Bioidentical Hormone Replacement Therapy in Women

Bioidentical Hormone Replacement Therapy in Women

Dr. Malaika Woods MD IFMCP Author Dr. Malaika Woods, MD, MPH
Functional Medicine Doctor
Bioidentical Hormone Replacement Therapy Expert

Definition | Estrogen | Progesterone | Testosterone | Thyroid | Cortisol | Types | Other factors

Hormone replacement therapy is a highly misunderstood, but important treatment for hormonal imbalances. Although hormone replacements often get grouped under the same umbrella, they are not all created equally. There is a significant difference in the safety and effectiveness between synthetic hormones and bioidentical hormones.

Bioidentical hormone replacement therapy (BioHRT, or BHRT) may help manage menopausal symptoms without many of the risks involved with conventional or synthetic hormones. At the same time, hormone therapy is not a quick fix or a one-size fits-all approach. While you may feel better as your levels are optimized, you still have to address other imbalances and underlying issues that may play a role in the way you feel.

Bioidentical Hormone Replacement Therapy in Women, The Functional Medicine Approach

In this interview, we spoke with Dr. Malaika Woods, M.D., a functional medicine doctor who specializes in bioidentical hormone replacement therapy and women’s health.  She discussed the difference between synthetic and bioidentical hormones, five key hormones any woman should know about, and other important factors that influence women’s health.

What are Bioidentical Hormones?

The main way to define bioidentical hormones is that they have the same chemical structure as the hormones your body naturally produces. This does not mean, however, that bioidentical hormones are 100% natural. Bioidentical hormones can be formulated in a lab, made from plants such as yams or soy, or in some cases, derived from animals.

Bioidentical vs. synthetic is an important distinction in hormone therapy, however. The chemical structure of synthetic hormones may not be the same as the natural hormones the body makes. As a result, synthetic hormones can work differently compared to the body’s own hormones. This means that synthetic hormones can produce a different effect in the body that may be too strong, leading to undesirable outcomes and health risks.

5 Key Hormones Every Woman Should Know About

Below are 5 key hormones that influence women’s health and often play a major role in bioidentical hormone replacement therapy. Keep in mind, while an imbalance of a specific hormone can cause symptoms, these different hormones often influence each other. So, it is important to consider the entire hormonal status of an individual, rather than trying to fix individual hormones.

1: Estrogen, the primary female hormone

While the exact age each woman reaches menopause may vary, the clinical definition of menopause is having no period for one year. As the ovaries ability to make estrogen (and other hormones) naturally declines with age, many women start to experience symptoms of menopause which typically include:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Mood swings
  • Low libido

Estrogen hormone replacement therapy can help with these symptoms, although other hormones (see below) may also play an important role and should be evaluated.
* Dr. Woods prefers to use a bioidentical version of estradiol (the body’s main form of estrogen). Synthetic estrogens such as Premarin combines different types of estrogens derived from the urine of pregnant mares (horses), which are not identical to the estrogen your body makes and each of these individual synthetic components haven’t been very well studied.

2: Progesterone, my “secret weapon” hormone

I like to refer to progesterone as my secret weapon hormone. Despite being often overlooked in the traditional setting, progesterone plays a critical role in women’s health. In fact, progesterone levels can start to decline years before menopause, even in the 30s or 40s, and may affect mood and sleep. Interestingly, this is the same time that many women start to take prescriptions for sleep, depression and anxiety. So, it is essential to consider the role progesterone may play and evaluate if the issues may be related to lower progesterone levels.

On that note, if you still have your uterus and consider taking estrogen, speak with your doctor about taking progesterone as well. Progesterone is needed to balance the impact estrogen has on the lining of the uterus.

Synthetic progesterone risks
The 2002 Women’s Health Initiative study evaluated the effects of synthetic estrogen and synthetic progesterone (technically called progestins) in healthy postmenopausal US women. The study was stopped after it became clear that the combination of synthetic estrogen and progestins increased the risks of heart disease, breast cancer, and stroke. According to the data, synthetic progestin was the biggest culprit.[1]

3: Testosterone, more than just a sex hormone

We often associate testosterone with men, although it is essential for women’s health as well. Testosterone plays an important role in sexual health, and helps to increase libido and enhance orgasm. But testosterone also has non-sexual benefits, especially its ability to support:

  • Mental clarity
  • Energy
  • Lean muscle mass, which can lead to more effective fat burning over time

4: Thyroid

While most people think of the thyroid hormone mainly in terms of its role on our metabolism and weight, almost every cell in our body has thyroid hormone receptors.

Even more, many people who suffer from a poorly functioning thyroid never get treated because they don’t meet the criteria for hypothyroidism. Some of the symptoms of an under functioning thyroid may include:

  • Fatigue
  • Constipation
  • Cold intolerance
  • Hair loss
  • Thinning of the eyebrows
  • Slow metabolism
  • Inability to lose weight
  • Mood issues

There are natural ways to support better thyroid function for those who have the above mentioned symptoms but do not meet the criteria for hypothyroidism. For example, zinc and selenium help to support healthy thyroid function. Also, the thyroid also functions better in a body that is subject to low stress and minimal inflammation.

5: Cortisol, the stress hormone

If you have high levels of cortisol, your body may shunt away from making other important hormones, like testosterone, estrogen, or progesterone. So, as you embark on a complete hormone evaluation, it is important to consider checking your cortisol levels.

Cortisol is the main stress hormone in the body produced by the adrenal glands as a response to stressful events. The cortisol response is an essential one and can save your life. The problem arises when the cortisol response doesn’t shut off, resulting in a chronic stress response. Many people who deal with ongoing stress in their life can end up with a chronic stress response, where there are changes in the normal pattern of cortisol production. Commonly referred to as “adrenal fatigue”, this dysfunction often starts with higher than normal cortisol levels, which, over time, may decline and become extremely low. Some of the common symptoms of chronic stress may include:

  • Fatigue and low energy
  • Trouble sleeping
  • Mood issues
  • Weight gain, or inability to burn fat efficiently

Testing for hormonal imbalances: beyond the lab

As you can see, hormones can affect your entire body and well-being. And even more, they can influence each other. Lab tests can help better understand an individual’s biochemistry, but to get the complete picture, patient input is always an important part of the story. The goal is to link lab findings to actual symptoms, both are essential to determine the best treatment.

For example, a lab test may find borderline low testosterone levels, but if the patient has good libido and doesn’t experience any symptoms that indicate low testosterone, then they may not need to take testosterone just to “correct” the lab tests.

Choosing the best form of bioidentical hormones

Bioidentical hormones are available in different forms which vary in their delivery method, how often you should take them, potency, price, and other factors. So, ideally, you should work with a doctor well-trained in bioidentical hormone replacement therapy to choose the best option for you.  Some of the most common options include:

  • Capsules
  • Creams
  • Patches
  • Troches, small lozenges you hold in your mouth until dissolved.
  • Injections
  • A compressed powder of hormone about the size of a Tic Tac that is placed under the skin, usually in the fatty tissue in the upper outer buttock area for women or the “love handles” for men. While pellets require a quick procedure in the doctor’s office, they offer a sustained, steady release of the hormone over a longer period of time. On average, pellets last three to four months for women, and up to six months for men.

Side Effects of Bioidentical Hormones in Women

While every woman may react differently to hormone therapy, some women may experience:

  • Irregular bleeding
  • Breast tenderness (usually with progesterone)
  • Increase in acne or facial hair (about 10% of women who take testosterone)

Will bioidentical hormones shut down my natural production?

When hormone levels are high the signal to make more of that hormone goes down, so the body produces less. (This is also called a negative feedback loop). This, however, is usually not a concern for women who experience menopause and consider bioidentical hormone therapy, since their body has already shut down its ability to make estrogen, progesterone, and testosterone.

Bioidentical Hormone Therapy: The Bigger Picture

When we view bioidentical hormone replacement therapy, it is also important to consider other individual factors that may play a role and affect a person’s overall health and well-being. Once your hormones are optimized you may feel better, but you still need to deal with other imbalances that can affect the way you feel.


You may have heard of inflammation in the context of an injury, muscle or joint pain. But, internal inflammation in the body has reached epidemic proportions in our society, causing many health problems. Very often inflammation is an underlying trigger of poor health that needs to be considered. Some of the common triggers of inflammation include:

  • Poor diet (excessive intake of processed foods, carbohydrates, sugars)
  • Gut issues (bloating, indigestion, diarrhea/loose stools, constipation)
  • Chronic stress (see symptoms in Section 5)
  • Blood sugar swings. Can also cause hot flashes and night sweats. Drinking alcohol at night or eating carbohydrate-rich or sugar-laden foods before bed can cause the blood sugar to swing high initially and then drop while sleeping. This drop in blood sugar is a common trigger for night sweats. Not every woman who has hot flashes or night sweats is menopausal!

Diet & Supplements for Women’s Health

While there’s no diet that works best for all women, a modified version of the Paleo diet may be a good starting point for most people. A Paleo diet may include:

  • Lower carbs and sugar
  • Higher protein, to help control blood sugar levels
  • Avoiding inflammatory foods, especially dairy, grains and gluten
  • Eating plenty of whole vegetables and leafy greens. These are loaded with vitamins, minerals, antioxidants and fiber and can help nourish the body, support gut health and promote satiation.

Certain supplements may help with menopausal symptoms, although they usually work in a more subtle way compared to the actual hormone therapy. As such, it may take longer for you to feel their effect:

  • Black cohosh.
  • Chaste tree.
  • Magnesium.
  • Diindolylmethane (DIM). A natural compound found in cruciferous vegetables. Although it may not directly improve the symptoms, it can help with estrogen metabolism.

Supplements do need to be tailored to the individual and should be one part of a treatment approach.

Final Thoughts

Bioidentical hormone replacement therapy may offer a great solution for women who are dealing with menopause symptoms and other hormonal imbalances. They can help put you on the path towards better health.

At the same time, hormones are just one aspect of a person’s health and well-being among many other variables. Once the hormones are optimized and that part of your body is taken care of, you still need to deal with other imbalances that also play a role in your symptoms.

So, when it comes to hormone replacement therapy, I recommend seeking a functional medicine doctor who offers a comprehensive approach in addition to utilizing bioidentical hormones when appropriate. Hormone replacement can be one piece of the puzzle towards better health.


  1. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women, Principal Results from the Women’s Health Initiative Randomized Controlled Trial.
Dr. Malaika Woods, MD, MPH, IFMCP
Latest posts by Dr. Malaika Woods, MD, MPH, IFMCP (see all)

Leave a Comment