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Day: January 29, 2026

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What Bioidentical Hormones Really Do and How They Support Women Through Midlife

Bioidentical hormone replacement therapy (BHRT) has become one of the most requested tools for managing perimenopause and menopause symptoms. Yet many women still feel unsure about what BHRT actually is, how it works and whether it’s the right choice for them.

As hormone science continues to evolve, so does our understanding of how individualized hormone support can help women feel better day to day and protect long-term health. Below is a clear, evidence-informed guide to BHRT, along with a short explanation of recent FDA updates that are reshaping the conversation around hormone therapy.

What BHRT Actually Is

BHRT uses hormones that have the same molecular structure as the ones the body naturally produces. This allows them to bind hormone receptors in a physiologic way, often offering improved symptom relief and better tolerability for many women.

Common bioidentical hormones include:
 • 17β-estradiol
 • Micronized progesterone
 • Testosterone (when appropriate)
 • DHEA

BHRT may be delivered through bioidentical products or compounded formulations when customization is needed.

Why Hormones Shift And Why Symptoms Show Up

Beginning in the late 30s and early 40s, hormone levels fluctuate unpredictably. These changes affect nearly every body system and can contribute to:

  • Sleep issues
  • Hot flashes and night sweats
  • Mood changes or anxiety
  • Cognitive shifts or brain fog
  • Weight changes or insulin sensitivity
  • Low libido
  • Vaginal dryness or discomfort
  • Bone density loss

BHRT is not designed to restore youthful hormone levels but to stabilize fluctuations and support healthy function during midlife transitions.

How BHRT Works in the Body

BHRT supports multiple physiologic systems, including:

  • Brain, mood, and cognition: Estrogen and progesterone influence neurotransmitters that help regulate mood, memory, and sleep.
  • Metabolic health: Hormone changes affect how women store fat, respond to insulin, and regulate appetite.
  • Bone density: Estrogen plays a central role in slowing bone turnover.
  • Sleep and stress pathways: Progesterone interacts with calming receptors that support deeper, more restorative sleep.
  • Pelvic and vaginal health: Local estrogen can restore elasticity, moisture and comfort.

News That Matters For Women Considering Hormone Support

In 2025, hormone therapy made headlines as the FDA announced it would remove long-standing, overly broad warnings from many menopausal hormone products. This decision reflects a more updated understanding of hormone safety and acknowledges that earlier messaging overstated risks for many women.

Here’s what this means:

  • Newer research shows that hormone therapy has a more favorable safety profile for women who start early in the menopausal transition.
  • Risks vary by age, timing, dose, and route of administration, rather than being universally high for all women.
  • Modern formulations, including bioidentical estradiol and micronized progesterone, behave differently from older synthetic hormones once used in earlier studies.
  • Women now have more accurate, balanced information when discussing hormone care with their providers.

This update doesn’t change whether BHRT is appropriate for an individual, but it does reinforce the importance of nuanced, personalized hormone care instead of fear-based avoidance.

Who May Benefit Most From BHRT

Women often find BHRT especially helpful when experiencing:

  • Significant perimenopausal swings
  • Reduced sleep quality
  • Low libido or discomfort with intimacy
  • Mood instability linked to hormone shifts
  • Increased abdominal fat or metabolic changes
  • Early menopause or surgical menopause
  • Bone loss or high fracture risk
  • Persistent or severe vasomotor symptoms

The Importance of Individualization

BHRT is effective when it is tailored to a woman’s:

  • Menopausal stage
  • Symptom pattern
  • Health history
  • Family history and genetics
  • Cardiovascular and metabolic risk
  • Breast health patterns
  • Lifestyle and stress load

This individualized strategy aligns with how hormone systems naturally function both dynamically and contextually.

Women deserve accurate, up-to-date information about hormone therapy. Modern research shows a far more nuanced and reassuring picture than the outdated warnings many women grew up hearing.

BHRT is one meaningful option within a broader, personalized approach to hormone health. When used thoughtfully and monitored appropriately, it can help women navigate midlife with clarity, energy and improved quality of life.

Sources:

U.S. Food & Drug Administration. (2025). HHS advances women’s health, removes misleading FDA warnings on hormone replacement therapy. Retrieved from https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy

Fournier, A., Berrino, F., & Clavel-Chapelon, F. (2014). Unequal risks for breast cancer associated with different hormone replacement therapies. Journal of Clinical Oncology, 32(35), 3623–3630.

Manson, J. E., & Bassuk, S. S. (2023). Menopausal hormone therapy and long-term health outcomes. Nature Reviews Endocrinology, 19, 382–396.

The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794.

Stuenkel, C. A., et al. (2015). Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 100(11), 3975–4011.

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Cravings, Bloat, Fatigue? It’s Time to Reset

Many people come out of the holiday season feeling heavier, more bloated, more tired, and much hungrier than usual. Patients often tell us, “I feel like my digestion just shut down,” or “I can’t stop craving sugar.” And that makes perfect sense. Holiday habits can disrupt almost every system involved in digestion and metabolism.

The good news is that once you understand why this happens, it becomes much easier to get things back on track. You don’t need an extreme cleanse or a restrictive detox. Most of the time, the goal is simply to support the body’s natural rhythms again.

 

Why the Holidays Wreak Havoc on Your Digestion, Hormones, and Metabolism

1. Blood sugar swings confuse hunger and fullness signals

Lots of sugar, grazing throughout the day, big dinners and alcohol can cause blood sugar spikes and crashes. When this happens repeatedly, hunger-related hormones like ghrelin and leptin stop communicating clearly.

That means:
 • You feel hungry more often.
 • You crave quick-energy foods like sugar or carbs.
 • You never quite feel satisfied, even after eating.

This imbalance alone can explain a big portion of post-holiday cravings.

2. Cortisol rises and slows digestion

Holiday stress, travel, disrupted sleep and alcohol all impact your stress hormone cortisol. High cortisol slows stomach emptying and intestinal motility, which makes food sit longer and ferment. This often shows up as bloating, gas, constipation or that “brick in the stomach” feeling.

Cortisol also increases cravings for calorie-dense comfort foods, so it becomes a double hit.

3. The gut microbiome shifts

The microbiome responds quickly to what you eat. A few weeks of holiday meals can:
 • Feed gas-producing bacteria
 • Reduce beneficial species that help regulate inflammation
 • Decrease short-chain fatty acid production, which influences cravings and metabolism

A more imbalanced microbiome can also impact mood and energy, which many people notice in January.

4. Digestive enzymes and stomach acid often drop

Large meals, alcohol and richer foods can temporarily reduce stomach acid and pancreatic enzyme production. When food is not fully broken down, fermentation increases and bloating follows. This is especially true for people who already have mild enzyme insufficiency or slower motility.

5. Liver detoxification can get overloaded

Alcohol, sugar and increased inflammatory foods put more pressure on the liver. When detox pathways become overwhelmed, you may feel puffy, sluggish or fatigued. Supporting liver function helps, but the key is bringing input and output back into balance.

 

What’s Actually Going On Inside Your Body

Here’s a quick summary in plain language.

Hormones

• Cortisol goes up.
 • Insulin spikes more easily.
 • Ghrelin rises, so you feel hungrier.
 • Leptin signaling weakens, so you feel less full.

This is why cravings feel stronger after the holidays.

Gut Function

• Motility slows.
 • Food sits longer and ferments.
 • Constipation becomes more common.
 • Bloating and gas increase.

Microbiome

• More sugar-loving microbes flourish.
 • Beneficial species decrease.
 • Inflammation in the gut rises.

Detox and Energy

• The liver has more to process.
 • Inflammation increases.
 • Fatigue and brain fog are more noticeable.

 

Steps to Reduce Bloat, Cravings, and Sluggish Digestion

These strategies help reset hormones, digestion, and metabolism without extremes.

1. Reset your meal timing

Going back to a predictable meal schedule is one of the most powerful ways to stabilize hormones. Eating at consistent times helps regulate insulin and cortisol, which naturally lowers cravings and supports smoother digestion.

Try to avoid late-night eating for a while. Motility slows dramatically in the evening, and nighttime eating directly increases bloating and next-day hunger.

2. Strengthen digestive capacity

Simple habits make a big difference:
 • Take a few deep breaths before eating to shift out of stress mode.
 • Chew more thoroughly than you think you need to.
 • Drink most fluids away from meals.
 • Eat without multitasking whenever possible.

For people with ongoing fullness after meals, functional stool testing or checking pancreatic elastase can help determine whether enzyme support might help.

3. Nourish the microbiome gradually

Instead of jumping into a high-fiber overhaul, add gut-friendly foods slowly. A sudden fiber increase often makes bloating worse, especially after a low-fiber season.

Aim for small, steady additions like:
 • A serving of cooked vegetables with lunch
 • A spoonful of chia or ground flax
 • A small amount of fermented foods if tolerated

Research from 2024 and 2025 shows that increasing fiber diversity, even in moderate amounts, can shift the microbiome and reduce cravings.

4. Balance blood sugar

This is one of the fastest ways to improve cravings and energy.

Easy ways to do this:
 • Eat protein with breakfast.
 • Pair carbohydrates with protein, fat or fiber.
 • Add a short walk after meals to improve glucose clearance.

Even a 10 minute walk can noticeably reduce bloating by stimulating motility.

5. Reestablish a healthy cortisol rhythm

Most people underestimate how much stress and poor sleep disrupt digestion.

Helpful resets include:
 • Morning sunlight exposure
 • Limiting screens before bed
 • A consistent bedtime and wake time
 • Relaxation practices such as breathwork or stretching

When cortisol normalizes, digestion improves and cravings decrease.

6. Increase hydration to improve motility

Dehydration is extremely common after the holidays. Drinking more water helps stool move more easily, reduces bloating and improves detoxification. Slight increases spread throughout the day work better than chugging large amounts at once.

7. Support your liver with targeted nutrition

You do not need an extreme detox. Your liver already knows how to do its job. What it needs is support, especially after an intense season.

Focus on:
 • Cruciferous vegetables
 • Adequate protein
 • Antioxidant-rich foods
 • Hydration and consistent meals

This helps the liver rebalance its phase I and II detox pathways.

8. Use functional testing if symptoms continue

If bloating or cravings persist beyond a few weeks, deeper insights may be needed.

Useful tests include:
 • Comprehensive stool analysis
 • Organic acids testing
 • Cortisol rhythm (HPA axis) evaluation
 • Fasting insulin and HOMA IR
 • Food sensitivity testing if needed

Testing ensures patients get targeted care instead of generalized suggestions.

 

Once you understand what is happening with hormones, gut motility, microbiome diversity, and detox pathways, you can make simple changes that help your body reset. And if symptoms persist, we can help you with functional testing to uncover deeper causes that deserve attention.

 

 

Sources:

Carlson, J. L., Erickson, J. W., Lloyd, B. B., & Slavin, J. L. (2018). Health effects and sources of prebiotic dietary fiber. Nutrients, 10(11), 1610.

Holscher, H. D. (2017). Dietary fiber and prebiotics and the gastrointestinal microbiota. Nutrients, 9(9), 1253.

Paukkonen, I., et al. (2024). The impact of intermittent fasting on gut microbiota. Journal of Metabolic Health, 18, 221 239.

Park, S., et al. (2025). Advanced understanding of dietary fiber with omics. Food Science and Biotechnology Horizons, 5(1), e13.

Leung, C., Rivera, L., Furness, J. B., & Angus, P. W. (2016). The role of the gut microbiota in NAFLD. Nature Reviews Gastroenterology and Hepatology, 13, 412 425.

Jakubowicz, D., et al. (2015). Influence of meal timing on hunger hormones and metabolic regulation. Obesity, 23(11), 2332 2340.