Bioidentical Hormone Repalcement Therapy
There are actually many FDA-approved options for bioidentical estrogen. One oral option that I like is called Bijuva. It combines estrogen along with progesterone in one tablet. However, I generally prefer to stay away from oral estrogen because it can increase clotting factors made in the liver, which may raise the risk of blood clots or stroke.
Because of that, there are many what we call transdermal options, meaning they are absorbed through the skin. Probably the most popular option for my patients is the patch. There are multiple brands and multiple dosages, but it is a thin, see-through patch that goes on the skin. Patients usually place it on the lower abdomen or lower back. It stays on for three to four days, so the patch is changed twice a week.
Another option is a gel. Instead of wearing a patch, you can use packets of gel. One particular brand is EstroGel. Again, there are multiple dosages, and you rub it into your skin once a day, where it is absorbed.
Another option is a mist or spray. One brand is Evamist. You pop off the cap, spray it on the skin, wait for it to dry, and it is absorbed through the skin once a day.
I don’t have an example here of a ring, but another method is using something called the ring. It is a vaginal ring that is inserted into the vagina and provides slow release over the course of three months. One common option is Femring.
Lastly, I wanted to discuss testosterone.
Testosterone is FDA-approved for men, but it is not currently FDA-approved for women. When we prescribe testosterone for women, we typically use a much smaller dose than what is used for men. It can be applied topically, often behind the knee or to another recommended area, depending on the formulation and dosing instructions.
I don’t have an example with me today, but progesterone is another important option. The form we commonly use is micronized progesterone. The brand name is Prometrium, and it typically comes in 100 mg or 200 mg doses.