or discomfort.
In addition to the symptoms of perimenopause and menopause you may feel, there are also changes happening within the body that you might not be aware of.
For example, during this time, women can lose bone density. As such, one can develop osteoporosis, which is a disease in which the bones become weak and brittle, leading to breaks.
Additionally, cholesterol levels can increase, thus increasing one’s risk of stroke and heart disease (3).
A common treatment for symptoms associated with perimenopause and menopause includes hormone therapy, specifically BHT. BHT can help replenish low or lost hormones. With increased hormone levels, uncomfortable symptoms can improve or resolve altogether (1).
Potential Benefits of BHT
Using BHT in women over 40 could help to manage symptoms associated with menopause. As many as 1 to 2.5 million women over the age of 40 in the United States take compounded bioidentical hormones for this reason.
The idea behind BHT is that these bioidentical hormones will supplement the loss or lack of hormones that occurs during this stage of life.
By restoring hormone levels and hormone balance, symptoms should dissipate. As such, one may expect improvements in symptoms such as:
- Hot flashes
- Vaginal dryness
- Sleeping difficulties
- Mood changes
- Night sweats
- Painful intercourse
- Memory loss and confusion
- Weight gain
- Low libido (1)
Replenishing one’s hormones may also help with conditions associated with perimenopause and menopause, such as high cholesterol and osteoporosis.
Risks and Considerations
As aforementioned, there could be some inherent risks associated with bioidentical hormone therapy.
Although some are approved by the FDA, compounded formulations are not. As such, compounded BHTs are not subject to the strict oversight and regulations that FDA-approved products are.
Additionally, there are no clinical studies in humans that prove the safety and effectiveness of these formulations.
Therefore, there may be some therapy risks that are not fully elucidated.
The American College of Obstetrics and Gynaecology (ACOG) mentions that there is an absence of high-quality data to establish the safety and effectiveness of BHT.
Thus, ACOG does not recommend using BHT when FDA-approved products are available. As such, patients should use caution when deciding to pursue BHT (4).
Weighing the Risks and Benefits
It is also essential to be aware of the risks of BHT so that you know what to look out for and when to consult a provider.
One study conducted in 2019 reviewed the relationship between breast cancer and hormone therapy across 59 prospective studies.
The analysis found that there was an increased risk of breast cancer associated with hormone therapy.
The risk was even greater with estrogen-progestogen therapy versus estrogen-only therapy.
Other risks include potential cardiovascular disease.
Across 47 observational and 26 randomised controlled studies, findings indicated that hormone therapy was associated with an increased risk of venous thromboembolism and stroke.
However, there was a decreased risk of myocardial infarction.
Alternatively, hormone therapy may improve other conditions like cognition.
A systematic review conducted in 2021 found that hormone therapy was associated with an 11 to 33 per cent decrease in dementia risk (5).
Responsible use of BHT will involve a careful assessment of your prior medical history and weighing the benefits and risks of starting therapy.
If you have had prior cardiovascular events, for example, BHT might not be right for you.
However, if you are overall healthy and your provider considers hormone therapy to be an option, it is worth considering.
How to Get Started Safely
Despite the lack of regulation surrounding BHT, there are several potential benefits which is why there is such widespread use.
If you decide to initiate BHT, the first step is to consult a licensed and experienced healthcare provider who is familiar with bioidentical hormones.
They will be able to assess your condition and recommend the right formulation and dose depending on your symptoms and presentation.
When prescribed and monitored by trained providers, compounded hormone therapies can provide a safe and effective alternative, especially for women whose needs don’t align with standardised doses or delivery methods.
The great thing about compounded formulations of BHT is that they are customizable. This includes the dose and formulation, so you are able to select the right option for you and your circumstances.
Bioidentical hormones are available in many different forms, which allows you to tailor therapy to your specific preferences and needs.
For example, BHT is available in the forms of pills, creams, patches, gels, implanted pellets, and shots.
A mainstay of hormone treatment is careful selection and monitoring of one’s dose.
Although the goal of therapy is to resolve symptoms, this should be done at the lowest possible dose and for the shortest period of time.
It is important not to overdo it, as this can cause other health complications in the process.
To monitor the safety and efficacy of your therapy, your provider should conduct routine blood, saliva, or urine testing to get a read on your hormone levels.
These measurements will provide a picture of where your hormone levels are at now versus where they should be.
These insights will help dictate your dose, whether it be maintaining your current dose, or increasing or decreasing the dose as appropriate.
Conclusion
If you’re going through perimenopause or menopause, you may have experienced hot flashes, night sweats, sleep disturbances, sexual dysfunction, and more. All of these symptoms can be disruptive to everyday life and your overall well-being.
Thankfully, these symptoms are easily treatable with solutions like BHT.
By restoring hormone balance to the body, BHT helps to resolve the daily disturbances associated with perimenopause and menopause.
However, as with any treatment, careful medical supervision is paramount to safe and effective use.
References
- https://my.clevelandclinic.org/health/treatments/15660-bioidentical-hormones
- https://medlineplus.gov/menopause.html
- https://menopause.org/patient-education/menopause-topics/perimenopause
- https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/11/compounded-bioidentical-menopausal-hormone-therapy
- https://www.ifm.org/articles/menopause-hormone-therapy