Hormonal deficiencies are determined through blood testing and appropriate levels of the three hormones, mentioned below are replaced. A prescription is created based on a blood test. The prescription is then compounded by specialist pharmacists to contain the correct amount of hormones in the form of a troche or lozenge.
After 2 months a repeat blood test is performed to ensure the appropriate blood levels have been achieved. All women are different in their ability to metabolise hormones and so on the follow up appointment it is sometimes necessary to fine tune the dosage of hormones. Once the levels are stable, we usually perform blood tests on a six monthly basis to check hormone levels. The ultimate goal is to give women the lowest dose of hormone that keeps symptoms under control.
Biest
Biest is a combination of oestriol and oestradiol in a ratio of 80:20.
The female body makes three different oestrogens.
Oestriol-this is the weakest of the female oestrogens but the safest one to replace.
Oestradiol- this is a stronger oestrogen and in most cases we need to include this in the Biest combination in order to control oestrogen deficiency symptoms of hot flashes and night sweats.
Oestrone- again a stronger oestrogen. We previously used Triest in troches which was a combination of estriol, oestradiol and oestrone in a ratio of 80/10/10 but recent evidence has suggested oestrone being a more powerful oestrogen may have some risks associated and in most cases we have switched to using Biest which contains Oestriol and Oestradiol in a ratio of 80/20.
Progesterone
Progesterone is often referred to as the forgotten hormone. Modern Medicine and pharmaceutical companies have tended to focus on oestrogen deficiency as the main cause of all symptoms relating to menopause. Progesterone deficiency typically begins in many women in the late 30’s, early 40’s and most commonly is responsible for the mood swings, irritability, depression, memory and cognitive issues, as well as sleep disturbance, fibromyalgia , dry skin and hair. Initially when a female continues to menstruate, progesterone deficiency symptoms are more pronounced in the 2 weeks prior to menstruation. As women move into full menopause and periods disappear the progesterone deficiency symptoms tend to occur continuously as opposed to cyclically.
Progesterone not only alleviates symptoms of peri-menopause and menopause but also helps halt accelerated bone loss associated with menopause through stimulation of osteoblastic activity. Osteoblasts are cells responsible for building new bone.
Replacement of Bio-identical Progesterone in appropriate dosage determined by blood testing can alleviate most symptoms relating to progesterone deficiency.
Testosterone
Testosterone deficiency in my experience is a real phenomenon in peri-menopause and menopause. The most common symptoms associated with Testosterone deficiency are low libido and low energy.
Approximately 7 out of 10 women who receive testosterone will experience an improvement in libido and energy levels.
Women after menopause tend to lose bone mass, muscle and connective tissue. Osteoporosis or bone loss is partly related to this loss of testosterone. Testosterone, like progesterone, helps halt the acceleration of bone loss that women experience in menopause by stimulating osteoblastic activity.