Bioidentical Hormone Replacement Therapy (BHRT) for Menopause & PCOS

For Hormonal Shifts in Perimenopause, Menopause, and PCOS

Hormones are having a moment right now, and for good reason. These “chemical messengers” influence everything from metabolism, sexual function, reproduction, bone health, mood, and so much more.

Hormones operate on a delicate see-saw. If they get too high or too low, things can go awry. And that’s where BHRT can sometimes help. While it’s commonly used for perimenopause and menopause, more and more women with hormonal imbalances—including PCOS—are exploring BHRT to support better symptom control.

What is BHRT?

Bioidentical hormone replacement therapy (BHRT) is a treatment used to correct hormonal deficiencies and imbalances. Its goal is to restore hormone levels to a more optimal range and ease related symptoms.

Both women and men can receive BHRT, but it's most often prescribed to women navigating the hormonal changes of perimenopause, menopause, or chronic conditions like PCOS that involve hormone dysregulation.

WHY BHRT?

Key Reasons Women Consider It

Hormonal shifts can happen for a wide range of reasons, including:

Pregnancy or breastfeeding
Medical treatments like hysterectomy or oophorectomy
Hormonal birth control use
Health conditions like PCOS, diabetes, or hypothyroidism
Cancer treatment or chemotherapy

Women with PCOS may struggle with chronically imbalanced levels of progesterone, estrogen, and androgens like testosterone and DHEA. Over time, this can lead to symptoms like irregular periods, acne, fatigue, mood swings, and difficulty managing weight. BHRT may offer support in certain cases when symptoms are severe, persistent, or aren’t improving with lifestyle interventions alone.

Of course, the most common use for BHRT remains addressing perimenopause and menopause. Let’s look at that more closely:

BHRT for Perimenopause and Menopause

Perimenopause is the transition years before menopause and can feel like hormonal chaos. Estrogen and progesterone levels fluctuate wildly, leading to symptoms like mood swings, sleep issues, and hot flashes.

Once you’ve gone 12 consecutive months without a period, you’re considered postmenopausal. At this point, your estrogen and progesterone levels are naturally much lower, which can aggravate symptoms further. That’s where BHRT may help restore some balance.

Common Symptoms BHRT May Help With

Weight gain or difficulty losing weight
Mood swings, anxiety, or depression
Hot flashes and night sweats
Vaginal dryness or pain during intercourse
Decreased libido
Memory issues and brain fog
Insomnia or disrupted sleep
Fatigue or low energy
Skin issues like acne

Note: These symptoms aren’t exclusive to menopause. Women with PCOS may experience many of them too—especially when progesterone is low or testosterone is high.

TYPES OF BHRT

BHRT comes in many forms: pills, creams, patches, gels, injectables, implantable pellets, and vaginal suppositories.

A doctor’s prescription is required for most BHRT. Some forms are FDA-approved and mass-produced, while others are custom-compounded by specialty pharmacies to match your individual needs.

Before starting BHRT, your provider will likely run a hormone panel to establish your baseline. Retesting is usually done every few months to make sure the protocol is working and adjust doses as needed.

BENEFITS OF BHRT

BHRT has been associated with many benefits in women who are good candidates:

Reduces hot flashes and night sweats
May improve mood and mental health
Improves sexual health and vaginal comfort
Supports bone density and reduces osteoporosis risk
Enhances sleep quality
May support longevity and reduce signs of aging
Helps manage weight and reduce belly fat
Supports heart health
Improves urinary tract health
Improves skin elasticity, appearance and acne

Many of these benefits aren’t just relevant to menopause—they also apply to women with PCOS who struggle with hormonal imbalance, disrupted sleep, anxiety, fatigue, or difficulty maintaining a healthy weight.

RISKS OF BHRT

Like any medical treatment, BHRT comes with risks. These may include:

Blood clots
Stroke
Heart disease
Possible increased risk of breast cancer (especially with synthetic progestins)

However, risks vary based on your personal and family history, the type of hormones used, and how/when the therapy is started. Bioidentical forms—particularly micronized progesterone—appear to carry fewer risks and side effects.

Always discuss these with your healthcare provider before beginning BHRT.

Side Effects of BHRT

While your body adjusts to new hormone levels, you may experience:

Bloating
Fatigue
Cramping
Acne
Spotting
Increased facial hair
Headaches
Breast tenderness
Mood swings

Side effects are usually temporary. If they persist, the dosage or delivery method may need adjusting.

BHRT CONTROVERSY

You’ve probably heard the warnings about hormone therapy and breast cancer. Most of that fear comes from the Women’s Health Initiative Study (WHI) published in 2002.

The study linked combined synthetic HRT to increased breast cancer risk. However, it had major flaws: participants were older, many had preexisting conditions, and the hormones used were synthetic—not bioidentical.

Recent research suggests that estrogen-only therapy may actually lower breast cancer risk, and micronized progesterone is considered much safer than synthetic progestins.

Takeaway for PCOS & BHRT

While BHRT isn’t typically the first step for managing PCOS, it can be a helpful tool when symptoms aren’t resolving with nutrition, lifestyle changes, or supplement support. Women with PCOS often deal with hormone imbalances for decades—not just in menopause—so BHRT may become relevant sooner than expected.

As always, it’s about finding the right tools for your body. If you’re curious whether BHRT could be part of your healing journey, talk to a provider who understands both PCOS and hormone therapy.

🌸 Wondering if BHRT is right for you or if your hormones just need a reset?

Before jumping into hormone therapy, it’s important to understand what’s actually going on under the surface. Inside PCOS Made Manageable, we focus on getting to the root of your symptoms, naturally.

You’ll have the option to add functional hormone testing if you want deeper insight into your estrogen, progesterone, cortisol, and more. From there, I’ll help you decide what your body actually needs, whether it’s BHRT, supplements, or just a serious nutrition and lifestyle shift.

Book a free call to talk through your symptoms, ask your questions, and see if PCOS Made Manageable is the right next step for you.

👉 Click here to book your call

Let’s finally get your hormones working with you, not against you.

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