Some people may have concerns about the potential side effects of conventional hormone replacement therapy (HRT). As such, they may be interested in trying natural, plant-based options.

This article outlines the different types of natural HRTs, along with their potential benefits and risks. It also provides some alternative methods for treating hormonal problems and offers advice on when to see a doctor.

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Bioidentical and traditional natural HRT can help treat hormonal imbalances.

Hormone replacement therapy (HRT) is a therapy that doctors may prescribe to treat hormonal imbalances or depletion, particularly following menopause.

Natural hormone replacement therapy (HRT) uses hormones derived from plants to treat hormonal conditions.

There are two main types of natural HRT: Bioidentical HRT, and traditional natural HRT.

Bioidentical hormone replacement therapy (BHRT)

Bioidentical hormone replacement therapy (BHRT) treats hormonal imbalances and depletion using synthetic hormones derived from plant estrogens.

Doctors refer to bioidentical hormones as hormones with the same molecular structure as ones that the human body produces naturally.

Most BHRTs contain plant hormones that mimic the following:

  • Estriol: This is a weaker form of the hormone estrogen that has associations with pregnancy.
  • Progesterone: This is a hormone associated with menstruation and pregnancy.
  • Dehydroepiandrosterone (DHEA): This is a type of androgen hormone that assists with the production of other hormones, such as estrogen and testosterone.
  • Melatonin:This hormone helps regulate the sleep-wake cycle.

There are two types of BHRT. They are:

  • United States Food and Drug Administration (FDA)-approved BHRT: These medications are similar in safety and efficacy to conventional HRT medications.
  • Custom-compounded BHRT medications: A pharmacist mixes these according to a doctor’s prescription.

The manufacturers of bioidentical hormones claim that custom-compounded BHRTs have fewer side effects and associated health risks than conventional HRT medications. However, there is no scientific evidence to support these claims.

Traditional natural hormone replacement therapies

Traditional natural HRTs involve consuming plants or supplements containing compounds that may alleviate hormonal symptoms.

Some plants and supplements that people may take to treat hormonal symptoms include:

Typically, people take natural HRT to treat the following conditions:

According to the FDA, there are no established benefits of taking BHRT medications over conventional HRT medications.

Despite the manufacturer’s claims, the FDA also indicate that there is no evidence that BHRT medications help prevent or treat the following conditions:

The FDA has since corrected most false statements and claims about BHRT’s efficacy in treating the above conditions.

Despite this, some doctors, pharmacists, and drug companies still promote misinformation about the benefits of BHRT.

However, a 2015 study in the Journal of Clinical Oncology suggests that BHRT may help reduce symptoms associated with cancer treatments, though research is ongoing.

According to the FDA Office of Women’s Health, conventional hormone therapies may not be safe for people with a history of the following medical conditions:

  • vaginal bleeding problems
  • bleeding disorders
  • blood clots
  • heart attack
  • stroke
  • certain cancers, including breast and uterine cancers
  • liver disease
  • allergic reactions to hormone medications


To date, no credible, large-scale scientific studies have investigated the potential adverse health effects of BHRT. The FDA state that there is no evidence suggesting that BHRT medications carry fewer health risks than conventional HRTs.

Risks include:

It is also tricky for doctors to track side effects linked to BHRT medications because symptoms may take years to develop.

Compounded BHRT

The FDA also state that compounded BHRT medications tend to carry greater risks than non-compounded forms.

Because pharmacists mix compounded BHRT medications, the FDA cannot approve them for quality or consistency. They also carry health risks because the precise dosage and formulation depend on a pharmacist’s precision and accuracy. As such, it is not possible to guarantee their safety.

It is important to note that pharmacists and drug companies are not obliged to report any side effects associated with compounded BHRT medications.

Non-compounded BHRT

The chemicals in non-compounded BHRT may also cause side effects. These chemicals may differ across medication types and brands.

Natural supplements

The FDA do not regulate natural supplements, meaning their quality, purity, and overall contents vary between brands and batches.

Some commonly recommended supplements for hormonal imbalances may cause side effects, especially if a person takes them incorrectly. These side-effects may include:

  • toxicity or overdoses
  • liver damage and jaundice
  • blood clotting disorders, and widespread bruising
  • increased blood-cortisol levels, which can cause the following:
    • heart disease

People should also consider that some supplements may interfere with certain medications. As such, a person who is taking any kind of medication should talk to their doctor before taking any supplement.

People should take BHRT medications according to the instructions of their doctor or pharmacist.

A person should take any natural supplements according to the packet instructions. However, they should only take such supplements after approval from their doctor.

BHRT medications are available as either oral or topical medications in the form of creams, lotions, and gels.

People typically take oral BHRT medications daily, ideally at the same time each day. People using topical BHRT products may need to apply them several times a day. A person should read the medication label for specific instructions.

According to the FDA, a person should take all forms of hormone therapy at the lowest effective dose for the shortest possible time.

Several alternative treatment options can help a person manage the psychological and physical symptoms associated with hormonal imbalances and depletion. We outline some examples below:


Some people may require prescription medications to ease symptoms of hormone depletion, such as:

  • Antidepressants: These medications may help people who develop depression as a result of hormonal imbalances or depletion. Most work by boosting levels of certain feel-good brain chemicals, such as serotonin and dopamine. Some boost levels of the brain chemical norepinephrine.

Complementary therapies

The following complementary therapies may also help to alleviate hormonally-induced symptoms of depression:

  • Folate supplements: A 2017 meta-analysis found that people with depression tended to have lower levels of folate (vitamin B-9, or folic acid). The authors note that taking folate supplements appears to increase the effect of some antidepressants and psychiatric medications. This seems especially true of the folate supplement L-methylfolate.
  • St. John’s wort: This herb has chemical properties similar to some antidepressants. People should always talk to a doctor before taking St. John’s wort and never take it while taking an antidepressant.

Lifestyle changes

The following lifestyle changes could help to prevent or treat symptoms of hormonal imbalances or depletion.

  • Exercise: Regular physical activity boosts mood by stimulating the brain chemical norepinephrine, and increasing endorphins, which are feel-good chemicals.
  • Bone-strengthening exercises: The North American Menopause Society (NAMS) indicate that this type of exercise may help reduce the rate of bone loss following menopause.
  • Mind and body practices: Certain practices may help to ease stress and promote relaxation. These include:
  • Consuming a healthful diet: The results of a 2019 study suggest that a diet containing a variety of whole, minimally-processed foods may help ease symptoms of depression.
  • Quitting smoking: According to a 2014 systematic review and meta-analysis, quitting smoking improves mental health in the long-term.
  • Avoiding alcohol and illegal or recreational drugs: While these substances may boost mood in the short-term, they increase anxiety and depression in the long-term.
  • Practicing good sleep hygiene: Following a regular sleep pattern may help to treat sleep disturbances associated with hormonal imbalances.
  • Managing underlying health conditions: People should try to manage health conditions that can increase the severity of menopausal symptoms. Examples include:
    • high blood pressure
    • high cholesterol and triglyceride levels
    • increased glucose levels

Anyone experiencing symptoms of a hormonal change or imbalance should see a doctor as soon as possible. Early intervention may help prevent complications.

People should also see a doctor if their condition does not improve while taking a medication or herbal supplement, or if they experience side effects associated with these treatments.

There are two main types of natural hormone replacement therapy (HRT):

  • Bioidentical HRTs involves taking bioidentical plant hormones to correct hormone imbalances.
  • Traditional natural HRTs involves consuming plants or supplements that may help to alleviate hormonal symptoms.

Some experts do not think that BHRTs are any safer or more effective than traditional HRT medications.

People should be aware that certain medications and supplements can cause side effects and interact with other medications.

As such, a person who wants to try natural HRTs should talk to their doctor about the potential risks and benefits of doing so.