In addition to being identical to a woman's own hormones, bioidentical hormones are meant to be taylored to each woman's specific needs. Every woman is different. Therefore, some initial testing should be done. I believe the saliva test is the best choice. Any doctor knowledgable about bioidentical hormone replacement therapy (BHRT), will have this done so he or she knows what to prescribe. This is unlike the usual mainstream method of prescribing synthetic estrogens and progestins in a one-size-fits all dosage without even testing. I know women who have had hysterectomies with oopherectomies (removal of the ovaries also). They have severe hot flashes, night sweats, memory problems and other symptoms very detrimental to their lives at home and at work. Their doctors simply handed them a prescription for the ever-popular Premarin (a synthetic horse urine estrogen). The doctors do no testing and completely ignore finding out what other hormones need replaced, like progesterone, testosterone, maybe even DHEA, cortisol, or thyroid hormones. This "therapy" does not work for these women.
BHRT should be done under the care of a doctor. A doctor knowledgable in BHRT will test and prescribe mainly through a compounding pharmacy. This is a pharmacy that works with the doctor to make the correct dosage of hormones prescribed for you, usually in a transdermal or sublingual form. Compounding pharmacies are not found in all areas, but a doctor can work with any compounding pharmacy online. There are also some pharmaceutical bioidenticals like the Vivelle patch, Estradot patch, Ovestin cream, and Prometrium capsules (bioidentical progesterone) that a doctor can prescribe.
However, I do not have a doctor, and do my own BHRT. I do it cautiously and have been doing it for about eight years in one form or another. I am not telling anyone to do this. I can only describe what I have learned by reading and experimenting, and what works for me. There is more information on obtaining hormones on the How do I get bioidentical hormones?" page. And anyone can order a saliva test--this does not need to be ordered through a doctor, although it can get expensive.
Transdermal vs. Oral Use
Transdermal (through the skin) use is usually the much better choice for BHRT than oral use (swallowing pills and capsules). Please go to the "Transdermal vs. oral use" page for more information.
Since progesterone can be used alone, unlike estrogen, I am giving it its own separate section.
Over-the-counter bioidentical progesterone creams all come with directions for use and dosage for if you are still having periods or if you have stopped having periods.
If you are still having regular or more or less regular periods, you would use the cream on the last 10-14 days of your cycle. The first day of your period counts as the first day of your cycle. Ten days worked best for me during perimenopause, and it is a matter of experimentation since everyone is different.
If you have stopped menstruating or are menstuating infrequently, the directions on the creams will tell you to take the progesterone continuously with at least a five day break every month to reset your cell receptors. Some doctors believe the break is not needed. I believe it is. As a matter of fact, the continuous use gives me frequent spotting so I don't do it.
Most directions that come with progesterone creams say to apply to soft-skin, fatty areas of the body so the progesterone can be absorbed into the fatty tissue and be released. These areas would include the backs of your arms, the abdomen, the buttocks, and the inner thighs. Some theories say this is incorrect and that the cream should be applied to non-fatty areas of the body that contain a lot of blood vessels to get it into the blood stream to prevent the progesterone from accumulating in the fatty tissue. I agree with this through experience. I only apply progesterone cream to areas like the throat, wrists, backs of the knees, and tops of the feet.
If I am using progesterone cream, I dose twice a day. For example, if my dosage is 1/2 teaspoonful, then I would take 1/4 teaspoon in the morning and 1/4 teaspoon at night.
I don't shower, work-out and sweat, or swim for about two hours after application to allow the progesterone to absorb.
I always wash my hands immediately after applying so I don't "share" the progesterone with others, especially children. If I am going to be in contact with a child within two hours after application, I make sure to cover the application site with clothing (usually not a problem, unless it's on my wrists or throat) so that I don't transfer any progesterone with direct skin contact.
Prometrium and Microgest are the same pharmeceutical prescription drug containing micronized bioidentical progesterone. Microgest is cheaper and made in India. I use it and it works as well as Prometrium. This is progesterone in a capsule in a peanut oil base, so anyone allergic to peanuts cannot use this. It can be used in the same cyclic or continuous ways the cream can be used. It is also used vaginally to help prevent miscarriages in pregnant women who do not have a high enough progesterone level. I currently use Microgest in combination with Natrol, a progesterone cream, for ten days a month. The oral progesterone is hard on the liver, but offers a more accurate dosage that leaves my body immediately when I stop taking it.
100 mg per day is the commonly prescribed dosage for continuous use.
200 mg per day is the commonly prescribed dosage for cyclic use (last 10 -14 days of the menstrual cycle). This can be broken into two 100 mg doses per day.
Some women do use it vaginally for BHRT to bypass the liver and get the progesterone directly to the uterus. I feel that even the 100 mg dose is much too high for a non-pregnant woman to use vaginally. Remember, if it is taken orally only about 10 mg would be absorbed and not the whole 100 mg which can be absorbed transdermally through the vagina. I have experimented with vaginal use, but it is too difficult to try to squeeze out a portion of the oil from the capsule. Additionally, it leaves some residue and an odor that is not conducive to sexual activity. Plus a male partner could receive a dose of progesterone and that is not good.
Some women find that Prometrium or Microgest makes them very sleepy or even light-headed about an hour after taking it and absolutely hate it. It does not do this to me, but as I keep saying, everyone is very different. One theory is that it is the metabolites from the liver breaking down the progesterone that cause this.
THE BIG RULE: YOU CANNOT USE ESTROGEN ALONE WITHOUT PROGESTERONE IN SOME FORM USED IN SOME METHOD!
Using estrogen only can give you fibroids, endometrial hyperplasia, and cancer. If you don't have a uterus or ovaries, it can still contribute to breast cancer. With that being said, we will move on to BHRT using a combination of estrogen and progesterone. I am referring to this use during the tail-end of perimenopause and after menopause, since most of perimenopause can be handled with progesterone cream in my experience.
From what I have learned, there are five methods to using estrogen/progesterone BHRT:
- Continuous combination
- Continuous combination with a one week break from both each month.
- Cyclical using estrogen continuously and progesterone for the last 10-14 days a month.
- Cyclical taking a break from estrogen for the first week of the cycle and using progesterone for the last 10-14 days a month.
- Cyclical taking a break from estrogen for the first 5-7 days of the cycle and using progesteron 10-12 days a month, but adjusting the dosages of both to mimic a normal menstrual cycle.
This method uses static doses (meaning always the same from day to day) of both estrogen and progesterone used in combination daily with continuous use. There is no break. This method is used with both synthetic and bioidentical hormones. It is commonly prescribed by doctors for menopausal women and commonly discontinued by the women because it causes irregular spotting and bleeding during the first year. But it is a simple method and research shows that about 80% of women stop bleeding altogether after one year. And who wouldn't want that. Sure, I tried it for over a year, adjusting the dosages lower and higher and adjusting the balance of hormones. I had all sorts of bleeding problems: period-like bleeding about every 15-17 days and spotting in between many months. I am not in the 80% that stop bleeding on this method.
Continuous combination with a one week break from both each month.
This method is the same as the one above only you stop taking both estrogen and progesterone for seven days during the first week of your month--if you can figure out what that is. Theoretically, you should have a withdrawal bleed from stopping the hormones, but this rarely happened when I tried this method. I still had all sorts of irregular bleeding.
Cyclical using estrogen continuously and progesterone for the last 10-14 days a month.
This method uses static doses of estrogen and progesterone and is cycled with no break on the estrogen. This method also gave me irregular bleeding although there were some months when there was none. Still, I did not always have a withdrawal bleed after stopping the progesterone. Better but still unacceptable.
Cyclical taking a break from estrogen for the first 5-7 days of the cycle and using progesterone for the last 10-14 days a month.
This method is the same as above only you do not use the estrogen for the first week of the monthly cycle. I tried this method also. I still was not sure when my withdrawal bleed period was going to occur and if it did it was at around 20 days into the cycle. This was also unacceptable.
Cyclical taking a break from estrogen for the first week of the cycle and using progesteron for the last 10-14 days a month, but adjusting the dosage of both to mimic a normal menstrual cycle.
This method is the same as above with one big exception. The estrogen and progesterone dosages are changed from day to day to mimic a normal menstrual cycle. In a normal cycle, the estrogen starts low and peaks at around day 12 and then decreases again. Progesterone production begins a few days later and peaks around day 21. Then both estrogen and progesterone decrease until around day 28 and then a new cycle starts with the shedding of the lining of the uterus which is the period. This is the method that works for me. I have a 26-28-day cycle, and the moderate and painless withdrawal bleed (the "period") lasts five days. It has been about a year and I have no signs yet of fibroid growth or heavy, clotty bleeding from hyperplasia. I guess this should come as no surprise since I am using the hormones in a more natural method. Yes, I will have monthly bleeds just like periods for as long as I continue this method of BHRT, but it is well worth it to me.
How do I adjust dosages? I am using the Estradot patch and Oestrogel. I use the 1.0 mg patch, which is the highest dosage it comes in and I can easily cut the patch with scissors to decrease the dosage. I can add Oestrogel if I need to and measure out whatever dose I want. I use Prometrium capsules in both the 100 mg and 200 mg and use the appropriate dose depending on what day it is. I also add transdermal progesterone cream to boost my progesterone intake on days 20-22.
All of this takes time and patience. I always start with low doses and work my way up. I have found what works well for me by trying different methods and adjusting dosages. Saliva tests were somewhat helpful in the beginning, but now I operate on how I feel and how my body is functioning. I have been willing to take some risks, keep trying, and sometimes put up with discomforts or inconveniences to find a BHRT method that works for me.
My Personal BHRT Program
My BHRT program costs me about $45.00 a month. That translates into about $540 a year total.
Maybe it's risky to do this on my own. But I'm like a lot of used-to-be middle class people now. I can't afford to go to the doctor for BHRT or hardly anything else because of extremely high costs and a really high health insurance deductible. Plus health insurance does not always cover BHRT, but will cover treatment with synthetic Premarin or Prempro. Ask yourself why that might be and think "$$$$." I had to get medical attention for a systemic bacterial infection from a tick bite a couple of years ago. I had a $600 bill racked up in no time, which took me a year to pay off. More and more people will be turning to self-care out of necessity in the forms of old home remedies and alternative health products and supplements. And let's not forget that the human body resolves many health problems on its own in a couple of weeks and the doctor takes credit for it. I think we'll find that people would have a better quality of life without so many unnecessay medical tests, most of which both risky and often inconclusive, and the rampant and harmful prescribing of way too many drugs.
Below is what I do each month. KEEP IN MIND THAT ALL WOMEN ARE VERY DIFFERENT. THIS IS WHAT CURRENTLY WORKS FOR ME. But if it helps anyone to see specifically what my BHRT program looks like, that's great. Also remember that the Estrodot patch is only replaced twice a week normally (for more information on Estradot go to the "What forms do bioidential hormones come in?"). So if I apply a 1.0 mg patch, for example, it releases 1.0 mg of estradiol each day for three or four days. I may also vary the dosages slightly depending on how I feel. Hormones levels can be affected by stress, diet, or illness.
Days 1-7: No hormones. This is when I have my withdrawal bleed for about 5 days.
Day 8: .5 mg estradiol (Apply 1/2 1.0 mg Estradot patch)
Day 9: .5 mg estradiol
Day 10: .5 mg estradiol + 1/8 tsp of Oestrogel
Day 11: 1.0 mg Estradot patch (Apply new patch)
Day 12: 1.0 mg Estradot patch + 1/4 tsp of Oestrogel
Day 13: 1.0 mg Estradot patch + 1/8 tsp of Oestrogel
Day 14: 1.0 mg Estradot patch
Day 15: .75 mg Estradot patch (Apply new patch)
Day 16: .75 mg Estradot patch
Day 17: .75 mg Estradot patch
Day 18: .75 mg Estradot patch (Apply new .75 mg patch), 100 mg Prometrium morning and night
Day 19: .75 mg Estradot patch, 100 mg Prometrium morning and night
Day 20: .75 mg Estradot patch, 100 mg Prometrium morning and night, 1/4 tsp of Natrol progesterone cream
Day 21: .75 mg Estradot patch, 100 mg Prometrium morning, 200 mg Prometrium night, 1/2 tsp Natrol progesterone cream
Day 22: .75 mg Estradot patch, (Apply new .75 mg patch), 100 mg Prometrium morning and night, 1/4 tsp Natrol progesterone cream
Day 23: .75 mg Estradot patch, 100 mg Prometrium morning and night
Day 24: .75 mg Estradot patch, 100 mg Prometrium morning and night
Day 25: .5 mg Estradot patch, (Apply new .5 patch), 100 mg Prometrium morning and night
Day 26: .5 mg Estradot patch, 100 mg Prometrium morning and night
Day 27: .5 mg Estradot patdh, 100 mg Prometrium morning and night
Day 28: Stop hormones for withdrawal bleed