Our Estrogen is prescribed only in a transdermal cream, because oral Estrogen is not safe. Progesterone is offered as both cream and capsules, and Testosterone is available as sublingual tablets, cream, and shots for men.
Bioidentical hormone replacement is a treatment that is usually done for life, unlike pharmaceutically altered “non-human” hormones which are dangerous and shouldn’t be used at all, or at least for the shortest period of time possible. If you were to stop the bioidentical hormone treatment your levels would quickly return to the same deficient place they were prior to you starting treatment, which would cause all of your hormone deficiency symptoms to return. We will decide this issue with each patient individually.
Hormone levels can be tested after being on them a minimum of a week, but we don’t usually test levels until we have made sure that the doses feel right for you for several months. There is no point in checking a level if you are still having symptoms. Since these hormones are natural to our bodies and are supposed to be there, we must find the right level for you. We check Estrogen levels on day 12 and Progesterone levels on day 21 for a baseline. Blood tests need to be drawn before your next appointment so that results are ready to discuss at your appointment. Allow a few days for results. Hormone levels fluctuate constantly in blood, so a blood test only tells us what the level was at that moment. After putting hormone creams on in the morning, the best time to draw blood is in the afternoon at least 6 hours later. Remember not to rub hormone creams on your arms before a blood draw. If you can’t check your hormones in the afternoon, draw them the next morning before taking your morning dose (usually around 12 hours after the last dose). For men on Testosterone shots, levels are usually drawn right before the next shot, at the trough.
The best way to monitor hormone levels when on BHRT is to do a 24 hour urine test. A full day urine collection evens out all the fluctuations in the day and gives us a total amount for each hormone so that we can accurately make sure that the balance between them correct. It also tells us how your body is metabolizing the hormones, which is very important, since some hormone metabolites are somewhat pro-carcinogenic, and some are very anti-carcinogenic. The balance between the two is very important in cancer prevention. The only way to find out how your body is processing and breaking down the hormones is to do the urine test. There are some simple supplements that can alter your metabolism to a safer pathway if there is a problem. Also increasing your intake of cruciferous vegetables is a good idea. Because of all these reasons, we will want you to do this test at least once per year while you are on BHRT.
For thyroid testing, we always recommend drawing the blood at the trough, which is 10-12 hours after you last took it. So if you took your thyroid at night at 9 pm, you could draw the blood between 7 am – 9 am the next morning, before taking the morning dose. Always write down the exact interval that was between taking the dose and drawing the blood so that we can replicate that interval the next time we draw your thyroid level – or else we wouldn’t be comparing “apples to apples.”
Cortisol testing is usually done through a saliva kit that you do at home four times in one day. Cortisol can be drawn in blood, but the act of getting up and going to a blood draw lab and getting stuck with a needle will often falsely elevate cortisol levels. This could mask Adrenal Fatigue, which is what we want to look for.
Continue taking your hormones as you normally would and continue counting days as though you did not miss doses. Do not double up on your doses. Missed doses could cause mild uterine bleeding or spotting, but this should not be considered abnormal as there is a clear cause for this.
We can book an earlier appointment to check your hormones. It can take 3-6 months to start feeling better, especially when many hormones are low and have to be simultaneously adjusted. Remember, there is no one-size-fits-all for hormones. When the levels are right for you, the only thing that you will feel is normal. If you have any side-effects at all, it means that the dose needs to be adjusted. If you are struggling, we want to see you every few weeks until things straighten out. Consider this an important time in your life to receive some help. We want you to feel better and are ready to help you. Please be patient and work with us to get the balance you need.
Try taking a little extra Estrogen while taking your Progesterone. Another suggestion is to lower your Progesterone a bit or to take your Progesterone only at night. Some women need the help of some natural herbs to help calm their adrenals to stop troublesome symptoms like hot flashes and night sweats.
When cycling Progesterone, it is not unusual to bleed while on your Progesterone, or to bleed once the Progesterone is finished. For the first few months, continue taking your Progesterone the fully prescribed time and do not stop it if you begin a period too early. Chart your bleeding pattern and report it to us during your follow up consults. If this continues beyond the first few months, let us know. Abnormal uterine bleeding needs to be evaluated by an OB/GYN doctor. Bleeding could mean that your Estrogen level is too high and your Progesterone is not high enough, or it could mean that you have fibroid growth, uterine polyps, or abnormal tissue in the uterus, including possibly cancer. We will check hormones levels and recommend a pelvic sonogram through your OB/GYN if this happens to examine the uterus and ovaries. Some patients may need a D&C through their OG/GYN, which is a way to sample the actual tissue from the uterus. If the bleeding persists beyond 10 days, please e-mail or call us so that we may begin to investigate this.
It is normal to experience these symptoms in the beginning, and they usually disappear within 3 months of beginning hormones. This is in part due to fluid shifts. If the symptoms are very pronounced or troublesome, we will need to lower your Estrogen.
It usually takes 3-6 months to balance hormones. After hormones are balanced we will see you every 6-12 months to assure that your hormones stay balanced.
Periods are usually light and accompanied by only light cramps, if any. If this pattern continues, we might order a sonogram or recommend a D&C from your OB/GYN to diagnose underlying problems causing heavy periods, such as uterine fibroids.
Currently there is no medical evidence that having a period is necessary to prevent illness, but it is more “natural” and mimics nature, which is our goal.
Headaches are usually caused by rapid drops in hormone levels. If you get headaches during your Progesterone use, increase your Estrogen a little bit during Progesterone use. If headaches persist, taking your hormones three times a day rather than just two can help. Keep your blood sugar steady by not missing a meal and having a snack mid-afternoon. Also try avoiding sugar, refined carbohydrates, dairy, alcohol and caffeine.
Many women gain weight during perimenopause and menopause. This happens in part because low Estradiol levels cause our insulin and cortisol levels to rise. Both these hormones cause weight gain. If these important hormonal systems are damaged, it takes time for them to heal. Weight gain is linked to lack of sleep, to a damaged metabolism and insulin resistance from excess carbs, as well as to an unhealthy gastrointestinal tract, among many other things. Not all women will automatically lose weight from replacing their deficient hormones. We can refer you to a nutritionist or recommend the HCG diet if your weight loss goals aren’t being accomplished by hormone balancing alone.