Synthetic vs. Bioidentical Hormones: What Women Actually Need to Know About HRT

Blog Post by Coach Julie

NCI Certified Nutrition Coach & Certified Mindset Coach
Specializing in Gut Health and Women's Health

Let’s start with the reality most women run into at some point in their 40s:
You’re exhausted.
Your sleep is a mess.
Your mood feels… unpredictable at best.
And your body is doing things that make you question if it’s still on your team.
So you start hearing about hormone replacement therapy (HRT).
Then immediately get hit with:

• “Synthetic hormones are dangerous!”
• “Only bioidentical is safe!”
• “Hormones cause cancer!”
• “Hormones will fix everything!”

Cool. Super helpful. Very clear. 🙃
Let’s simplify this—because the truth is a lot less dramatic and a lot more nuanced. Also, before we dive in, let me be very clear that Coach Kayli and I are both taking HRT, but that doesn't mean you have to. We want you to have good information to make informed decisions about your body so you can make the best decisions for you.

First: What Is Hormone Replacement Therapy?Hormone replacement therapy (HRT) is used to restore declining hormone levels, primarily:

• Estrogen
• Progesterone
• Sometimes testosterone

It’s most commonly used during perimenopause and menopause to help manage symptoms and protect long-term health.
According to the North American Menopause Society, HRT is the most effective treatment for menopausal symptoms and can also provide protective health benefits when used appropriately.

Synthetic vs. Bioidentical Hormones: What’s the Difference?This is where things get confusing—and where the internet tends to spiral.
Synthetic HormonesSynthetic hormones are chemically altered and not identical to the hormones your body naturally produces.
Examples include:

• Certain forms of progestins
• Older oral estrogen formulations

Some early studies (like the Women’s Health Initiative) raised concerns about risks with specific synthetic combinations—but those results don’t apply to all modern therapies.  However, it is important to noted that while these are generally safe, they do carry more risk of side effects than bioidentical options.

Bioidentical HormonesBioidentical hormones are structurally identical to the hormones your body makes.
They can be derived from plant sources (like yams or soy) but are processed to match human hormones exactly.
Here’s the important part most people don’t realize:
👉 Many FDA-approved hormone therapies are already bioidentical.
This includes forms of:

• Estradiol (estrogen)
• Micronized progesterone

So “bioidentical” doesn’t automatically mean “custom” or “compounded.”

FDA-Approved vs. Compounded HormonesThis is where things really matter.
FDA-Approved Hormone TherapyThese are regulated, tested, and standardized for:

• Safety
• Dosage consistency
• Effectiveness

Examples include:

• Estradiol patches
• Oral progesterone
• Estrogen gels

The U.S. Food and Drug Administration supports these therapies because they’ve undergone clinical testing.

Compounded HormonesCompounded hormones are custom-mixed by a pharmacy based on a provider’s prescription.
They’re often marketed as:

• “More natural”
• “Personalized”
• “Safer”

But here’s the catch:
They are not FDA-approved, meaning:

• Doses can vary
• Quality isn’t standardized
• Safety data is limited

According to the American College of Obstetricians and Gynecologists, compounded hormone therapy should generally be used only when FDA-approved options are not suitable. Compounded hormones are not necessarily dangerous, but you need to make sure you are trusting a reputable pharmacy. I am currently taking a compounded testosterone cream and I like it. However, testosterone is not FDA approved for women and can be difficult to get an FDA approved version from a normal pharmacy. It is possible, but there are usually questions raised.

Different Types of Hormone Therapy (And Why It Matters)HRT isn’t one-size-fits-all. The delivery method can affect how your body absorbs and responds.
1. Patches (Transdermal Estrogen)

• Applied to the skin
• Steady hormone delivery
• Lower risk of blood clots compared to oral estrogen

2. Pills (Oral Estrogen/Progesterone)

• Convenient
• Processed through the liver
• May slightly increase clotting risk in some women

3. Gels & Creams

• Absorbed through the skin
• Flexible dosing
• Often used for estrogen

4. Vaginal Estrogen (Creams, Rings, Tablets)

• Targets local symptoms (dryness, discomfort)
• Minimal systemic absorption

5. Pellets (Implanted Hormones)

• Inserted under the skin
• Long-lasting
• Often compounded (not FDA-approved)

Signs You Might Benefit from HRTNot every woman needs HRT—but many could benefit from at least exploring it.
Common symptoms include:

• Persistent fatigue
• Hot flashes or night sweats
• Poor sleep or insomnia
• Mood swings, anxiety, or irritability
• Brain fog or memory issues
• Low libido
• Vaginal dryness
• Weight gain, especially around the midsection

If you’re reading this thinking, “Okay wow, that’s… all of them,” you’re not alone.

Benefits of Hormone Replacement TherapyWhen prescribed appropriately, HRT can offer significant benefits:
1. Relief from Menopausal SymptomsHRT is the most effective treatment for hot flashes and night sweats (NAMS, 2022).
2. Improved Bone HealthEstrogen helps maintain bone density and reduces the risk of osteoporosis.
3. Better Sleep and MoodHormone balance can improve sleep quality and reduce mood swings.
4. Cardiovascular Support (When Started Early)Research suggests starting HRT near menopause may support heart health (Hodis & Mack, 2011).
5. Improved Quality of LifeThis one gets overlooked—but feeling like yourself again matters.

Important: HRT Isn’t One-Size-Fits-AllHRT is highly individualized.
Factors that matter include:

• Age
• Health history
• Time since menopause
• Personal risk factors

The North American Menopause Society states that for healthy women under 60 or within 10 years of menopause onset, the benefits of HRT often outweigh the risks.
Translation: timing matters.

Where Fitness and Nutrition Still Come InHRT is powerful—but it’s not magic.
To get the full benefit, it should be paired with:

• Strength training
• Adequate protein intake
• Daily movement
• Stress management
• Sleep support

Because hormones + lifestyle = results.

If You Want Help Navigating ThisIf you’re trying to figure out how to support your body through midlife—whether that includes HRT or not—you don’t have to guess.
You can:
👉 Apply for coaching for a personalized plan around training, nutrition, and lifestyle
👉 Join the Ascend app for structured strength programs designed for women navigating hormonal changes
Because feeling strong, energized, and like yourself again shouldn’t feel this complicated.

Final ThoughtsThe conversation around hormone therapy has been confusing for years.
But here’s the bottom line:

• Not all hormones are the same
• “Bioidentical” doesn’t always mean better
• FDA-approved options are often the safest starting point
• The right approach is individualized

And most importantly:
You deserve to understand your options—and make informed decisions about your body.

Sources

• North American Menopause Society
• American College of Obstetricians and Gynecologists
• U.S. Food and Drug Administration
• Hodis HN, Mack WJ. Menopause, 2011
• Rossouw JE et al. JAMA, 2002