What You Should Know About Use of Bioidentical Hormone Supplementation After Menopause

By Grattan Woodson, M.D., FACP and Kim Teasley 

Having a physician who is skilled in women’s health, understands gynecoendocrinology, and is comfortable prescribing compounded pharmaceuticals is a requirement for hormone therapy replacement success. It is this physician who will monitor your clinical response to treatment, evaluate you for any side effects you might have, and adjust the dose of your compounded prescription to precisely meet your needs. A vaginal cream with the components described below can only be obtained from a compounding pharmacy following the ordering physician’s prescription. All of these elements are necessary to ensure a successful outcome for a woman on balanced hormone replacement therapy.

How the Hormones are Delivered

In my opinion, the preferred way for a postmenopausal woman to use estradiol (a replacement for estrogen) is topically. I recommend this because the dose that effectively reverses the estrogen deficiency state caused by menopause is one-tenth of the dose needed if given orally.

The surface of the vagina is ideal for absorption of steroid hormones. Applying them in an elegant cream by applicator at bedtime is a simple way to deliver the product that serves two purposes. The hormones are easily and completely absorbed through the mucosa of the vagina, much more readily than through the skin because there is no cornified epithelium to penetrate. Secondly, the vagina, vulva and surrounding pelvic muscles are key targets for hormone replenishment in postmenopausal women.

The pelvic region is often inadequately treated with other routes of administration, be they topical, oral or injection. A dose of 10 milligrams of natural progesterone administered to the vagina via a cream combined with the other sex steroids at bedtime is usually adequate to protect the uterus. Annual monitoring Having a physician who is skilled in women’s health, understands gynecoendocrinology, and is comfortable prescribing compounded pharmaceuticals is a requirement for hormone therapy replacement success. with transvaginal ultrasound technology is a good way to be certain that this approach is effective. There should be a minimal effect on mammogram density with this dose and use of it allows adoption of the every other year mammography recommendations of the United States Preventive Services Task Force that avoids the pitfalls of annual testing.

The Importance of Staying Balanced

The forgotten sex steroid is testosterone. To obtain hormonal balance and return women to a simulated premenopausal status requires the addition of an androgen. Testosterone is necessary for women to maintain their muscle and bone mass. The loss of ovarian testosterone production at menopause robs women of half their androgen source.

The hallmark of frailty is the loss of muscle and bone mass and the replacement of that tissue with fat. Androgen deficiency makes it very hard, if not impossible, to build new muscle tissue. You can eat very healthy food, practice daily vigorous exercise but it is all to no avail. If you are androgen-deficient, the mesenchymal stem cells that become muscle, bone, cartilage, and other healthy tissues cannot change into those tissues. They become fat instead. To become a muscle cell, testosterone must occupy its receptor in the nucleus. Without testosterone, the stem cell will turn into a fat cell. This is why everyone needs testosterone.

Grattan Woodson, MD, FACP • 404-574-2373 • 1418 Dresden Dr., Suite #225 Atlanta, GA • FemeRegen.net 

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