Hormone Deficiency

Dr. N provides bio-identical treatment regimens that will resolve your  hot flashes, sweats, sleep disturbances, headaches, fatigue, depression, give you back your sex life and keep you looking younger. Our goal is for every one of our menopausal patients to be able to say … I’m Back to being me.

Bio-Identical and Natural Hormone Therapy, Hormone Pellet Implants, Compounded Hormone Gels, Patches and Creams. The most effective and safest options for. Dr. N’s office is located in Southeastern Michigan. For an appointment or phone consultation call (248) 644-7200 and speak to Caroline .

Click link below to see videos of Dr. N’s patients discussing their menopause and their therapy.

Menopause – Symptoms, Sex and Hormones – YouTube

Having reached menopause by definition you are hormone deficient.

How will this effect me?

There are hormone-dependent tissues in every organ system in your body. As your hormone levels fall these tissues can no longer function optimally. The skin thins, looses collagen and wrinkles. The vagina atrophies, looses its elasticity and the labia and clitoris regress. This along with a decreased ability to lubricate can make intercourse painful if not impossible. The skeleton loses bone mineral content increasing the risk of osteoporosis and fracture. Hormone deficiency can cause an increase in the incidence of coronary artery disease, strokes, osteoporosis, depression and dementia. This list is a fraction of what happens in a hormone deficient state.

Jeanine has been a patient for over 25 years

Does that mean these things will happen to me without hormone replacement?

No it does not. Some women at least on the surface seem to avoid most changes in their hormone dependent tissues and other women appear to suffer from a wide range of hormone deficient problems. In theory the women who do better may have higher amounts of residual sex hormones in their body and more efficient sex hormone receptors. Nevertheless, no menopausal woman is unaffected.

It is impossible to predict if a specific woman will experience problems, however there are a number of factors that significantly increase the risk:•Heredity: A family history of Osteoporosis, Cardiovascular Disease or Alzheimer’s.
•Surgical removal of the ovaries: Unlike a natural menopause where the fall is more gradual, the decline in ovarian sex hormone production is sudden and complete and so women in this category tend to be at greater risk.
•Early menopause: Early menopause can be due to premature menopause, surgery or ovarian injury. The risks begin once the hormone levels decrease, and the they increases with each passing month that the problem is not corrected..
•Lifestyle: Smoking, excess alcohol intake, sedentary lifestyle, high fat diet and low intake of calcium and other important nutrients all affect the risk factor.
•Concurrent medical problems: There are a number of medical conditions that increase risk, either as an effect of the disease itself or the medication necessary to treat it. 


Here are a few examples. Elevated levels of lipids (fats) in the blood, hypertension, obesity and diabetes increase the risk of coronary artery disease and stroke.

There are also a number of medical conditions that risk of osteoporosis including diseases of kidney function and calcium metabolism, of stomach and intestinal absorption, chronic lung disease, hyperthyroidism and Cushings disease – a disorder of the adrenal gland.

Medications can also cause problems. Medications called glucocorticoids, such as prednisone given in high doses over a period of time as short as a few months can cause significant mineral loss from bone as can heparin an anticoagulant. Also, thyroid hormone in excess of replacement requirements taken over an extended period of time results in significant bone loss as well.


The majority of women experience symptoms which range from mild to debilitating, including hot flushes, sweats, insomnia, problems with memory and/or concentration, headaches, loss of sex drive, mood changes, and muscle aches. A woman may experience some of these symptoms, all of them, or none of them.


Almost all women will experience alterations in sex hormone dependent “target tissues” and “organ systems”. This includes atrophy of the vagina, urethra, labia and clitoris, loss of skin thickness and collagen content, loss of bone mineral content from the skeleton as well as effects on the brain and cardiovascular system. Again, these changes are preventable by appropriate use of HRT.


I know Aunt Sadie lived to 94, was sharp as a tack, had a younger boyfriend she nearly killed with her sexual demands, drove a car, mowed her lawn and was active until the day she died. Everybody thinks it’s great. Hormone deficient women can function, of course they can. Aunt Sadie did. But that’s not issue. The point is that no one, regardless of gender can function optimally, if they are hormone deficient.

Information on Bio-Identical and Natural Hormone Therapy, Hormone Pellet Implants, Compounded Hormone Gels, Patches and Creams. A review of the most effective and safest options for you. Dr. N has specialized in care of menopausal women for over 30 years. His office is located in Southeastern Michigan. For an appointment or phone consultation call (248) 644-7200 .

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Breast Cancer and HRT

Does Hormone Replacement Therapy increase the risk of breast cancer?  

The belief that HRT increases the risk of breast cancer is without merit.  It is primarily based on misinformation communicated to the media and health professionals by a seemingly reliable source, the National Institutes of Health (NIH) sponsored Women’s Health Initiative (WHI).  The results of the WHI  Estrogen Plus Progestin (E Plus P) Trial was published in the July, 17, 2002 issue of the Journal of the American Medical Association (JAMA) The article stated that there was a substantial increase in the risk of breast cancer associated with the hormones used in the study.

It is clear that the writers group of the NIH-sponsored project misrepresented their study findings as the data collected in the study did not support this conclusion.   What their agenda was remains unknown.

If this is true why does my doctor tell me estrogen causes breast cancer?

Unfortunately, very few physicians actually bothered to read the WHI article and most received their information from the media or from colleagues who didn’t read it.  As a result how they advised and treated their patients was often sub optimal.  The WHI article including the conclusions and recommendations was written by twelve individuals, eight non-physicians and four physicians, known as The Writing Group for the Women’s Health Initiative Investigators.  Only two of the four physicians were practicing and none of them were known to have expertise in menopausal medicine.  Incredibly the conclusions of the writers group were accepted by most physicians and the media with a complete absence of professional skepticism.  Physicians who had prescribed HRT for years with good patient results without independent thought or analysis simply stopped writing prescriptions for HRT and told their patients they could no longer use it.

Dr. Jacque Rossouw, the physician who heads the WHI and was in charge of the study, did not believe the WHI study provided evidence that the hormones used in the study increased the risk of breast cancer.  He said the WHI E Plus P study lasted only a little over five years and that during that time a breast cancer initiated by the hormones could not have grown to a size large enough to have been detected by mammography or a physician examination.  Dr. Rossoux was clear in saying that the breast cancers discovered were there before the study began.   How would I know that Dr. Rossoux said this?  I have spoken to Dr. Rossoux several times, face to face and on the phone. He told me this directly and the wording he used was that the breast cancers pre-existed the study.  I would presume that if an investigative reporter took the time to call him at the NIH he would tell them the same thing.

Consider some comments from recognized authorities in menopausal medicine:

A recent article in the Journal of the International Menopause Society, Climacteric, The Journal of Adult Women’s Health and Medicine in June 2014 concluded:

“Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits.” 

An excerpt from an editorial published in a prior issue of the Climacteric, and was endorsed by seven members of the Board of the International Menopause Society concluded:

“On current assessment, the WHI trial the most important and the most ambitious project in menopause medicine, has done a great disservice to the well-being and health of adult women.”

In an issue in the Journal Menopause Management, James Simon, MD, clinical professor at George Washington University, President and Medical Director of Woman’s Health & Research Consultants, Washington, DC, and a Past president of the North American Menopause Society, wrote in a “Letter to the Editor:

“While I applaud those WHI investigators who are finally emerging to voice their concern and frustration with being excluded from the July 2002 media- grabbing media-distorting WHI publication, they now must find their own absolution and path to redemption.

An entire generation of women, their partners and their families suffer unnecessarily for their collective sins.”


The events that transpired following the WHI publication were and continue to be a tragedy for menopausal women.  The media did their job which is primarily to sell advertising by sensationalizing anything that is remotely possible to sensationalize. Physicians failed in their responsibility to their patients by responding to the WHI’s publication without independent thought or compassion for their patients. 

Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Sex & Libido With HRT

Dr. N provides bio-identical treatment regimens that will resolve your  hot flashes, sweats, sleep disturbances, headaches, fatigue, depression and give you back your sex life. Our goal is for every one of our menopausal patients to be able to say … I’m Back to being me.

Libido & HRT



There just doesn’t seem to be any way of getting around it. If you’re menopausal, by definition sex hormone deficient, and would like to be at your optimum sexually, you will need to replace your hormones.

This section addresses the role of sex hormones in maintaining libido and sexual function. It discusses the manner in which the fall in sex hormone levels that accompany a natural, or surgical menopause, or medications may affect your sexual experience and provides treatment options to restore sexual desire and function.

 Menopausal women, without the benefit of hormone replacement, may be capable of enjoyable and satisfying sex. They may be capable of great sex. But ultimately they loose the potential, as least as far as sex is concerned, to be the best they can be.

Click on the link below to go to Dr. N’s You Tube Video Channel

Menopause – Symptoms, Sex and Hormones – YouTube

A healthy lifestyle, a positive attitude, exercise, a loving, giving, patient and understanding partner …all are important. But, they can not substitute for adequate hormone levels. It is clear and unequivocal; the integrity of the sexual experience is dependent on sex hormones.


Diminished hormone levels interfere with optimum sexual function by their affect on sexual desire and hormone sensitive tissues.

Sexual desire, or libido, consists of thinking about sex, fantasizing about sex, the development of “sexual tension” and the awareness of a need for sexual release. Some people may call feeling this way as being “horny”. It motivates us to initiate and participate in sex and if circumstances require, search for a sexual partner.

Lack of, or diminished sexual desire and loss of sexual motivation is sometimes referred to as a “desire phase” disorder.



A postmenopausal woman’s decrease in libido can range widely, from a barely noticeable fall in sexual interest to a “sexual aversion” where the very thought of being touched in a sexual context is repulsive. A number of patients have told me, ” I feel dead from the waist down”, to describe their lack of sexual interest. Several who were effected to a lesser extent have shared, that although they really had no interest in sex or in initiating sexual contact, once they were aroused by direct stimulation, the sexual activity was welcomed and enjoyable. I have found that some women evidence little concern over their loss of libido and have no interest in restoring it. And this is the very essence of not having a libido. Other women are devastated by their loss and are interested in pursuing any reasonable treatment that will allow them to regain their previous sexuality.

Unfortunately, many women who speak to their physician because they are troubled about a low sex drive are subjected to the response, “How are things at home?” Next, they are referred to a psychiatrist, counselor or psychologist before their hormonal status or a hormone replacement therapy program is considered. Certainly, stressful life events, health, psychological or relationship problems influence libido, but these factors should only be considered along with the menopausal woman’s hormonal status.


The decline in sexual desire is a direct result of diminished sex hormone levels in the brain itself. Although estrogen plays a part, the hormone that has been shown to be most closely associated with sex-drive is testosterone.

The ovary, although incapable of producing estrogen after a “natural” menopause, may continue to produce significant amounts of testosterone for several years. This is the reason why many women maintain a good sex-drive for a considerable length of time. These testosterone levels provide additional benefits to the naturally menopausal woman. Tissues of the body are able to convert some of this circulating testosterone to estrogen. This is the mechanism by which some naturally menopausal women have fewer and less severe symptoms and health problems. If a postmenopausal woman were to undergo removal of her ovaries, this benefit would be lost.


If the surgery is performed prior to menopause and the ovaries are preserved and their hormone secretion is unaffected, there may be no change in libido following the post-operative healing period. In fact, some women experience a post-surgical increase in sexual desire if prior to the surgery they had been distracted by heavy bleeding or significant pelvic pain. There is evidence, however that in this group of patients, ovarian failure occurs up to 50% of the time within 3 years following the surgery. If this happens, a diminished libido and menopausal symptoms would reflect the decline in hormone levels. Some physicians are not aware of the frequency of ovarian failure following hysterectomy. I have seen many patients in this category, whose physicians simply did not believe their symptoms were related to the surgery.

If the surgery is performed prior to menopause and the ovaries are removed, the fall in estrogen and testosterone levels is abrupt and severe. As would be expected this type of surgically induced menopause almost always, results in a dramatic fall in sexual desire.


Significant health problems, depressive illnesses, relationship problems and certain medications can affect libido.


A class of anti-depressants, SSRI’s frequently depress both libido and potential for orgasm. I have had several patients express a concern over a fall in their libido who had recently begun treatment with an SSRI, not realizing that this was the cause. Occasionally, delayed ejaculation or inability to ejaculate develops in men who are not aware of this side effect and can lead to conflict in a relationship if the couple doesn’t realize the medication is responsible.

Orally administered estrogen replacement medications and oral contraceptives are absorbed by the gastrointestinal tract and reach the liver in a “bolus”. This so called “bolus effect”, induces the liver to increase its production of a substance, “sex hormone binding globulin” (SHGB) which binds to circulating testosterone, leaving less “unbound” or “free” testosterone available to maintain libido. This is not well known and is often not recognized as a cause for a diminished libido.


How long will hormone replacement therapy maintain my sexual desire?

Treatment with non-oral bio-identical estrogen and testosterone in sufficient amounts will maintain sexual desire indefinitely as long as the menopausal woman continues to be in a reasonable state of health.

A number of years ago a television journalist who had been using me as a source for menopausal issues contacted me. He wanted to know if I would be able to find a woman for an on-air news segment who was over 50 and still wanted to have sex. I told him I would see what I could do. Arrangements were made for an on-scene interview to be taped at my office the following week.

The journalist and his camera crew appeared at the appointed time. I introduced them to June, an attractive woman of 80, who had been on hormone replacement therapy for over 30 years. The interview was broadcast on the evening news the following day to a potential audience of several million. June, an educated articulate woman was not camera shy. She informed the journalist and the viewing public, that she had a “very healthy” libido, enjoyed sex, had intercourse twice a week and was orgasmic. As she was leaving the office she mentioned in private to me that she would be having sex more often if she and her husband were getting along better.


Yes …appropriate hormone replacement therapy is very effective in maintaining libido.

Part 1: Sex and Menopause

Loss of sexual desire and ability to participate in and enjoy sex is not a normal part of aging. Dr Nosanchuk explains why a menopausal woman’s desire to have sex and her capacity to physically participate in sex are both affected by her menopause…

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Regimens of HRT

Dr. N provides bio-identical treatment regimens that will resolve your  hot flashes, sweats, sleep disturbances, headaches, fatigue, depression and give you back your sex life even when previous treatments didn’t help you. Our goal is for every one of our menopausal patients to be able to say … I’m Back to being me.

Dr. N specializes in the care of menopausal women.  His office is located in Southeastern, Michigan.  For an appointment call: (248) 644-7200 and speak to Caroline

The defining difference between HRT programs for women with and without a uterus is the need to give progesterone (progestin) when the uterus is present. For this reason HRT programs for women who have had a hysterectomy are less complex and avoid the symptoms of progesterone intolerance experienced by many women.

Click on the link below to g o to Dr. Nosanchuk’s Video Channel

Menopause – Symptoms, Sex and Hormones – YouTube


Approximately 30-40% of women who take progesterone experience unpleasant PMS-like symptoms which can range from mild to severe such as moodiness, irritably, breast tenderness and muscle aches. Individuals who had significant premenstrual symptoms while they were premenopausal are more likely to be affected. Progestins produce moodiness and irritability by effecting specific sites in the brain. Changing the type of progesterone, the dose, the route of administration and the length of treatment can lessen this effect. Forms of natural progesterone given by either the oral or vaginal route may be less of a problem than synthetic progestins. But some patients are so sensitive to the effects of progesterone they continue to have significant problems and just feel miserable. It is one of the most challenging aspects of caring for the postmenopausal woman. A few physicians are vigorous in their suggestion that natural progesterone cream as sole therapy is a miracle treatment for the postmenopausal woman, however a careful and responsible analysis of accepted medical literature and investigations does not support this view.


HRT programs for women who have not had a hysterectomy fall into two categories, Cyclic, where progesterone is given for part of the month and continuous combined therapy (CCT), where it is given daily. 

Cyclic Therapy

Cyclic therapy usually consists of the daily administration of estrogen usually in the form of an oral estrogen tablet or a transdermal estrogen patch replaced once or twice weekly but worn continually plus progesterone in tablet form taken 10-12 days a month. Estrogen stimulates and thickens the endometrium, (the lining of the uterus) and then progesterone, which has antiestrogenic effects blocks the estrogen stimulation. Progesterone both shrinks the uterine lining and prevents the development of abnormal changes.

Alternatively, the route of administration of the estrogen can be sublingual, transdermal gel or subcutaneous implantation. The route of administration of the progesterone can include sublingual tablets and vaginal suppositories. If this works the way it’s supposed to, 2-5 days after finishing the progesterone the patient experiences “scheduled withdrawal bleeding” which usually lasts from 3-5 days. And this “cycle” is repeated monthly. If the bleeding occurs at any other time during the month it is called “unscheduled bleeding” and signals the need to determine if any overgrowth or abnormal change of the uterine lining is present.

Continuous Combined Therapy

Continuous combined therapy usually consists of a daily estrogen tablet or a transdermal estrogen patch worn as above plus a smaller dose of progesterone taken daily. The purported benefit of this regimen is that in the majority of cases daily progesterone even in small doses keeps the uterine lining thin and no bleeding occurs. Menstrual bleeding is a very unattractive prospect for many postmenopausal women.

Some common oral estrogen and progesterone combinations. For years the most frequently prescribed combination consisted of conjugated equine estrogen tablets (brand name Premarin) and medroxyprogesterone acetate (MPA) tablets (brand name Provera). The congugated equine estrogen (CEE) or Premarin in earlier years was usually given in dose of 1.25 mg daily the 1-25th days of the month and the Provera was given the 16-25th days of the month. Nothing was given from the 17th to the end of the month at which time the cycle was repeated. Many women experienced symptoms such as hot flashes or sweats during the time they were off the estrogen and in more recent years the (CEE) is most commonly every day instead of the 1-25th. The dose of CEE in most HRT regimens is usually lower and is most frequently .625 mg. I have found that most of the time if a patients symptoms are not alleviated by this dose that higher doses are no more effective and another product or route of administration might be more effective. The MPA is usually given in a dosage of 10mg for 10-12 days a month. Some physicians give the MPA in a lower dose such as 5mg or every 2nd or third month to decrease the incidence of PMS like effects but this is a trade off you must be aware of as the protection of the uterine is lessened.

In more recent years additional formulations of estrogen and progesterone were developed and are often substituted in this regimen. Micronized estradiol brand name Estrace is from a plant source and has the hypothetical advantage of actually being estradiol the bioactive form of estrogen although it is altered during intestinal absorption as any other oral preparation would be. Some other brands of oral estrogen preparations include Ogen and Estratab.

Norethindrone acetate, brand name Aygestin and oral micronized progesterone brand name Prometrium are both commonly used forms of oral progesterone replacement. Aygestin is more potent in its ability to shrink the lining of the uterus and is useful as an alternative to MPA when heavy or “unscheduled bleeding” is a problem. It is available as a 5 mg tablet and can be given in doses ranging from 1/4 of a tablet to 2 tablets 10-12 days a month according to each individual’s needs. Prometrium seems to cause less PMS-like effects in women who are sensitive to progestins. It is distributed in 100 mg tablets and is usually given in a dose of 2 tablets at bedtime for 10-12 days a month.

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

Methods of HRT

Look younger, prevent skin aging, avoid hair loss and have a great sex life

When you reach menopause your skin ages rapidly, it looses collagen, thins, wrinkles and you look older. Fortunately this change in your appearance is preventable and reversible. This may sound too good to be true but I can assure you it is accurate. I can also assure you that optimal hormone therapy is more effective in rejuvenating the structure of your skin than any other therapy available.

Our goal is for every one of our menopausal patients to be able to say … I’m Back to being me.

Dr. N provides bio-identical treatment regimens that will resolve your  hot flashes, sweats, sleep disturbances, headaches, fatigue, depression, give you back your sex life and keep you looking younger.


Menopause – Symptoms, Sex and Hormones – YouTube

Is there a perfect method for everyone?

There is no perfect method of hormone replacement and none that precisely mimics nature. Fortunately this isn’t all bad. During a woman’s reproductive years, peaks and valleys of hormone concentration in the blood can influence your mood and sense of well being. But in many hormone therapy regimens there are no peaks and valleys to negatively influence your sense of well being.

In a woman’s reproductive years the peaks and valleys are necessary to trigger ovulation. If you count the first day of menstruation as day one this is the time your estrogen level begins to rise and will will reach its highest level around day 14 at which time ovulation occurs. For many women the days around the mid cycle estrogen peak is the time they feel best. It is also the time they are most interested in intimacy. It is natures way of increasing the possibility of conception. If the ovum or egg is not fertilized her estrogen level begins to fall until it reaches its lowest level the first day of the next menstruation and then the cycle repeats itself. For most women the rise in estrogen level has a positive effect on mood and sense of well being. A declining estrogen may have the opposite effect and is likely the mechanism responsible for PMS.

It is of note that some patients request that they be given the “lowest possible dose” of hormone replacement a reflection of a perception that somehow hormone replacement is unwise, dangerous, unnatural or all of the above. This is contradicted by the weight of medical research which suggests hormone replacement increases longevity and enhances quality of life and maintains a more youthful appearance. Hormone replacement should be given in a dose appropriate for each specific individual as everyone differs in their desires, needs and capacity to absorb and metabolize hormones. Ideally, this would be in an amount sufficient to fully accomplish its beneficial effect.

The hormones replaced in menopausal women include:

The ovarian hormone responsible for the development and maintenance of what we refer to as secondary sexual characteristics.

The ovarian hormone responsible for protecting the uterine lining from being overly stimulated by estrogen. Estrogen given alone (unopposed) when the uterus is present can result in the development of abnormal changes of the endometrium (uterine lining) including cancer. The addition of adequate amounts of progesterone to a program of hormone replacement as this prevents this from occurring. Progesterone is not usually given following a hysterectomy as there is no uterine lining present to protect. In those patients who still have a uterus progesterone is usually indicated.

The ovarian hormone responsible for sex drive, energy, muscle mass and assertiveness. Thought by many to be exclusively a male hormone it has important functions in women. Along with the other ovarian hormones it is markedly diminished when the ovaries have been removed. In menopausal women consideration should be always be given to including testosterone in their hormone replacement regimen.

Any of these sex hormones, estrogen, testosterone and progesterone can be administered alone or in combination.

In addition there are a number of routes of administration available to get these hormones into your system. Your choice may be influenced by: 

•Type of menopause
•Concurrent medical conditions
•Age at menopause
•Response to previous therapy
•Current age
•Intolerance to previous hormone replacement program
•Individual perception of hormone replacement program
•Hormones to be replaced
•Individual psychological makeup

Ultimately, the choice of which hormone or hormones and which route of administration should depend on what each individual is comfortable with in view of what she perceives to be her needs, goals and lifestyle.

Estrogen, progesterone and testosterone can all be given using any of the described methods. But, for the sake of clarity and simplicity and I will first discuss the routes of administration using estrogen alone.  Progesterone, testosterone and combination therapy is discussed elsewhere.

Subcutaneous Implantation of bio-identical estrogen pellets and testosterone pellets. It is the most effective method and is used primarily by physicians who have a special interest or training in the treatment of menopausal women. It resolves menopausal symptoms and sexual dysfunction unresponsive to previously administered therapies. I have found it to be the therapy of choice when other methods of hormone replacement have failed as is too often the case following hysterectomy and ovarian removal. It is effective in restoring quality of life in patients with persistent and life-altering menopausal symptoms and sexual dysfunction. The pellets which consist of estradiol, are derived from Soy a naturally occurring substance. They are inserted into the subcutaneous tissue of the abdomen or buttock usually at 3-6 month intervals.


Transdermal Patch This is a method of delivering bio-identical estrogen into the bloodstream. There are a number of patches available today and they share some common elements. To my knowledge they all contain estradiol a bio-identical form of estrogen and a delivery system which allows the hormone to be gradually absorbed by the skin and an adhesive to keep it on. It is applied to the skin and replaced once or twice weekly. The estrogen is absorbed gradually over the length of time each individual patch is worn and this is more physiologic. It has the disadvantage of causing skin irritation in 10-30% of those who try it. Sometimes this is mild and can be alleviated simply by moving the patch to a different area of skin daily but can be severe enough to require its discontinuance. It is not as acceptable to some women who exercise strenuously or live in warmer climates as there is greater difficulty with adherence to the skin with increased perspiration. When skin irritation becomes a significant problem a switch can be made to a gel or an estrogen implant.

Transdermal Gel is a very useful method of delivering bio-identical estrogen replacement. A measured amount of gel is rubbed on the skin once daily. It is absorbed and in theory at least, the skin acting as a reservoir releases it gradually into the bloodstream. It is simple, well tolerated, relatively inexpensive, there is no “bolus” effect and it avoids the “first liver pass”.

Sublingual administration of estrogen can be used and in this method a tablet, usually “estradiol” the biologically active form of estrogen is placed under the tongue. It is absorbed through the lining of the mouth into the blood vessels located under the tongue and then into the bloodstream. It avoids the “first liver pass” but is delivered into the blood all at one time as opposed to the gradual “trickle” delivery of the patch.

Intramuscular Injection is a common method of estrogen replacement and is used by many physicians. The hormone is usually mixed with a “vehicle” to slow its release into the bloodstream and depending on the dose administered is usually given at 2-4 week intervals. It has the disadvantage of relatively high levels soon after administration which decline rapidly after a week or so.

Creams have been used as a method of hormone replacement for several years and is an interesting story. Vaginal dryness and loss of elasticity of the vagina can be painful and a distressing symptom of hormone deficiency. Estrogen cream is considered an effective treatment for this problem. One important point is the estrogen in vaginal creams may be absorbed into the bloodstream and stimulate other estrogen dependent tissues including the uterine lining. Another important point is that a woman should not use estrogen vaginal cream prior to intercourse as the estrogen in the product can be absorbed into her partners bloodstream through the skin of the penis..

Suppositories perform the same function as the cream delivery method. They are preferred by some users who find them less messy.

Oral Estrogen Therapy

Oral route of estrogen is the only route of estrogen therapy listed here that is not bio-identical. I rarely use this route of administration and only when the patient insists after a discussion of benefits and risks. There are safer and more effective methods. The oral route of administration is known to increase the potential of cardiovascular events, including heart attacks, strokes, blood clots and an elevation of blood pressure. Other potential problems with this route of administration include decreased libido and nausea. From my standpoint the only advantage is cost and for many individuals this is an important concern. At this moment none of my patients are on oral estrogen. Nonetheless, I believe the oral route of hormone replacement is the most frequently utilized method of hormone replacement in the world.

 There are several oral estrogen products available and each manufacturer gives various reasons why their product is superior. The advantage of the oral route is that for most people it’s easy to take a pill and as mentioned above it is relatively inexpensive.

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.

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About HRT

Look younger, prevent your skin from aging, avoid hair loss and have a great sex life  

Dr. N provides natural hormone regimens for both men and women including hormone pellet implants to keep you looking years younger, restore your sex life, maintain lean body mass, resolve hot flashes, sweats, sleep disturbances, headaches, fatigue and depression. Call us for an office or virtual visit (248) 644-7200

The rationale for using hormone replacement therapy is to improve and maintain your quality of life and increase your life expectancy.

Every menopausal woman is unique. Her menopausal experience and her response to hormone therapy is unique. Some women respond to the more the routine programs of hormone replacement and other women require a more ideal program to regain their optimal quality of life. If your quality of life was great and your sex life was great before your menopause your quality of life and sex life can be great after your menopause.

I regularly see women on a sub-optimal program of hormone replacement therapy and who continue to experience persistent menopausal symptoms and sexual dysfunction. Their physician may tell them that they are already on appropriate treatment that “always works on my other patients.”  The implication is that the patient is the problem. It’s not the patient it’s the hormone therapy program and a more effective program will resolve the issue.

Dr. N is a practicing physician who has specialized in the care of menopausal women and hormone deficient men for over 30 years.  His office is located in Southeastern Michigan.  Call for an office or virtual appointment (248) 644-7200 Monday through Friday from 10AM to 4PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.