Bioidentical Hormone Therapy for Women in Atlanta

Why Women Need Estrogen & Progesterone Therapy

A woman’s estrogen levels peak during their 20s and gradually decrease by 50% by the age of 50. This is because the amount and quality of the follicles (potential eggs) in her ovary are rapidly declining every month.

As follicle quality decreases, the hormone levels of each ovulation decline and change. So each menstrual cycle can bring wide fluctuations in hormones and a different experience for the woman from month to month — especially in cases where sometimes they have an ovulation (produce an egg and hormones) and sometimes they may not (skipped period and no hormones).

Combatting Symptoms

As natural estrogen levels decrease — the transitional stage known as perimenopause — women begin to experience various symptoms of menopause such as:

• Irregular periods
• Hot flashes and night sweats
• Mood swings and anxiety
• Sleep disturbances
• Vaginal dryness
• Decreased libido
• Fatigue or brain fog
• Weight gain in stomach and thighs

As estrogen levels continue to fall become more susceptible to more serious health risks including:

• Heart disease (heart attack, high blood pressure, stroke)
• Mild cognitive impairment
• Bone loss (osteoporosis)
• Insulin resistance (rapid weight gain and prediabetes)

The worst menopausal symptoms can be:

• Depression & Anxiety
• Loss of Pleasure
• Poor Sleep
• The feeling of Losing Control of their Bodies
• Weight Gain Despite Exercise and Good Eating Habits
• Lack of Sexual Desire
• Thinning of the Vaginal Skin that can make Sex Unpleasant or Painful
• Rapid Aging of the Skin and Hair

Increased Risk of Health Concerns

The continued decline in follicular quality and number eventually leads to menopause when there are no longer any follicles capable of becoming an egg. Then hormone levels of estrogen, progesterone and testosterone will decline rapidly to very low levels leading to further increased risk for:

• Heart Disease
• Diabetes
• Osteoporosis
• Cognitive Decline

Brain Function & Emotional Wellbeing

What most doctors don’t talk about and should be is the toll on mental health for women at this time period. Women are much more likely to commit suicide during perimenopause and menopause than at any other time in their lives.

Still, if women don’t have hot flashes or night sweats, or if they still have a cycle (even if it is irregular) most doctors will not treat them with hormone therapy or worse to tell them “it’s just a natural stage of life, embrace it.” This represents a basic misunderstanding of the importance of hormones to the female brain.

Meanwhile children grow and leave home, relationships with spouses shift and change, and women are supposed to navigate all of this without the hormones essential to making their bodies and their brains perform at peak function.

That is unacceptable. Hormone therapy should be offered to all women in perimenopause and menopause with a frank, science based conversation to discuss what they are experiencing, how that can be related to hormonal changes, and what their healthcare practitioner can do with hormones to provide relief.

The most important part of the conversation is simply verifying that yes, things are different, no you are not crazy and it is not just you, and most importantly there are safe hormonal therapies to get you feeling and looking like yourself again.

How Bioidentical Hormones Work

We understand some medical professionals frown upon the use of the word bioidentical. This is because there are multiple types of estrogens and progestins (chemicals invented to mimic progesterone but not having the same qualities) that are usually found in birth control pills, IUDs and some types of menopause therapies (premarin from pregnant horse urine).

When we say Bioidentical we are referring to estrogen and progesterone produced in a laboratory that are chemically identical to estrogen and progesterone produced naturally in the ovaries of women. Therefore, they work exactly the same as estradiol and progesterone produced by the ovaries. Premarin and progestins can have very different functions in the body, often not advantageous to the woman taking them.

Due to their identical molecular structure, the body sees them as more compatible than non-bioidentical progestin or premarin, and can metabolize the bioidentical estrogen and progesterone to help restore hormonal balance while minimizing side effects.

HRT Treatment Options for Women

Using bioidentical estrogen, testosterone, and progesterone, HRT treatments for women replace critical female hormones lost during perimenopause and menopause.

Bioidentical estrogen and progesterone replacement therapy can be administered through multiple methods including:

• Pellets (estradiol and testosterone)
• Patches
• Pills (progesterone only)
• Topical creams or gels (estradiol, progesterone and testosterone)

Oral Tablets

Often used to treat perimenopausal and menopausal symptoms, daily Estradiol tablets are a convenient and easy-to-administer method of estrogen replacement therapy. With pills, the estrogen is absorbed through the digestive system, providing a steady release of hormones throughout the day.

To help maintain consistent hormone levels, estrogen pills should be taken each day around the same time. Vital Living Healthcare does not use estradiol orally at our practice due to the fact that oral estrogen causes the liver to increase blood clotting factors. This can result in an increased risk for users for DVT (deep vein thrombosis) and PE (pulmonary embolism).

Progesterone is also commercially available in oral tablet form, taken once daily in the evenings due to its sedative effects. When taken orally progesterone has a specific metabolite 7-allo pregnenolone that is highly effective at helping women sleep and reducing anxiety. Unlike progestins, progesterone is not associated with increased risk of heart disease and other health risks.

Transdermal Patches, Gels & Creams

Estrogen, progesterone and testosterone can be delivered topically via commercially prepared or custom compounded transdermal gels or creams. The commercial estrogen products are:

• Elestrin
• Estrogel
• Divigel
• Alora
• Vivelle

Once per day, creams and gels are applied directly to the skin — typically in the forearm, upper arm, lower abdomen, inner thighs, or wrist areas — allowing for easy absorption over a 24-hour period.

The application must be done on clean dry skin, allowed to dry for 3-5 minutes and should not be used on areas where others may touch them and inadvertently absorb hormones. They are generally not effective for women who have lots of hot flashes, night sweats or who exercise, sweat or swim often as they require hours to be fully absorbed. There are also many people who find they are unable to absorb enough hormones transdermally to effectively treat their symptoms.

Estrogen patches are applied 1-2 times per week based on the specific patch and formulation. These patches are typically affixed to the lower abdomen, buttocks, or hip area, allowing the estrogen to be absorbed gradually over a 3-7 day period.

Like creams or gels, the effectiveness depends on the patient’s ability to absorb hormones from the skin. Additionally women with sensitivity to adhesives (think band aids) may develop a rash at the area of application. Like the topicals they are not good choices for heavy sweaters, those with frequent hot flashes or night sweats or swimmers as all of these can dislodge the patches.

Hormone Pellet Implants

Long-lasting and convenient, small, sterile estradiol and testosterone pellets are inserted directly under the skin in a sterile procedure. After a numbing shot and sterile preparation of the skin, the pellets are inserted with a small metal straw (trochar) through a small incision typically in the buttocks or hip area.

Hormone pellets provide a consistent flow of hormones into the patient’s bloodstream over a 3-5 month period. Progesterone is not commonly delivered in pellet form due to inconsistent absorption and more effective methods of administration.

Injectable Shots

While this is a less common BHRT delivery method due to its frequent hormonal fluctuations, bioidentical estrogen can be injected intramuscularly typically to the buttocks or thigh.

Progesterone can also be injected either intramuscularly or subcutaneously. Because this method does not provide optimal results, we do not use this method in our clinic as it is not in the best interest of our patients. This method can increase risk for migraines, acne and other deleterious side effects.

Risks & Side Effects of HRT for Women

When administered and monitored by a qualified medical professional, HRT for women is a safe treatment option to restore hormonal balance. While HRT offers significant benefits, such as relief from hot flashes, mood swings, and major reduction in the future risk of heart disease, cognitive decline, muscle loss and bone loss, we do acknowledge and address the potential side effects associated with the therapy. Potential short-term side effects of hormone therapy may include:

• Bloating (temporary if estrogen levels are too high)
• Breast tenderness (again if estrogen levels are elevated)
• Unexpected bleeding if you have a uterus (rare but possible and usually easy to stop)
• Edema in feet (swelling) that is rare but usually happens during travel
• Excessive sleepiness in the morning from progesterone if the dosage needs adjustment
• Scalp hair loss in women who are genetically predisposed to it (with testosterone use only)
• 2-3 lb weight gain as estrogen rehydrates the tissues and makes skin firmer
• Mild acne (testosterone only)
• Oily hair or more oil on skin (testosterone- dosages can be adjusted)
• Increased muscle mass (estrogen and testosterone)
• In women with a history of fibroid uterus, estrogen can increase fibroid size.
• Increased libido above what women are used to which can be normalized with adjustments to the HRT

These short-term effects are generally manageable and tend to subside over time.

Potential Long-Term Risks & Side Effects

Studies have shown potential long-term effects of prolonged estrogen therapy, including:

• Increased risk of endometrial cancer – only in women with a uterus treated with estrogen only.
• Decreased risk of breast cancer – suggested by observational data with estrogen only therapy and estrogen/progesterone therapy.
• Possible decreased risk of colon cancer
• Increased risk of DVT/PE in oral estrogen and estrogen/progestin users
• Possible increased risk of heart disease in estrogen/progestin users (NOT progesterone)
• Little or no decreased risk of heart disease or dementia if HRT is started more than 10 years after menopause.

At Vital Living Healthcare, our female HRT patients receive ongoing care through regular check-ins and comprehensive health monitoring. We tailor each treatment plan by adjusting methods and dosages as needed to ensure safety, effectiveness, and optimal results.

What Female Patients Can Expect From HRT

At Vital Living Healthcare, our approach to female HRT involves a comprehensive evaluation of symptoms, medical history, and health goals.

Female patients starting HRT with Vital Living Healthcare can expect personalized, compassionate care throughout their journey. This is not a one-size-fits-all program; we tailor each treatment plan to meet the unique needs of every patient. Regular follow-up visits ensure their individualized plan aligns with their evolving health needs.

Many women experience relief from symptoms within weeks — including notable improvements in:

• Sleep
• Energy
• Mood
• Menopausal Hot Flashes
• Night Sweats