Hormone Replacement Therapy Options

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Background

The term “Bioidentical Hormone Replacement Therapy” or BHRT, refers to the forms of hormones used for replacing hormones in your body. Dr. Leslie Peterson only uses bioidentical forms of hormones, but the actual method of delivery of hormones may vary from person to person depending on their goals and overall health.

There are a variety of commercially available, prescription only “bioidentical” products available that may be covered by insurance. These include estradiol patches in a variety of doses, oral tablets, and low dose gels commonly used vaginally. Progesterone is also available in pill form only as a commercial product. There are currently no testosterone drug products available for women so this must be compounded for accurate and best usage.

Compounding is provided by specific pharmacies who use the raw hormone materials, also bioidentical and the same that are in commercial products, but these can be formulated individually for each patient. All of the available hormones can be mixed together or used separately as determined by your needs: estradiol, estriol, testosterone, dhea, pregnenolone and oxytocin are all examples of hormones that can be compounded. Compounding formulas may be in creams, sublingual lozenges known as “troches”, suppositories or gels for vaginal administration and more.

In the big wide world of hormone therapies, there is limited consensus on HOW hormones are best delivered to a woman’s body with many “experts” claiming their method is the best. This has left patients and doctors confused as to how best to administer and manage hormonal therapies for women. Because each woman is unique, the types of hormones and methods of delivery also need to be unique. Finding the best combination of hormones for you is the essence of our work together.

Dr. Peterson prefers to use transdermal hormones and often compounds with local and regional pharmacies who specialize in the different protocols she uses with her patients.

Dr. Peterson’s approach is to help her patients (you) build a strong foundation of health, to create “hormone readiness” so that no matter what type of hormone protocol is used, (you/her patients) are more likely to have better success and results. Once it is determined that HRT is a wise choice to be implemented, we have a conversation about your options.

Methods of Delivery

Static Dosing

When hormones are delivered in the same dose every day, we call this static dosing. While there is nothing inherently wrong with this method, and it is the standard approach for most methods of BHRT, it is dissimilar to the way a woman’s hormones are produced naturally in her body during her reproductive years.

Rhythmic Dosing

An alternative approach is to use rhythmic dosing of hormones and to mimic the physiologic ebbs and flows of a woman’s natural monthly hormones, as they are designed perfectly by nature during our healthiest premenopausal, reproductive years.

Rhythmic, or physiologic dosing of hormones is intended to recreate normal premenopausal hormone levels, with the intention of reinitiating a woman’s monthly endometrial shedding (period). Estrogen will increase the blood lining of the uterus, so the long term management of women on BHRT necessitates paying attention to the uterine lining to make sure it’s not getting too thick and possibly increasing the risk of uterine cancer from excess estrogen. It is expected that women will have to use some amount of progesterone in an oral or vaginal form, to prevent this excessive build-up. As a result of this side-effect, the amount of estrogen a woman can use is limited: as she increases her estrogen levels to meet her needs, she may need to also increase progesterone which can have it’s own side-effects (for some women).

Mimicking the natural cycling of a woman’s hormones at physiologic levels, in a woman with a uterus, will result in a healthy endometrial lining build-up that is then intentionally managed to shed normally every 28 days, just like in her premenopausal years. Having a period is the best sign of a woman’s good health and the vast majority of women will say this! When their periods are off, they know something about their general health is off too, and they seek help for understanding why.

Menopause has never been approached or appreciated as the hallmark of a woman’s decline into aging. We lose our periods, and we lose our health. This isn’t to say that a woman can’t have good health after menopause, but most women will experience significant declines in their health beginning in her 40’s and continuing on until death. The risk of chronic disease for women after menopause outpaces that of men, especially in the realm of cardiovascular disease.

PHRT™ or Physiologic Hormone Restoration Therapy

Dr. Peterson is currently the only provider in the State of Utah certified with the Women’s Hormone Network to prescribe PHRT™, Physiologic Hormone Restoration Therapy™. As a provider for this unique approach since 2017, her clinical experience has convinced her that this is the most effective method available to women who want to experience the full benefits of hormone health and vibrant aging.

For more information: https://womenshormonenetwork.org/

Static BHRT Options

Static BHRT delivery methods include the following:

  • Estradiol patches and oral progesterone. The “standard of care” for BHRT in the conventional model, as supported by the North American Menopause Society and American College of Obstetricians and Gynecologists. Patches are typically started in lower doses with a nightly administration of oral progesterone for women who still have an intact uterus.
  • Compounded creams or gels. A long-standing practice, common with many providers, is to use two types of estrogen: estradiol (E2) and estriol (E3) in a “biest” formula. Testosterone may be added to these combinations of estrogens, or used on it’s own in a cream or troche. Creams are applied to the skin or inserted vaginally depending on the desired treatment. Oral progesterone may be given at night, or a cream or suppository may be used every night, or for two weeks out of the month.
  • Troches or lozenges. These are used buccally (between cheek and gum) or vaginally where mucosal tissues are able to readily absorb the hormones. All of the hormones can be used with this method.
  • Pellets. An alternative method of delivery, these are not offered at FCC at this time.