Menopausal Hormone Therapy: Patch, Gel, or Pellet? Understanding Doses and Options | Dr. Susan

This has been an exciting year with much more attention being paid to midlife women's hormonal health. Finally perimenopause/menopause is getting a voice, and the use of MHT (menopausal hormone therapy) is becoming widely accepted. Once we have decided to take menopausal hormone therapy, there are multiple options of products and routes of administration. Today I'll be discussing the different options for bioidentical menopausal hormone therapy, and the pros and cons of each. It's also important to understand why the doses are vastly different for the various different products, and why it's important to have your blood drawn to make sure that you are reaching optimal levels, because absorption is highly variable between patients. In the end, reaching the appropriate blood levels is much more important than the route of administration, which is really just a matter of personal choice and lifestyle. While the vital hormone testosterone continues to be controversial, in my practice we consider "optimal" for female testosterone to be in the upper range of what is physiologic for women (restoring levels to the high end of what they were when we were younger). Multiple studies have shown that these levels safely provide benefits for sexual wellness as well as muscle and bone conservation, sleep and mood. We recognize that long-term very high levels of testosterone put patients at risk of not only nuisance symptoms, but also irreversible masculinizing effects, which is why we never dose at that level, and why we have developed a novel dosing protocol which has proven to be safe and effective. Unfortunately, the practice of "Supra-physiologic dosing" continues elsewhere in the community, and is at the root of many people's misunderstanding about the safety of testosterone . We set ourselves apart from others who put their patients at risk with levels that are too high, and we pay the utmost attention to making sure we keep hormone levels optimal, without elevating risk.