Natural HRT vs Conventional HRT: What Is the Difference?
Understand the difference between natural HRT and conventional HRT for perimenopause. Compare body-identical, bioidentical, and synthetic hormones clearly.
What People Mean by Natural HRT
The term natural HRT is used loosely, and it means different things in different contexts. Most often, women asking about natural HRT are asking about body-identical hormones, sometimes also called bioidentical hormones. Body-identical means the hormone is chemically identical to what the human body produces. The oestradiol in NHS-prescribed patches, gels, and sprays is body-identical. So is the micronised progesterone found in Utrogestan. When women hear natural HRT described as something you need to seek outside mainstream medicine, it can cause confusion, because body-identical hormones have been the standard NHS option for years.
What Conventional HRT Contains
Conventional HRT refers to the full range of licensed hormone replacement therapy products available through standard prescribing channels. This includes body-identical oestradiol (gels, patches, sprays, vaginal creams) and micronised progesterone, as well as older synthetic options such as norethisterone and medroxyprogesterone acetate. Synthetic progestogens have been associated with a slightly higher risk of blood clots and breast cancer in some research compared with micronised progesterone, which is one reason many prescribers now prefer body-identical progesterone. Conventional does not mean synthetic. Most up-to-date NHS prescribing now favours body-identical oestradiol and micronised progesterone.
Compounded Bioidentical Hormones
Some private clinics offer compounded bioidentical hormone therapy, which involves having hormones custom-mixed and often tested via saliva or blood. These compounded preparations are not licensed by the MHRA or equivalent regulatory bodies in other countries, meaning they have not gone through the same safety and efficacy testing as licensed products. Professional bodies including the British Menopause Society advise caution with compounded hormones because potency and purity can vary between batches. Women drawn to this option are often seeking a more personalised approach, which is understandable, but the same body-identical hormones are available in licensed, regulated form through standard prescribing.
Herbal and Supplement Alternatives
Some women use the phrase natural HRT to refer to herbal supplements such as black cohosh, red clover, or phytoestrogen-rich foods. These are not HRT. They do not contain oestrogen and their effects are much weaker and less predictable than licensed hormonal therapy. Some may offer modest symptom relief for certain women, but they do not protect bone density or cardiovascular tissue in the way that oestradiol does. They also carry their own interaction and safety considerations, particularly black cohosh in women with liver conditions. Herbal options can be part of a broader wellness approach but should not be considered equivalent to HRT.
Which Is Safer
Licensed body-identical HRT has a well-established safety profile. The risks associated with HRT in older research were largely linked to synthetic progestogen and oral oestrogen, both of which have different absorption pathways and risk profiles compared with transdermal oestradiol and micronised progesterone. For most women under 60 starting HRT within ten years of their last period, benefits outweigh risks. Unlicensed compounded products carry more uncertainty. Herbal supplements are not equivalent. If you are weighing up options, the safest route is to discuss your history and preferences with a menopause specialist or GP who is up to date on current guidance.
Making a Practical Choice
If you are looking for body-identical hormones, they are available through standard NHS prescribing. You do not need to seek them through private compounding clinics to get them in their natural form. Oestradiol gel or patches combined with Utrogestan are body-identical and licensed. The most useful step is to book a menopause consultation and come prepared with a record of your symptoms. PeriPlan lets you log and track symptoms over time, giving you clearer data to share with a prescriber and a better basis for deciding what kind of support might help most.
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