BHRT vs HRT: what 'bioidentical' really means

"Bioidentical is the natural, safer kind."

Bioidentical describes the molecule

Bioidentical describes the molecule. It doesn't mean natural, and it doesn't mean safer.

A bioidentical hormone has exactly the same chemical structure as a hormone your body makes. That's all the word promises. It says nothing about where the product came from, how well it was tested, or whether it suits you.

The SOGC, Canada's obstetrician-gynaecologist society, notes that many body-identical hormones are available in well-tested, Health Canada approved prescription products.

Source: SOGC, Menopause and U, "Bioidentical hormone therapy".

So BHRT and HRT overlap

HRT (hormone replacement therapy) is the everyday name. MHT (menopausal hormone therapy) is simply the newer name for HRT. Body-identical hormone therapy, prescribed as an approved product, sits inside that same family. So when someone asks "BHRT or HRT?", the honest answer is often: both, at once.

What matters more than the label is whether hormone therapy suits you at all, and that comes from your symptoms and your history, not from a word on a jar.

Where the word gets stretched: compounded BHRT

"Custom-made for your body means safer."

"BHRT" is also used for custom-compounded hormones: creams and mixes made up by a compounding pharmacy to an individual recipe. These are not the same as approved body-identical products.

• They aren't Health Canada approved.

Source: SOGC, Menopause and U; HealthLinkBC, "Bioidentical Hormones".

• The Menopause Society lists safety concerns: minimal regulation and monitoring, the risk of overdosing or underdosing, impurities or lack of sterility, missing efficacy and safety data, and no label setting out the risks.

Source: The Menopause Society, 2022 hormone therapy position statement.

• The Endocrine Society finds no rationale for routinely prescribing unregulated, untested custom-compounded hormone therapy.

Source: Endocrine Society, position on compounded bioidentical hormone therapy (2019).

• Ontario Health says compounded bioidentical hormones are not recommended for treating menopause symptoms, and most insurance plans don't cover them.

Source: Ontario Health, Menopause quality standard, patient guide.

That's why custom-compounded creams and saliva-tested doses aren't something we offer.

What "natural" doesn't tell you

"If it's natural, it can't hurt."

Approved or compounded, a hormone is a hormone. Body-identical hormone therapy is still prescription treatment, with the same questions about your history: breast cancer, a blood clot, stroke or heart attack, liver disease, or unexplained vaginal bleeding all mean we go carefully. Your clinician goes through your own risks either way.

What happens at Hormone Therapy Ontario

At your assessment, the Nurse Practitioner goes through your symptoms, history and medications, in your words. If hormone therapy is appropriate, we talk about body-identical hormone therapy in Health Canada approved products, and we explain why. If it isn't, there's a plan B: non-hormonal prescription options exist for hot flashes and night sweats.

Source: SOGC Guideline No. 422a (2021).

Does BHRT change what's covered?

Not for approved body-identical hormones: the usual drug coverage rules apply. For compounded products, ask your drug plan how it treats them before you assume they're covered.