FDA Approved Options
FDA approve bioidentical estrogen and progesterone are available in branded and generic form in a limited number of formulations. The generic forms are generally covered by insurance.
The Science
What do estrogen and progesterone do?
Estrogen and progesterone do a lot more than drive the menstrual cycle and pregnancy. They affect virtually all body systems, including the cardiovascular system, the musculoskeletal system, the brain, bone, skin, hair, mucous membranes, and the pelvic muscles.
When estrogen and progesterone become low, in perimenopause and menopause, all of these body systems can be affected. Symptoms vary from none to many, and from mild to severe.
If you have symptoms due to perimenopause or menopause, hormone replacement with bioidentical estrogen and progesterone can resolve your symptoms and help you to feel like your younger self again.
Symptoms of Perimenopause and Menopause
Loss of estrogen and progesterone can cause significant symptoms that disrupt relationships, self-image, activities of daily living, and health-related quality of life.
-
Menstrual CycleIrregular periods, worsening PMS, hot flashes, night sweats.
-
Mood & Quality of Life
Irritability, mood swings, brain fog, anxiety, depression
-
Body Changes
Vaginal dryness and atrophy, skin and hair changes, difficulty with sleep, joint and muscle pain.
-
Health
Increased cardiac risk, osteoporosis, dementia, weight gain, increase in cholesterol
-
Sexual Function
Vaginal atrophy and dryness, painful sex, less arousal and desire.
Doctors Overlook Perimenopause & Menopause
Our healthcare system is focused on the diagnoses and treatment of disease, not on optimizing wellness and quality of life. Doctors, in general, aren’t well-trained in perimenopause and menopause care, have misconceptions about the safety and utility of hormone replacement, and therefore don’t make hormone replacement part of their practice.
The result is that women often cannot get the care they seek for perimenopause and menopause from our healthcare system.
Rationale for Hormone Replacement
Hormone replacement is used to treat symptoms caused by perimenopause and menopause, and to improve quality of life and health. The determination of whether you are a candidate for hormone replacement requires an assessment by an expert to evaluate your symptoms and risk.
Replenishing lost hormones can be life changing, but the benefits go far beyond this. If hormone replacement is started within 10 years of menopause (before age 60), the health benefits include a lower risk for osteoporosis and fractures, lower risk for heart disease, lower risk for dementia, and lower risk for mortality.
What About The Risk For Breast Cancer?
The top fear of doctors and patients about hormone replacement is that it increases the risk for breast cancer. This is an old fear, dating from the early 2000s, that persists. Breast cancer risk was reported to be increased in the Woman’s Health Initiative (WHI) study published in 2002. This study used the synthetic progesterone Provera, which is no longer used due to complications. Bioidentical estrogen and progesterone has not been shown to increase the risk of breast cancer.
Fear stemming from the WHI study led to millions of women stopping hormone replacement in the 2000s, which led to many subsequent deaths due to increased osteoporosis and bone fractures, and cardiovascular disease.
Don’t Forget About Testosterone
Testosterone levels also decline as women age and cause distinct symptoms that can be effectively treated with testosterone replacement. Symptoms of testosterone deficiency typically start before symptoms of estrogen and progesterone deficiency, often in a woman’s 30’s. Read more about testosterone replacement in women here.
Hormone Replacement Options
Bioidentical estrogen and progesterone are molecularly identical to the estrogen and progesterone your body makes, and are available in many forms, including oral, injectable, topical, vaginal, and pellet.
Compounded Options
Compounded bioidentical estrogen and progesterone are available in a wide variety of formulations, including topical creams, orally dissolving formulations, and implantable pellets.
Synthetic Options
FDA approved synthetic hormones are available, but they are different than the hormones your body makes, and therefore function differently, and are associated with more side effects and complications.
Comparison of Treatment Modalities
FDA approved generics (FDA) vs. compounded bioidenticals (C) vs. synthetic hormones (S).
Have Questions? We’ve Got Answers
Bioidentical hormones are exactly the same as the hormones your body naturally makes. This means they function in exactly the same way as your natural hormones. Synthetic hormones that are patented and sold by the pharmaceutical companies, and often favored by our healthcare system, function differently than your natural hormones, and are associated with more side effects and risks.
Yes! Bioidentical hormones are the same as what your body normally makes, and therefore function exactly the same as your normal hormones. Pharmaceutical companies make altered version of hormones (so they can patent them), but they don’t work in the same way as your body’s normal hormones. Mother Nature has provided us with the ideal hormones, and pharmaceutical companies have not been able to improve upon them with their synthetic hormones.
Yes, hormone replacement can improve quality of life and provide anti-aging benefits when started at an older age, but the maximal medical benefits (prolong life, decrease risk for heart disease, osteoporosis, and dementia) occur when hormone replacement is started within 10 years of menopause. Your individual medical situation, symptoms, and goals would have to be assessed to determine whether hormone replacement would be appropriate.
Studies suggest that bioidentical hormones do not increase the risk of breast cancer. It makes sense. Why would a hormone the body normally makes cause cancer? Medroxyprogesterone acetate, a synthetic progesterone, on the other hand, does slightly increase the risk for breast cancer, and is the reason for why hormone replacement fell out of favor in the early 2000s. Pharmaceutical companies can’t patent naturally occurring hormones, so their approach is to alter natural hormones so they can patent and “own” them. The risk with medroxyprogesterone acetate is for about 1 in 1000 women to get breast cancer who wouldn’t otherwise get it.
Often benefits will be felt within the first week, but it can take several weeks to months to feel the full effect of hormone replacement.
If HRT is started within 10 years of menopause, the benefits far outweigh the risks for most women. Benefits include a lower risk of all cause mortality, heart disease, osteoporosis, and dementia. If HRT is started more than 10 years after menopause, the risk reward ratio is not as clearcut. Oral estrogen (which we don’t use) does increase the risk for blood clots, and synthetic progesterone (which we don’t use) does increase the risk for breast cancer.
Our healthcare system focuses on the diagnosis and treatment of disease, and perimenopause and menopause aren’t considered diseases. 80% of gynecologists say they are untrained in menopause. Managing perimenopause and menopause is not considered important in medical education and training. Furthermore, many doctors wrongly believe that the risks of HRT outweigh the benefits for most women, because of old studies utilizing synthetic hormones, not bioidentical hormones. The fact is, if HRT is begun within 10 years of menopause, the benefits far outweigh the risks in most women, including a decrease in mortality, heart disease, osteoporosis, and dementia.
Yes, we accept blood tests done within 6 months of evaluation and treatment. Lab work previously obtained is not required for your initial consultation but may be helpful if it was conducted in the past 3-6 months. Labs may be requested prior to initiating hormone replacement therapy and are routinely obtained as part of ongoing monitoring and follow-up.
Are You Ready to Feel the Difference?
Let’s do it! Feeling younger and healthier starts with a free consult and in-office testosterone test with a board certified hormone and wellness expert.
Real Patients, Real Results
Real Patients, Real Results"I'm in my 20's, so I never thought my testosterone…"
View full testimonial
Real Patients, Real Results"I've been interested in the GLP-1 medications for…"
View full testimonial
