1. Replacing the hormones that we lose during menopause (estradiol, progesterone and testosterone) can dramatically improve quality of life, as well as significantly reducing the risk of heart attack, diabetes, osteoporosis, colon cancer and neurologic decline – and the sooner we start it after menopause the better.

2. The term “bio-identical” is often used in marketing but applies to any hormone that looks chemically identical to human hormone. Any product called estradiol, progesterone or testosterone is by definition bio-identical. Some bio-identical products are FDA approved and come from a commercial pharmacy and some come from a compounding pharmacy. These are both good options for different patients.   

3. Estradiol (i.e. bio-identical estrogen) and testosterone ideally should not be given by mouth, since the effect on the liver seems to be responsible for the risks that have been shown in some studies related to blood clotting.

4. Estradiol does not cause breast cancer, and when given non-orally does not increase this risk of a blood clot, heart disease, and stroke. The risk of dying from breast cancer, heart disease, diabetes and all causes is significantly reduced in patients who take estradiol after menopause, if we start it within the first 10 years. Timing is important to prevent disease processes from starting. Once started, there is no reason to stop at any particular age, and long-term (lifelong) use can be considered. 

5. Testosterone is important for women as well as men. We make more testosterone than estrogen throughout our lives as women, although 10 times less than men. Replacing low testosterone improves sex drive, muscle mass and bone density, and may reduce the risk of breast cancer. 

6. Hormone pellets are one option for replacing estradiol and testosterone. They are tiny slow-release rods that last several months and can be dosed differently for each patient, based on age, where she is in the menopause spectrum, her symptoms, and her personal history. 

7. Other great options include an estradiol patch or gel, or testosterone cream. The FDA has not approved any testosterone products for women in the US (yet), so all testosterone for women comes from a compounding pharmacy, or we can use male FDA approved products at 1/10 of the male dose. 

8. Every patient with a uterus should take progesterone to prevent uterine cancer, as well as improving sleep and moods. Progesterone is safe for the liver and is taken by mouth at night, since it helps with sleep and is not included in a pellet (since it makes you sleepy and is not absorbed well through the skin). Some patients chose a progestin IUD for uterine cancer protection. Many patients without a uterus choose to take progesterone for its other benefits. Progesterone cream has not been shown to prevent uterine cancer. 

9. MHT is not contraindicated due to any family history, for example a family history of breast cancer or heart disease. It is also not contraindicated if you have an increased risk of breast cancer due to genetics. 

10. For the vast majority of women, MHT has significantly more benefit that risk, and is much more likely to extend our lifespan and healthspan than to reduce it. 

We look forward to discussing all of these options with you!

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