Bioidentical Hormone Replacement Therapy for Perimenopause and Menopause
For many women, the transition into perimenopause and menopause can feel surprisingly disruptive.
Sleep changes. Periods become unpredictable. Anxiety may suddenly appear or worsen. You may notice changes in your weight, energy, mood, libido, memory, or ability to recover from exercise.
And while these symptoms are common, that does not mean you simply have to live with them.
I have worked with women and hormones for more than a decade, and one of the things I have learned is that there is rarely a one-size-fits-all approach to this stage of life.
For some women, lifestyle changes and targeted nutritional support can make a significant difference. For others, bioidentical hormone replacement therapy — often referred to as BHRT — can be an important part of feeling like themselves again.
What is bioidentical hormone replacement therapy?
Bioidentical hormones are hormones that have the same molecular structure as hormones naturally produced by the human body.
Depending on the individual, hormone therapy may include estrogen, progesterone, testosterone, and DHEA (and more- depending on the person).
The goal isn't simply to make a lab value fall into a particular range. Treatment should take into account your symptoms, medical history, stage of life, goals, laboratory results and overall health.
That is why I approach hormone therapy as part of a larger picture rather than treating hormones in isolation.
Symptoms I commonly see in perimenopause and menopause
Women often come to me experiencing several symptoms at once, including:
Hot flashes or night sweats
Difficulty falling or staying asleep
Brain fog or changes in memory
Anxiety or mood changes
Fatigue
Changes in body composition or unexplained weight gain
Low libido
Vaginal dryness or discomfort
Changes in menstrual cycles
Headaches or migraines
Reduced resilience to stress
Changes in exercise recovery or muscle mass
Some of these symptoms can be related to changing estrogen, progesterone or testosterone levels, but hormones are not always the whole story.
Thyroid function, insulin resistance, nutrient deficiencies, stress, sleep, digestive health and other factors can create very similar symptoms.
That is why a thorough evaluation matters.
My approach to hormone care
My approach combines conventional hormone therapy with the broader perspective of naturopathic medicine.
Depending on your individual situation, we may look at:
Your symptoms and menstrual history
Estrogen, progesterone and testosterone
Thyroid function
Metabolic health and blood sugar
Nutrient status
Sleep and stress
Nutrition and movement
Digestive health
Supplements or botanical medicine when appropriate
Bioidentical hormone therapy may be one part of your treatment plan, but it does not automatically have to be the entire plan.
For women who are good candidates for hormone replacement therapy, I prescribe and monitor individualized hormone treatment and adjust it based on symptoms, response and appropriate laboratory monitoring.
You do not have to wait until menopause
One of the biggest misconceptions I hear is that hormone therapy is only something to consider once your periods have completely stopped.
Perimenopause can begin years before the final menstrual period.
During this time, hormones can fluctuate considerably, and symptoms may appear even when a single hormone test looks "normal."
This is one reason I look at your symptoms, history and overall clinical picture rather than relying on one isolated laboratory value.
Do I need a DUTCH test?
Not necessarily.
I use both conventional blood testing and more advanced testing when it will meaningfully change what we do.
Some women benefit from more in-depth hormone testing such as DUTCH testing. Others can be evaluated and treated effectively with their medical history, symptoms and standard laboratory testing.
My goal is not to order every test available. It is to choose the testing that will actually help us make better decisions about your care.
How to work with me
For new patients who want a comprehensive evaluation of their hormones and overall health, the first step is my Comprehensive Strategy Session.
This includes a detailed review of your health history, symptoms and goals, appropriate laboratory testing, and a personalized strategy for what I recommend next.
For women who need ongoing support, I also offer six-month care programs designed to provide more comprehensive treatment and follow-up.
Programs I offer after the Strategy Session include:
Foundation
Foundation is designed for women who want a structured plan, education, ongoing visits and foundational laboratory assessment.
Restore
Restore is my more comprehensive hormone and metabolic health program. It is designed for women who want deeper testing, ongoing medical management and the option for prescription hormone therapy when appropriate.
Depending on your individual needs, care may include bioidentical hormone prescriptions, comprehensive laboratory testing, metabolic evaluation and additional tools such as continuous glucose monitoring.
Concierge
Concierge provides my highest level of support for women who want more frequent access, additional testing and more intensive ongoing care.
After completing a six-month program, established patients may also transition into a maintenance option for continued follow-up and prescription management.
Is hormone replacement right for you?
Hormone therapy can be incredibly helpful for the right person, but it should always be individualized.
Your personal and family history, symptoms, risk factors, goals and preferences all matter.
If you are struggling with symptoms of perimenopause or menopause and aren't sure whether hormones, natural therapies, or a combination of both makes the most sense, that is exactly the kind of question we can work through together.
Ready to get started?
You can schedule a complimentary Discovery Call to learn more about working with me, or book a Comprehensive Strategy Session if you're ready for a deeper evaluation and personalized plan.
— Dr. Katie Brussard, ND, FABNE
