The symptoms of perimenopause and menopause can be life -altering! Hot flashes, night sweats, poor concentration and sleep disturbance are just a few of them. A key study for our generation was the Women’s health Initiative published in 2002. The results showed increased risk of cardiovascular disease and 26 % increased risk of breast cancer. Related to hormone replacement. In 2002 the prescriptions for synthetic estrogen and progesterone therapy decreased by 60%. The Pendulum has shifted and now women are again seeking remedies for hot flashes, and other disturbing menopausal symptoms. Compounded bioidentical hormone therapy and pellet therapy are becoming more mainstream.

The Endocrine society has defined Bioidentical Hormone Replacement Therapy as “compounds that have the exact chemical and molecular structure as hormones that are produced in the body.” There are 3 main types of Estrogen hormones. Estradiol and Estrone are produced in the ovaries. Estradiol is the predominant female hormone prior to menopause, and Estrone becomes more prominent after menopause. Estriol is the third hormone and it is short acting. It is also the least potent endogenous estrogen.
There are two cellular receptors that bind estrogen, alpha and beta. Alpha receptors are found in the endometrium, breast cancer cells, and ovaries. Beta receptors are found in bone, kidney, lung and endothelial cells. Estradiol has the highest affinity for the receptors, then Estrone is mid-range, and Estriol is the weakest.

A common compounded estrogen is Biest which is 80% Estriol and 20 % Estradiol. Although lower dose, estradiol accounts for the most estrogenic activity. Progesterone is used in hormone therapy to prevent development of endometrial hyperplasia or neoplasia as a result of estrogen administration. Micronized progesterone allows for improved absorption of oral progesterone. It does contain peanut oil. Progesterone can also be compounded and delivered in a topical cream.

Testosterone therapy with very small doses allows females to build more muscle mass. Muscle is more efficient at burning calories than fat. In small doses, 1-5 mg/day, it improves mood, focus and may improve memory. Testosterone therapy helps improve sex drive, builds bone mass and improves skin tone and texture.

The most common methods of replacement are creams, pills, or bioidentical pellet therapy. Each of us has our own special dose which is identified after lab work is done.